Gastroscopy

A gastroscopy is a test that we use to look inside of the throat, food pipe (oesophagus), stomach and duodenum (the first part of the small intestine).

A gastroscopy involves a long, thin, flexible tube (endoscope) being passed into the mouth and then down the throat and into the stomach until it reaches the duodenum. The tube is about the thickness of a little finger.

At the end of the tube is a camera and a light which allows the endoscopist to investigate problems and diagnose conditions affecting the upper digestive tract. A gastroscopy is the most effective way of detecting inflammation, ulcers, tumours or bleeding. The procedure also allows treatment to be carried out if necessary.

On average, the procedure takes 10 minutes. Please be aware that procedure times may vary as we will want to ensure we have investigated and treated everything we can. As well as having a clear view of the upper digestive tract we are also able to take a biopsy which involves removing a piece of tissue for testing. If a biopsy is taken, you will not feel this happen so we will let you know at the time if we do this.

A gastroscopy common procedure and is often performed to examine symptoms including persistent abdominal pain, nausea, vomiting, bleeding or difficulty swallowing. You may be referred by your hospital consultant or directly by your GP. Our department has JAG accreditation to reflect the specialist services and resources our staff are dedicated to maintaining.

Please be aware that 10 minutes is the average time in the procedure room, and we recommend preparing to spend about 2-3 hours in the hospital on the day of the procedure.

Preparing for the procedure

Prior to the procedure our pre-assessment team will contact you. We will try to contact you by phone so that we can tailor the procedure as much to you as possible and arrange a convenient time for your appointment. If we cannot reach you, we will send a letter in the post regarding the time of your procedure and pre-assessment phone call. If you cannot make your appointment time, please contact our administration team on 01752 438407.

We may ask for some information regarding certain medical conditions which may affect your procedure. The information we need is usually already on the endoscopy referral that has been sent to us by the doctor who wants you to have the gastroscopy. We may need to contact you to ask some more questions or to alter your use of certain medications before the procedure. Therefore, your appointment letter will ask you to contact us if you have any of the following: Pacemaker or other implanted device, Diabetes, Sleep Apnoea or if you take any blood thinning medication.

Please read all the information in the leaflets and on the consent form. If you have no questions or queries you can sign the consent form at home, otherwise this will be done prior to the test after you have had the opportunity to speak to a nurse or your endoscopist. Please bring the consent form with you to your appointment. If you forget your form, we will be able to supply you with another however this can cause delays.

You will be asked to take some bowel preparation. It is very important to follow the instructions carefully in order to achieve a clean upper digestive tract. The endoscopist will need to see the lining of the digestive tract clearly in order to check for anything suspicious or treat any abnormalities. If the upper digestive tract is not clean enough the procedure may need to be delayed and you will need to have another appointment. We understand that following a different diet can be challenging and that the bowel preparation can be unpleasant however it is very important that the instructions are followed.

On the day of your appointment, you must not have anything to eat 6 hours before your procedure. You may be able to have very small sips of water up to your appointment time, your appointment letter will give you more details about drinking on the day.

Please see our pre-procedure pages to help prepare for your appointment and make your experience as comfortable as possible. We have shared some techniques suggested by patients and healthcare professionals which we hope will improve your experience.

Pain Relief

Gastroscopy can cause some discomfort and it is completely normal to feel anxious. We have different options at our disposal which will help you to relax.

Sedation reduces discomfort and helps you to relax, it does not put you to sleep but it does make you feel sleepy. It is important we can communicate with you during the procedure. We may need to ask you to carry out very simple instructions and monitor your comfort; we will communicate by asking you questions which you will be able to respond to by raising your hand. Sedation can make the procedure more comfortable however your recovery will take longer. If you choose to have sedation you will need a friend or family member to accompany you home after the procedure and have someone stay with you for 24 hours. You cannot use public transport to get home. You also must not drive, operate machinery or sign any important documents for 24 hours after the procedure. Sedation doses and the type of sedation used may have to be altered if you have certain medical conditions such as sleep apnoea or breathing problems. You will have a chance to talk about this with the doctor and endoscopist on the day of the procedure.

Local anaesthetic spray numbs the back of the mouth and the throat. When the scope touches the back of the throat you may have a gag reflex. To prevent this gag reflex we can use a throat spray. It may feel like your throat is swelling up after the spray is administered however this is not the case. Your throat and the back of your mouth will stay the same and this is just a sensation caused by the anaesthetic. If you elect to have throat spray and no sedation you will be able to leave the endoscopy unit more quickly after your procedure and will be able to drive home.

During the procedure

During the procedure, you will have a nurse with you at all times. They will be focused on your comfort. Your endoscopy team want to make you feel as relaxed as possible so please communicate anything you think may be helpful and we will always listen.

Once you are in the procedure room you will be introduced to your endoscopy team. At this point we will ask that you remove any false teeth and glasses, and we will place a plastic mouthpiece between your teeth to keep your mouth slightly open. We will ask you to lay on a bed on your left-hand side and place a probe on the end of your finger to monitor your pulse and oxygen levels. We will give you oxygen through a small plastic tube placed into the nose.

The endoscopist will start any pain relief you have requested and insert the endoscope carefully to begin the procedure. Many people find that the procedure can be performed without sedation as new innovations in technology have enabled the medical equipment that we use to be smaller and easier to swallow.

As the endoscope passes into your stomach it will not interfere with your breathing or cause any pain. You may feel discomfort and feel like you need to be sick. If this does happen it should stop once the endoscope has reached your stomach. Sedation can help to prevent this feeling.

