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1. Preparation

WHAT IS A GASTROSCOPY?

Gastroscopy is a diagnostic test that enables the doctor to look inside your oesophagus (the pipe that leads to the stomach), the stomach, and the duodenum (small intestine). The gastroscope is very thin – typically around 9mm in diameter - and is passed into the stomach through the mouth. Your doctor is then able to visualise your oesophagus (the pipe that leads to the stomach), your stomach, and the top part of your duodenum, or small intestine. The images are magnified many times and viewed on a video screen. It is considered a very safe and precise way of investigating the upper gastro-intestinal tract.

WHY IS IT DONE?

A Gastroscopy is performed to check for any abnormalities in the oesophagus, stomach and duodenum. Some common reasons for performing an endoscopy include abdominal pain, reflux, difficulty with swallowing, persistent nausea and vomiting, and abdominal bloating. The cause of these complaints may be due to a wide range of disorders including ulcers, stomach polyps, intestinal bleeding, inflammation of the stomach (gastritis), hiatal hernia, oesophageal stricture and cancer of the stomach or oesophagus.

A Gastroscopy may also be performed as a screening tool when there is a strong family history of stomach cancer, or to follow up previous treatment.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a gastroenterologist who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Gastroenterological Society of Australia via their website at www.gesa.org.au.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Gastroenterologists who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent. Your doctor will ask you to sign a consent form, which you should fully understand.
• In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments
  • Aftercare
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication are examples of those that may require special instruction:
  • Aspirin (or any related products),
  • Blood thinners (Warfarin, heparin.),
  • Arthritis medication,
  • Pain medication,
  • Insulin

WHERE IS IT DONE?

Gastroscopy can be done in either a day surgery or in a day facility located in an overnight hospital.

HOW LONG IS THE PROCEDURE?

The time needed for a gastroscopy will vary, but on average the procedure takes about 10 to 20 minutes.

WHO IS INVOLVED?

The procedure is usually carried out as a Day Surgery Patient in a specialised day surgery or in a Hospital. The people involved in the procedure are:

• The Gastroenterologist, your doctor (Specialist)
• Anaesthetist: they give you medication that make you relaxed and sleepy, and look after you whilst the procedure is being carried out
• Specialised Nurses for the procedure and recovery

HOW DO I PREPARE FOR A GASTROSCOPY?

You will need to fast for at least 6 hours prior to the procedure. Please follow any instructions given to you by the Day Surgery/ Hospital. Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated later.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not bring any valuables with you
• It’s best not to wear any jewellery (sometimes plain bands are acceptable)
• Wear comfortable clothing
• Take any recent, relevant x-rays and scans
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• You may also wish to bring something to read whilst you wait
• Remove all nail polish and do not wear any make-up

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he/she will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Gastroscopy admissions for the financial year 09/10 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 7,517 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 30473.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• There is no excess payable for same day admissions.

¹ These medical services are inpatient services only.

² The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($701) differs from the sum of the individual average charges as

shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all

gastroscopies. The percentages shown for each type of medical service are much higher

as they are calculated for those services only and not the entire admission, which

includes all medical services and the hospital services. In an admission you may have

one medical service with an out of pocket expense, which then excludes the whole

admission from being fully covered. Hence the significant difference in percentage for

individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive, the receptionist will do all the paperwork necessary for your stay. Please ensure that you let the staff know of any medication you are taking and any allergies that you may have. Remember to mention any herbal or homeopathic remedies you may be taking, as these can have interactions and side effects too.

At some stage before the procedure, your specialist will ask you to sign a consent form indicating that you give him or her permission the procedure, and you understand all potential risks and complications.

Once this admission procedure is completed, usually you will then be taken to the procedure room. An anaesthetist may see you during this time. Once there, an anaesthetic spray will be used to numb your throat. If an injection is being used, a plastic tube called a cannula is placed in your vein and is used to give medication to make you relaxed and drowsy. An intravenous drip may also be attached to the cannula.

WHAT CAN I EXPECT DURING A GASTROSCOPY?

During the procedure, everything will be done to ensure your comfort. The sedation administered will enable you to remain awake and cooperative, but it may prevent you from remembering much of the experience.

