Gastroscopy

What is an OGD?

The procedure you will be having is called an oesophagogastroduodenoscopy (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 doctor 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. A video recording and/or photographs may be taken for your records.

The procedure will be performed by or under the supervision of a trained doctor or nurse 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 a 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 investigations.

There are many reasons for this investigation including: indigestion; anaemia; weight loss; vomiting; passing black motions, vomiting blood or difficulty swallowing.

A barium meal x-ray examination is an alternative investigation. It is not as informative as an endoscopy and has the added disadvantage that tissue samples cannot be taken.

Eating and drinking

It is necessary to have clear views and for this the stomach must be empty. Therefore do not have anything to eat for at least six hours before the test. Small amounts of water are safe up to two hours before the test.

If your appointment is in the morning have nothing to eat after midnight.

If your appointment is in the afternoon you may have a light breakfast no later than 8am and small amounts of water until two hours before your appointment.

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, if possible, please discontinue them 2 weeks before your investigation.

If you are having a follow up OGD to check for healing of an ulcer found during the last 2-3 months or for an inflamed gullet or Barrett’s Oesophagus, then please continue your acid reducing medications right up to the day before your repeat endoscopy. If unsure please telephone the unit.

Diabetics

If you are a diabetic controlled on insulin or medication please ensure the Endoscopy Department is aware so that the appointment can be made at the beginning of the list.

Please see guidelines printed in the back of the book.

Anticoagulants

Please telephone the unit if you are taking blood-thinning medication such as warfarin, clopidogrel (Plavix), Rivaroxaban, Apixaban or Dabigatran. Please bring a copy of your prescription.

How long will I be in the endoscopy department?

This largely depends upon how busy the department is. You should expect to be in the department for approximately for the whole of the morning or afternoon depending on your appointment time. The department also looks after emergencies and those can take priority over the outpatient list. We suggest you bring a book or a magazine.

What happens when I arrive?

When you arrive in the department you will be met by a qualified nurse 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 or local anaesthetic throat spray (this is dealt with in more detail in the next section of this booklet).

If you have sedation, the nurse may insert a small cannula (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 she can contact them when you are ready for discharge.

You will have a brief medical assessment when a qualified endoscopy nurse will ask you some questions regarding your medical condition and any surgery or illnesses you have had in the past to confirm that you are sufficiently fit to undergo the investigation.

Your blood pressure and heart rate will be recorded and if you are diabetic, your blood glucose level will also be recorded. Should you suffer from breathing problems a recording of your oxygen levels will be taken.

If you are happy to proceed, you will be asked to sign your consent form at this point.

Sedation or throat spray?

Intravenous sedation

Please note that as you will be having 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. We recommend someone responsible stays with you overnight after the procedure.

Anaesthetic throat spray

The throat can numbed with a local anaesthetic spray.

As the gastroscopes have become thinner 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 about an 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 investigation

In turn you will be escorted into the procedure room where the endoscopist and the nurses will introduce themselves and you will have the opportunity to ask any final questions.

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, 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 benefits of having the procedure carried out.

The risks can be associated with the procedure itself and with the administration of the sedation.

The endoscopic examination

The main risks are of mechanical damage to teeth or bridgework; perforation or tear of the linings of the stomach or oesophagus which could entail you being admitted to hospital. Certain cases may be treated with antibiotics and intravenous fluids. Perforation may require surgery to repair the hole.

Bleeding may occur at the site of biopsy and nearly always stops on its own.

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 breathing difficulties due to a bad chest may not be suitable for sedation due to increased risks.

After the procedure

You will be moved to our recovery area where your blood pressure and heart rate will be recorded and if you are diabetic, your blood glucose will be monitored. Should you have underlying breathing difficulties or if your oxygen levels were low during the procedure, we will continue to monitor your breathing. Once you have recovered from the initial effects of the sedation (which can take up to 60 minutes) you will be offered a drink and moved to a seated area.

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 friend with you when you are given this information although there will be a short written report/discharge letter 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, try and arrange for someone to stay with you, or if possible, arrange to stay with your family or a friend for at least 4 hours.

If the person collecting you leaves the department, the nursing staff will telephone them when you are ready for discharge.

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. The time on your appointment letter is your arrival time and not the time of your test as some preparation is required before the procedure. However, the department is very busy and your investigation may be delayed.If emergencies occur, these patients will obviously 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, chest or abdominal pain or bleeding please leave a message on the Endoscopy Helpline for advice after the procedure. Contact details will be on your discharge letter.

