Hi Yang Meng,
Thanks for the D2D. During the actual procedure, I always start by spraying a local 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).
The gastroscope is a long thin flexible tube with a camera and light source at the end. The tube is about the same diameter as my little finger, and can pass through the different areas with ease.
I'll examine the various parts of the upper digestive tract and document pictures of the various landmarks according to the accepted international standard. If necessary, I will obtain tissue biopsies or performed endoscopic treatment through the gastroscope.
Most of my standard diagnostic gastroscopy is completed within 15 minutes. Throughout the procedure, I add doses of sedating or ‘sleeping’ medication as necessary to ensure that the patient is just sufficiently asleep and comfortable.
This avoids giving too much sedating medication, which in turn minimizes the side effects and complications. Over 95% of my patients will wake up within the hour after gastroscopy, and can resume normal activity.
Obviously, complex and advanced endoscopy cases take more time and are done differently. Prior to such cases, I will counsel the patient on the differences from standard gastroscopy so that they will know exactly what to expect. Hope this helps!
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.
I use gastroscopy to examine the internal lining of the oesophagus, stomach, and duodenum (it's the first and shortest segment of the small intestine), and may 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.
The top 10 symptoms that I perform gastroscopy for include: upper abdominal discomfort or pain, ‘gastric symptoms’, ‘reflux symptoms’, heartburn, chest pain, bloating, belching, nausea, and ‘indigestion’.
2. Patients with increased risk of oesophageal and gastric cancer. This includes patients with certain chronic symptoms or digestive disorders, and patients with family history.
Most general practitioners will be able to advise if a person is at increased risk. In these patients, I use gastroscopy to identify precancerous and cancerous changes. I will incorporate image enhanced endoscopy as the early changes may be difficult to see with routine gastroscopy.
Accurate detection of precancerous changes allows me to determine the patient’s cancer risk in the future, and to plan monitoring of these areas so that they may be removed before developing into cancer.
Precancerous areas and even early cancers can be removed endoscopically with good results and safety, avoiding the need for surgery.
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.
Patients should inform their doctor about all the medication they are taking so that they can be properly advised. I will discuss whether my patients should continue or stop their existing medication.
For example, I may recommend that certain blood thinning medication be stopped before the procedure. This will allow me to take biopsies and perform endoscopic interventions without an increased risk of bleeding.
Thanks for the D2D. When I find an abnormality, I will do the following:
Even if no abnormality is found, I may still obtain tissue biopsies to look for abnormalities at the microscopic level. Some disorders have a normal endoscopic appearance, and can only be diagnosed through a biopsy.
I will assess the possibility of such conditions based on the patient’s symptoms and risk factors, and will plan the biopsies accordingly.
If I detect something that can be treated endoscopically, I may proceed to treatment immediately. This includes abnormalities which are bleeding or have high risk of bleeding, and growths that are simple to remove.
If the endoscopic treatment is more complex, I will usually defer it to another day. This will allow me to discuss the findings with the patient, to explain endoscopic treatment and the alternatives, and to advise on the increased risk and cost of the treatment.
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.
This way, I ensure that just enough sedation is given, and I avoid the side effects and complications of the medication. Most of my gastroscopy procedures are completed within 15 minutes, so the total dose of medication I give is low. Hence, the sedation is safe and wears off quickly, allowing patients to return to normal activities quickly.
With effective sedation, gastroscopy is a painless procedure. Patients are comfortable throughout the procedure, and the gag reflux is usually not elicited.
After the gastroscopy, 20-40% of patients may complain of minor symptoms such as abdominal discomfort, bloating, nausea, headache and sore throat. These usually resolve the next day.
Less than 10% of patients complain of such symptoms, and mostly after complex or advanced procedures. Over 95% of my patients are fully awake and back to normal activities within the hour.
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:
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.
The top 10 symptoms that I perform gastroscopy for include: upper abdominal discomfort or pain, ‘gastric symptoms’, ‘reflux symptoms’, heartburn, chest pain, bloating, belching, nausea and ‘indigestion’.
In these patients, I use gastroscopy to identify precancerous and cancerous changes. I will incorporate image enhanced endoscopy in the gastroscopy as the early changes may be difficult to see with routine gastroscopy.
Accurate detection of precancerous changes allows me to determine the patient’s cancer risk in the future, and to plan monitoring of these areas so that they may be removed before developing into cancer. Precancerous areas and even early cancers can be removed endoscopically with good results and safety, avoiding the need for surgery.
Emergencies such as internal bleeding and swallowed foreign body can be effectively treated through gastroscopy, and this can be life-saving.
Other examples of treatment I have performed through gastroscopy include: removal of precancerous areas and early cancers, bypassing or opening up of blocked passages, and insertion of feeding tubes for nutrition.
These procedures are usually performed by advanced endoscopists, and doctors like me undergo years of additional focused and sub-specialized training in endoscopy after we have become specialists.
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|
The cost is significantly higher if gastroscopy is done as an inpatient with an overnight stay.
The cost also increases if endoscopic treatments are performed. In such cases, the cost is even more variable due to the multitude of techniques and equipment that may be used. Proper financial counselling is usually possible only after discussion with the doctor.
My patients are fully counselled on the cost and whether their insurance will cover before they commit to any procedure, which is usually done at a later date to allow the patient time to think and clarify the information.
Some patients even get the financial counselling done before they even see me, so that they may see another doctor instead if the cost is more suitable for them.
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