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 onto a television screen. Samples of tissue (biopsies) may 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 lab. 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 (injected into a vein), while others prefer to have local anaesthetic throat spray.
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.
Gastroscopy can also be done:
- As a follow up check for certain conditions affecting the stomach or oesophagus
- If a scan or x-ray has shown there may be something wrong in the upper part of the gut, to allow a closer look at the area.
What are the risks of the procedure?
Complications are rare. These may be linked to the procedure itself or the sedation medicine.
Damage to teeth or bridgework may occur. To reduce this risk your teeth will be protected with a mouth guard.
Perforation or tear of the lining of the stomach or oesophagus (about 1 for every 2000 cases). If this happens you may need an operation.
Bleeding may happen when a biopsy is taken. It usually stops on its own but may need cauterization or injection treatment. In some cases a blood transfusion may be needed.
There is a small chance that a cancer may not be seen.
Sedation can sometimes cause problems with breathing, heart rate and blood pressure. If any of these problems do occur, they are usually short lived. 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 an 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. Current evidence suggest this may happen in around 1 in every 10,000 examinations.
What are the alternatives?
A barium meal x-ray is an alternative test but this involves some radiation exposure. It does not give the same information as a gastroscopy and biopsies cannot be taken.
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. Small amounts of water are allowed up to 2 hours before your appointment time. 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.
If you are having a colonoscopy procedure at the same appointment as your gastroscopy please follow the bowel preparation instructions given in the colonoscopy booklet. You may drink water up to 2 hours before your appointment time.
What if I take regular medication?
Your routine medication should be taken as usual with a small amount of water.
Acid reducing medication (PPIs or Ranitidine)
It is sometimes useful if you stop taking tablets that reduce the acid in your stomach for the 2 weeks before the gastroscopy.
If your symptoms make this difficult or if you are having a follow-up gastroscopy to check the healing of an ulcer or Barrett’s Oesophagus, then please continue your acid reducing medication right up to the procedure.
Blood thinning medication (anticoagulants)
Sometimes these medications need to be stopped and if this is the case the person who referred you for the test should have given you clear instructions. If you are unsure please contact your consultant’s secretary. For your safety, if the correct instructions are not followed, it may not be possible to do the gastroscopy and you may have to return on another day.
Warfarin: unless you have been advised to stop this medication, continue taking it and have your INR checked within the week before the test. The procedure may be cancelled if your INR has not been checked within the last 7 days. It should be within your target range. If you have been advised to stop your Warfarin you should do so for 5 full days before the procedure and have your INR checked the day before the procedure. It needs to be less than 1.5 for the procedure to go ahead. Please bring your yellow book to the appointment.
Dabigatran, Rivaroxaban, Apixaban, Edoxoban: please do not take on the morning of the procedure. If you have been advised to stop taking this medication you should do so for 2 full days before the procedure.
Clopidogrel (Plavix), Prasugrel, Ticagrelor: these medications can generally be continued but if you have been advised to stop you should do so for 5 full days before the procedure.
Diabetes
If you have diabetes controlled on insulin or tablets, please make sure the relevant endoscopy appointments’ team is aware so that the appointment can be made towards the beginning of the list. You will find also find advice further down this page.
How long will I be in the Endoscopy department?
Overall you may expect to be in the department for 1 to 3 hours. The department deals with emergency patients too and they will take priority if needed.
What happens when I arrive?
When you arrive for your appointment please book in at reception.
It is our aim for you to be seen as soon as possible after your arrival. However, if the department is very busy your appointment may be delayed. The department looks after emergency patients who will be seen first if needed.
A nurse will take you through to the admission room and ask you about your general health to check if you are fit to have the procedure. You will also be asked about your plans for getting home afterwards.
The nurse will make sure you understand the procedure and discuss any further concerns or questions you may have. If you have not already done so and you are happy to go ahead, you will be asked to sign your consent form.
Your blood pressure and heart rate will be checked and if you are having sedation a cannula (small plastic tube) will be inserted into a vein (sometimes this is done in the procedure room).
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 or tongue piercings you will be asked to remove them. Any remaining teeth will be protected by a small plastic mouth guard which will be inserted just before the examination commences.