Advice for people with diabetes

Inform the endoscopy department that you have diabetes so the appointment can be arranged where possible for the beginning of the list.

You need to avoid all solid food for 6 hours before the examination. You can sip water up to 2 hours before the test.
It may be necessary to modify normal diabetic treatment so that fasting can be tolerated. This may result in erratic blood sugar levels for a short period but diabetic control should return to normal within 1–2 days.

Remember to monitor blood glucose levels four hourly if you are on insulin (bring your meter with you). If your blood glucose level falls below 4mmol/L inform a member of staff in the Endoscopy Unit. Take 4-5 glucose tablets or 150mls of a glucose drink e.g. glucojuice if you have these with you and ensure you re-check after 10 minutes.
For people with Type 1 diabetes on pump therapy, discuss with a member of the diabetes team.

Morning Appointments

Diabetes treated with tablets

  • Take tablets as normal on the morning of the day before the procedure. After this, omit all diabetes tablets and only restart at lunchtime after the test.

Diabetes treated with GLP-1 injections

If your diabetes is treated with GLP-1 injections e.g. (Exenetide (Byetta), Liraglutide (Victoza), Lixisenatide (Lyxumia) or Dulaglutide (Trulicity)

  • Omit on the day of the procedure
  • Resume once you are eating normally again

Diabetes treated with insulin

For once daily insulin e.g. Lantus (Glargine), Abasaglar, Levermir (Determir), Tresiba (Degludec), Toujeo, Insuman Basal, Insulatard or Humulin I

  • No dose change is required.

For twice daily long acting or intermediate acting

  • Take half of your normal dose in the morning
  • Take the normal dose after the test when it is next due once you resume your normal diet

For twice daily mixed insulin e.g. Humulin M3, Humalog Mix 25, Humalog Mix 50, Novomix 30, Insuman Comb 15, Insuman Comb 25, Insuman Comb 50

  • Take half of the normal dose in the morning
  • Resume your regular dose in the evening once you are eating normally

For four or more injections a day

  • Omit the quick acting insulin (Novorapid, Humalog, Apidra, Humalog U200, Humulin S, Actrapid or Fiasp) whilst you are not eating and drinking
  • Take the same long acting insulin in the morning if it is due
  • Inform the nurse of any symptoms of hypoglycaemia. Give morning dose of insulin as soon as you are able to eat and drink safely after the procedure followed by breakfast (bring your insulin and food with you).

Afternoon Appointments

Diabetes treated with tablets

Do not take your diabetes tablets on the day of the test. Take your next dose of tablets when you are allowed to eat again.
If your diabetes is treated with a combination of insulin and tablets, follow the advice for tablets as before and insulin as outlined below.

Diabetes treated with GLP-1 injections

If your diabetes is treated with GLP-1 injections e.g. (Exenetide (Byetta), Liraglutide (Victoza), Lixisenatide (Lyxumia) or Dulaglutide (Trulicity)

  • Omit on the day of the procedure
  • Resume once you are eating normally again

Diabetes treated with insulin

For once daily insulin e.g. Lantus (Glargine), Abasaglar, Levermir (Determir), Tresiba (Degludec), Toujeo, Insuman Basal, Insulatard or Humulin I

  • No dose change is required

For twice daily long acting or intermediate acting

  • Take half of your normal dose in the morning
  • Take the normal dose after the test when it is next due, once you resume your normal diet

For twice daily mixed insulin e.g. Humulin M3, Humalog Mix 25, Humalog Mix 50, Novomix 30, Insuman Comb 15, Insuman Comb 25, Insuman Comb 50

  • Take half of the normal dose in the morning
  • Resume your regular dose in the evening once you are eating normally

For four or more injections a day

  • Omit the quick acting insulin at lunchtime (Novorapid, Humalog, Apidra, Humalog U200, Humulin S, Actrapid or Fiasp) but take the breakfast dose as normal
  • Take the same long acting insulin in the morning if it is due

If you have any concerns about adjusting your dosage please contact the Diabetes Nursing Team well in advance of the appointment, to discuss appropriate measures.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

0117 414 5040

© North Bristol NHS Trust. This edition published January 2020. Review due January 2022. NBT002230

Gastroscopy