Introduction
You have been advised by your GP or hospital doctor to have an investigation known as a gastroscopy (OGD).
If you are unable to keep your appointment, please notify the department as soon as possible. This will enable the staff to give your appointment to someone else and they will be able to arrange another date and time for you.
This patient information has been written to enable you to make an informed decision in relation to agreeing to the investigation. This procedure requires your formal consent.
Should you wish to change your mind and withdraw your consent you can do this at any time even when the procedure is taking place. The endoscopist will stop and clarify the problem with you. If you still wish and safe to do so the endoscopist will start to remove the endoscope. Please note that this may not be done immediately as it needs to be removed in a safe manner.
What is an OGD?
The procedure you will be having is called an oesophago-gastro-duodenoscopy (OGD) sometimes known more simply as a gastroscopy or endoscopy.
This is an examination of your oesophagus (gullet), stomach and the first part of your small bowel called the duodenum.
The instrument used in this investigation is called a gastroscope. It is flexible and has a diameter less than that of a little finger. Each gastroscope has an illumination channel which enables light to be directed onto the lining of your upper digestive tract and another which relays pictures back to the endoscopist onto a television screen.
During the investigation, the endoscopist may need to take some tissue samples (biopsies) from the lining of your upper digestive tract for analysis: this is painless. The samples will be retained. Photographs may be taken for your records.
The procedure will be performed by or under the supervision of a trained doctor or clinical endoscopist, and we will make the investigation as comfortable as possible for you. Some patients have sedation injected into a vein for this procedure, although others prefer to remain awake and have local anaesthetic throat spray.
Why do I need to have an OGD?
You have been advised to undergo this investigation to try and find the cause for your symptoms, help with treatment and if necessary, to decide on further investigation.
There are many reasons for this investigation including: indigestion; anaemia; weight loss; vomiting; passing black motions, vomiting blood or difficulty swallowing.
A barium x-ray examination is an alternative investigation. These tests expose you to a small amount of radiation. They are not as informative as an endoscopy and have the added disadvantage that a tissue sample can not be taken if any areas of concern are identified.
Preparation
Eating and drinking
It is necessary to have clear views and for this the stomach must be empty. You should have no food or milky drinks for at least 6 hours prior to the test. You can have clear fluids until 2 hours before the test.
What about my medication?
Your routine medication should be taken.
Digestive medication
If you are presently taking tablets to reduce the acid in your stomach please discontinue them 2 weeks before your investigation.
If you are having a follow up test to check for healing of an ulcer or inflamed oesophagus found in the last 2-3 months, or as part of a long term monitoring of a condition such as Barret Oesophagus, then please continue your acid reducing medications right up to the day before your repeat endoscopy. If unsure please telephone the unit.
Anticoagulants/allergies
If you are taking anticoagulants or blood thinning medication such as apixaban, edoxaban warfarin, clopidogrel, ticragelor, prasugrel, Dabigatran, Phenindione , or Rivaroxaban (Xarelto) and have not discussed this with your doctors or GP please contact the unit. Phone for information if you have a latex allergy.
Patients with diabetes
If you have diabetes controlled with insulin or medication please ensure the Endoscopy department is aware so that the appointment can be made at an appropriate time during the list. Please see the guidelines at the back of the leaflet.
How long will I be in the endoscopy department?
This largely depends upon whether you have sedation and also how busy the department is. You should expect to be in the department for approximately 1-3 hours. The time given on your letter is your admission time, not the time for your procedure. The department also looks after emergencies and these can take priority over outpatient lists.
What happens when I arrive?
When you arrive in the department you will be met by a trained member of staff who will ask you a few questions, one of which concerns your arrangements for getting home. You will also be able to ask further questions about the investigation.
The nurse will ensure you understand the procedure and discuss any outstanding concerns or questions you may have.
You will be offered the choice of sedation, local anaesthetic throat spray or entonox (this is dealt with in more detail in the next section of this booklet).
If you have sedation, the nurse will insert a small cannula (small plastic tube) into a vein usually on the back of your hand through which the sedation will be administered later.
If you have sedation you will not be permitted to drive home or use public transport alone, so you must arrange for a family member or friend to collect you. The nurse will need to be given their telephone number so that they can contact them when you are ready for discharge.
The nurse will ask you some questions regarding your medical condition and any past surgery or illness you have had to confirm that you are sufficiently fit to undergo the investigation.
