Gastroscopy of the stomach: sensations, what it reveals, and how the results are assessed

Gastroscopy, or esophagogastroduodenoscopy, is an endoscopic examination of the esophagus, stomach, and duodenum using a flexible, thin instrument with a video camera and light source. This method allows for real-time visualization of the mucous membrane, biopsy, rapid testing for Helicobacter pylori infection, and, if necessary, therapeutic interventions, such as stopping bleeding or widening a stenosis. Gastroscopy is highly valuable for the early detection of inflammation, peptic ulcers, and precancerous conditions. [1]

Current guidelines clarify the indications: examination is prescribed for alarm symptoms such as dysphagia, unintentional weight loss, anemia, bleeding, repeated vomiting, as well as suspected complications of gastroesophageal reflux disease and peptic ulcer disease. In patients under 60 years of age without alarm symptoms, the diagnostic yield of gastroscopy is low, so a conservative approach is initially used, with testing and eradication of Helicobacter pylori in the presence of dyspepsia. This approach improves resource efficiency without compromising oncological alertness. [2]

In addition to diagnostics, the examination is often combined with treatment: during a single procedure, the physician can cauterize a bleeding vessel, remove a small polyp, take targeted biopsies from standard maps, and widen a scarred stenosis. This reduces the number of visits and expedites decision-making. With proper patient selection and adherence to protocols, gastroscopy remains a safe procedure with a low rate of serious complications, according to large multicenter observational studies. [3]

In recent years, thin endoscopes and transnasal access through the nose have been widely used. For some patients, this is easier to tolerate, as it reduces the gag reflex and the sensation of a "foreign body" in the throat, and the need for sedation is less frequent. The concept of shared decision-making has been introduced to address the choice of approach: the physician explains the options, and the patient chooses what is psychologically and physiologically most appropriate. [4]

Table 1. What a gastroscopy can show

Find	What does it mean?	What do they do next?
Erosive esophagitis, Los Angeles classification	The degree of damage to the esophageal mucosa during reflux	Selection of antisecretory therapy, correction of risk factors. [5]
Barrett's esophagus, Prague scale C and M	Precancerous change in the esophageal mucosa	Biopsies according to the protocol, observation at intervals, in case of dysplasia - endoscopic treatment. [6]
Gastritis, atrophy, intestinal metaplasia	The risk of stomach cancer varies	Biopsies according to the updated Sydney system, risk staging. [7]
Ulcers of the stomach and duodenum	Sometimes associated with Helicobacter pylori and NSAID use	Testing and eradication of infection, monitoring of healing as indicated. [8]
Tumor-like formations, polyps	Require morphological verification	Excision or targeted biopsy followed by treatment plan.[9]

Indications: who needs a gastroscopy and when

The first set of indications relates to alarm symptoms. These include progressive dysphagia, unintentional weight loss, gastrointestinal bleeding, iron deficiency anemia, recurrent vomiting, and new dyspeptic complaints in older age groups. In these situations, examination is necessary to rule out tumors, complicated peptic ulcers, and strictures, as early detection changes the prognosis and allows for the use of organ-preserving methods. [10]

The second set of indications relates to gastroesophageal reflux disease. Gastroscopy is indicated for signs of complications, such as chest pain unexplained by cardiac examinations, persistent swallowing difficulties, signs of bleeding, or suspected stricture. A separate objective is screening for Barrett's esophagus in high-risk patients based on age, gender, body mass index, smoking status, and family history. Observation intervals depend on the segment length and the presence of dysplasia. [11]

The third set of indications is monitoring healing and verifying the causes of peptic ulcer disease. In gastric ulcers, it is often necessary to confirm healing and exclude neoplasms. If Helicobacter pylori is detected, eradication is confirmed by a non-invasive test or histology, depending on the local protocol and the treatment administered. Consensus documents emphasize that Helicobacter pylori infection is always accompanied by gastritis and requires a well-thought-out treatment regimen taking into account regional resistance. [12]

The fourth block of indications covers therapeutic tasks: stopping bleeding, removing small polyps, dilating strictures, inserting a feeding tube, and other procedures. In such situations, gastroscopy is performed as a first-line procedure, as it allows for simultaneous diagnosis and treatment. Decisions regarding preparation, adjusting anticoagulants, and choosing sedation are made in advance based on specialist recommendations. [13]

Table 2. Indications and diagnostic purposes

Clinical situation	Why is it important?	The purpose of gastroscopy
Symptoms of anxiety	The risk of serious pathology is higher	Rule out cancer and complications, treat immediately if necessary. [14]
Severe reflux or dysphagia	Possible stricture or Barrett's esophagus	Confirm the diagnosis, take biopsies, and plan a course of action. [15]
Peptic ulcer disease	It is necessary to exclude complications and achieve healing.	Healing control, Helicobacter pylori tests. [16]
Therapeutic interventions	Time is critical	Immediate endoscopic therapy. [17]

