Endoscopy Unit – Having a Gastroscopy

Your doctor has recommended that you have a gastrointestinal endoscopy, this is sometimes called a Gastroscopy or Endoscopy.

This leaflet will explain the procedure and what to expect on the day of your test. If you have further questions, please telephone the department or discuss them with a member of staff on the day of your procedure.

A gastroscopy is a test to examine the upper part of your digestive system. This is your oesophagus (gullet), stomach and duodenum (small intestine). A flexible tube with a camera on the end is used for this procedure. Pictures from this camera are seen on a television screen by the endoscopist. The test takes between 5 and 20 minutes (depending if treatment is required). You can expect to be in the Endoscopy Unit about 1½ to 4 hours, depending on whether you have throat spray or sedation.

Why am I having a Gastroscopy?

Your doctor has referred you for a gastroscopy to investigate the symptoms you have been having such as indigestion, heartburn, stomach pain, difficulty swallowing, or to exclude other abnormalities.

During your gastroscopy, the endoscopist (doctor or nurse practitioner) may take a small piece of tissue (biopsy) to aid diagnosis. Taking biopsies is painless and is achieved by passing a special piece of equipment down the inside of the camera, you will not feel this. Biopsies have to be sent away to the laboratory so the results will not be available straightaway. You will be able to discuss the results of your biopsies with the doctor who referred you.

What are the benefits to having a Gastroscopy?

A gastroscopy provides detailed information of the appearances of the lining of the digestive system. The information gained during your test may reveal a cause for your symptoms and will assist your doctor in your further treatment. If you prefer not to be investigated, we advise you to discuss the implications with your doctor.

What are the alternatives to having a Gastroscopy?

Other methods of examining the stomach such as a barium meal or CT scan. These methods; however, do not allow biopsies and photographs to be taken and provide less information about the lining of your digestive tract.

What are the risks of having a Gastroscopy?

The risks associated with your test are detailed on your consent form and below. Please read this. If you have any questions, speak to the nurse or endoscopist on the day, or alternatively, ring the Endoscopy Unit. Complications are rare but it is important that you are aware of them before the test begins. As with any medical procedure, the risk must be compared to the benefit of having the procedure carried out.

• Having a gastroscopy carries a small risk of bleeding or making a hole in the digestive system (perforation). The risk of this happening is less than 1 in 1000. Although this is a serious complication for which surgery may be necessary, it is rare.
• Using sedation can affect your breathing. To reduce this risk, we monitor your pulse and oxygen level. The endoscopist may recommend that you don’t have sedation if you are at a high risk of breathing difficulties during the test. This often applies to patients with heart disease and breathing problems such as Asthma and Chronic Obstructive Pulmonary Disease (COPD).
• Despite sedation, some patients can experience abdominal discomfort or bloating during the procedure. If this persists at home or you have signs of bleeding such as black tarry stools, you should contact your nearest Emergency department for further advice and also inform us.
• Other rare complications include damage to loose teeth, crowns or to dental bridgework.

What preparation will I need?

Gastroscopy must be performed on an empty stomach, your appointment letter will tell you when you will need to stop eating and drinking.

Do I keep taking my tablets?

You must keep taking any essential tablets unless your doctor tells you specifically not to. Please take you tablets early morning with a sip of water. If you have an afternoon gastroscopy appointment, please make sure you take your medication four hours before your appointment or leave it until after your test.

• Please telephone the Endoscopy Unit if you are diabetic, have sleep apnoea or are taking tablets that prevent blood clots. Examples of blood thinning tablets or injections are Warfarin, Dabigatran, Apixaban, Rivaroxaban, Edoxaban, Aspirin, Clopidogrel (Plavix), Dipyridamole (Persantin), Prasugrel (Efient), Tigralor (Brilligue), Acenocoumarol (Sinthrome), Tinzaparin or Heparin injection.

What should I bring on the day?

Please bring a list of medication that you take and also any medication that you may require, whilst in the department such as GTN spray, inhalers and insulin. Please don’t bring valuables to the department or wear lots of jewellery. Please can you also ensure that you remove nail varnish as this interferes with the signal we receive from our monitors about your oxygen levels.

Choosing how to have the test.

What’s the difference between throat spray and sedation?

You will need to decide if you want to have throat spray or sedation for your gastroscopy. The test is the same whichever way you have it done and will usually take 5 to 20 minutes.

