Dr Jarrod Lee is a well-recognised endoscopist in the region. He has established himself in advanced endoscopy, in complex endoscopic cases and in combining endoscopic platforms and techniques. Despite the many advances in endoscopy, Dr Lee believes that technology does not replace the fundamentals of good clinical practice: the evidence based yet patient centric clinical care, multi-disciplinary teamwork and good communication with patients and family physicians.
Gastroscopy is one of the most effective screening tool for stomach cancer. However, there's a negative stigma that surrounds gastroscopies in Singapore. Many people fear the procedure is painful or have misconceptions about how and why it is done.
Dr Jarrod answered readers questions on:
- Reasons for doctors to suggest a gastroscopy
- How is a gastroscopy performed
- Cost of gastroscopy in Singapore
- How to prep for a gastroscopy
- What does a gastroscopy test for
Hi Yang Meng, thanks for the D2D. During the actual procedure, I always start by spraying alocal anaesthetic to numb the back of the throat. The patient then lies on the left side, and I give medication through an intravenous line to put the patient to sleep.
Once the patient is adequately sleepy, I'll pass the gastroscope through the mouth into the oesophagus, stomach, and duodenum (it's the first and shortest segment of the small intestine).
Hi Yun Ling, thanks for the D2D. Based on the MOH website on October 2018, the median cost of a standard diagnostic gastroscopy performed as day surgery ranges from $300 to $910 for subsidized patients, depending on the hospital.
Medisave can be used to cover the cost of gastroscopy. For standard diagnostic gastroscopy performed as day surgery, up to $650 may be used. In most cases, this is sufficient to cover the entire cost if performed as a subsidized case in a public hospital.
However, the cost of gastroscopy is highly variable, depending on who and where it's performed. Here's a breakdown of the cost estimates:
|Subsidised patients||Public hospitals||$300 - $910|
|Private patients||Public hospitals||$700 - $1080|
|Private patients||Private hospitals||$1500 - $2080|
Hi Saidul, thanks for the D2D. Unlike colonoscopy, ‘routine’ gastroscopy for general screening is not proven. I typically advise 2 groups of people to go for ‘screening’ gastroscopy.
1. Patients with symptoms that may be due to disorders of the upper digestive tract, as the gastroscopy may be able to diagnose a problem to allow treatment and prevent it from getting worse.
Hi Theresa, thanks for the D2D. Preparation for gastroscopy is surprisingly simple. My patients are allowed to take a light meal 6 hours or more before the procedure.
Clear liquids such as water, fruit juice without pulp and carbonated beverages may still be taken until up to 2 hours before the gastroscopy. In certain cases, I may recommend a longer fasting period, for example, after heavy meals or in patient with slow stomach emptying.
Although the fasting preparation is very simple, it is crucial to allow clear visualization of the stomach to enable accurate diagnosis and treatment.
Hi Bernard, thanks for the D2D.
When I find an abnormality, I will do the following:
- Make an endoscopic diagnosis. In many conditions, a good endoscopic diagnosis and picture documentation is sufficient to proceed to management.
- Try to find an underlying cause of the condition. For example, if there is a stomach ulcer, I will look for an underlying infection which may have caused the ulcer.
- Assess the severity of the condition and look for associated complications.
- Determine whether tissue biopsy is needed, and obtain the appropriate samples if so.
Hi Sam, thanks for the D2D. Gastroscopy is usually performed under moderate or ‘conscious’ sedation. This is a state where patient is ‘put to sleep’ or sedated, but can be respond purposefully when called or touched.
The medication is given through an intravenous line, and I adjust the dose accordingly to achieve the desired state of sedation.
Gastroscopy is used to examine the organs of the upper digestive tract: the oesophagus, stomach and duodenum (it's the first and shortest segment of the small intestine).
I perform gastroscopy for 3 groups of patients:
- Patients with symptoms that may be due to disorders of the upper digestive tract.
I use gastroscopy to examine the internal lining of the oesophagus, stomach and duodenum for disorders. I may also obtain tissue biopsies to allow further examination of cellular structures under a microscope by a pathologist. This allows me to make an accurate diagnosis and recommend the appropriate treatment.
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- Vyas D et al. Advances in endoscopic balloon therapy for weight loss and its limitations. World J Gastroenterol. (2017)
- Rahnemai-Azar AA et al. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. (2014)