Gastroscopy

Introduction

This booklet has been written to enable you to make an informed decision in relation to agreeing to the investigation. At the end of this pack is the consent form.

The consent form is a legal document therefore please read it carefully. Once you have read and understood all the information, including the possibility of complications, and you agree to undergo the investigation, please SIGN and DATE the consent form. You will notice that the consent form is duplicated, allowing you to keep a copy for your records. Please fill it in while it is still attached to this booklet and BRING THE BOOKLET WITH YOU to your appointment.

If there is anything you do not understand or wish to discuss further, do not sign the form but bring it with you and sign it after you have spoken to a health care professional.

The procedure you will be having is called a gastroscopy (OGD). This is an examination of the oesophagus (gullet), stomach and duodenum. It will be performed by or under the supervision of a specialist doctor or a nurse endoscopist and we will make the investigation as comfortable as possible for you. This booklet will enable you to make an informed decision in relation to agreeing to the investigation and whether you wish sedation to be used.

Why do I need to have a Gastroscopy?

You have been referred for Gastroscopy for one of the following reasons.

To find a cause for your symptoms, help with treatment, and if necessary, to decide on further investigation.

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To follow up previous disease To assess the clinical importance of an abnormality seen on an x-ray or

scan To take samples of the lining of the upper gastrointestinal tract

What is a Gastroscopy?

This test is a very accurate way of looking at the lining of your oesophagus (gullet), stomach and the first part of your small bowel called the duodenum. A thin flexible tube called a gastroscope is passed through your mouth and guided around the upper part of the gastro intestinal tract. It has a diameter less than that of a little finger.

At the end of the gastroscope is a small camera with a light attached which allows the specialist to see the inside of your gastro-intestinal tract on a TV screen. During the investigation the endoscopist may need to take some tissue samples from the lining of your gastro intestinal tract for analysis in the pathology laboratory. These samples will be retained. A photograph may also be taken for your medical records.Some patients have sedation injected into a vein for this procedure, although others prefer to remain awake and have local anaesthetic throat spray.

What are the benefits of having a gastroscopy?

If there is any abnormality in the upper gastro-intestinal tract, then it should be possible to see it during the procedure, which is relatively quick (about 5 minutes). It allows the doctor to take samples (biopsies) of tissue so that they can be examined under a microscope. The lining of the tract is insensitive to pain so you should not feel anything when the samples are removed.

Is there an alternative to having a gastroscopy?Alternative procedures include a barium meal or barium follow-through which are both less invasive tests that use x-ray equipment and computers to obtain an interior view of the upper gastro-ntestinal tract. However, they are strictly diagnostic procedures that still require the patient to have nothing to eat or drink before the test but do not allow tissue to be sampled. Although barium studies are less accurate than gastroscopy (they can give false negatives), for some patients they may be more appropriate.

Preparation for the investigation

Eating and drinking

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It is necessary to have clear views and for this the stomach must be empty. Therefore do NOT have anything to eat for at least 6 hours before the test. Small amounts of water are safe up to two hours before the test.If your appointment is in the morning, have nothing to eat after midnight but you may have a drink of water at 6am. If your appointment is in the afternoon you may have a light breakfast no later than 8 am and small amounts of water until 2 hours before your appointment.

What about my medication? Routine MedicationYour routine medication should be taken UNLESS otherwise stated below.It is advised that you continue to take any medications for the heart or blood pressure; you may take them with a sip of water on the day of your examination.

Digestive MedicationIf you are attending for your FIRST appointment and are currently taking any of the medication listed below to reduce the acid in your stomach, STOP taking them up to 2 weeks before your investigation if appointment date permits:Omeprazole (Losec) Lansoprazole (Zoton)Rabeprazole (Pariet) Pantoprazole (Protium)Esomeprazole (Nexium) Cimetidine (Tagamet)Ranitidine (Zantac) PepcidFamotidine Nizatidine (Axid)Gavilast

You may use as a substitute any simple antacid preparations such as Gaviscon, Asilone, Algicon, Milk of Magnesia, Rennies, etc. If you have been given an appointment at short notice you will not have been able to stop the medication for two weeks. This is not a problem.

If you are having a FOLLOW UP gastroscopy, then please CONTINUE your acid reducing medications right up to the day before your repeat endoscopy. If you have any queries about this, please discuss this with your doctor or telephone the unit.

Antiplatelets/Anti-coagulants Aspirin – continue taking;

Clopidogrel – stop 7 days before procedure. However, please consult your doctor if on dual antiplatelet for coronary stent.