If you are having local anaesthetic throat spray this will be sprayed onto 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, 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 small bowel. 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 a recovery area where your heart rate, oxygen levels and blood pressure will be monitored. Before you leave the department, the nurse or doctor will explain the findings and if any medication or further tests are required.
If you have had throat spray you must not have anything to eat or drink for about 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 detailed advice about this after the procedure.
Throat spray or conscious sedation?
Anaesthetic throat spray and/or 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.
If you choose to have only throat spray you can go home on your own almost immediately after the procedure. You are allowed to drive and may carry on as normal, but must not eat or drink for about an hour afterwards 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 note if you have sedation into the vein, you will need someone to accompany you home 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
- Drink alcohol
- Sign legally binding documents
Guidance for people with diabetes
Treatment by diet alone
If you control your diabetes with diet alone, you simply need to follow the instructions given earlier in this booklet to prepare for your gastroscopy.
Treatment with tablets and/or insulin
You should inform the endoscopy appointments team about your diabetes and ask for a morning appointment.
Adjusting your diabetes medication to prevent hypoglycaemia
You may need to adjust your diabetes medication on the day of the procedure to reduce the risk of hypoglycaemia (‘hypo’ or low blood sugar level). As a result your blood sugar may be a little higher than usual but this is only temporary to maintain your blood sugars during the procedure and you should be back to your usual level within 24 to 48 hours. If needed please contact the Specialist Diabetes Nursing Team on 01522 573074 well in advance of the appointment for advice.
Carrying glucose to treat hypoglycaemia
On the day of the procedure carry glucose tablets in case of hypoglycaemia. These are absorbed quickly through the tissues of the mouth and if sucked they will not interfere with the procedure. If you have symptoms of low blood sugar suck 4 to 6 tablets initially, followed by a further 4 to 6 if your blood sugar is still low after 10 minutes.
Blood glucose monitoring
If you usually test your blood sugar level, check it as usual on the morning of the procedure and bring your equipment with you to the appointment. If you do not usually test your blood, do not worry, your blood sugar will be checked when you arrive for the procedure.
Please report to the nursing staff if you have needed glucose before arriving for your appointment and tell them immediately if you feel ‘hypo’ at any time during your visit
Instructions for your appointment
Morning appointment
If you take tablets for your diabetes (no insulin):
- You should have nothing to eat for at least 6 hours before the procedure but may have small drinks of water up to 2 hours before the procedure. If you feel ‘hypo’ suck glucose tablets (do not chew)
- You may need to adjust your diabetes medication. If unsure please contact the specialist diabetes nursing team for advice on 01522 573074.
If you are on insulin:
- You should have nothing to eat for 6 hours before the procedure but you may have small drinks of water up to 2 hours before the procedure. If you feel ‘hypo’ suck glucose tablets (do not chew)
- You will need to adjust your morning insulin dose. If you are unsure please contact the diabetes nursing team for advice on 01522 573074.
Afternoon appointment
If you take tablets for diabetes (no insulin)
- You should have nothing to eat for at least 6 hours before the procedure but you may have small drinks of water up to 2 hours before the procedure. If you feel ‘hypo’ suck glucose tablets (do not chew)
- You may need to adjust your diabetes medication. If you are unsure please contact the specialist diabetes nursing team for advice on 01522 573074.
If you are on insulin
- You should have nothing to eat for 6 hours before the procedure but you may have small drinks of water until 2 hours before the procedure. If you feel hypoglycaemic suck glucose tablets (do not chew)
- You may need to reduce your usual insulin dose. If you are unsure please contact the specialist diabetes nursing team for advice on 01522 573074.
What must I remember?
- If you are unable to keep your appointment please notify the endoscopy department as soon as possible
- Follow the instructions about food and drink given on page 6 or your procedure may be postponed
- 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 emergencies occur, these patients will be seen before less urgent cases
- If you have sedation please arrange for someone to collect you and someone to stay overnight if possible
- The hospital cannot accept any responsibility for the damage to personal property during your time on the premises.
If you have any questions or concerns, or are worried about any symptoms you experience after the test, you may ring the enquiry numbers on the front cover of this booklet. Out of hours please contact the NHS non-emergency service on 111.