Many patients are concerned at the thought of swallowing the tube but we would reassure you that the test is not painful. You will be able to breathe normally and you will not choke. This is because the camera is in your food pipe and this is separate to your breathing pipe. During the test, we have to inflate your stomach with air, some patients find this unpleasant.

You also must have someone at home to care for you for 24 hours and must rest indoors. This means no work, no driving, no alcohol and you shouldn’t operate machinery. Sedation will not be given if the above are not arranged, before the start of the test.

There are known adverse effects from the intravenous drugs administered during the procedure. These range from mild and common (for example, headache, nausea, dizziness) to rare and serious (for example, depression of respiratory and nervous system, which may result in aspiration pneumonia, anaphylaxis and coma. Although these serious complications are rare, they are more common in patients with deeper sedation and / or general anaesthesia.

Please note: although the choice of sedation / throat spray is yours to make, the endoscopist / admission nurse may advise you on the option that may be more appropriate considering your medical history (see risks associated with sedation).

What will happen on the day of the test?

When you arrive at reception in the Endoscopy Unit, your personal details will be checked. The assessment nurse will collect you and take your medical history, discuss and explain the test, and take your blood pressure and pulse. You will be able to ask any questions and discuss any worries or questions that you have about the test.

You will be asked for your consent form (supplied with this leaflet). This will be attached to your notes and taken to the procedure room. Please make sure that you have read the consent form through before you come for your test as when you sign this form you are agreeing that this is a test you want. Remember, you can change your mind about having this procedure at any time. The endoscopist will discuss the consent form with you.

Please note: every effort will be made to see you at your appointment time; however, due to hospital in-patient emergencies delays may occur. The endoscopy staff will keep you informed of any delays.

What happens in the procedure room?

You will be greeted by two nurses who will remain with you during the test. The nurses and the endoscopist will complete a checklist to ensure that all your information is correct. If you have chosen to have sedation, a cannula will be placed in your vein so that sedation can be administered and you will be given oxygen through a small plastic tube in your nose. If you are having throat spray, your throat will be numbed. You will then be asked to remove any dentures or glasses and lay on a trolley on your left-hand side.

All patients pulse and oxygen levels are monitored by a probe placed on your finger during the test. Before the test starts, a plastic mouthpiece is placed between your teeth to keep your mouth slightly open.

When the endoscopist gently passes the endoscope through your mouth, you may gag slightly. This is quite normal and will not interfere with your breathing. During the procedure, air is put into your stomach so that the endoscopist can have a clear view. This may make you burp a little, some people find this uncomfortable. When the procedure is finished, the camera is gently withdrawn and most of the air is taken out at this point to make you feel more comfortable. If you become uncomfortable or want the procedure to stop at any point, you can indicate this by raising your hand.

Please note: all hospitals in the Trust are teaching hospitals and it may be that a trainee endoscopist performs your procedure under the direct supervision of a consultant, registrar or nurse practitioner.

What happens after the test?

You will be transferred to the recovery room after the test. The length of your stay is dependant on if you have had sedation or throat spray.

If you had local anaesthetic spray for your test, you can leave the department after the recovery nurse has checked your blood pressure. You will have to wait one hour before you have anything to eat or drink as the throat spray can make swallowing difficult.

If you have had sedation, the recovery nurse will monitor you during your recovery from sedation. This can take 2 to 3 hours.

For 24 hours after the test, you must have someone with you and must NOT:

• drive a vehicle;
• drink alcohol;
• operate machinery (applies to sedated patients only);
• go to work; and
• sign legal documents.

The recovery nurse will prepare you for discharge home and give you after-care instructions. If you have had sedation, your relative or carer will need to be present at this time as the sedation can cause some amnesia. You may experience a sore throat and feel bloated due to the air left in your stomach. Both sensations are normal and should clear up quickly by themselves.

When will I get my results?

A full report will be sent to your referring doctor and your GP. The endoscopist or nursing staff will usually have the opportunity to speak to you after your test regarding the results. An appointment to see the doctor who referred you for the test will be sent to you in the post or given to you in the department. Any enquires regarding your outpatient
appointment should be directed to your consultants secretary. If you feel that you are waiting a long time for an appointment to discuss your results, your GP will also have a report so you can see them too.

This leaflet has been designed as a general guide to your test. If after reading this, you have any questions that you feel have not been answered, please contact the Endoscopy department on the numbers below.