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Warfarin – continue with your normal dose but check your INR during the week before your procedure. If your INR is within range, continue as normal, however if out of range then discuss with your GP. If abnormalities are seen during endoscopy, requiring therapeutic intervention, a repeat procedure OFF warfarin may be necessary;Rivaroxaban (Xarelto®) and Apixaban (Eliquis®) stop 24 hours before procedure and then restart 48 hours after the procedure.

AllergiesYou will be asked on admission for details of any allergies. We offer a latex free environment.

DiabetesIf you are diabetic there is specific guidance at the back of this booklet about how to manage your medication and blood sugars over this time.

How long will I be in the endoscopy department?This largely depends on if you have the sedation and how busy the department is. You should expect to be in the department for up to 3 hours from appointment time. You might like to bring something to read. The department also looks after emergencies and these can take priority over our outpatient lists.

What happens when I arrive?Your appointment time is the time you are expected to report to Endoscopy reception. You will be admitted by a nurse who will ask you a few questions, one of which concerns your arrangements for getting home and the contact numbers for the family member or friend who you have arranged to take you home if you are having sedation. The nurse will ensure that you understand the procedure and will discuss any outstanding concerns or questions you may have. You will also be able to ask further questions about the investigation.

You will be offered the choice of sedation or local anaesthetic throat spray (this is dealt with in more detail in the next section).

If you have sedation, an intravenous cannula (a small plastic tube) will be inserted into a vein in the back of your hand through which sedation will be administered later.

Your blood pressure, heart rate and oxygen levels will be recorded. If you are diabetic, your blood glucose level will also be monitored.

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If you have not already done so, and you are happy to proceed, you will be asked to sign your consent form at this point.

You do not need to get changed but please wear loose clothing.

Please keep in mind that several endoscopy lists run in parallel and you will be called for your endoscopy procedure at different times to other patients admitted at the same time or after you.

Whilst we try to ensure that you are seen quickly and efficiently, you may find that there will be a wait in the waiting area before you are admitted by the nurses. This should not affect your overall time in the department. You should plan to be in the department for the whole morning or afternoon depending on your appointment. If you are being collected, please ask your lift to be on standby as some appointments are shorter than others.

Sedation, throat spray or both?Intravenous sedation or topical local anaesthetic throat spray can improve your comfort during the procedure so that the endoscopist can perform the procedure successfully.

Intravenous sedationThe sedation will be administered into a vein in your hand or arm which will make you relaxed but not unconscious. You will be in a state called co-operative sedation; this means that you will still hear what is said to you and will therefore be able to follow simple instructions during the investigation. Sedation also makes it unlikely that you will remember much about the procedure. You will be able to breathe quite normally throughout.Whilst you are sedated, we will check your breathing, heart rate and blood pressure so that changes will be noted and dealt with accordingly. Please note that if you decide to have sedation you are not permitted to drive, take alcohol, operate heavy machinery or sign any legally binding documents for 24 hours following the procedure AND you will need someone to accompany you home and stay with you for 12 hours.

Anaesthetic throat sprayWith this method, sedation is not used but the throat is numbed with a local anaesthetic spray.

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As the gastroscopes have become thinner, many patients are happy for the procedure to be carried out without sedation and to have throat spray instead. The throat spray has an effect very much like a dental injection.

The benefit of choosing throat spray is that you are fully conscious and aware and can go home unaccompanied almost immediately after the procedure. You are permitted to drive and carry on as normal. The only constraint is that you must not have anything to eat or drink for about 30 minutes after the procedure, until the sensation in your mouth and throat has returned to normal.

Intravenous sedation and Anaesthetic throat sprayWe can use a combination of both sedation and throat spray. You will be able to breathe quite normally throughout but the throat is numbed with a local anaesthetic spray.

Whilst you are sedated we will check your breathing, heart rate and blood pressure so that changes will be noted and dealt with accordingly.

Please note that if you decide to have sedation you are not permitted to drive, take alcohol, operate heavy machinery or sign any legally binding documents for 24 hours following the procedure AND you will need someone to accompany you home and stay with you for 12 hours.

The InvestigationIn turn you will be escorted into the procedure room where the endoscopist and the nurses will introduce themselves and you will have the opportunity to ask any final questions. If you have any dentures you will be asked to remove them at this point, any remaining teeth will be protected by a small plastic mouth guard which will be inserted immediately before the examination commences.