Preparation: How to Reduce Risks and Increase Informativeness

The day before the procedure, the doctor and patient agree on medication and dietary guidelines. To reduce the risk of aspiration, universal fasting guidelines apply before anesthesia: solid foods for at least 6 hours, fatty foods for approximately 8 hours, and clear liquids for up to 2 hours. These timeframes are supported by anesthesia guidelines, including updates on the consumption of carbohydrate-containing beverages and chewing gum. [18]

The use of anticoagulants and antiplatelet agents is discussed in advance. For diagnostic gastroscopy with biopsy, the risk of bleeding is low, and many patients continue therapy with aspirin. For high-risk procedures, temporary discontinuation and bridging are chosen depending on the drug and the risk of thromboembolism. Current joint guidelines from European societies are regularly updated and contain clear algorithms. [19]

If local anesthesia of the pharynx with a spray is planned, the patient is warned about temporary numbness of the oropharynx and is advised not to eat or drink after the procedure until the swallowing reflex is restored. This typically takes about 30 minutes. This reduces the risk of aspiration. If sedation is chosen, an escort home is arranged in advance, as driving, operating machinery, and signing legally binding documents are prohibited for 24 hours after sedation. [20]

Psychological preparation plays an important role. Discussing the possible sensations and how to control the gag reflex and gas inhalation reduces anxiety and improves tolerance. Current sedation guidelines emphasize the need for detailed information and a shared choice between spray, light sedation, and transnasal technique. [21]

Table 3. Minimum preparation checklist

Paragraph	What to consider
Fasting period	Clear liquids up to 2 hours, light foods 6 hours, fatty foods 8 hours. [22]
Anticoagulants and antiplatelet agents	Coordinate according to the algorithm of risk of procedure and thrombosis. [23]
Choice of pain relief	Spray, sedation or transnasal access, according to preference and indication. [24]
Escort	After sedation, there will be a person who will take you home and be in touch. [25]

How is a gastroscopy performed and what sensations are possible?

Before beginning, the physician explains the plan again, ensures consent and compliance with the fast. Under local anesthesia, lidocaine is sprayed onto the back of the throat; under sedation, a short-acting medication is administered under monitoring of vital signs. An endoscope is carefully passed through the mouth or nose, air or carbon dioxide is administered to straighten the folds, the esophagus, stomach, and duodenum are examined, findings are recorded, and biopsies are taken. The entire procedure typically takes minutes, but may take longer in complex cases. [26]

Sensations include a brief gag reflex, a feeling of fullness due to the gas injection, and salivation. Sedation reduces discomfort and produces partial amnesia, but requires observation and 24-hour recovery. A transnasal technique with an ultra-thin endoscope reduces the gag reflex and may be preferable for patients with hypersensitivity. The choice of method depends on the clinical objectives and individual tolerance. [27]

After the throat spray, drinking and eating are permitted only after the swallowing reflex returns. Typically, a leaflet is provided with signs requiring immediate medical attention: increasing pain, black stools, vomiting blood, and severe weakness. After sedation, written instructions are provided and a phone number for contact within 24 hours, when rare delayed reactions are still possible. This is part of safety standards. [28]

The sedative effect depends on the drug. Propofol promotes rapid sleep onset and awakening, and according to meta-analyses, it offers shorter recovery times and higher patient satisfaction compared to benzodiazepines, provided appropriate monitoring and a competent team. The decision to use it is made by a physician, taking into account comorbidities and risk level. [29]

Table 4. Feelings and how to cope with them

Possible sensation	How the team helps	What can a patient do?
Gag reflex	Transnasal technique, local anesthesia of the pharynx, sedation	Breathe calmly through your nose and do not talk during the examination. [30]
Distension in the abdomen	Use of carbon dioxide, careful gas supply	Get up and walk around after the procedure, drink warm drinks after the doctor’s permission. [31]
Fear of the procedure	Detailed explanation, shared decision making	Discuss pain relief preferences in advance. [32]
Bitterness and numbness	Short spray effect	Do not drink or eat until swallowing is fully restored. [33]

Security: Risks and how to minimize them

Gastroscopy is a safe procedure with a low rate of serious complications. According to prospective studies, perforations during diagnostic examinations occur in approximately 1 in 2,500 to 1 in 11,000 procedures, and fatalities are extremely rare. Most complications are associated with cardiopulmonary events associated with sedation, so monitoring and discharge criteria are essential. [34]

The risk of bleeding after a targeted biopsy is low and usually does not require special treatment. Risks are higher with therapeutic interventions and are discussed in advance. Standardized preparation protocols, saturation and blood pressure monitoring, pulse oximetry, and risk assessment for comorbidities and drug therapy are used to reduce the incidence of complications. [35]

Anticoagulant and antiplatelet therapy management remains an important part of safety. Joint documents from specialized societies recommend separating procedures based on the risk of bleeding and thrombosis, with clear algorithms for discontinuing and reinitiating therapy. This is particularly important for planned dilations of stenosis, endoscopic excision, and other interventions. [36]

Following sedation, restrictions apply for 24 hours: driving, operating machinery, drinking alcohol, and signing legal documents are prohibited. A responsible adult is required to accompany the patient home and assist with household chores if needed. These rules are included in clinical guidelines and patient information sheets. [37]

