UPPER GI PROCEDURE

GASTROSCOPY

Gastroscopy is done using a narrow, flexible, telescopic camera called a gastroscope. The gastroscope is swallowed and passed down your oesophagus into your stomach. Gastroscopy (also called endoscopy) is a procedure that allows the doctor to look inside the oesophagus (the pipe that goes from the mouth to the stomach), stomach and the first part of the duodenum (small intestine).
A gastroscopy can help find out what is causing symptoms such as indigestion (especially if you're aged over 55, repeated vomiting or vomiting blood, difficulty swallowing and anaemia.
It's also used to check for certain gastrointestinal conditions such as coeliac disease, ulcers, Barrett's oesophagus and early signs of cancer.

How long do I have to be hospitalized?

Gastroscopy is usually done in a hospital as out-patient or day case. However you will be asked to prepare for the procedure. You will usually be asked to follow fasting instructions. Typically, you must not eat or drink for eight hours before your test. You may be allowed occasional sips of water for up to an hour and a half before the procedure.
You may need to stop taking some prescribed or over-the-counter medicines for indigestion two weeks before your gastroscopy, as these medicines can hide problems that would otherwise be found during the gastroscopy. You can continue to take antacids (eg sodium alginate, Gaviscon). If you normally take other medication (eg tablets for blood pressure), continue to take this as usual, unless your doctor tells you not to. If in doubt, check with your doctor.
At the hospital your nurse may check your heart rate and blood pressure, take a blood sample and test your urine. Gastroscopy may be done under local anaesthesia, which is usually given in the form of a throat spray. This completely blocks feeling from your throat area, but you will stay awake during the procedure. You may be offered a sedative to help you relax during the procedure. If you have a sedative, you will have very little memory of the test.

The Procedure

The procedure usually takes 10 to 20 minutes to complete. If you're having sedation, this is usually given through a small plastic tube (cannula) in a vein on the back of your hand. You should start to feel relaxed and drowsy almost immediately. While you're sedated, your doctor will monitor the amount of oxygen in your blood through a sensor on your finger and give you extra oxygen through a mask.
With you lying on your side and your head bent slightly forward, your doctor will place a mouth guard over your teeth before carefully putting the gastroscope into your mouth. Your doctor will ask you to swallow to help the gastroscope pass into your oesophagus and down towards your stomach. It's important to keep your head and neck still and not try to straighten it. You should be able to breathe normally during this test. A nurse will help the doctor by using a suction tube to remove excess saliva from your mouth during the procedure.
Air is pumped through the gastroscope and into your stomach to make it expand and your stomach lining easier to see. When this happens, you may briefly feel a sensation of fullness or nausea.
The camera lens at the end of the gastroscope sends images from the inside of your body to a monitor. Your doctor will look at these images to examine the lining of your oesophagus, stomach and duodenum.
If necessary, your doctor will take a biopsy (a small sample of tissue) and/or remove small growths of tissue called polyps. This is done using special instruments passed inside the gastroscope and is quick and painless, although you may feel a slight pinch. The samples will be sent to a laboratory for testing to determine the type of cells and if they are benign (not cancerous) or malignant (cancerous).
When the test is finished the gastroscope is taken out quickly and easily. The gastroscopy won't hurt but it may be a bit uncomfortable. You may belch during or after the procedure to expel the air that has been pumped in.

What to expect afterwards

You will need to rest until the effects of the sedative have passed. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home.
It may take several hours before the feeling comes back into your throat. You shouldn't drink hot drinks until the local anaesthetic has worn off.

Results

If you have a biopsy or polyps removed, your results will be ready several days later and will usually be sent to the doctor who recommended your test. At the hospital, your doctor may discuss other findings from the gastroscopy with you before you leave, or you may be given a date for a follow-up appointment.

Recuperation

After having a gastroscopy you may have a numb mouth and tongue for a few hours, feel bloated ( but this usually passes quite quickly), feel sleepy as a result of the sedative and have a sore throat for a few hours.

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ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY (ERCP)

ERCP removes gallstones and is often performed in addition to having your gallbladder removed. The procedure enables the doctor to examine the common bile duct and the pancreatic duct. The doctor passes a tiny camera on the end of a narrow and flexible tube called an endoscope (or "scope") through your mouth, stomach and into your small intestine (bowel). Then diagnostic and therapeutic procedures can be performed and tissue or biliary samples obtained to detect infection, obstruction or any other abnormality.

ERCP allows the doctor to establish reasons for jaundice (yellow skin), abnormal liver function, gallstones, biliary and pancreatic inflammation. This will benefit you by providing a clear diagnosis. Sometimes doctors will first perform an MRI scan of the bile ducts and pancreas called an MRCP.

How long do I have to be hospitalized?

This procedure must be performed on an empty stomach, so you must not eat or drink for six hours before the procedure. You are to stop taking anti-inflammatory tablets 5 days before your test. A straight forward ERCP requires only an overnight stay for observation.