Once you are fully relaxed, a mouth guard will be placed in your mouth. This is to enable easy passing of the gastroscope and to prevent you from accidentally biting on the scope and damaging your teeth. If you wear dentures, you will be asked to remove them.

The Gastroscope is passed through the mouth and slowly guided down the oesophagus and into your stomach. You may feel a desire to cough or gag when the instrument is passed into the oesophagus. If possible this impulse should be suppressed as a sore throat can result.

During the course of the procedure medical and nursing staff will monitor your heart rate, blood pressure, and oxygenation of the blood. If needed, you may receive additional doses of medication during the procedure.

Samples (biopsies) are sometimes taken from the oesophagus, stomach or duodenum during the procedure. This is not painful. These samples will be examined by the pathologist and tested for the presence of infection. If any abnormalities are seen in the stomach or oesophagus, like a polyp or inflamed tissue, the surgeon can remove all or part of it using tiny instruments passed through the scope.

3. Aftercare

WHAT HAPPENS AFTER A GASTROSCOPY?

You will wake up in a recovery area and at this time will be given light refreshments once the anaesthetic spray has worn off. If an anaesthetic spray was the only medication used, you will be able to leave as soon as you are ready. If an intravenous anaesthetic was used you will be asked to rest for an hour or two until the effects of the sedatives/anaesthetic have worn off. It is common to have a sore throat for a day or two. Patients often have a full feeling and pass gas for a while after the procedure. Soft stools and changes in bowel movements are common for the first day or so.

Though most of the effects of the sedative/anaesthetic wear off quickly you should not drive yourself home after your gastroscopy. It is common to feel a little light headed or forgetful after having sedation, especially as you won’t have eaten for some time. You should therefore arrange for a friend or relative to accompany you when you leave and, if possible, remain with you overnight. If you find this difficult please inform the staff prior to admission.

Sometimes minor side effects, such as a sore throat, can continue after you have gone home. You should receive specific instructions concerning any side effects you can expect to experience once home, and any symptoms for which you should seek further assistance.

1. Preparation

WHAT IS A GASTROSCOPY?

Gastroscopy is a diagnostic test that enables the doctor to look inside your oesophagus (the pipe that leads to the stomach), the stomach, and the duodenum (small intestine). The gastroscope is very thin – typically around 9mm in diameter - and is passed into the stomach through the mouth. Your doctor is then able to visualise your oesophagus (the pipe that leads to the stomach), your stomach, and the top part of your duodenum, or small intestine. The images are magnified many times and viewed on a video screen. It is considered a very safe and precise way of investigating the upper gastro-intestinal tract.

WHY IS IT DONE?

A Gastroscopy is performed to check for any abnormalities in the oesophagus, stomach and duodenum. Some common reasons for performing an endoscopy include abdominal pain, reflux, difficulty with swallowing, persistent nausea and vomiting, and abdominal bloating. The cause of these complaints may be due to a wide range of disorders including ulcers, stomach polyps, intestinal bleeding, inflammation of the stomach (gastritis), hiatal hernia, oesophageal stricture and cancer of the stomach or oesophagus.

A Gastroscopy may also be performed as a screening tool when there is a strong family history of stomach cancer, or to follow up previous treatment.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a gastroenterologist who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Gastroenterological Society of Australia via their website www.gesa.org.au

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Gastroenterologists who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask.
• What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent. Your doctor will ask you to sign a consent form, which you should fully understand.
• In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments
  • Aftercare
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication are examples of those that may require special instruction:
  • Aspirin (or any related products),
  • Blood thinners (Warfarin, heparin.),
  • Arthritis medication,
  • Pain medication,
  • Insulin.

WHERE IS IT DONE?

Gastroscopy can be done in either a day surgery or in a day facility located in an overnight hospital.

HOW LONG IS THE PROCEDURE?

The time needed for a gastroscopy will vary, but on average the procedure takes about 10 to 20 minutes.

WHO IS INVOLVED?

