Important information

Please read all of this leaflet or you may miss important information about your test. If you do not follow the instructions we may need to cancel your test on the day.

What is a Oesophago-Gastro-Duodenoscopy (OGD)?

An OGD looks at your oesophagus (gullet), stomach, and the first part of the small intestines (duodenum). It uses a long flexible telescope (endoscope) with a light and camera on the end.

It is done by a consultant or non-medical clinical endoscopist. The endoscope is passed through the mouth, into the oesophagus, and to the duodenum. Many patients just have local anaesthetic throat spray, but some prefer to have a light sedative. It is not a general anaesthetic. 

You will need to arrange for someone to collect you from the unit and stay with you for at least 6 hours.

Trans-Nasal Endoscopy (TNE)

Some patients can have a Trans-Nasal Endoscopy (TNE) where the scope is passed through the nose instead of the mouth. It is usually more comfortable and you can talk during the procedure.

Please ask if you are interested. It may not always be possible.

How long will the OGD procedure take?

OGD usually takes between 5 to 10 minutes. In some cases this may be longer, but this does not mean anything is wrong. You should expect to be in the department 2 to 4 hours. Unfortunately, it may not always be possible to run to time. The staff will try to keep you informed.

Why do I need to have an OGD?

To help your doctor find the cause of your symptoms by looking directly at the lining of the oesophagus, stomach, and duodenum. Your symptoms may include indigestion, reflux, difficulty swallowing, anaemia, vomiting, weight loss, or blood loss.

Finding the cause for your symptoms helps us treat you, and if necessary, decide on further tests. 

You may have a gastroscopy as part of ongoing surveillance for Barrett’s or ulcers. During this test the endoscopist may take a biopsy (small sample of tissue) for testing. The sample is removed through the endoscope using tiny forceps and does not hurt.

What are the benefits to this procedure?

To help diagnose and/or treat your condition. It may also help your doctor decide if any further investigations are required.

What if I do not have the OGD or change my mind?

It may be difficult to diagnose your condition or offer suitable treatment. You may find it helpful to discuss the test with your family, friends, and/or GP. If you decide not to go ahead, please let us know.

Can I seek a second opinion?

Yes, please seek advice from your GP or referring consultant.

Is there an alternative to an OGD?

X-rays and CT scans are useful but can miss some diagnoses. OGD directly looks at the lining of your oesophagus, stomach, and duodenum. Biopsies can be taken, and in some cases, treatment can be provided.

What are the risks?

Bleeding: may occur at the site of biopsy or polyp removal (risk of less than 1 in 1000 examinations where this is performed). This usually isn’t too serious and bleeding may stop on its own. If it does not, it can be controlled by cauterization or injection treatment.

Perforation: (or tear in the oesophagus) the risk is about 1 in every 15,000. 

Reaction to medication: if you choose to have sedation, this may cause a problem with breathing, heart rate, or blood pressure. You will be monitored during the procedure to look out for this. Medication to reverse the sedation is available and we will support you as needed.

Missed diagnoses: there is a very small risk that the OGD misses an abnormality due to small folds in the lining of the digestive tract. In these areas the views may be less clear.

Pain: most people can cope well with this procedure. It is common to experience discomfort for a short time, however, a small number of patients may have some pain.

Failure to complete the procedure: your comfort and safety are our priority, we will stop at any time if we cannot ensure this, or if there is a problem with equipment (this is rarer).

How do I prepare for my OGD?

Your stomach needs to be empty for the examination to be safe.

On the day of your test, you must not eat any food for 6 hours before your appointment time. 

You can continue to drink clear liquids until 2 hours before your appointment time.

You should wear loose, comfortable clothing, as you may feel slightly bloated with air following your procedure.

If you have a heavy cold, sore throat, or chest infection, you may need to postpone your OGD until you feel better. Please contact the endoscopy department for advice.