Your blood pressure, oxygen levels and heart rate will be recorded and if you have diabetes, your blood glucose level will also be recorded.
Sedation, entonox or throat spray explained
Intravenous sedation, entonox or topical local anaesthetic throat spray can improve your comfort during the procedure so that the endoscopist can perform the procedure successfully.
Intravenous sedation
The sedation will be administered into a vein in your hand or arm which will make you slightly drowsy and relaxed but not unconscious. You will be in a state called co-operative sedation: this means that, although drowsy, you will still hear what is said to you and therefore will be able to follow simple instructions during the investigation. Sedation can also make it unlikely that you will remember anything about the procedure. You will be able to breathe quite normally throughout. In some cases the endoscopist may administer a dose of local anaesthetic throat spray also. This will depend on the individual case and at the discretion of the endoscopist.
Whilst you are sedated we will check your breathing and heart rate so changes will be noted and dealt with accordingly. For this reason you will be connected by a finger probe to a pulse oximeter which measures your oxygen levels and heart rate during the procedure. Your blood pressure may also be recorded.
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 at least 12 hours.
Entonox
You may decide that intravenous sedation is not for you or in some cases this type of sedation may not be appropriate e.g. If you have a serious underlying condition that makes it unsafe or you have no one to look after you after your procedure. An alternative is the use of Entonox (‘gas and air’). Entonox is an inhaled effective painkiller which has a sedative effect without loss of consciousness. It is a mixture of nitrous oxide and oxygen. The effects last no more than 10 minutes.
Following the use of Entonox you would need to remain in the unit for a short while and you would not be able to drive for at least 30 minutes. If Entonox is used it is usually in combination with anaesthetic throat spray to improve comfort and tolerance of the test.
Anaesthetic throat spray
With this method sedation is not generally used. The throat is numbed with a local anaesthetic spray. This will not affect the swallowing mechanism; although it may feel like it, and does not affect your ability to breathe.
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 life as normal.
The only constraint is that you must not have anything to eat or drink for between 30 minutes to 1 hour after the procedure, until the sensation in your mouth and throat has returned to normal.
It is strongly advised that when having your first drink after the procedure, it should be a cold drink and should be sipped to ensure you do not choke.
The OGD examination
Your consent to the procedure will be confirmed by the endoscopist and you will be given the opportunity to ask any further questions before you are escorted to the treatment room.
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.
If you are having local anaesthetic throat spray this 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.
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, a small tube will be placed into your nose so you can be given a little bit of oxygen to assist your breathing. The drug will be administered into a cannula (tube) in your vein and you will quickly become sleepy.
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 procedure samples may be taken from the lining of your digestive tract for analysis in our laboratories. These will be retained. Any photographs will be recorded in your notes.
Risks of the procedure
Upper gastrointestinal endoscopy is classified as an invasive investigation and because of that it has the possibility of associated complications. These occur extremely infrequently; we would wish to draw your attention to them and so with this information you can make your decision.
The doctor who has requested the test will have considered this. The risks must be compared to the benefit of having the procedure carried out.
The risks can be associated with the procedure itself and with administration of the sedation.
Endoscopic examination
The main risks are of mechanical damage to teeth or bridgework; perforation or making a hole in the wall of the stomach or oesophagus and bleeding which could entail you being admitted to hospital. Certain cases may be treated with antibiotics and intravenous fluids.
The risk of perforation is approximately 1 in 2000 cases. This can be higher in older people as the tissues become less flexible. In severe cases these may require surgery to repair the hole.
Bleeding may occur at the site of biopsy, and nearly always stops on its own.
There are other extremely rare complications which can occur during a procedure. Most of these are related to specific people or conditions. We also need to make you aware that there are rare occasions when the endoscopist may fail to detect abnormalities on this examination. Should you have any particular concerns or worries regarding this please discuss this with your endoscopist when you attend and before you sign your consent form.
Sedation
Sedation can occasionally cause problems with breathing, heart rate and blood pressure. If any of these problems do occur, they are normally short lived. Careful monitoring by a fully trained endoscopy nurse ensures that any potential problems can be identified and treated rapidly.
Older patients and those who have significant health problems, for example, people with significant breathing difficulties due to a bad chest may be assessed by a doctor before being treated.
