Your procedure information
Please read this booklet as it contains important information on how to prepare for your procedure
Endoscopy Department Contact Numbers
for Help and Enquiries (8.30am to 6.00pm)
Boston 01205 446559
Grantham 01476 464085
Lincoln 01522 573016 / 01522 512512 ext 458669
For more information please see: www.ulh.nhs.uk/services/endoscopy
Aim of the leaflet
The aim of this leaflet is to help you make a choice about having a gastroscopy. It describes how a gastroscopy is carried out and explains the benefits and risks. It will also help you prepare for the procedure.
It is important that you follow the instructions about food and drink before the test. If you do not, you may find that your procedure has to be rearranged.
Introduction
You have been advised by your hospital doctor to have an investigation known as a gastroscopy.
Enclosed with this booklet is a consent form. Your signature is needed for the test to go ahead.
The consent form is an important document, please read it carefully together with the information given in this booklet. Once you have read and understood the information, including the possible risks and you agree to have the test, please sign and date the consent form.
If there is anything you do not understand or wish to discuss further, please ask the nurse or doctor on the ward as they should be able to help. You can sign the consent form after you have spoken to the nurse or doctor, if you are happy to go ahead with the procedure.
What is a gastroscopy?
The procedure is called OesophagoGastroDuodenoscopy (OGD) known more simply as gastroscopy or endoscopy. It involves looking at the upper part of the gut which includes the oesophagus (food pipe), stomach and the first part of your small bowel (duodenum) with a narrow flexible tube called a gastroscope. The scope is about the thickness of a little finger and is passed through the mouth and down into the stomach. The procedure is performed by, or under the supervision of, a specially trained doctor or nurse (endoscopist). A light and camera at the end of the gastroscope relay pictures on to a television screen.
Samples of tissue (biopsies) may also be taken during the test. This is done through the scope. It does not cause any pain and the samples are kept to be looked at under a microscope in the laboratory. Photographs may be taken for your clinical records and may be used for teaching purposes.
The procedure generally takes 5 to 10 minutes.
We aim to make the procedure as comfortable as possible for you. Some people choose to have sedation (medicine injected into a vein), while others prefer to only have local anaesthetic throat spray. More information about sedation and throat spray can be found on page 7.
What are the benefits of having a gastroscopy?
If you have been troubled by symptoms, the cause may be found and help decide if you need treatment or further tests.
A gastroscopy can be done as a follow up check, for certain conditions affecting the stomach or oesophagus.
If a scan or x-ray has suggested there may be something wrong in the upper part of the gut, a gastroscopy allows a closer look at the area.
The test not only helps us to find a cause for your symptoms but may also allow us to give treatment to deal with problems in the oesophagus, stomach or duodenum. In an emergency, you may need a treatment to save your life or reduce complications and the endoscopist will, in this situation, act in your best interests. If you have any concerns about this, please discuss those concerns at any time with your nurses or the endoscopist.
If we see a bleeding ulcer or blood vessels (varices), we are able to use various treatments down through the endoscope, to stop any bleeding and reduce the chances of any further complications.
If we see a narrowing, we can often stretch this gently (dilatation) to open up the narrowing for you and relieve any blockage.
When patients are unable to swallow and take food, we can use the endoscope to assist with placing a very narrow feeding tube through which we can give food whilst the swallowing problem is sorted out.
Treatments are used depending on what is seen at the time of the endoscopy, so we cannot always explain the exact treatment to you before the procedure. Treating a bleeding ulcer or blood vessel is an emergency and treatment is needed quickly, to avoid further blood loss. The benefits of these treatments far outweigh the risks and are intended to help you get better quicker and in some cases avoid an operation.
For most patients the treatments do not usually cause any pain or discomfort, but if you do have any pain or discomfort, please let the doctors or nurses know so that they can give you a medicine to help.
You may ask the doctors or nurses in the endoscopy department for more information if you wish. They will be happy to explain things to you.
What are the risks of the procedure?
Complications are rare. These may be linked to the procedure itself, the condition causing the illness or the sedation medicine.
Sore throat, damage to teeth or bridgework; to reduce this risk your teeth will be protected with a mouth guard.
Sometimes the procedure cannot be completed and a repeat test or a different test is needed.
Perforation (tear) of the lining of the stomach or oesophagus (about 1 for every 9000 cases). If this happens you may need an operation.
Bleeding may happen where a biopsy is taken. It usually stops on its own but may need treatment. In some cases a blood transfusion may be needed.
Endoscopy treatments for bleeding ulcers and blood vessels are usually successful but other treatments may be necessary when the treatment does not solve the problem.
There is a small chance that a cancer may not be seen.
Sedation can sometimes cause problems with breathing, heart rate and blood pressure. These problems usually get better without any treatment. Careful monitoring by a specially trained endoscopy nurse means that potential problems are picked up early and dealt with quickly. The sedation can also cause small food particles to fall into the lungs which can trigger a chest infection (aspiration pneumonia). That is why it is important for your stomach to be empty.
In extremely rare cases the procedure can lead to death.
What are the alternatives?
A barium meal x-ray or CT scan are alternative tests and involve some radiation exposure. They do not give the same information as a gastroscopy, biopsies cannot be taken and treatment cannot be given.
Preparing for the investigation
Eating and drinking
For your safety, to reduce the risk of complications and give clear views, your stomach must be empty. Do not have anything to eat for at least 6 hours before the test and only have a light meal before this time. You may have small amounts of water up to 2 hours before your appointment time but other fluids such as milk are NOT allowed (even in tea and coffee) as they coat the stomach. You should have nothing to drink for at least 2 hours before the test. If you do not follow this advice, your procedure will be rearranged.