Table 5. Frequency of key risks and prevention

Risk	Estimated frequency	How to reduce
Perforation during diagnostics	From 1 in 2,500 to 1 in 11,000	Gentle technique, experienced team, risk control. [38]
Cardiopulmonary events during sedation	Very rare, but dominate among serious ones	Monitoring, patient selection, correct dosage. [39]
Bleeding after biopsy	Low	Evaluation of antithrombotics using algorithms. [40]
Aspiration after spray	Preventable	Do not drink or eat until swallowing is restored. [41]

Biopsies and sampling "cards": how to collect material and how to read the protocol

For gastritis, atrophy, and intestinal metaplasia, the updated Sydney system is used: at least five biopsies are taken from standard sites—the antrum along the lesser and greater curvatures, the angular notch, and the body along the lesser and greater curvatures. This system improves the detection of precancerous changes and allows for risk staging according to international systems. The protocol typically specifies the sampling sites and preliminary assessment. [42]

If Barrett's esophagus is suspected, the Prague scale is used, measuring the circumferential and maximum length of the segment, and biopsies are performed using a stepwise protocol with uniform sample distribution. This improves the accuracy of dysplasia diagnosis and helps determine the observation interval or the need for endoscopic treatment. Standardization of descriptions reduces observer error. [43]

For Helicobacter pylori, a rapid urease test and histology are combined. Consensus guidelines emphasize a universal principle: Helicobacter pylori infection is considered an infectious disease that requires treatment, as it promotes inflammation and increases the risk of peptic ulcer disease and gastric cancer. Treatment regimens depend on resistance and previously used antibiotics. [44]

Biopsy results are available within a few days. The pathologist's report details signs of inflammatory activity, the presence of atrophy and intestinal metaplasia, the Helicobacter pylori test result, and, if necessary, the degree of dysplasia. Based on this, the physician develops an individualized monitoring and additional treatment plan. [45]

Table 6. Standard biopsy "maps" for gastroscopy

Clinical task	Biopsy scheme	For what
Gastritis, atrophy, metaplasia	The updated Sydney system: 5 points	Complete morphological picture and risk staging. [46]
Barrett's esophagus	Prague scale and step biopsies	Early dysplasia and choice of observation intervals. [47]
Suspected Helicobacter pylori	Urease test and histology	Confirm infection and choose eradication regimen. [48]

Understanding the Conclusion: Examples of Wording and Next Steps

Reflux esophagitis is classified according to the Los Angeles classification. The physician assigns a grade from A to D depending on the extent of the erosions. With grades C and D, the diagnosis of reflux disease is virtually certain; with milder grades, clinical evaluation is required. Treatment includes antisecretory medications, lifestyle modification, and symptom control. Repeat gastroscopy is indicated when clinically indicated. [49]

Barrett's esophagus according to the Prague scale. The conclusion indicates the length of the circular portion and the maximum length of the segment. In the absence of dysplasia, the observation interval depends on the length: a short segment is usually observed less frequently, while a long segment is observed more frequently. If low-grade dysplasia or higher is diagnosed, endoscopic treatment followed by a strict follow-up program is discussed. [50]

Gastritis with intestinal metaplasia. The presence of metaplasia requires attention to risk factors and Helicobacter pylori eradication. Biopsies using the Sydney system allow assessment of the degree of atrophy and the distribution of metaplasia. If significant changes are observed, the physician may recommend monitoring on an individualized schedule with repeat biopsies based on the overall risk. [51]

Peptic ulcer disease. For gastric ulcers, healing monitoring is often prescribed. In addition, if the result is positive for Helicobacter pylori, eradication is performed and its success is then verified by a non-invasive test or histology. This reduces the risk of recurrence and complications, including bleeding. [52]

Table 7. Typical conclusion wording and recommended actions

Formulation	What does this mean?	What is usually recommended
Erosive esophagitis grade B	Damage to the mucous membrane with moderate reflux	Secretion inhibitors, correction of risk factors, dynamics of symptoms. [53]
Barrett's esophagus C1M2 without dysplasia	Short segment, no dysplasia	Observation at intervals according to the segment length. [54]
Focal intestinal metaplasia	Precancerous condition of the stomach	Helicobacter pylori eradication, planned control. [55]
Ulcer of the duodenal bulb	Often associated with Helicobacter pylori	Eradication, symptom control, in gastric ulcers - healing control. [56]

Frequently asked questions

Is it painful and how long does it last? The procedure is short and tolerable for most patients. Sedation significantly reduces discomfort but requires recovery and restrictions for 24 hours. The transnasal technique further reduces the gag reflex. [57]

Can I eat or drink immediately after the procedure? After the throat spray, I'm not allowed until my swallowing reflex returns, usually about 30 minutes. After sedation, I'm advised to do so based on my individual condition. [58]

How safe is it? Serious complications with diagnostic gastroscopy are rare. Perforations are very rare, and cardiorespiratory events are monitored. Discharge occurs after assessment of recovery criteria. [59]

Is gastroscopy necessary for heartburn without alarming symptoms? In many cases, drug therapy and testing for Helicobacter pylori are sufficient. The decision to perform endoscopy is made based on risk factors or treatment failure. [60]