Gastroscopy (Upper Endoscopy): What to Expect Before, During and After

A gastroscopy is one of the quickest ways to find out what is causing heartburn, swallowing problems or stomach pain. The test usually takes less than 15 minutes, and knowing what to expect takes away much of the worry.

Imagine months of burning indigestion that tablets only half-control, and food that sometimes feels as if it sticks on the way down. Your healthcare provider suggests a “camera test”. You picture gagging for an hour. In reality, it is over in about ten minutes.

What a gastroscopy is

A gastroscopy, also called an upper endoscopy or OGD, uses a thin, flexible tube with a camera to look at the lining of your food pipe (oesophagus), stomach and the first part of your small intestine (duodenum).,The endoscopist can take small tissue samples (biopsies), test for the stomach bacterium Helicobacter pylori, stretch narrowed areas, treat bleeding and remove small growths during the same test.

Common reasons for a gastroscopy

• Persistent heartburn or acid reflux that does not respond to treatment
• Difficulty swallowing or food sticking
• Ongoing indigestion or upper tummy pain, especially in older adults
• Vomiting blood or passing black, tarry stools
• Unexplained iron deficiency anaemia or weight loss
• Checking for coeliac disease, ulcers or Barrett’s oesophagus
• Monitoring known conditions such as varices in liver disease

How to prepare

You will usually be asked not to eat for about six hours before the test, so the stomach is empty and the endoscopist can see clearly. Small sips of water may be allowed until a couple of hours before; follow your hospital’s instructions exactly.,You may be asked to stop acid-reducing medicines (PPIs) for up to two weeks beforehand, as they can hide some findings. Tell the team in advance if you take blood thinners, diabetes medicines or have any allergies. Remove dentures and bring a list of your medicines.

Throat spray or sedation?

There are usually two options. A local anaesthetic spray numbs the back of your throat. You stay fully alert, can go home straight away and can drive afterwards, which many people prefer.,Alternatively, you can have sedation through a small needle in your hand or arm, which makes you relaxed and drowsy. You will need someone to take you home and stay with you, and you must not drive or make important decisions for 24 hours. Some people have both.

What happens during the test

You will lie on your left side, and a small plastic mouthguard is placed between your teeth to protect them and the scope. The endoscopist passes the scope over your tongue and asks you to swallow as it enters the food pipe. You may gag briefly; this usually settles quickly.,Air is gently passed into the stomach to open it up, which can make you feel bloated or want to burp. A nurse will stay by your side, clear saliva from your mouth with a small suction tube and talk you through it. The test usually takes 5 to 15 minutes.

Breathing and staying calm

The scope does not block your airway, so you can breathe normally through your nose and mouth. Many people find it helps to breathe slowly in through the nose and out through the mouth, keep their shoulders relaxed and focus on a point on the wall. If you are very anxious, tell the team; they can explain each step and may suggest sedation.

Risks

Gastroscopy is a very safe test. Most people have only a mild sore throat or bloating afterwards. Rare risks include a reaction to sedation, bleeding after a biopsy or treatment, damage to teeth, and a small tear in the food pipe or stomach, which may need treatment. Seek urgent help if you have severe chest, neck or tummy pain, difficulty breathing, fever, vomiting blood or black stools after the test.

After the test

If you had throat spray, you will usually be asked not to eat or drink for about an hour until the numbness wears off, to avoid choking. Then start with a cool drink. If you had sedation, you will rest until you are awake enough to go home.,The endoscopist will often tell you the main findings before you leave and give you a written report. Biopsy results usually take one to three weeks. Ask who will contact you and what happens next.

What a gastroscopy can find

• Inflammation of the food pipe (oesophagitis) from acid reflux
• Hiatus hernia
• Stomach or duodenal ulcers
• Helicobacter pylori infection
• Barrett’s oesophagus, a change in the lining that needs monitoring
• Coeliac disease
• Less commonly, cancer of the food pipe or stomach

Barrett’s oesophagus

Long-term acid reflux can change the cells lining the lower food pipe, a condition called Barrett’s oesophagus. It slightly increases the risk of oesophageal cancer, so people with Barrett’s are often offered regular gastroscopies to check for early changes that can be treated. Controlling reflux, stopping smoking and maintaining a healthy weight are important.

Frequently asked questions

Will it hurt?

Most people describe it as uncomfortable rather than painful.

Can I take my medicines on the day?

Usually yes, with a small sip of water, unless told otherwise.

How soon can I eat?

About an hour after throat spray once your swallowing feels normal, or once you are awake after sedation.

But what if I gag and cannot cope?

Gagging is common at the start and usually settles. The team can pause, give more throat spray or offer sedation. Telling them you are anxious helps them support you.

Related: Acid reflux and heartburn · Colonoscopy: what to expect

Sources: NHS, British Society of Gastroenterology, American Society for Gastrointestinal Endoscopy, US National Institute of Diabetes and Digestive and Kidney Diseases.