The Procedure

An ERCP usually takes between 30 minutes and 1 hour, depending on what is done. Local anaesthetic is sprayed on to the back of your throat to make it numb. A sedative and analgesia (painkiller) are administered through a drip in your arm to make you drowsy.
A plastic mouthpiece is placed between your teeth to keep your mouth slightly open so that the doctor can gently pass the thin endoscope through your mouth. During the procedure, some air is put into your stomach so that the doctor can have a clear view - this may make you burp a little. The air is removed at the end of the test.
The procedure itself requires the doctor to pass the endoscope beyond your stomach into the small intestine (bowel). Water-soluble dye is injected into the bile ducts to allow the doctor to visualize the pancreas and common bile ducts. Photographs or video may be taken, and bile samples, brushings or biopsies (tissue samples) obtained. Often the doctor needs to perform therapeutic interventions like inserting a hollow tube, called a stent, into the bile duct; expanding a narrowed area (called dilating a stricture); removing gallstones or widening the entrance to the biliary system (called a sphincterotomy). Throughout the procedure a nurse cares for you and monitors your pulse and oxygen levels.

What to expect afterwards

Some patients suffer from inflammation of the pancreas (called pancreatitis) after the procedure. This usually requires admission to hospital for several days, but occasionally may require longer stays.

Results

The doctor will be able to tell you the results after the procedure. If samples were taken, you will be told the final diagnosis by your doctor within about 1 week. Copies of your ERCP report will be sent to your GP.

Recuperation

You may experience bloating if there is still some air in your stomach, and a sore throat. Both sensations are normal. You can resume normal activities, work etc the following day.

CAPSULE ENDOSCOPY

This involves ingesting a small capsule (the size of a large vitamin tablet) which will pass naturally through your digestive system, taking pictures of the intestine.
The images are transmitted to sensors attached to a data recorder held in a harness, which you will wear. The capsule is disposable and will be excreted naturally in your bowel movement.

Are there any risks?

Very occasionally the capsule can become stuck in the intestine (less than 1%) in which case it may need to be removed surgically. In about 80% of such cases an operation is required anyway. In certain patients (eg those with intestinal fistulas or strictures, those with Crohn’s disease or with prior abdominal/pelvic surgery), your consultant will organise an x-ray test (eg a barium follow-through) before the capsule endoscopy to see whether capsule retention is likely to occur. Capsule endoscopy is not usually performed in patients who are pregnant.

The day before Capsule Endoscopy

If your consultant would like you to take a preparation to clear your bowel:
Eat a light breakfast at about 8am and have a light lunch about midday. After lunch on the day before the capsule endoscopy - start a clear liquid diet. In the early evening - In the box you have been given or sent, you will find a pack of Moviprep, which includes sachets A and B. Dissolve both sachets in 1 litre of water and drink over 1 – 2 hours. Flavouring can be added to this. Thereafter, continue with clear liquids. Have nothing further to drink from 10pm.
If your consultant would not like you to take bowel preparation:
Eat a light breakfast and light lunch, thereafter drink clear liquids only. Have nothing further to drink from 10pm.

Day of the Procedure

You are requested not to take any medication for 2 hours before undergoing the procedure and advised to wear loose fitting, two piece clothing as you will be wearing a data recorder in a harness.
Male patients may need to shave their abdomen 15cm above and below the navel on the day of the procedure.

The procedure

At the beginning of the procedure you are given medication to prevent the accumulation of wind. An adhesive sensor pads will be applied to your abdomen and connected to a data recorder which you will wear in a belt around your waist. You will then be asked to swallow the capsule. Once you have swallowed the capsule you are not allowed anywhere near any source of powerful electromagnetic fields such as an MRI or amateur radio for at least 8 hours. You are advised NOT to take public transport during this time, or go to crowded public places.
You are instructed not eat or drink for at least 2 hours. After 2 hours you may have clear fluids. After 4 hours you may have a light snack. However you must contact the endoscopy unit immediately if you suffer from any abdominal pain, nausea, or vomiting during this time.
Capsule endoscopy lasts approximately 8 hours. You are instructed not to disconnect the equipment or remove the belt at any time during this period and you must handle the equipment carefully. Avoid sudden movements and avoid banging the (blue) data recorder. Do not expose it to shock, vibration or direct sunlight as this may result in the loss of information.
During the capsule endoscopy you will need to verify every 15 minutes that the small light on top of the data recorder is blinking twice per second. If it stops blinking at this rate, record the time and contact the endoscopy department.
You should also record the time and nature of any event such as eating, drinking, and any unusual activity on the capsule endoscopy event form (see the end of this document).
Avoid any strenuous activity, especially if this involves sweating, and do not bend over or stoop during the eight hour period.

After completing the capsule endoscopy

You will be given a time to return to the endoscopy unit to return the equipment with your capsule endoscopy event form. You may commence a normal diet once the test is completed. The capsule is normally passed in your stool after 24 to 72 hours. It can be flushed down the drain safely.

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