Follow the manufacturers recommendations at all times.
Use an endoscope cleaning bath wherever possible.
Use whatever cleaners and disinfectant the manufacturer recommends.
Follow health and safety rules regarding use of these products.
Nil by mouth for a minimum of twelve hours, longer if there is delayed gastric emptying.
Step 1 - Pass tube along esophagus
Following induction of anesthesia - it is essential to intubate patient.
Tie endotracheal tube to mandible to aid passage of endoscope.
Lay patient in left lateral recumbancy.
Place mouth gag to protect endoscope.
Insert endoscope along hard palate and into proximal esophagus .
Advance scope along length of esophagus (see Esophagoscopy Esophagoscopy).
Step 2 - Enter stomach
Once cardia is reached gently apply force on endoscope to enter stomach.
'Red out' will occur during intubation of stomach. (Vision is lost).
Once you feel the endoscope pass the cardia, STOP, gently inflate stomach with air.
Step 1 - Examine rugae
Only introduce enough air to visualize the mucosa.
It is very important NOT to overdistend the stomach with air.
Examine the rugal folds of the fundus .
Step 2 - Examine antral region
Advance endoscope in the direction of the rugal folds. This will direct you towards the antrum.
The angular incisure of the lesser curvature of the stomach will be seen as a band of mucosa and marks the entrance to the antrum . This is an important endoscopic landmark.Rugal folds are NOT seen if stomach is overinflated with air.
Retroflex the endoscope to visualize the cardia .
Step 3 - Examine pylorus
Pass endoscope along antrum to visualize the pylorus .
Bile may be observed entering the stomach as may antral peristaltic contraction. These contractions are not seen if the stomach is overinflated.
Step 4 - Biopsy
Collect biopsy samples from any focal lesions observed.
In any case collect biopsy samples from the fundus, body, cardia and antrum.
A minimum of 6 biopsy samples are required. Always deflate the stomach with the endoscopic suction unit or stomach tube after the procedure.
Do not overinflate the bowel as this will make mucosa stretch tightly reducing ability to collect samples.
Try and advance biopsy forceps perpendicular to the mucosa.
Tent mucosa before closing biopsy forceps and retrieving sample.
Deeper samples can be collected by sampling repeatedly at the same site.
Perforation will occur if this is done too frequently.
Capillary bleeding from biopsy sites is normal.
Step 1 - Remove endoscope
Gently withdraw endoscope.
Support end of scope as it is withdrawn to prevent damage.
Routine post-anesthetic observation.
Check mucus membrane color, heart and respiratory rates in case of hemorrhage.
Check there is no evidence of gastric dilation.
Do not overinflate stomach.
Apply only enough air to allow adequate visualization.
Always deflate the stomach after gastroscopy to reduce risk of gastric dilation.
Arterial bleeding from biopsy sites.
Gastric perforation from applying too much force.
Iatrogenic damage to mucosa caused by advancing endoscope along gastric wall.