During a gastroscopy a doctor checks your upper digestive tract (esophagus, stomach, duodenum: meaning the beginning of the small intestine). Common reasons why your medical team may recommend a gastroscopy are abdominal pain, discomfort and indigestion, anemia, dysphagia (difficulty swallowing), pain during swallowing, vomiting, digestive bleeding, unexplained weight loss, anorexia, or acid reflux disease that does not respond to treatment. Gastroscopies are also part of cancer screening programs.

A gastroscopy is usually scheduled ahead of time, except in emergencies for acute conditions or conditions that require a diagnosis on short notice. You must fast from the night before the examination, not consuming any food or fluids beforehand, to minimize the risk of these contents moving into the lungs, which can cause pneumonia.

You will be placed under moderate sedation (soft form of aneasthesia) to ensure you feel as comfortable as possible during the examination, using a peripheral intravenous catheter.

During a colonoscopy a doctor checks your lower digestive tract (colon and ileum). Common reasons why your medical team may recommend a colonoscopy are digestive bleeding, iron deficiency anemia, abdominal pain, a change in your bowel habits, or to monitor polyps or cancer. Colonoscopies are also an important part of cancer screening programs. 

Colonoscopies are usually scheduled ahead of time as a lot of preparation is required. The stool in the bowel must be cleared so that it doesn’t obstruct your doctor’s vision when they are checking the mucosa (colonic and terminal ileum). This is usually achieved through 3-4 days of a specific diet, as well as with laxatives prescribed for the day before and in some cases for the day of the examination. All the steps you need to take will be given to you in writing, as well as explained to you during your consultation. 

Just like for a gastroscopy, you will be placed under moderate sedation during the examination.

To check the bowel, the procedure requires air to be injected to prevent the walls from collapsing. This allows us to inspect the entire lumen (inside area) of the bowel. Air inside the bowel may cause some bloating and discomfort until it is expelled. As a rule, CO2 (carbon dioxide) is used as it is easier for the body to tolerate and it reduces discomfort after the examination, as CO2 is 250 times faster to absorb than regular air.

It is a common misconception that general anesthesia must be administered to undergo an endoscopy. General anesthesia is required for critical surgery, or surgery where a patient must be intubated. Our department only uses moderate sedation for endoscopies.

We do not recommend you use heavy machinery or drive for the rest of the day after being sedated. Therefore, we recommend you are accompanied to the center by someone who can then drive you home.

Our trained staff administer the medicaments which are warranted for a soft sedation. The team includes normally a gastroenterologists, and endoscopic nurses. However, we always have an anesthesiologist on site ready to intervene, if necessary, when performing these examinations.

The presence of an anesthesiologist throughout the entire examination is mainly required for patients with severe health problems, where there is an estimated higher risk for anesthesia-related complications.

The most common complications are:

Bleeding, which occurs in less than 1% of examinations and is most often caused by a polypectomy, with the removal of large polyps, or if a patient has a coagulation disorder. In this event, patients will notice either dark red or black blood and should notify their physician. Usually, the bleeding will occur immediately after the procedure. On very rare occasions, it can occur up to 14 days after the procedure. 

Perforation, meaning the tearing of the wall of the intestine, is another possible complication with an extremely low probability. The risk of this occurring depends on each patient’s underlying condition. The existence of a bowel inflammation, bowel stenosis, old age, multiple health problems, adhesions from past surgery, bowel cancer, bowel ischemia, resection of polyps (larger than 1 cm), dilatation of stenoses and others such variables increase the risk of a perforation. A perforation commonly manifests with severe abdominal pain, nausea, fever, vomiting, or rectal bleeding. Treatment, depending on the circumstances, can be performed endoscopically on the spot, or surgically.

Post-polypectomy syndrome involves a localized inflammation, without perforation of the bowel, that can cause pain, tenderness, and a fever up to 5 days after a polypectomy. Typically, the onset is immediate, and it is treated with intravenous fluids, antibiotics, and bowel rest (no oral fluid or solid intake) for 1-3 days.

After the examination, you will be taken to the recovery room where you can lie down until you have fully recovered from sedation. Patients are supervised by a nurse throughout this process. If you feel abdominal pain or bloating, you should report this to a member of staff immediately. This discomfort is usually caused by excess air, and we encourage you to expel this. Recovery from the procedure is brief and any feelings of discomfort are rare and last for only a few minutes.

You will then be briefed by your medical team about the procedure and their findings. This is followed by a written report, printed images of the examination and any further recommendations whenever appropriate, including medication, follow-up examinations, laboratory/imaging tests or a future appointment for regular monitoring.

In the case where a biopsy or polypectomy was performed, histopathological results will be ready after a period of about 10-12 days. Once the findings are ready, your medical team will inform you immediately and if there are any pathological findings that require further investigation, they will offer recommendations for how to proceed.