The procedure is usually carried out as a Day Surgery Patient in a specialised day surgery or in a Hospital. The people involved in the procedure are:

• The Gastroenterologist
• Anaesthetist: they give you medication that make you relaxed and sleepy, and look after you whilst the procedure is being carried out
• Specialised Nurses for the procedure and recovery

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he/she will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Gastroscopy admissions for the financial year 09/10 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 7,517 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 30473.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• There is no excess payable for same day admissions.

¹ These medical services are inpatient services only.

² The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($701) differs from the sum of the individual average charges as

shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of th

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all

gastroscopies. The percentages shown for each type of medical service are much higher

as they are calculated for those services only and not the entire admission, which

includes all medical services and the hospital services. In an admission you may have

one medical service with an out of pocket expense, which then excludes the whole

admission from being fully covered. Hence the significant difference in percentage for

individual types of medical services as compared to the total admission fully covered.

HOW DO I PREPARE FOR A GASTROSCOPY?

You will need to fast for at least 6 hours prior to the procedure. Please follow any instructions given to you by the Day Surgery/ Hospital. Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated later.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not bring any valuables with you.
• It’s best not to wear any jewellery (sometimes plain bands are acceptable)
• Take any recent, relevant xrays and scans
• Wear comfortable clothing.
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these.
• You may also wish to bring something to read whilst you wait.
• Remove all nail polish and do not wear any make-up.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive, the receptionist will do all the paperwork necessary for your stay. Please ensure that you let the staff know of any medication you are taking and any allergies that you may have.

At some stage before the procedure, your specialist will ask you to sign a consent form indicating that you give him or her permission the procedure, and you understand all potential risks and complications

Once this admission procedure is completed, usually you will then be taken to the procedure room. An anaesthetist may see you during this time. Once there, an anaesthetic spray will be used to numb your throat. If an injection is being used, a plastic tube called a cannula is placed in your vein and is used to give medication to make you relaxed and drowsy. An intravenous drip may also be attached to the cannula.

WHAT CAN I EXPECT DURING A GASTROSCOPY?

During the procedure, everything will be done to ensure your comfort. The sedation administered will enable you to remain awake and cooperative, but it may prevent you from remembering much of the experience.

Once you are fully relaxed, a mouth guard will be placed in your mouth. This is to enable easy passing of the gastroscope and to prevent you from accidentally biting on the scope and damaging your teeth. If you wear dentures, you will be asked to remove them.

The Gastroscope is passed through the mouth and slowly guided down the oesophagus and into your stomach. You may feel a desire to cough or gag when the instrument is passed into the oesophagus. If possible this impulse should be suppressed as a sore throat can result.

During the course of the procedure medical and nursing staff will monitor your heart rate, blood pressure, and oxygenation of the blood. If needed, you may receive additional doses of medication during the procedure.

Samples (biopsies) are sometimes taken from the oesophagus, stomach or duodenum during the procedure. This is not painful. These samples will be examined by the pathologist and tested for the presence of infection. If any abnormalities are seen in the stomach or oesophagus, like a polyp or inflamed tissue, the surgeon can remove all or part of it using tiny instruments passed through the scope.

3. Aftercare

WHAT HAPPENS AFTER A GASTROSCOPY?

You will wake up in a recovery area and at this time will be given light refreshments once the anaesthetic spray has worn off. If an anaesthetic spray was the only medication used, you will be able to leave as soon as you are ready. If an intravenous anaesthetic was used you will be asked to rest for an hour or two until the effects of the sedatives/anaesthetic have worn off. It is common to have a sore throat for a day or two. Patients often have a full feeling and pass gas for a while after the procedure. Soft stools and changes in bowel movements are common for the first day or so.

Though most of the effects of the sedative/anaesthetic wear off quickly you should not drive yourself home after your gastroscopy. It is common to feel a little light headed or forgetful after having sedation, especially as you won’t have eaten for some time. You should therefore arrange for a friend or relative to accompany you when you leave and, if possible, remain with you overnight. If you find this difficult please inform the staff prior to admission.

Sometimes minor side effects, such as a sore throat, can continue after you have gone home. You should receive specific instructions concerning any side effects you can expect to experience once home, and any symptoms for which you should seek further assistance.