Throat spray will be sprayed onto the back of your throat whilst you are sitting up and swallowing; the effect is rapid and you will notice loss of sensation to your tongue and throat. Your throat may feel as though it is swelling, this is normal. Please be assured that you can still swallow and breath normally.

The nurse looking after you will ask you to lie on your left side and will then place the oxygen monitoring probe on your finger. If you have decided to have sedation, the drug will be administered into a cannula (tube) in your vein and it will quickly take effect.

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Any saliva or other secretions produced during the investigation will be removed using a small suction tube, again rather like the one used at the dentist.

The endoscopist will introduce the gastroscope into your mouth, down your oesophagus into your stomach and then into your duodenum. Your windpipe is deliberately avoided and your breathing will be unhindered.

During the examination, air is gently passed into your stomach to allow the specialist to see the lining clearly. This may give you a bloating or cramping feeling. You may feel slight pressure in your stomach during the procedure, this is normal.

During the procedure samples (biopsies) may be taken from the lining of your digestive tract for analysis in the laboratory. Any photographs will be recorded in your medical notes.

Risks of the procedureUpper gastrointestinal endoscopy is classified as an invasive investigation and because of that it has the possibility of associated complications. Although these occur extremely infrequently; we would wish to draw your attention to them so that with this information you can make your decision.

The doctor who requested the test will have considered this. The risks must be compared to the benefit of having the procedure. The risks can be associated with the procedure itself and with administration of the sedation.

The potential complications of gastroscopy include the following: Mechanical damage to teeth or bridgework; Perforation or tear of the lining of the stomach or oesophagus (risk approximately

1 in 2000 cases) bleeding which could entail you being admitted to hospital. Certain cases may be treated with antibiotics and intravenous fluids. Perforation may require surgery to repair the hole.

Bleeding may occur at the site of biopsy but nearly always stops on its own. Breathing or heart problems. You may have a reaction to the sedative that may

make you have temporary breathing or heart problems. Serious problems are rare as you are carefully monitored during the investigation.

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After the procedure

You will be escorted to the recovery area where you will wait for your paperwork to be completed. If you have had sedation, you will be allowed to rest for as long as is necessary. Your blood pressure and heart rate will be recorded and if you are diabetic, your blood glucose will be monitored. Should you have underlying difficulties or if your oxygen levels were low during the procedure, we will continue to monitor your breathing and can administer additional oxygen. Once you have recovered from the initial effects of any sedation (which normally takes 30 minutes) you will be offered a drink and biscuits.

Before you leave the department, the nurse or doctor will explain the findings and any medication or further investigations required.

They will also inform you if you require further appointments.

Since sedation can make you forgetful, it is a good idea to have a family member or a friend with you when you are given this information although there will be a short written report given to you.

If you have had sedation, you may feel fully alert following the investigation, however the drug remains in your blood system for about 24 hours and you can intermittently feel drowsy with lapses of memory. If you live alone, you must arrange for someone to stay with you for at least 12 hours.

The nursing staff will telephone the person collecting you when you are ready for discharge.

After care

After diagnostic gastroscopy there are few side effects. You may feel bloated and a little sore but this is normal

Food and Drink

Alcohol in combination with any sedation you may have received is more likely to make you much more drowsy than usual. If your throat was sprayed with local anaesthetic, you should not eat or drink until normal sensation returns, usually within 30 minutes of

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the procedure. A mildly sore throat is no cause for concern and should resolve itself within 24 hours. Normal food can be taken 30 minutes after the examination, though you may prefer light meals on the day of the examination.

PainAbdominal pain is uncommon after gastroscopy. Some patients have discomfort due to wind in the stomach during the procedure but this subsides rapidly. Peppermint tea may help. If you are troubled by more than this please contact A&E or the Endoscopy Unit.

ActivitiesIf you have been given sedation during the procedure, it will make you less alert than usual and you should therefore not drive, drink alcohol, operate machinery or make any important decisions for 24 hours. You may resume normal activities the day after examination.

MedicationsYou may resume normal medications immediately after the gastroscopy.Please ask if you are not sure if a medication is safe.

Things to report to your Doctor• Severe pain or vomiting• Temperature greater than 38 degrees• Redness, tenderness and swelling at the site of the intravenous injection that persists.

If you have any worries please do not hesitate to contact the Endoscopy Unit on 01737 768511 extension 8213 between 9-5 Monday to Friday.

After these hours you should call 01737 768511and ask for Charlwood ward ext 6346 before your procedure, after your procedure 01737 768511 asking for the Surgical Assessment Unit ext 6345 OR go to your local Emergency Department.

