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How to undergo gastrocopy

The following procedures apply to the patient who undergoes the examination in the morning;

Some notification
  • On the day before the planned examination, you take dinner earlier than usual, and eat foods which are easily digested.
  • You go to bed earlier than usual and take no extra foods after dinner.
  • On the day of the examination, you don't eat breakfast. Drinking water and smoking are also avoided.
  • As a rule, medication is also avoided, but indispensable medication is permitted. In any event, you should consult your physician about taking drugs.
  • You shouldn't drive a car to the clinic, as you may be taking anti-cholinergics (to suppress gastric juice and saliva secretion and to relax the gastric wall) and even tranquilizers before the examination.
  • Before the examination, you wear an examination robe. You should be ready to loosen your belt, waist-band, etc.
  • Dentures are removed before the examination. Lipstick should be wiped off to allow accurate observation of lip color by the physician.
  1. A nurse or a gastrointestinal endoscopy technician licensed by the Japan Gastroenterological Endoscopy will give you the following advice;
    • Don't tense your body.
    • Continue abdominal breathing slowly.
    • Don't bite the endoscope, let alone withdraw it!
    • Keep your eyes open as much as possible during the examination.
    • Don't swallow saliva after the endoscope has been inserted through the throat.
      ( if saliva is swallowed, it can enter the trachea and cause coughing, because the pharynx has been anesthetized for the examination).
  2. Now, premedication is administered. An anti-cholinergic is injected intramuscularly 10-15 minutes before the examination. If you have or are suspected of having glaucoma, prostate hypertrophy or myocardial disease (angina pectoris, etc.) should inform your physician of your diseases, because other drugs need to be substituted for anti-cholinergics in such cases.
  3. After the injection, an anti-foaming agent is orally taken to remove mucus on the mucosal surface.
  4. Immediately before the examination, about 5ml of liquid anesthetic is held within the throat for about 5 minutes. If you have a history of allergy to anesthetics, you should tell the physician so, before anesthesia is performed. It's important for you to hold the anesthetic within the deep throat for the instructed period, otherwise only the tongue is anesthetized and the throat remains unanesthetized.
  5. A local anesthetic is sprayed onto the pharynx.
  6. Before lying on the examination table, you loosen your belt and undershirts to avoid compression of the chest and abdominal area. You lie on your left side, with the knees bent slightly. The examination table is designed to keep the head slightly lower than the other parts of the body to facilitate the accumulation of gastric juice in one place and to ensure an adequate visual field for the physician.
  7. he examination now begins. You protrude your chin forward when the endoscope is inserted as shown in the figure below. Don't stretch the neck or pull the chin back. The nurse or the endoscopy technician occasionally holds your neck when necessary. yFigure1z

    yFigure1z

    XR[v}̎p
    Endoscope insertion is easy when the chin protrudes slightly.

    XR[v}̎p
    Endoscope insertion is difficult when the chin is retracted.

    XR[v}̎p
    Endoscope insertion is difficult when the neck is stretched intensely.

    quoted from Technique Manual of Gastrointestinal Endoscopy(Nankodo)
  8. Slightly move your tongue forwards. The endoscope will enter your mouth. You're told to swallow it. You close your lips slightly and swallow the endoscope as if swallowing saliva. Take care not to bite the endoscope too hard. Unless you close your lips slightly, it's difficult to swallow saliva. If endoscope insertion fails, the endoscope is withdrawn, and it's inserted again after an addtional local anesthesia of the pharynx using a spray anesthetic.
  9. Once the endoscope has successfully been inserted through the throat into the esophagus, a mouthpiece is put into your mouth (in cases where you're expected to strongly bite the endoscope, the mouthpiece is used during the endoscope inserting processes). Begin abdominal breathing slowly. Too rapid breathing can induce symptoms associated with hyperventilation such as numbness of extremities.
  10. The endoscope is advanced from the esophagus into the stomach. When the endoscope reaches the exit of the stomach, you'll have the sensation of a swollen stomach. At that time, belching is likely occur, but you should avoid belching as much as possible. Belching repuires air to be sent into the stomach again, thus prolonging the time of the examination.
  11. Upon completion of the observation, the endoscope is withdrawn while aspirating the air in the stomach. You must hold your breath when the endoscope passes through your throat.
  12. You'll be pleased to hear; "Examination is finished." Take care so as not to fall when you stand up from the examination table or leave the table.
  13. The effect of the local anesthetic to the pharynx still remains. Avoid drinking water or smoking for about an hour after the examination, because of the risk of misswallowing. Well done!