Having an upper GI endoscopy (gastroscopy) · What is an upper GI endoscopy (gastroscopy)? An upper...

Having an upper GI endoscopy (gastroscopy)A guide to the test

Information for patientsEndoscopy

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Welcome to the Endoscopy Unit

Sheffield Teaching Hospitals NHS Foundation Trust has two Endoscopy Departments.

One is at the Northern General Hospital and the other is at the Royal Hallamshire Hospital.

You may have your test at either hospital depending on current waiting lists. When you book your test you will be told which hospital you need to go to.

It may not be your own consultant who undertakes the procedure. It may be another doctor or a nurse endoscopist.

At the Northern General Hospital there are four Endoscopy rooms and at the Royal Hallamshire Hospital there are three Endoscopy rooms in use at any one time, performing different procedures; therefore other patients may be seen before you.

Please feel free to make a note of your appointment details:

If you are unable to keep your appointment, please tell the department you are attending as soon as possible. This will allow us to give your appointment to someone else and arrange another date and time for you.

Hospital:

Date:

Time:

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Introduction

You have been advised to have an upper gastrointestinal endoscopy to help find the cause of your symptoms. The test is sometimes called a 'gastroscopy' or simply an 'endoscopy'.

We have written this booklet to help answer some of the concerns you may have about the test. It may not answer all your questions; if you have any worries please don't hesitate to ask. The staff involved in doing your test will be available to answer any queries.

The Endoscopy Suite telephone number is:

Northern General Hospital: 0114 226 9174

Royal Hallamshire Hospital: 0114 271 2990

You may get an answer machine. If so, please leave a message and contact number and someone will get back to you.

The aims of this booklet are:

• to explain what will happen on the day of your test.• to answer some of the questions you may have about the test.

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What is an upper GI endoscopy (gastroscopy)?

An upper gastrointestinal endoscopy (gastroscopy) is a test which allows the endoscopist to look directly at the lining of the oesophagus (gullet), the stomach and around the first bend of the small intestine - the duodenum.

The gastroscope is a long flexible tube (thinner than your little finger) with a bright light on the end.

Using the gastroscope we can see a picture of the lining of your stomach on a monitor.

Sometimes the endoscopist will take tissue samples (a biopsy). These biopsies are removed painlessly through the gastroscope using tiny forceps and are sent to the laboratory for analysis.

Oesophagus

Stomach

Duodenum

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Can there be complications or risks?

The majority of gastroscopies are very safe and uncomplicated. However, as with any procedure there is a small chance of side effects or complications.

• National studies have shown that serious complications such as drug reaction, bleeding and perforation (causing a hole) are very rare; less than 1 in 5000.

• You may suffer from a sore throat or feel some wind in your stomach. These will settle in a few days.

• There is a small risk of damage to crowned teeth or dental bridge work.

• You should also be aware that this examination is not perfect and even with a skilled endoscopist some abnormalities may be missed.

If you are worried about any of these, talk to one of the doctors or nurses about it during your visit.

Complications are more likely to occur as a result of the more complicated procedures that can be done during gastroscopy, for example if the oesophagus is narrow and needs to be stretched. If you are attending for this kind of treatment the endoscopist will explain the specific risks before you have the procedure.

Do I have to have an endoscopy or is there another type of procedure which can examine the inside of my body?

An alternative to a gastroscopy is a barium meal or a CT scan (computerised tomography). The disadvantages of these procedures are that specimens cannot be taken for examination. Gastroscopy is also the most accurate way of examining the oesophagus, stomach and duodenum.

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The consent form

Before a doctor or healthcare professional examines or treats you, they will need to gain your consent. This will be required in writing. If you later change your mind, you are entitled to withdraw consent even after signing. A copy of the consent form will be offered to you.

What should I know before deciding?

The endoscopist or health professional will ensure you know enough information about the procedure to enable you to decide about your treatment. They will write this information on the consent form as well as discussing choices of treatment with you. We encourage you to ask questions and inform us of any concerns that you may have. It may be helpful for you to write these down as a reminder.

