Gastroscopy

Performed only by an experienced gastroenterologist in a properly equipped endoscopy suite. At times, it may be necessary to carry out this procedure in an emergency room or ICU bed. Following sedation, patient

is placed in the left lateral decubitus position (although successful intubation is possible in other positions). A hollow mouthpiece is inserted to protect the patient's teeth and facilitate instrument passage. The endoscope is slowly advanced orally and is "swallowed" by the patient. Once past the cricopharyngeal region the instrument is guided only under direct visualization. An important landmark is the Z-line at the gastroesophageal junction, approximately 40 cm from the teeth. The tip is then advanced into the cardia, with gentle insufflation of air. The various portions of the stomach are inspected - cardia, fundus, greater and lesser curvature, antrum. Following thus, the tip is then passed through the pylorus, into the duodenal bulb, and sometimes as far as the descending portion of the duodenum. Mucosal surfaces are reinspected as the instrument is withdrawn. Biopsies, cytologic brushings, polypectomy, cauterization of bleeding lesions, etc, are performed as indicated.