If you prefer to have sedation, please make sure a responsible adult is available to collect you from the department and stay with you for at least 6 hours. Make sure you bring their contact details so we can let them know you are ready to be collected.

What about my medication?

You should take all your usual medication at the normal times with small sips of water unless you have been advised not to. Some medications need to be stopped or adjusted 1 to 2 weeks before your appointment. Please notify the department as soon as possible if you:

• have diabetes
• take medication to thin your blood/prevent clotting like warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel
• take long term steroids
• take iron tablets
• take weight loss injections

Why have I been asked if I have a pacemaker/internal cardiac defibrillator?

Implanted permanent pacemakers or cardiac defibrillators latest device checks will be reviewed before your appointment. Please notify the department if you have one.

Do I need to bring anything with me?

• A list of your medications and any you may need to take while you are in the department, such as insulin, inhalers, or GTN spray.
• You are advised not to bring valuables with you. Your belongings will stay with you throughout your stay.

What happens when I arrive?

Please speak to the receptionist. They will check your details and may ask you to complete a form with details of your medical history, and contact details of your next of kin and the person collecting you.

We ask your family and friends not to come with you beyond this point. The department can be very busy and space is limited. We will tell them the approximate time that you will be ready. The recovery staff will call them with a time they can collect you.

The nurse will take you to an admission room to complete the paperwork, check your blood pressure, pulse, and oxygen levels to make sure you are well enough to have the procedure. If you have diabetes the nurse may also test your blood glucose level.

If you decide to have sedation, a cannula (flexible needle) will be inserted into a vein in the back of your hand or arm so that the intravenous sedation can be given. 

The nurse will discuss the risks and benefits of having the procedure to make sure you understand what the procedure involves. You will be asked to sign the consent form. You will be able to ask questions at this point.

Will I have sedation?

OGD can be slightly uncomfortable but not painful. Many patients do not require sedation as a local anaesthetic is sprayed to make the back of your throat numb. This makes it easier for the endoscope to pass down. This also means you can leave the unit shortly after the examination and carry on as normal.

If you choose to have sedation, a cannula will be inserted in a vein in the back of your hand or arm. The sedation will make you drowsy but not unconscious. You will still hear what is being said to you. It is not a general anaesthetic. You will need to arrange for someone to collect you from the unit and stay with you for at least 6 hours. 

Your reaction times will be slower and your judgement affected so you will not be able to drive, operate heavy machinery, sign any legally binding documents, or look after small children or vulnerable adults for 24 hours.

OGD with throat spray

If you have the procedure with throat spray alone, you may leave the department once the discharge paperwork has been handed over to you. There are no restrictions apart from not eating or drinking for 1 hour after having the throat spray. 

Once 1 hour has passed you are able to test your swallowing with sips of water at room temperature, after which you are able to eat and drink as normal. You will be awake during the procedure.

Can my relative/friend stay with me?

There is limited space within the department so unfortunately this is not possible. We will advise them of an approximate time for you to be collected. 

Will I be in a mixed ward?

There are separate male/female waiting and recovery areas.

Who will be in the procedure room with me?

• A nurse who will monitor and support you.
• The endoscopist who will do the procedure.
• Another nurse who will assist the endoscopist.

The procedure will be done by a consultant or a non-medical/ clinical endoscopist. In some cases, an endoscopist who is doing further training (a qualified professional) may also be there. They will be learning to perform endoscopy under direct, expert supervision.

If you would prefer not to have your OGD done by someone training, you can tell us before coming into the procedure room.

Student nurses may also be there and be supervised by the training nursing staff.

What can I expect during the procedure?

When you enter the room, you will be introduced to the team. A checklist will be completed and you will be asked to confirm your details. This is standard procedure to ensure your safety.

You will be made comfortable on a trolley and any monitoring equipment attached. The nurse looking after you will be at your head throughout.