What if I take regular medication?
Your routine medication should be taken as usual.
Blood thinning medication (anticoagulants)
If you take anticoagulant medication such as Warfarin, please remind your ward doctor or nurse. If your warfarin needs to be stopped before the procedure the person booking the test should have discussed this with you. If you are unsure please feel free to ask.
Other blood thinners such as Dabigatran, Rivaroxaban, Apixaban, Edoxaban should not be taken on the morning of the procedure. In some cases, these medications need to be stopped for 3 days before the test. The person who booked the test should have discussed this with you, but if you are unsure please ask the ward doctor or nurse.
Clopidogrel, Prasugrel or Ticagrelor may be generally continued but, in some cases, these medications need to be stopped for 7 days before the test. The person booking the test should have discussed this with you, but if you are unsure please ask the ward doctor or nurse.
Diabetes
If you have diabetes controlled on insulin or tablets, please make sure that the doctors and nurses looking after you on the ward are fully aware so that your treatment can be adjusted. Please feel free to tell them if you have any concerns about your diabetes.
Blood glucose monitoring
The nurses in the endoscopy department will check your glucose level when you arrive for the procedure, unless it was checked just before you were sent to the endoscopy department.
Please report to the nursing staff if you have needed glucose before arriving for your appointment and tell them immediately if you feel your blood sugar becomes low (‘hypo’) at any time during your visit.
Throat spray and conscious sedation?
Anaesthetic throat spray and conscious sedation are available to improve your comfort during the procedure. Many people choose to undergo the procedure with throat spray alone.
Anaesthetic throat spray
This is a local anaesthetic spray which numbs the back of the throat. It has an effect very much like a dental injection.
The throat spray wears off within an hour, but you must not eat or drink until the sensation in your throat is back to normal.
Intravenous conscious sedation
The sedation is administered into a vein in your hand or arm just before the start of the procedure. This will not make you go to sleep but should help you to feel more relaxed. It is important that you are awake for the procedure so that you are able to follow simple instructions. Please see further information overleaf.
Sedation is not always possible when a patient is very frail, has a very low blood pressure, heart or breathing problems.
If you are going home after the procedure, please note that if you have sedation into the vein, you will need someone to accompany you and stay for at least 4 hours and if possible overnight. You are not allowed to take part in the following activities for 24 hours afterwards:
- drive a vehicle
- go to work
- look after children on your own
- operate heavy/dangerous machinery (including a cooker)
- drink alcohol
- sign legally binding documents
How long will I be in the Endoscopy department?
Overall you may be in the department for about an hour.
What happens when I arrive in the department?
When you arrive, one of the nurses will check your details and relevant medical history before you are taken into the procedure room.
It is our aim for you to be seen as soon as possible after your arrival. However, if the department is very busy your gastroscopy may be delayed.
The nurse will make sure that you understand the procedure and discuss any further concerns or questions you may have. The nurse will confirm that you have given consent and that you are happy to go ahead.
What will happen during the procedure?
The nurse will take you through to the procedure room where you will be able to ask any final questions. If you have any dentures you will be asked to remove them. Any remaining teeth will be protected by a small plastic mouth guard which will be inserted into your mouth, just before the examination commences.
A local anaesthetic will be sprayed on to the back of your throat. It works quickly and will make your tongue and throat feel numb.
You will be asked to lie on your left side and a probe will be placed on your finger to monitor your oxygen levels. You will receive oxygen through the nose and if you are having sedation it will be given into the cannula in your vein.
Any saliva or other secretions produced during the procedure will be removed using a small suction tube, rather like the one used at the dentist.
The endoscopist will pass the gastroscope into your mouth, down your oesophagus, into your stomach and then into your duodenum. Your wind pipe is deliberately avoided so you will be able to breathe normally throughout.
What will happen after the procedure?
You will be taken to the recovery area where you will be able to rest. Your heart rate, oxygen levels and blood pressure will be monitored and when the recovery nurse feels you are ready, you will be returned to your ward.
Before you leave the department, the nurse or doctor will explain the findings and if any medication or further tests are needed.
For safety, following the throat spray, you must not have anything to eat or drink for at least an hour after the procedure, until the sensation in your mouth and throat has returned to normal.
It is strongly advised that your first drink after the procedure is cold and that you sip it to ensure you do not choke. You will be given more information about this after the procedure.
You may have a sore throat from the insertion of the tube which can last up to 48 hours. This will wear off but simple lozenges may help. You may also feel bloated if some of the air has remained in your stomach. To help this, sit upright and if possible walk around.
Pain relieving tablets, such as paracetamol, may be taken according to the manufacturers instructions.
If you have not had sedation and are discharged from hospital after the procedure, you may return to work as soon as you feel fit and able. If you have been given sedation you are advised not to return to work for 24 hours afterwards.
What must I remember?
- It is our aim for you to be seen as soon as possible after your arrival. However, the department is very busy and your appointment may be delayed.
- If you have any problems, after the procedure, with a persistent sore throat, worsening chest or abdominal (tummy) pain, please tell the ward doctor or nurse.
- The hospital cannot accept any responsibility for the loss or damage to personal property during your time in the department.
If you go home shortly after the test and have any concerns or are worried about any symptoms you have after the test, you may telephone the contact numbers on page 2 of this booklet or, out of hours, ring 111 for advice.