Having a Gastroscopy Gastroenterology Department Patient Information Leaflet Options available If you d like a large print, audio, Braille or a translated version of this leaflet then please call: 01253 955588 Our Four Values: People Centred Positive Compassion Excellence
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Introduction You have been advised by your GP or hospital doctor to have an investigation known as a gastroscopy. This procedure requires your formal consent. This booklet has been written to enable you to make an informed decision in relation to agreeing to the investigation. At the back of the booklet is your consent form. The consent form is a legal document, therefore please read this information booklet and the consent form carefully. Once you have read and understood all the information including the possibility of complication and you agree to undergo the investigation, please sign and date the consent form. You will notice that the consent form is carbonised, allowing you to keep a copy for your records, please fill it in while it is still attached to this booklet. REMEMBER TO BRING THE BOOKLET AND CONSENT FORM WITH YOU TO YOUR APPOINTMENT. If there is anything you do not understand or wish to discuss further do not sign the form but bring it with you to sign after you have spoken to a health care professional. Page 3
What is a Gastroscopy? A Gastroscopy is a test that allows the endoscopist (doctor or nurse performing the test) to look into your upper gastrointestinal tract. This is done by passing a long flexible tube (gastroscope) through your mouth, passing over your tongue to the back of your throat, down your gullet (oesophagus), into your stomach and into the first part of your small intestine (duodenum). The gastroscope is connected to a television system where pictures of your oesophagus, stomach and duodenum can be seen. Benefits By performing a Gastroscopy examination the cause of your symptoms may be found and sometimes we are able to treat them there and then. Pictures (for your medical notes) and samples of the lining of your stomach (biopsies) may be taken with instruments passed down a channel in the endoscope. These procedures are pain free. Risks A Gastroscopy is a safe examination but there are risks you need to be aware of. Occasional dental damage can occur, if you have loose teeth please visit your dentist prior to your appointment. Rarely (1 examination in 1000) a complication such as bleeding or a chest infection can occur. Very rarely perforation can happen, this means a hole (in your oesophagus, stomach or duodenum) and you may need an operation to repair it. If you have a sedative the added risks are nausea and vomiting, becoming over sedated which could reduce your breathing effort and having a prolonged sedative effect. Page 4
Alternative treatments An alternative to a Gastroscopy is a barium meal / swallow. This is an X-ray based test, it does not provide very detailed pictures of your oesophagus, stomach and duodenum. It does not allow biopsies or treatment to be carried out at the same time therefore you may still require a Gastroscopy examination. Please note Your appointment time takes into account the time required to admit you to the unit. You should not expect to go immediately through for the test when called. You should expect to be with us for 1-3 hours including waiting and recovery time. Page 5
What should I do before attending? Please make sure you follow the instructions in this leaflet and on your appointment letter. It is important to inform the department if you are unable to attend your Gastroscopy appointment on Telephone 01253 956584. Your appointment can be given to another person if you do not require it. Take any medication you are on up to 2 hours before your gastroscopy with water. If you are taking medication for DIABETES please refer to the specific diabetic instructions towards the end of this booklet. If you are having an Open Access Gastroscopy (a routine test referred straight from your GP) you must stop taking acid suppressing drugs 2 weeks before your procedure. These drugs include Omeprazole (Losec), Esomeprazole (Nexium), Lansoprazole (Zoton) and Pantoprazole (Pariet). You must have nothing to eat or drink for the 6 hours before your gastroscopy appointment (except medication). Your stomach needs to be empty to ensure a clear view and to reduce the risk of a chest infection. Please bring a list of your medication with you on the day. Leave valuables and jewellery at home where possible, we cannot look after these for you. Page 6
What to expect on the day Many patients are concerned about the thought of swallowing the endoscope. We would like to reassure you that the test is not painful but you may experience some discomfort. You will be able to breathe normally and swallow normally throughout. Before the Gastroscopy the nursing staff will admit you to the unit and fully explain the test to you whilst answering any questions or concerns you may have. You will be asked to sign a consent form for the Gastroscopy. You will then be taken to a seated area where you will wait to be called into the room for your Gastroscopy. Please note we usually have 4 different lists running simultaneously and this may mean some people will have to wait longer than others, even with the same appointment time. In the endoscopy room you will have the Gastroscopy whilst lying on your left side on a trolley. The procedure will be made more comfortable with throat spray to numb your throat or conscious sedation. A Gastroscopy lasts approximately 5 minutes. Following the test you will be moved to the recovery area for a rest before being discharged home. You will be given the results of the Gastroscopy before leaving the unit barring any biopsy results. Page 7
