Norm of Gastroscopy or Gastroduodenojejunoscopy (GJD)
Cardiac and pyloric sphincters are intact. Rugal folds of the stomach are continuous. No blood or lesions are detected. Blood vessels are not visible.
Usage of Gastroscopy or Gastroduodenojejunoscopy (GJD)
Detection of gastric cancer, gastric ulcer, gastritis, hiatal hernia, and Mallory-Weiss tears; investigation of unexplained weight loss or dysphagia; and to obtain brushings of gastric mucosa to help determine infectious states such as Helicobacter pylori infection.
Description of Gastroscopy or Gastroduodenojejunoscopy (GJD)
Gastroscopy involves the insertion through the esophagus of a lighted flexible fiberoptic endoscope into the stomach and upper portion of the small intestine, with concurrent visual examination of the mucosal lining for active bleeding sites, varices, ulcers or perforations, lesions, or tears. The procedure takes approximately 30 minutes. Gastroduodenojejunoscopy involves advancing the instrument further into the small intestine to evaluate the integrity of the jejunum as well as any structural or obstructive abnormalities.
Professional Considerations of Gastroscopy or Gastroduodenojejunoscopy (GJD)
Consent form IS required.
Gastrointestinal perforation and hemorrhage, peritonitis, aspiration, respiratory arrest, death.
Thrombocytopenia. Sedatives are contraindicated in clients with central nervous system depression.
- See Client and Family Teaching.
- Dentures should be removed.
- A sedative may be prescribed.
- Obtain baseline vital signs.
- Follow facility policy and procedure for clients receiving conscious sedation.
- Obtain a blood pressure cuff, lidocaine spray, a suction machine and tubing, an endoscope, pulse oximetry, and a gastroscopy cart. A cardiac monitor may be required with some clients.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- A blood pressure cuff is left in place on the client's arm, and vital signs along with pulse oximetry are monitored on an individual basis throughout the procedure.
- The mouth and oropharynx are anesthetized locally.
- Oral secretions are suctioned or allowed to drain out as they accumulate.
- The client is placed in a left lateral position with the head tilted forward.
- As the endoscope is advanced into the esophagus, the head is slowly tilted back.
- The esophagus and cardiac sphincter are examined as the endoscope is advanced. The endoscope is rotated clockwise as it is advanced into the stomach and the stomach lining, and the cardiac and pyloric sphincters are examined. The scope is advanced through the pylorus into the duodenal bulb and beyond the bulb apex into the second portion of the pH duodenum. Advancement can continue into the jejunum as well. Photographs of suspicious areas and biopsy specimens or brushings may also be taken. Sclerotherapy is commonly performed during this procedure if active bleeding is noted. Polypectomies are also common. The endoscope is slowly withdrawn.
- Fasting is required until the gag reflex returns.
- Continue assessment of respiratory status. If deep sedation was used, follow institutional protocol for postsedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds to commands spoken in a normal tone.
- Observe for symptoms of complications, which may include hypotension; pallor; tachycardia (from bleeding); shoulder, neck, back, or abdominal pain (from perforation); or tachypnea and rales caused by pulmonary edema after thoracic perforation.
- Use of topical and injected local anesthetics has been associated with methemoglobinemia in rare instances. Consider this condition in clients exhibiting signs and symptoms of hypoxia refractory to oxygen therapy.
Client and Family Teaching
- Fast from food and fluids for 8–12 hours before the procedure.
- Arrange for someone else to drive you home because clients receiving sedation should not drive until 24 hours later.
- It is important to swallow when asked as the endoscope is being inserted through the mouth and advanced into the stomach.
Factors That Affect Results
- The client must be able to swallow.
- This test is to be performed with caution in clients with perforated ulcer, aortic aneurysm, recent bleeding esophageal varices, or Zenker's diverticulum.
- Complications of this procedure include esophageal, thoracic, gastric, or diaphragmatic perforation.