What are the key things to remember?

The main thing to remember is that it is your decision. It's up to you to choose whether or not to consent to what is being proposed. Ask as many questions as you like and please express any concerns about medication, allergies or past medical history.

Can I find out more about giving consent?

There is more information about consent on the NHS Choices website:

• www.nhs.uk/Conditions/Consent-to-treatment

Training at the hospital

The Sheffield Teaching Hospitals Trust is a teaching organisation and has a responsibility to ensure that students (both medical and nursing) receive a high standard of training. The Endoscopy Unit is a regional Training Centre. Occasionally there may be students observing procedures in the department or the doctor may be a trainee under the

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supervision of an experienced endoscopist. In either case you will be told of any student involvement beforehand. Please remember you do not have to let students be part of your care so please tell us if you do not want them involved.

The Trust also employs Nurse Practitioners who after training undertake endoscopic examinations. In all these cases you will be informed beforehand and it is your right to refuse anything you are not comfortable with.

Preparation for the test

To allow a clear view, the stomach should be empty.

If your test is in the morning please have nothing to eat or drink from midnight of the day before.

If your test is in the afternoon please have nothing to eat or drink after 7.00am on the day of test.

If your test is in the evening please have nothing to eat or drink after 11.00am on the day of the test.

Medication

Please stop all stomach treatments for at least 2 weeks before your test except: Antacids, Gaviscon, Rennies, Maalox, Aludorox, Andrews and Settlers, which are permitted. However, if your test is for a repeat gastroscopy, please continue to take your stomach treatment.

If you are taking anti-blood clotting medicines such as Warfarin, Rivaroxaban, Apixaban, Dabigatran or Clopidogrel (Plavix) please contact the Endoscopy Suite as soon as possible as these may need to be stopped before your procedure.

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If you take essential medication, for example for epilepsy or a heart condition, you may take these with a little water. Please try to take them as early as possible before your test as some tablets leave a residue in the stomach, which may affect the quality of the results.

Do bring your other tablets or medicines with you so that you can take them after you have had your gastroscopy.

If you are diabetic, please refer to the 'Managing your diabetes' booklet which you received with your appointment letter.

The telephone number to call is:

Northern General Hospital: 0114 226 9174

Royal Hallamshire Hospital: 0114 271 2990

You may get an answer machine, if so please leave a message and contact number and someone will get back to you.

Before your appointment

Before you come to the Endoscopy Suite you should:

• ensure you have completed your pre-assessment questionnaire and returned it to the Endoscopy Suite.

• contact the Endoscopy Suite if you are suffering from a sore throat, cold or chest infection, as it may be necessary to postpone the test because of the risks from sedation.

• bring with you any letters or cards you have received from the hospital.

• bring any tablets you are currently taking. It is especially important to remember any asthma inhalers, angina sprays or diabetic medication.

• follow all instructions included with this booklet.• come on time for your appointment.

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• you should not bring valuables or large amounts of money into hospital. We cannot accept responsibility for them.

• do not drive yourself to or from hospital. Make sure someone is able to bring and collect you as you must have a responsible adult to accompany you home.

How long will I spend in hospital?

This will depend on your individual procedure and on whether or not you choose to be sedated for your test.

If you choose sedation, please allow for a stay of anything from 2 - 4 hours. If you choose not to be sedated, then your stay will be much shorter.

Please note that your appointment time is for your pre-procedure assessment and not the time of your examination. You may find your test is delayed. We do sometimes have to deal with unexpected emergency cases and this can prevent us seeing you as quickly as we would like. We apologise if such delays happen to you. If they do we will try to keep them to a minimum and make sure you know the reason for the delay. Please be patient.

Arriving at the Endoscopy Suite

On arrival at the hospital, please go to the reception desk in the Endoscopy Suite.

Once checked in, you will be asked to take a seat in the waiting room.