The endoscopist will spray the back of your throat. You will lie on your left-hand side and a mouth guard be placed between your teeth. The nurse looking after you will be at your head throughout.

If you are having sedation this will be given through the cannula in the back of your hand or arm. Once you are relaxed the procedure will begin.

When the endoscopist passes the endoscope over the back of your tongue, or through your nose, it is important to stay calm. It may make you gag, but this feeling will go away. It should not cause you any pain or stop you being able to breathe through your nose and mouth. The nurse will suction/wipe any secretions away to keep your airway clear.

As the endoscope slides down the oesophagus into the stomach. Air will be passed through to ensure a clear view of the lining. This may make you feel bloated, but it will pass. 

You may feel a bit of pressure as the endoscopist passes the endoscope through the stomach. This should not be painful. 

The duodenum will be checked and then the endoscopist begins to remove the endoscope. They take photographs and possibly biopsies for analysis on the way back, this is painless.

Is OGD painful?

It is normal to feel some discomfort during the procedure due to air being introduced into the stomach. You may have a sore throat afterwards, but this will pass. 

What happens after the procedure?

If you have had throat spray only, you will be discharged shortly after the procedure with your discharge paperwork saying the time you can drink/eat from.

If you have had sedation, you will be taken into the recovery area for monitoring. When you have recovered from the initial effects of the sedation the staff will contact your relative/friend to tell them when you will be ready to go home. 

You will be given written discharge advice and your cannula will be removed.

When do I find out the results?

Before you leave the department the results of will be explained to you together with any further tests that may be required.

Biopsies usually take at least 4 weeks to be processed, sometimes longer. You will be told the results by letter or at an outpatient appointment.

How will I feel after the OGD?

Your throat may feel a bit sore. It will settle without treatment, but simple pain medication like paracetamol may help.

You may feel bloated due to air still in your stomach but this should soon settle.

What should I do when I get home?

If you have had throat spray you can return to your normal day as soon as you feel able. 

If you have had sedation, rest quietly for the rest of the day. You will be able to return to normal activities after 24 hours. 
You will be given detailed discharge advice before you leave the unit.

What if I feel unwell or have any concerns after I have been discharged?

If you have any of the following please contact your GP, NHS 111, or go to the Emergency Department and take your results with you:

• a fever
• passing a lot of blood from your bottom or black stools (poo)
• severe abdominal (tummy) pain 
• severe bloating or vomiting

A copy of your results is sent to your GP. You will also be given a copy in case you need to seek medical advice before your GP receives their copy.

If you have any concerns about your test please contact the  helpline. Leave your name, number and a short message: 0117 414 5077.

Date published: 25 March 2026 Review due: 31 March 2029 PI number: BFT002823

Important information

Please read all of this leaflet or you may miss important information about your test. If you do not follow the instructions we may need to cancel your test on the day.

What is an enteroscopy from above?

An enteroscopy is a way of looking at the lining of your small bowel. The endoscope is passed through the mouth, into the oesophagus, and to the duodenum (small bowel). It is normally done with sedation - you won’t be fully unconcious. The consultant will also spray your throat with a local anaesthetic to numb your throat.

Please make sure a responsible adult is available to collect you from the department and stay with you for at least 6 hours. Make sure you bring their contact details so we can let them know you are ready to be collected.

How long will the enteroscopy take?

An enteroscopy takes around 30 to 45 minutes. In some cases this maybe longer, but this does not mean anything is wrong. should expect to be in the department 2 to 4 hours.Unfortunately, it may not always be possible to run to time. The staff will try to keep you informed.

Why do I need to have an enteroscopy?

To help your doctor find the cause of your symptoms, or to follow-up from a previous examination like an X-ray, scan, or pill camera test. It does this by looking directly at the lining of your small bowel. 

Finding the cause of your symptoms helps us treat you, and if necessary, decide on further tests. During this test we may take a biopsy (small sample of tissue) for testing. The tissue is removed through the endoscope using tiny forceps and does not hurt.

