Gastroscope

Everything you Need to Know About Gastroscopes

A gastroscope, or esophagogastroduodenoscope, is an endoscopic instrument that allows the physician to visualize the upper gastrointestinal tract.

This device is designed to confirm a diagnosis and perform mini-surgical procedures, such as biopsies.

The popularity of gastroscopy increased in the past decade due to technological advances in the design and functionality of endoscopes. Moreover, the substantial increase of gastrointestinal pathologies in the general population pushed hospitals and healthcare facilities to get these devices and train medical professionals to use them properly.

In this article, we will discuss the history of gastroscopy, how gastroscopes work, their indications/contraindications, and the market-leading brands.

History of Gastroscopy

Historians and experts are still debating about the exact date of the first endoscope-like instrument ever recorded, which was found in the ruins of Pompeii.

However, most experts agree that the first endoscope was developed by a German physician by the name of Philip Bozzini in 1805. Bozzini used this device to visualize the urinary tract of his patients.

In 1868, another German physician named Adolph Kussmaul used a gastroscope to examine the stomach on a living patient for the first time in history.

Jumping forward to 1881, when a Polish-Austrian surgeon named Johann von Mikulicz designed the first gastroscope that's capable of going inside the patient's esophagus, stomach, and intestines.

To improve the design of Johann von Mikulicz's, Rudolph Schindler added the characteristic of flexibility to the gastroscope, which allowed it to reach the duodenum.

Later, in the 1950s, a group of medical engineers added a tiny camera to the gastroscope to record the procedure.

Since then, several modifications were made on gastroscopes to enhance their flexibility and the image quality they produce.

How a Gastroscope Works

Like other modern endoscopes, a gastroscope works by capturing live-video streaming of the stomach to visualize any abnormal anatomical structures or to diagnose conditions, such as ulcers.

The instrument is equipped with a tiny full HD camera and a bright light on one end, and on the other one, it has the handle that the gastroenterologist will use to guide the gastroscope into the desired area.

Modern gastroscopes are flexible to accommodate the twisty anatomy of the digestive tract and prevent any direct trauma to the esophagus or other vital organs.

Once the physician takes a good look at the inside of the stomach and the upper part of the intestines, he/she will decide whether the case needs any further investigation/biopsies before removing the endoscope.

Note that the patient will be conscious, partially sedated, or under general anesthesia during the procedure.

The choice of anesthesia varies greatly, depending on where the procedure is being performed, the hospital's policies, and the history of the patient.

The indications to use a gastroscope

Diagnostic evaluation of digestive signs and symptoms

Digestive signs and symptoms are prevalent in the general population.

If the gastroenterologist suspects that something is wrong inside the GI tract, he/she may opt for a gastroscopy to get a direct view of the intraluminal tract and look for any abnormal findings.

Generally speaking, the digestive complaints that may require endoscopy are divided into two big entities:

  • Upper gastrointestinal issues
  • Lower gastrointestinal issues

For our purpose, we will only cover the upper GI issues.

The symptoms that warrant the use of the gastroscope include:

  1. Dysphagia is defined as a swallowing difficulty of liquids or solid foods.
  2. Severe chest pain that is not cardiopulmonary in origin with a clear history of GI problems. 
  3. Severe upper GI pain without a previous diagnosis (e.g., peptic ulcers, gastritis).
  4. Recurrent vomiting that cannot be explained by other findings.

Systemic surveillance of the upper gastrointestinal (GI) tract in high-risk patients

The other people that need gastroscopy are patients with advanced medical conditions that put them at a higher risk of developing a malignant tumor.

These include:

  1. Barrett's esophagus, which is a precancerous pathological state caused by chronic tissue exposure to acid caused by gastroesophageal reflux disease (GERD), can transform into esophageal cancer if left untreated.
  2. Polyposis is a genetic disease that affects a set of patients, leading to multiple, tiny masses that could become cancerous.

The evaluation of these conditions helps internists and gastroenterologists to intervene before it is too late.

Performing a biopsy 

Several indications warrant procedural biopsy, which includes first-time peptic ulcer disease, malabsorption syndromes (e.g., celiac disease, Crohn's disease), irregular masses, and chronic infections.

The biopsied tissue will get meticulously studied by the pathologist to look for any histological abnormalities that would help with the suspected diagnosis.

Therapeutic interventions

The final category of gastroscopy's indications covers the interventional procedure to retrieve foreign bodies, halt severe bleeding, widen the esophagus using a stent or strictures, and ablate a tumor.

These interventions are extremely sensitive and rely on the quality of the gastroscope and the experience of the physician.

The contraindications of using a gastroscope

The contraindications of gastroscopy are somewhat debated, but the vast majority of the medical community agree on the following ones:

  • Suspicion of a GI perforation
  • Hemodynamically unstable patients (e.g., hemorrhagic shock, septic shock)
  • Clear objection of the patient against this procedure
  • Chronic anticoagulation treatment
  • Zenker's diverticulum

The market-leading brands of gastroscopes

As mentioned earlier, the market share of gastroscopes and other endoscopic instruments is prospering due to the increased incidence of gastric and esophageal cancers.

In 2017, flexible gastroscopes' revenue exceeded 590 million dollars, with this number expected to reach one billion dollars in the near future.

The competition in this field is fierce, and dozens of companies develop new marketing strategies to take over the bigger share of the market.

By far, the US dominates this field, with 10 massive corporations competing in the field of endoscopy.

Here a list of the top ten US-based companies that produce gastroscopes and other endoscopic instruments:

  • Medtronic
  • Ethicon (Johnson & Johnson)
  • Boston Scientific
  • Olympus
  • R. Bard
  • Coloplast
  • Hologic
  • Bayer
  • Applied Medical
  • Cook Medical

Each of these companies produces a massive number of medical equipment in several specialties, including gastroenterology, gynecology, and orthopedic surgery.

What is sure is that this competition leads to creative designs and advanced technology, which is beneficial for physicians and their patients.

General specifications of a gastroscope

Due to the variety of gastroscopic designs, we decided to opt for Olympus' flexible gastroscope –model GIF HQ190–:

Field of view 

  • Normal – 140 degrees
  • Near – 140 degrees

Direction of view

  • Forward viewing

Depth of field

  • Normal – 5-100 mm
  • Near 2-6 mm

Distal and outer diameter

  • 9.9 mm

Insertion tube outer diameter

  • 9.9 mm

Working length

1030 mm

Channel inner diameter

  • mm

Minimum visible distance

  • 3 mm from the distal end

Angulation range

  • Up – 210 degrees
  • Down – 90 degrees
  • Right – 100 degrees
  • Left – 100 degrees

Total length 

  • 1350 mm

Conclusion

Gastroscopes spare patients from massive and invasive surgical procedures that would have been necessary if these crucial instruments were not available.

With the continuous trend of high rates of gastroesophageal cancer and the increase in life expectancy, the need for these devices is more critical than ever.

Hopefully, this article helped you learn more about gastroscopes and how physicians use them.