A nurse will call you in for pre-assessment. This involves checking your pulse and blood pressure, whether you have any allergies, and confirming your discharge arrangements. Please feel free to ask questions or voice any worries you may have regarding your test.

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The nurse will explain the options of sedation (injection) and local anaesthetic (throat spray). Both are available for you to have for your procedure. The endoscopist will discuss this with you.

Throat spray

This is a local anaesthetic spray to numb your throat.

It has a slightly bitter banana taste. You may have the feeling of a 'lump' in your throat or a gritty tongue, this is normal following throat spray and the sensation will wear off over about an hour.

• It is very safe• You recover quickly• You can hear and talk about the results of the test right away• There is no delay in going home• You can drive home• You will be more aware of discomfort

Sedation

This is a sedative injection which may make you sleepy. It is not like a general anaesthetic so you may still be aware of having the procedure. It does however sometimes have a short term 'amnesic effect' which means you may not remember having the procedure. You:

• will be less anxious• may be sleepy• may not remember the test at all• will need to be monitored carefully• will take longer to recover• will not be able to drive home• will have to have an adult with you to take you home

We advise you to refrain from taking any sleeping tablets on the day of your procedure if you have had sedation.

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If you choose to have the injection you must have a relative or friend to accompany you home and who can also stay with you for 24 hours.

After pre-assessment you will be called through for examination and the endoscopist will discuss the procedure with you. Again, if you have any questions or are unsure, please ask.

It is necessary to remove any false teeth if you wear them. These will be placed in a denture pot and labelled. They will stay with you at all times.

What happens during the test?

You will be seated or laid on an examination trolley and a local anaesthetic will be sprayed onto the back of your throat. This will numb your throat and make the test easier. A nurse will stay with you throughout the procedure. If you wish to have a sedative injection a needle will be put into your arm or hand at this point. You will feel relaxed and may not remember the test but it will not put you to sleep. Many hospitals now find that the test can be performed without sedation as the gastroscopes have become much smaller and are easier to swallow. If you chose an injection you will be given oxygen through a plastic mouthguard.

A small peg will be placed on your finger to measure your heart rate and oxygen level.

It is necessary that you lie on your left side for the test.

To keep your mouth open a plastic mouth guard will be placed between your teeth.

When the endoscopist passes the gastroscope into your stomach it is uncomfortable but it will not cause you any pain, nor will it interfere with your breathing at any time.

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The test usually lasts about 5 - 10 minutes. The endoscopist will carefully examine all areas of the stomach. During this time air will be passed down the tube to distend the stomach and allow clear views.

Sometimes the doctor or nurse doing the test will need to take tiny samples of your stomach lining. You are not likely to feel this.

If you get a lot of saliva in your mouth the nurse will clear it using suction.

When the examination is finished, the tube is removed quickly and easily.

What happens after the test?

If you choose to have the test done using just a throat spray you will be able to go home as soon as you feel ready to leave.

Since your throat has been numbed you will be asked not to have anything to eat or drink until you are able to swallow normally. This usually takes about an hour.

The back of your throat may feel sore for the rest of the day. It will settle without any treatment.

You may also feel a little bloated if some of the air has remained in your stomach. This feeling should pass naturally in time without requiring treatment.

If you choose to have throat spray and sedation you will have to rest in the Endoscopy recovery area for approximately one hour. Whilst we try to keep male and female patients separate in the recovery area, this is not always possible especially at peak times. However, the staff will ensure that your privacy is maintained at all times.

You may feel a little bloated with wind pains, these usually settle quickly once you have passed the wind and will not need any treatment.

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Once you are fully awake the needle used to give you the sedation will be removed. You will then be able to get up and have a drink and biscuits.

The effects of the sedation can last for at least 24 hours and even though you will probably feel perfectly recovered your judgement can remain impaired during this time.

It is essential that someone comes to pick you up. Once home, it is recommended that you rest quietly for the remainder of the day and that someone stays with you overnight.

It is important that you do not:

• drive a car• operate machinery or domestic appliances as your reaction times

may be slowed• drink alcohol• sign legally binding agreements• take sleeping medication

When can I get back to my normal activities?

