Gastroscopy

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Gastroscopy
The time of your arrival will be indicated on your letter. This is to allow time for your assessment and admission to be completed by the nurses. Your actual procedure time will therefore differ from your arrival time and you may well be in the hospital for the whole morning or afternoon. Please be prepared for what may be a long wait if unforeseen alterations to the consultant’s list occur. Bring a good book with you!

What is a Gastroscopy?
A gastroscopy is a procedure in which the doctor uses an instrument called an endoscope to look directly at the lining of the oesophagus (gullet), stomach and duodenum (first part of the intestine). An endoscopy is a long, flexible tube, thinner than your little finger, which transits a picture to a TV screen.

Some treatments can also be carried out through the endoscope. These include stretching (dilating) narrowed areas of the oesophagus stomach or duodenum, removing polyps and swallowed objects, and treatment of bleeding vessels and ulcers by internal injection or application of heat.

What is an Oesophageal Dilatation?
The procedure to assist patients who have difficulty in swallowing because of a stricture (narrowing) of the oesophagus (gullet).

Current Medication
You are advised to bring all your current medication with you on the day of your endoscopy. If you are having sedation, your medication will be either locked away or given to an accompanying adult.

If you are taking Warfarin
Your consultant will discuss with you whether or not you should continue your Warfarin prior to the procedure. Some patients are sometimes asked to stop this medication for a few days, to reduce the likelihood of bleeding. Should your consultant suggest continuation of Warfarin prior to the procedure, he/she will make sure that a blood test to check your INR (clotting time) is performed at an appropriate time before conducting the endoscopy. If you have not received clear instructions or if you have any doubts, please contact The Quadrant and we will advise you if and when you should withhold these tablets prior to your gastroscopy.

Aspirin does not need to be discontinued.

If you are diabetic and have not received clear instructions regarding your medication prior to the procedure then please contact The Quadrant and we will advise you.

You may continue to take any other medications.

Preparation
Your stomach must be empty, so you must not eat anything for at least six hours before your appointment time. You may drink clear fluids, i.e. water, tea or coffee with no milk, up to two hours before. Any prescribed medication or tablets should be taken as normal unless you are diabetic, in which case this should have been discussed between you and the consultant at your consultation. If you have any queries, please contact The Quadrant before your appointment for further advice.

Please keep jewellery to a minimum, if at all possible only wear wedding bands in order to avoid loss or damage occurring. Please do not bring excessive amounts of money with you. You may bring your own dressing gown if you wish.

Sedation / Local Anaesthetic
The procedure can be done with sedation, which is an injection to make you sleepy. Many patients prefer local anaesthetic spray to the throat instead, as they can continue their normal activities afterwards. However, you can choose to have a light sedative but this does mean that you must follow the instructions as laid out below headed 'IF YOU HAVE HAD SEDATION'.

The procedure
When you arrive in the hospital, you will be taken to the ward where the staff will explain the procedure and you will be given the opportunity to ask questions before signing the consent form (if you have not already done so).

You will be asked to undress and change into a hospital gown.

You will be taken to the Endoscopy Suite (where the procedure will be performed). After you have asked the consultant any further questions, you will be made comfortable. A plastic clip will be placed on your ear or finger to monitor your pulse rate and oxygen levels.

If you have chosen to have the local anaesthetic, your throat will be sprayed and you will be made comfortable on a trolley. A plastic mouth guard will be placed between your teeth.

If sedation has been chosen, the consultant will give you a sedative injection which will make you feel sleepy and relaxed and oxygen will be administered to you via a small tube gently attached below your nose.

The consultant will pass the gastroscope carefully over your tongue and you may be asked to swallow once or twice at this stage. This will not cause any pain or interfere with your breathing. The gastroscope will then gently pass into your stomach and upper part of the small intestine (duodenum). Sometimes the consultant will take a very small piece of tissue (biopsy) for analysis in the laboratory.

If you are having an Oesophageal Dilatation the consultant will pass a fine guide wire through the gastroscope into the stricture (narrowed area) and then withdraw the gastrscope, leaving the wire in place. The consultant then passes a dilator (another type of tube) along the guide wire. Firm but gentle pressure is then used to stretch the narrow segment. Slight pressure/discomfort may be felt if you are not sedated. The procedure is sometimes repeated with increasingly larger dilators until the narrowed area has been stretched adequately.

After the procedure
If you have had a local anaesthetic spray and no sedative, you will usually be able to go home fairly soon after the procedure. If you have had a sedative injection, you may need to stay for about 1-3 hours after the procedure. As you have been given a sedative injection, you must have someone to collect you from the hospital to take you home. For the next 24 hours you should follow the instructions as laid out below headed 'IF YOU HAVE HAD SEDATION'.

Your throat may feel a slightly sore for up to 24 hours but this should soon ease. If you have had an oesophageal dilatation, please tell the staff if you have any severe pain or discomfort in your chest or abdomen. You will be able to eat and drink a little before you go home. In general, it is wise to avoid chunks of food, to chew your meals well and to take them with plenty of water.

Results
Sometimes the consultant will be able to give you the results as soon as you have recovered from the sedation. However, if a biopsy was taken a follow-up appointment will be arranged by your consultant or the results forwarded to you.

Risks
Gastroscopy can result in complications such as reactions to medication, perforation (tear) of the intestine, bleeding. These complications are very rare (less than one in 1000 examinations), but may require urgent treatment, and even an operation. Gastroscopy may very rarely be fatal (less than 1 in 2000 examinations). Be sure to advise your GP if you have any severe pain, bloody stools, or troublesome vomiting in the hours or days after colonoscopy.

IF YOU HAVE HAD SEDATION

As you have had sedation, it is important for the next 24 hours to have someone stay with you and to observe the following instructions.

You should make arrangements for someone to take you home by car or taxi (public transport is not appropriate) and to stay with you for the next 24 hours.

Do not drive a car or any other vehicle, including bicycles (note that your insurance is invalid if you do so).

Do not operate machinery or appliances such as cookers and kettles.

Do not drink alcohol.

Do not make important decisions or sign important documents.

Do not lock the bathroom or toilet door, or make yourself inaccessible to the person looking after you.

Drink plenty of fluids and eat a light diet.

Take things easy for the next 24 hours, and if you have any problems, please contact your GP.

After 24 hours, the effects of the sedation should have worn off and you should be able to resume normal activities.

For further information on any aspect of the procedure, please contact The Quadrant.

Download printable version of this document.

The above guidelines are derived from the Royal Devon & Exeter Foundation Trust information leaflet "Gastroscopy"