Gastroscopy in Sydney

What a gastroscopy is

A gastroscopy, also called an upper endoscopy, is an examination of the oesophagus, the stomach and the duodenum with a thin flexible camera passed through the mouth. Because the upper gut empties naturally with fasting, there is no bowel preparation to drink.

What it costs, and why a procedure generates several separate accounts, is set out on the fees and rebates page. Referrals, waiting times and what to bring are on the patient questions page.

Like a colonoscopy, it is not only a camera. Biopsies can be taken from anything that looks abnormal and from normal-looking lining when a diagnosis such as coeliac disease or eosinophilic oesophagitis depends on it. Some problems can be treated during the same procedure.

Why it is done

The common reasons for a gastroscopy are:

• reflux or heartburn that persists despite treatment or that starts later in life
• difficulty swallowing or food sticking on the way down
• persistent upper abdominal pain or indigestion
• iron deficiency or anaemia without an obvious cause
• vomiting blood or black tarry stools
• confirming coeliac disease after a positive blood test
• testing for Helicobacter pylori infection in some situations
• surveillance of Barrett's oesophagus or of other conditions that carry a risk of cancer
• unexplained weight loss or persistent vomiting

A gastroscopy and a colonoscopy are often done in the same sitting, for example to investigate iron deficiency, with one sedation and one day off.

What can be treated during a gastroscopy

• Stretching a narrowing of the oesophagus with a balloon, for strictures, rings and webs that cause difficulty swallowing.
• Removing food that has become stuck in the oesophagus.
• Stopping bleeding from an ulcer or blood vessel, with injection or clips.
• Removing small polyps in the stomach or duodenum.
• Surveillance of Barrett's oesophagus, with systematic biopsies. If precancerous change is found, treatment is arranged in a specialist Barrett's service. There is more on the page about reflux and Barrett's oesophagus.

Preparing for a gastroscopy

No food for about six hours beforehand and no fluids for about two hours. You will be given exact times, which may differ slightly between hospitals.

Tell the rooms in advance about blood thinners and antiplatelet medicines. The plan for these is agreed with the endoscopist before the day, because it depends on which medicine it is and why you take it, and low-dose aspirin is the one that is usually continued. Tell them too about diabetes medication, which needs adjusting for the fast. If you take a GLP-1 medicine, which patients commonly know as Ozempic, Wegovy or Mounjaro, say so early. This matters more for a gastroscopy than for anything else, because the camera goes into the stomach itself: these medicines hold food there for longer, and retained food both obscures the view and raises the risk of it going the wrong way under sedation. The plan is usually clear fluids only for a full day beforehand and nothing at all for the final six hours, except a sip of water with tablets.

If the gastroscopy is to test for Helicobacter pylori, some acid-suppressing medicines and antibiotics need to be stopped beforehand, and you will be told which.

On the day

Sedation is given through a small cannula in the arm, and a mouthguard protects the teeth and the instrument. Most people remember little or nothing of the procedure, which usually takes 10 to 20 minutes. Afterwards you stay in recovery until the sedation wears off.

For 24 hours afterwards, no driving, no operating machinery, no alcohol and no signing legal documents, and someone has to take you home. A mild sore throat and some bloating are common and settle within a day.

You will normally be told what was seen before you leave. Biopsy results take one to three weeks and are best gone through at a follow-up appointment.

What are the risks

Gastroscopy is a common and generally safe procedure, and serious complications are uncommon. They include reactions to sedation, bleeding (more likely where a biopsy has been taken or a treatment carried out), and, rarely, a tear in the wall of the oesophagus or stomach, which is more likely when a narrowing is stretched or a lesion removed. Damage to teeth is possible and rare.

After the procedure, severe chest or abdominal pain, difficulty breathing, fever, vomiting blood or black stools are not normal. Contact the rooms or the hospital straight away, and if it is severe, go to an emergency department.

What it costs

In a public hospital a gastroscopy is free. Privately, the bill has three parts that are charged separately: the doctor performing it, the anaesthetist and the facility. Medicare rebates part of the first two against their item numbers, and a health fund covers the facility according to the policy. What is left, if anything, is the gap. The rooms will give you the item numbers and a written estimate beforehand, the anaesthetist's fee included. Phone the rooms and ask.

Procedures are performed at Norwest Private Hospital, Macquarie University Hospital and Pennant Hills Day Surgery.

Where gastroscopy is performed in Sydney

A/Prof Viraj Kariyawasam is a consultant gastroenterologist and hepatologist with an advanced therapeutic endoscopy fellowship. Consultations before and after the procedure are in Norwest, Rouse Hill, Pennant Hills and Macquarie Park.

The gastroscopy is performed at Norwest Private Hospital, Macquarie University Hospital and Pennant Hills Day Surgery. A referral from your GP is needed for a consultation.