You should be ready to get back to your normal activities by the next day.

Getting my results

The endoscopist may be able to tell you the results of your tests straight away. However, if you had sedation you may not remember what has been said. To make sure you have had and understood your results, the recovery nurse will give them to you again when you are fully awake.

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If a biopsy has been taken or if polyps have been removed these have to go to the laboratory and the results from these tests may take several days. A copy of the procedure report will be sent to your GP/referring doctor. Further details of the examination and any necessary treatment should be discussed with your GP in 10 to 14 days or at your next outpatient appointment.

Is there anything I should look out for when I go home?

If you have any problems when you go home, or are feeling worse than you expected, please contact the Endoscopy Department on the telephone numbers given to you on discharge.

Frequently asked questions and answers

If my symptoms have stopped before the gastroscopy/OGD, should I still come for the test?

Yes. It is important that you still come for the test. Your doctor has organised this test to ensure you have no problems in your oesophagus (gullet), your stomach and your duodenum. Although your symptoms may have gone, it important to have a look to ensure all is clear.

Will it hurt?

No, these examinations are not painful. You may feel some discomfort from the air that is pumped into the stomach so that the Endoscopy can view the lining adequately. Some patients find the air used to inflate the stomach slightly uncomfortable. It should not hurt. A mild sedative is available to you should you wish to have one.

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Can I drive home after the procedure if I choose to have sedation?

If you have sedation you will not be allowed to drive home and must arrange for someone to accompany you and drive you home. Medication given during the test will prohibit you from driving until 24 hours after your examination. Please do not plan to take public transport home. If you are unable to arrange transportation we can arrange a taxi to take you home, however, you are responsible for the fare. You will need a responsible adult with you for at least 12 hours.

Will I get my results on the day?

Upon completion of the gastroscopy/OGD the findings will be discussed with you. We will be able to tell you any visual findings, however any biopsies will need to be sent to the laboratory for testing, and this can take up to 3 weeks. A copy of the procedure report will be sent to your referring doctor and your GP.

What is the address for the Endoscopy Suite?

Endoscopy Suite, Huntsman B floor,Northern General Hospital, Herries Road, S5 7AU

Endoscopy Suite, B floor,Royal Hallamshire Hospital, Glossop Road, S10 2JS

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Can I park at the hospital?

Yes. We have car parks at both hospitals and rates are as follows:

Northern General Hospital

Up to 4 hours = £2.50Over 4 hours = £3.70

All the disabled parking bays around Northern General Hospital are free of charge.

Royal Hallamshire Hospital

Up to 2 hours = £2.50Up to 4 hours = £3.70Over 4 hours = £8.40

Disabled parking bays in the multi-storey car park are charged at normal rate, however there are disabled parking bays on A and B Roads which are free of charge.

Car parking charges are correct at time of printing. Please ensure you check the rates before parking.

Can I get public transport to the hospital?

Yes. You may use public transport. See below for details of how to find out which bus routes serve the Endoscopy Suite you are visiting. Please remember if you have sedation you will not be able to travel home using public transport.

• Traveline: 01709 515151• www.travelsouthyorkshire.com

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Are there facilities for my relatives / friends to obtain refreshments while they are waiting for me?

Yes. We have refreshments available at both hospitals:

Northern General Hospital

• AMT Coffee Shop situated in the main entrance on C Floor

Royal Hallamshire Hospital

• WRVS cafe situated in the main entrance on B floor

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Please use this space to make a note of any questions you may have about your test

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PD8437-PIL467 v5 Issue Date: August 2017. Review Date: August 2019

Produced with support from Sheffield Hospitals Charity

Working together we can help local patients feel even better

To donate visitwww.sheffieldhospitalscharity.org.uk Registered Charity No 1169762

Alternative formats can be available on request.Please email: [email protected]© Sheffield Teaching Hospitals NHS Foundation Trust 2017Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email [email protected]

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