Gastroscopy with Throat Spray Prior to the Gastroscopy you will be given a throat spray to numb the back of your throat. This reduces the sensation of the scope in your mouth and throat and helps to reduce gagging. The endoscopist and nurses will explain things to you during the test. You will be able to breathe and swallow normally but it will feel strange. You will be able to leave the department when your discharge information is ready (approximately 20 minutes, this may be longer depending on how many people need discharging at a similar time). You should not eat and drink for 90 minutes following throat spray administration to allow the numbness to wear off. You may experience a sore throat following the Gastroscopy and some bloating but this will soon settle. You do not need an escort with you if you have throat spray but you may wish to have someone accompany you on the day Page 8
Gastroscopy with Sedation You will need a cannula (small plastic tube) in your hand or arm through which a mild sedation is given. This should relax you but will not put you to sleep, it is not a general anaesthetic nor will it numb the throat like the throat spray. You will be awake and aware during the procedure with sedation. Sedation may cause loss of memory and judgement for 24 hours after the test. You must not: 1. Drive 2. Drink alcohol 3. Operate machinery 4. Sign legal documents If your job involves any of the above you will need to take the day off work following the sedation. You will be able to breathe and swallow normally during the Gastroscopy. After the Gastroscopy you will have a rest for about half an hour and will then be offered a drink and biscuits. After about an hour you will be discharged with your Gastroscopy results. You may experience a sore throat and some bloating following the test but this will soon settle. You will need a responsible adult to accompany you from the unit because of the effects of the sedation and remain with you for the rest of the day and overnight following sedation. Page 9
Instructions for Patients with Diabetes Patients on Hypoglycaemic Tablets Do not take your tablets on the morning of the Gastroscopy, but take them with some food after the test. Patients on Insulin Morning appointment - Do not take your usual dose of insulin if the Gastroscopy is in the morning. Bring your insulin with you (along with some food) so that you can take it following the test, after checking your blood sugar, when diet and fluids can be commenced. Afternoon appointment - Take a reduced dose of insulin (reduce dose by 25-50%) at breakfast time together with a glucose drink. Test your blood glucose 2-4 hourly to check for hypoglycaemia. Bring your insulin with you (along with some food) so that you can take it following the procedure after checking your blood sugar when diet and fluids can be commenced. Patients on GLP-1 agonist therapy (exenatide, liraglutide) with hypoglycaemic tablets or insulin should omit the morning dose of exenatide or liraglutide. Patients should postpone their once weekly Bydureon injection until after the procedure if it is due that day. Blood glucose testing should be done 2-4 hourly in order to prevent hypoglycaemia. You can take 10-20g of carbohydrate in sugary drinks if your blood sugar falls to around 5 mmol/l or less, or if you are experiencing symptoms of hypoglycaemia. Page 10
Sugary drinks include: Glucose drinks - 55mls contains 10g of carbohydrate. Fizzy lemonade - 100mls contains 10g of carbohydrate. If you have any queries contact the Diabetic Liaison Nurses for advice. Page 11
Frequently asked questions - Gastroscopy How long does the procedure take? A gastroscopy usually lasts between 3 and 10 minutes. You will be in the department for between 1 and 3 hours Does it hurt? The test is uncomfortable but should not hurt. A numbing throat spray or sedation is available to make the test more comfortable. Do I have to have it done? No the choice is yours, see page 3 for alternatives and the reason why this test is appropriate. Can I take my tablets as normal? Yes. Please take medications with a small amount of water at you usual time. Diabetic patients please read page 6 for diabetic medication instructions. Will I be put to sleep for this procedure? No. A relaxing sedative is offered if your circumstances permit but you will be aware of the procedure. Do I need to change for the procedure? No. Please wear comfortable clothing. You will be wearing the clothes you arrive in for the procedure. If you need advise following your procedure please contact: The Gastroenterology Unit between 7.45 am to 6.00 pm weekdays on Tel: 01253 953043 or out of hours ward 12 on 01253 953412 Page 12
Your consent form will fold out from the next page Please read page 3 regarding completion of your consent form. Page 13