After the procedure
If you have chosen to undergo the test with throat spray, the endoscopist will be able to speak to you as soon as you sit up following the test. When the nursing staff have assessed that your condition is stable and if you feel quite comfortable and ready, you can then leave the department. If you would prefer, or if the nurse caring for you feels it would be advisable, you will be transferred into the recovery area for further monitoring until everyone is happy for you to leave.
Following 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 have diabetes, your blood glucose will be monitored. Once you have recovered from the initial effects of any sedation (which normally takes 30 minutes) you will be offered a snack and may be moved into a comfortable chair.
Before you leave the department, the nurse or doctor will explain the findings and any medication or further investigations required. She or he will also inform you if you require further appointments.
Since sedation can make you forgetful it is a good idea to have a member of your family 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 will need to arrange for someone to stay with you for at least 12 hours after the procedure or, if possible, arrange to stay with your family or a friend during this time.
If the person collecting you leaves the department, the nursing staff will telephone them when you are ready for discharge.
What if I choose not to have this procedure?
If you decide not to proceed with the examination, your doctors will still treat your symptoms, however they may find it harder to identify the underlying cause of your problems. This may affect their ability to provide a long-term solution or treatment for your condition or exclude conditions like cancers.
General points to remember
- If you are unable to keep your appointment please notify the endoscopy unit as soon as possible.
- It is our aim for you to be seen and investigated as soon as possible after your arrival. However, the department is very busy and your investigation may be delayed. If emergencies occur, these patients will 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 these premises.
- If you have any problems with a persistent sore throat, worsening chest or abdominal pain, please contact your GP immediately informing them that you have had an endoscopy.
- If you are unable to contact or speak to your doctor, you must contact the hospitals Accident and Emergency department.
Guidelines for people with diabetes undergoing upper GI endoscopy (Gastroscopy)
Adjusting therapy
Because you have diabetes you will need to adjust your treatment according to the timing of the appointment. As a result your blood sugar control may be a little higher than usual. This is only temporary to maintain your blood sugars through the procedure and you will be back to your usual level of control within 24 – 48 hours of the procedure.
If you have concerns about your blood sugar control during this period please contact whoever you receive your Diabetes care from at your GP Practice well in advance of the appointment to discuss the appropriate measures.
Avoiding hypoglycaemia (low blood glucose)
On the day of the procedure, carry Glucose Tablets. If your blood glucose drops too low (hypoglycaemia) you can suck these so they are absorbed through the tissues of the mouth. This will not affect the procedure. Take three (3) tablets initially, followed by a further three (3) if symptoms continue after 5 minutes.
Blood glucose monitoring
If you usually test your blood sugar levels, check them as usual, on the morning of the procedure and carry your equipment with you to the appointment.
If you do not usually test your blood, do not worry, your blood levels will be checked when you arrive for the procedure.
Instructions for your appointment
Please check the appropriate section, type of treatment and time of procedure, check with the Endoscopy department if this is an appropriate time for your procedure.
Morning appointment
People on insulin and/or tablets
- You should have nothing to eat after midnight, if you feel hypoglycaemic take glucose tablets.
- Take 80% of your usual long-acting or intermediate-acting insulin doses. Half your usual morning dose of mixed insulin. Omit your usual morning dose of quick acting insulin. Omit your morning dose of tablets.
- If you are still in doubt please contact your diabetes nurse
- Report to the nursing staff if you have needed glucose before arriving and inform them immediately if you feel ‘hypo’ at any time of your visit.
- Once you are able to eat and drink safely your next dose of insulin and/or tablets can be given. The nursing staff will inform you when this is safe.
Afternoon appointment
- You may need to reduce or omit morning insulin and/or diabetes tablets. The details will need to be discussed with the endoscopy department well in advance of the appointment.
- If still in doubt contact your diabetes nurse.
- Inform the nursing staff if you have needed to suck glucose tablets before arriving and tell them immediately if you feel hypoglycaemic at any time during your visit.
- Once you are able to eat and drink safely your next dose of insulin and/or tablets can be given. The nursing staff will indicate when this is safe.
Contact details
Cumberland Infirmary Endoscopy Unit: 01228 814289
West Cumberland Endoscopy Unit: 01946 523061
Booking/appointments team: 01228 210430
Confidentiality
‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.
For further information on confidentiality contact the Information Governance Team:
Information.Governance@ncic.nhs.uk | 01228 603961
Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302