Endoscopic investigations

Defi nition

Occasionally patients will be required to undergo further invasive

diagnostic procedures such as an endoscopy. An endoscopy is
the direct visual examination of the GI tract (Figure 10.14 ) which
may include gastroscopy or colonoscopy. Endoscopy allows the
practitioner to evaluate the appearance of the visualized mucosa
for the purpose of diagnosis and therapeutic procedures (Smith
and Watson 2005 ).

Gastroscopy
Defi nition

A gastroscopy or oesophagogastroduodenoscopy (OGD) is a procedure

in which a long fl exible endoscope is passed through the
mouth, allowing the doctor or nurse endoscopist to look directly
at the mucosal lining of the oesophagus, stomach and proximal
duodenum. The endoscope is generally less than 10 mm in diameter
but a larger scope may be required for therapeutic procedures
where suction channels are required (Smith and Watson 2005 )
(see Figure 10.14 ).

Anatomy and physiology

See Figure 10.15 .

Oesophagus

The oesophagus is a muscular thin-walled tube approximately

25 cm long and about 2 cm in diameter. It is located behind
the trachea and in front of the vertebral column. It begins at the
inferior end of the laryngopharynx and ends at the stomach.
There are two sphincters within the oesophagus: the upper or
hypopharyngeal sphincter and the lower gastro-oesophageal or
cardiac sphincter. The upper moves food from the pharynx to the
oesophagus and the lower the food passing into the stomach. The
oesophagus has three layers, the mucosa, submucosa and the
muscularis, with the innermost layer consisting of stratifi ed squamous
epithelium (Jenkins and Tortora 2013 ).

Stomach

The stomach connects the oesophagus and the small intestine or

duodenum. It is a J-shaped dilated portion of the alimentary tract
and one of its functions is a holding reservoir and mixing chamber.
It is also located between the epigastric, umbilical and left hypochondriac
regions of the abdomen. It is divided into four regions:
the cardia, fundus, body and pyloric part. Distally, the pyloric
sphincter is located between the stomach and the duodenum. The
stomach has three muscle layers to allow for gastric motility to
move the contents adequately whereas other parts of the alimentary
tract only have two muscle layers (Jenkins and Tortora 2013 ).

Duodenum

The duodenum is part of the small intestine. It is approximately

25 cm long and 3.5 cm in diameter and is the shortest region. It
begins at the pyloric sphincter of the stomach and joins the jejunum.
Both the pancreas and the gallbladder release secretions
into the duodenum (Jenkins and Tortora 2013 ).