Gas is introduced to the upper digestive tract so that the endoscopist can see where to guide the scope. Inflating the digestive tract and passing the endoscope through can cause some discomfort so we move carefully and keep the amount of gas we use to a minimum. You may experience bloating from the air which can be relieved by burping; this is completely normal and the endoscopist will expect this to happen.

Your nurse will be with you and will be focused on your comfort. You will be able to communicate with your endoscopy team by raising your hand. Your endoscopy team will remind you of this on the day of your procedure.

You will be able to see the endoscope moving through your upper digestive tract on a screen in front of you. The endoscopist will keep you informed about what they are doing and may ask you to perform simple instructions to aid the movement of the endoscope and reduce discomfort. The nurse may help to remove excess saliva from your mouth using a sucker.

During a gastroscopy the endoscopist will investigate to discover the cause of your symptoms. We may also take a small sample of cells for testing, called a biopsy, in order to help confirm or rule out causes of symptoms. You will not feel anything if a biopsy is taken so we will let you know at the time if we do this.

When the procedure is complete the endoscope is removed easily and quickly by gently withdrawing the scope. Most of the air introduced to the digestive tract is removed at this point to improve your comfort.

Whilst all procedures carry risks, the chance of a major complication occurring in a gastroscopy is small. We will do our best to make sure you are as comfortable and as relaxed as possible. Please remember you can stop the procedure at any time and your endoscopy team will respect your wishes.

After the procedure

You will be discharged from the hospital the same day as your gastroscopy.

After the gastroscopy you will be accompanied to the recovery area. Your length of stay here is dependent on the pain relief method you have chosen. If you have had sedation you will need to recover here in the unit for a few hours.

While you rest in the recovery area a nurse will monitor you carefully and make sure you are comfortable. You may feel bloated or have stomach cramps after the procedure. Walking once you are ready, or burping can help to relieve this discomfort. You may also find that the back of your throat is sore for the rest of the day. Both discomforts will pass and are completely normal. They will not require medical attention.

Once you can stand and the nurse is happy you are ready, you will be able to change back into your clothes in privacy and transferred to the second stage of recovery. If you have had a throat spray to numb the back of your throat your swallowing reflex will be affected. Usually, your reflex will return in no more than an hour and after this you can eat or drink as normal.

You will be offered a warm or cold drink and a biscuit in the second stage recovery area. Here a nurse or a doctor will go through your procedure with you and explain the results. If you have had a biopsy taken, we will have the results from this in about two weeks.

We will give you a report of your procedure to take home with you. We find that sometimes sedation can cause patients to forget explanations they receive even once they have moved into the second stage of recovery. It is completely normal for the sedation to take some time to leave your system. If you can’t remember what the doctor or nurse has told you, you will be able to obtain details or results from the procedure from your GP or specialist.

If you have had sedation, you will also need someone to collect you from the endoscopy unit and take you home (not on public transport). Someone will also need to stay with you for 24 hours. You will also not be able to work, drive a car or operate machinery for 24 hours.

Before you leave the endoscopy unit the nurses will give you advice about what to expect and a contact number in case you experience any problems.

If you notice:

Bloody, black or very dark coloured stool.

Severe abdominal pain which becomes worse.

Vomiting, especially if the vomit looks like coffee grounds.

Fever.

Difficulty swallowing.

Chest Pain.

Shortness of breath.

You should contact either the Endoscopy Unit, your GP or go to your nearest Accident & Emergency Department. Please take a copy of your endoscopy report with you.

If you experience any other problems or symptoms after your procedure, from 8am to 6pm please telephone the endoscopy unit in which you had the procedure for further advice on 01752 438407.

Results

A doctor or nurse endoscopist will talk to you about your results after your procedure. If you have had sedation, it may be difficult to remember your results even after you are ready to go into the second stage of recovery. A full report will be sent to your GP or specialist. If you have had a biopsy, it may be a few weeks before you get the results. Further details and any treatments which may be necessary will be discussed with your GP or specialist.

Repeat procedures

It may be necessary to have a repeat gastroscopy or an alternative examination.

If the lining of the upper digestive tract was obscured and therefore a complete examination was not possible, the doctor may recommend a repeat gastroscopy. The doctor may recommend alternative bowel preparation to ensure the tract is clean for the next procedure.

If the produce could not be completed for any reason, the doctor may recommend an alternative procedure to ensure you receive the appropriate care and the best health outcomes.

Medications

You can start taking any medications as normal after the procedure however if a biopsy was removed, we may need to delay any blood thinning medications and anti-inflammatory drugs. You can take stool softeners and bran but not laxatives. Please ask if you have any questions about medications.

Food and drink

If you have elected to have the throat spray, you will need to wait until feeling has returned to the back of your throat before eating or drinking. Once you have been discharged, you may eat and drink as normal after your procedure. If you have had any sedation and you drink alcohol after the procedure it can make you more tired than usual.

Risks

There are risks involved in a gastroscopy.

• A perforation or tear could occur in the Digestive tract during the procedure which would then require surgery.
• If a biopsy is taken, there may be bleeding from the site. It should stop on its own.
• A reaction from the sedative injection.
• There is a possibility damage to loose teeth, crowns or dental bridgework could occur.

Complications can arise from a gastroscopy procedure. The risk increases with certain health conditions or if polyps are removed. If you experience any of the following symptoms please contact your GP, the endoscopy department on 01752 438407 between (8am and 6pm) or 111.

• Fever or chills.
• Severe abdominal pain.
• Vomiting.
• Continual bleeding and the passage of large blood clots on more than one occasion.
• Redness, tenderness and swelling at the site of the intravenous injection which persists.