As a necessary test to diagnose gastric cancer, what does the doctor do to prepare, how does the patient need to cooperate and what to look for before a gastroscopy is performed? Learn more.
Evaluating if you want to do and can do a gastroscopy
The doctor will first determine if a gastroscopy is necessary, and the patient should cooperate with the doctor by providing relevant information. Suspected upper gastrointestinal lesions, no symptoms but the person wants to be examined for the purpose of regular physical examinations, group examinations, abnormalities detected during physical examinations requiring reexamination, the presence of lesions already confirmed, and fine examinations for the purpose of choosing a treatment are all indications for performing gastroscopy.
Extremely poor general condition, intestinal obstruction, perforation of the digestive tract, risk of gastroscopy due to respiratory and circulatory diseases are in principle contraindications to gastroscopy and should be considered only if the doctor assesses that the usefulness of gastroscopy for these patients outweighs its risk.
Learn about it and sign the consent form
The subject should listen carefully to the physician’s description of the need for gastroscopy, the method and the possibility of complications, and after understanding and agreeing to undergo the examination, he/she needs to sign the instructions and informed consent form for gastroscopy.
Perfecting the preoperative examination
Before the gastroscopy, the patient will be screened for infectious diseases, such as hepatitis B virus, hepatitis C virus, syphilis, and HIV, to avoid cross-infection.
Preoperative fasting and adjustment of daily medications
Dinner the day before the test should be completed by 21:00, after which all food intake is prohibited, and if the patient has gastric retention, gastrointestinal decompression, gastric lavage, and therapeutic operations such as emetics should be performed by the healthcare provider in advance. Appropriate water intake prevents dehydration, so patients are not restricted from drinking, but liquids that interfere with the examination, such as milk and juice, are prohibited.
The discontinuation of medications routinely taken by the patient is subject to the circumstances. However, according to the Gastrointestinal Endoscopy Guidelines (3rd edition), anticoagulants and antiplatelet agents [e.g., warfarin, aspirin, ticlopidine, ticagrelor, etc.] must be discontinued some time earlier, warfarin 3-4 days earlier, aspirin 3-4 days earlier, ticagrelor 3-4 days earlier, and ticagrelor 3-4 days earlier. Warfarin must be stopped 3 to 4 days in advance, aspirin 2 days in advance, and ticlopidine 5 days in advance. The doctor will tell the patient if and when to stop the medication on a case-by-case basis.
Patients should not eat on the day of the examination, but may drink appropriate fluids without restriction. To safely cooperate with the gastroscopy, the patient must answer the doctor’s questions carefully and honestly.
It is important to note that if a painless gastroscopy is planned, the patient should abstain from drinking and eating for 6 hours before the examination.
Performing preprocedure handling
In the first 5 minutes of the procedure, intramuscular antispasmodics may be considered as necessary to suppress gastric and esophageal motility, tension, and gastric and salivary secretions, but they are controlled in elderly patients over 70 years of age and in patients with glaucoma, prostatic hypertrophy, cardiomyopathy, and arrhythmias.
To dissolve mucus in the stomach for observation, pepsin and simethicone solutions are prescribed in advance and taken before the exam.
Usually gastroscopy is performed with pharyngeal anesthesia (except for painless gastroscopy), where the patient is given 4 ml of Lidocaine Mucilage deep in the throat for 1 to 2 minutes and then spit it out, or the patient is given a spray of Lidocaine in the mouth and spits it out after 30 seconds in the throat.
Use appropriate clothing and body position for the examination
On entering the examination room, the patient is asked to loosen the collar and belt, remove the removable dentures if present, and gently bite down on the mouth pad. The patient is usually asked to lie in a left lateral position on the examination bed with the head slightly tilted forward, the body relaxed, and the legs flexed. The physician’s request should be kept in mind that saliva and vomitus during the examination should be made to flow out and avoided down the throat to avoid inconvenience to the examination or to cause misaspiration and danger.
Patients should cooperate with the doctor to prepare for the above and take the first step of gastroscopy. (Contributed by Yu Miao, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)