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General points to remember

If you are unable to keep your appointment please notify the endoscopy booking office as soon as possible.

You are welcome to bring one family member or friend with you to wait with you in reception until you are called through for admission. Only patients are permitted at this point

It is our aim for you to be seen and investigated as soon as possible after your appointment time. However, the department is very busy and your investigation may be delayed. If emergencies occur, these patients will obviously be given priority over less urgent cases.

The hospital cannot accept any responsibility for the loss or damage to personal property during your time on our premises.

If you are having sedation, please arrange for someone to collect you. If you have any problems with a persistent sore throat, worsening chest or abdominal pain,

please contact the hospital on the numbers above. If you are unable to contact or speak to a doctor, you must go immediately to the Hospital’s

Emergency Department.

The Endoscopy Unit is open between 8.30 and 18.30 Monday to Friday.

Advice for patients with DIABETES having a GASTROSCOPY

The information below is to help you manage your diabetes before, during and after your procedure. This is important because your food intake will be altered. The doses of your diabetes medicines will be lower because you will be eating less.

In general you will need to check your blood sugar more often than normal. If your blood sugar falls below 4 or you feel unwell, please take a sugary drink (Lucozade is ideal).

While you are at the Endoscopy Unit, please report to the nursing staff if you have needed glucose before arriving. Inform them immediately if you feel hypo at any time during your visit.

If you are unsure then please contact us, your diabetes nurse or your GP.

If you need further advise about care of your diabetes for the procedure, please contact the Diabetes Nurse Specialists on 01737 231788.

The advice you need differs according to the type of medicine you are taking. If you use more than one type of medicine, you may need to refer to more than one section of this leaflet.

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Insulin Pumps

On the Day Before the Procedure Continual basal rate unchanged but reduce evening meal bolus by half.

On the day of the Procedure Please follow starving instructions as advised in the procedure leaflet Continue your usual basal rate After the procedure you will have a delayed breakfast and can take a bolus using your usual

ratio a time.

Once daily Insulin Regimens

Example insulin’s:Insulin Glargine (Lantus), Insulin Detemir (Levermir), Insulatard, Humulin I

On the day before the procedure Continue your insulin unchanged

On the day of the Procedure Please follow starving instructions as advised in the procedure leaflet. Bring your insulin with

you to the Endoscopy Unit If long-action insulin is given in the evening:

- Take the night before the procedure- You will be given a delayed breakfast after the procedure- Food and insulin are taken normally later in the day

If Long-acting insulin is given in the morning:- No insulin is taken before the procedure- After the procedure is complete you will be asked to take your insulin with a delayed

breakfast

Tablet Medicines

If you are taking one or more of:

Metformin (Glucophage, Glucophage SR) Sitagliptin (Januvia, Janumet) Vildagliptin (Galvus, Eucreas) Saxagliptin (Onglyza) Linagliptin (Trajenta) Acarbos(Glucobay) Pioglitazaone (Actos, Competact)

- Take your medicine as usual on the day before the procedure

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- Please follow starving instructions as advised in the procedure leaflet. Bring your medicine with you to the Endoscopy Unit

- Do not take your tablets on the morning of the procedure- After the procedure you will have a delayed breakfast and can take your usual morning

doses at that time- Food and table are taken normally later that day.

If you are taking any of: Gliclazide (Diamicron, Diamicron MR) Glimepiride (Amaryl) Glipizide (Minodiab) Glibenclamide Tolbutamide

- Reduce your doses by half on the day before the procedure- Otherwise please follow the instructions for tablet medicines above

Contact usTeam nameSurrey and Sussex Healthcare NHS TrustEast Surrey HospitalRedhill Surrey RH1 5RHTel: 01737 768511 x8213www.surreyandsussex.nhs.uk

For medical advice please call NHS 111 or visit the NHS Choices website at www.nhs.uk

Tell us about your experienceWe welcome your feedback and comments about our staff and services. This will help share what we do well, learn and make improvements. To share your compliments, comments, concerns or complaints please speak to the Patient Advice and Liaison Service (PALS) in the first instance.

Patient Advice and Liaison Service (PALS)PALS can provide confidential advice and support, and can negotiate prompt solutions by liaising with staff and, where appropriate, relevant organisations on your behalf. You can also ask a member of staff to contact PALS on your behalf.

Telephone: 01737 231 958Email: sash.pals@nhs.net Write to: PALS, East Surrey Hospital, Redhill, Surrey RH1 5RH

Document information

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Author: RG/CALast updated: 06/18Gastroscopy

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