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Useful contact details Gastroenterology Unit between 7.45 am to 6.00 pm weekdays Tel: 01253 953043 Out of hours Ward 12 01253 953412 If you d like a large print, audio, Braille or a translated version of this booklet then please call 01253 655588 Patient Relations Department The Patient Relations Department offer impartial advice and deal with any concerns or complaints the Trust receives. You can contact them via: Tel: 01253 655588 email: patient.relations@bfwh.nhs.uk You can also write to us at: Patient Relations Department Blackpool Victoria Hospital Whinney Heys Road Blackpool FY3 8NR Further information is available on our website: www.bfwh.nhs.uk References This leaflet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. Details of the references used in writing this leaflet are available on request from: Procedural Document and Leaflet Coordinator 01253 953397 Approved by: Clinical Improvment Committee Date of Publication: 20/04/2015 Reference No: PL/018 V4 Author: Wanda Yorke Review Date: 01/04/2018 Page 16
File in Section 3 Use black biro to complete form. Patient agreement to investigation or treatment CONSENT FORM 1 Write patient details or affix Identification label Hospital Number: Name: Address: STAFF USE ONLY Name of proposed procedure or course of treatment Gastroscopy an examination of your upper gastro-intestinal tract with or without biopsy and photography. Biopsy specimens will be retained as per national guidelines. The intended benefits To view and diagnose your upper gastro-intestinal tract. Date of Birth: NHS Number: All patients about to undergo any elective or emergency surgical or endoscopic procedure likely to involve contact with tissues of medium or low level infectivity should be asked the question:- Have you ever been notified that you are at increased risk of Creutzfeldt-Jakob disease (CJD) or variant Creutzfeldt-Jakob disease (vcjd) for public health purposes? If the patient s response is No, proceed using normal infection prevention measures. If the answer is Yes, please ask the patient to explain further and consult the Infection Prevention Team for advice. If the procedure is likely to involve contact with tissues of potentially high level infectivity (Brain, spinal cord, implanted dura mater grafts prior to 1992, cranial nerves and ganglia, pituitary gland and posterior eye (specifically: posterior hyaloid face, retina, retinal pigment epithelium, choroid, sub retinal fluid and optic nerve) the following questions should be asked:- 1. Have you a history of CJD or other prion disease in your family? 2. Have you ever received growth hormone or gonadotrophin treatment? 3. Have you ever had surgery on your brain or spinal cord? If the answer to any of these questions is Yes, please discuss with the consultant in charge of the case and consult the Infection Prevention Team for advice. Significant, unavoidable or frequently occurring risks Sometimes a sore throat. Rarely, dental damage, a chest infection, even more rarely (about 1 in 2000) bleeding or perforation may occur in certain cases hospital admission and/or an operation may be necessary to treat these complications. Rarely sedation may cause nausea and vomiting, prolonged sedation or over sedation which can reduce your breathing effort. Very rarely if a complication occurs a blood transfusion may become necessary. I would like to have: local anaesthetic throat spray or Sedation (Please tick box) (eg other language/other communication method) Approved by the Health Records Committee 10/03/2015 STAFF USE ONLY Statement of interpreter (where appropriate) I have interpreted the information above to the patient to the best of my ability and in a way in which I believe s/he can understand. Signed... Date... Name (PRINT)... Bottom copy accepted by patient: yes / no (please ring) Patients Notes
Statement of patient Please read this form carefully. The attached patient copy is for you to keep. You have the right to change your mind at any time, including after you have signed this form. I agree to the procedure or course of treatment described on this form. I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience. Where a trainee performs this examination, this will be undertaken under supervision by a fully qualified practitioner. I understand that any procedure in addition to those described on this form will only be carried out if it is necessary to save my life or to prevent serious harm to my health. I have been told about additional procedures which may become necessary during my treatment. I have listed below any procedures which I do not wish to be carried out without further discussion....... If you would like to ask further questions please do not sign the form now. Bring it with you and you can sign it after you have talked to the healthcare professional. Patient s signature... Date... Name (PRINT)... A witness should sign below if the patient is unable to sign but has indicated his or her consent. Young people/children may also like a parent to sign here (see notes). Signed... Date... Name(PRINT)... Confirmation of consent (to be completed by a health professional when the patient is admitted for the procedure, if the patient has signed the form in advance). On behalf of the team treating the patient, I have confirmed with the patient that s/he has no further questions and wishes the procedure to go ahead. Signed... Date... Name(PRINT)... Job title... Important notes: (tick if applicable) See also advance directive/living will (eg Jehovah s Witness form) Patient has withdrawn consent (ask patient to sign/date here... VS 764 (R10) 05.13