What are the benefits to this procedure?

To help diagnose and/or treat your condition. It may also help your doctor decide if any further investigations are required.

What if I do not have the enteroscopy or change my mind?

It may be difficult to diagnose your condition or offer suitable treatment. You may find it helpful to discuss the test with your family, friends, and/or GP. If you decide not to go ahead, please let us know.

Can I seek a second opinion?

Yes, please seek advice from your GP or referring consultant.

Is there an alternative to an enteroscopy?

Other tests like MRI and CT scans are useful but you cannot take samples during them.

What are the risks?

Bleeding: (1 in 100-200) there is a small risk of bleeding due to damage from the endoscope or when biopsies are taken. This is usually minor and stops without treatment. If it does not, be controlled by cauterization or injection treatment.

Aspiration: there is a small risk of inhaling secretions (dribble) into your lungs. To reduce this risk you must follow the instructions about fasting to make sure your stomach is empty. Staff looking after you will help protect your airway by suctioning secretions.

Reaction to medication: sedation may cause a problem with breathing, heart rate, or blood pressure. You will be monitored during the procedure to look out for this. Medication to reverse the sedation is available and we will support you as needed.

Perforation: (or tear in the oesophagus, stomach, small bowel) the risk is about 1 in every 1000. This would mean you need to stay in hospital and may need an emergency operation.

Pancreatitis: inflammation of the pancreas (less than 1 in 100).

Missed diagnoses: there is a very small risk that the endoscopy misses any abnormalities. This is because the folds in the lining of the digestive tract makes the view less clear.

Failure to complete the procedure: your comfort and safety are our priority, we will stop at any time if we cannot ensure this, or if there is a problem with equipment (this is rarer).

Dental damage: a small risk of damage to any crowned teeth or dental bridge work. A nurse will hold a mouth guard in place during the procedure to reduce this risk.

How do I prepare for my enteroscopy?

Your stomach needs to be empty for the examination to be safe.

On the day of your test, you must not eat any food for 6 hours before your appointment time. 

You can continue to drink clear liquids until 3 hours before your appointment time.

You should wear loose, comfortable clothing, as you may feel slightly bloated with air following your procedure.

If you have a heavy cold, sore throat, or chest infection, you may need to postpone your enteroscopy until you feel better. Please contact the endoscopy department for advice. 

What about my medication?

You should take all your usual medication at the normal times with small sips of water unless you have been advised not to. Some medications need to be stopped or adjusted 1-2 weeks before your appointment.

 Please notify the department as soon as possible if you:

• have diabetes
• take medication to thin your blood/prevent clotting like warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel
• take long term steroids
• take iron tablets
• take weight loss injections

Why have I been asked if I have a pacemaker/internal cardiac defibrillator?

Implanted permanent pacemakers or cardiac defibrillators latest device checks will be reviewed before your appointment. Please notify the department if you have one.

Do I need to bring anything with me?

• A list of your medications and any you may need to take while you are in the department, such as insulin, inhalers, or GTN spray.
• You are advised not to bring valuables with you. Your belongings will stay with you throughout your stay.
• You do not need to undress for your test but should wear loose, comfortable clothing.

What happens when I arrive?

Please speak to the receptionist. They will check your details and may ask you to complete a form with details of your medical history, and contact details of your next of kin and the person collecting you.

We ask your family and friends not to come with you you beyond this point. The department can be very busy and space is limited. We will tell them the approximate time that you will be ready. The recovery staff will call them with a time they can collect you.

The nurse will take you to an admission room to complete the paperwork, check your blood pressure, pulse, and oxygen levels to make sure you are well enough to have the procedure. If you have diabetes the nurse may also test your blood glucose level.

A cannula (flexible needle) will be inserted into a vein in the back of your hand or arm so that the intravenous sedation can be given.

The consultant will discuss the risks and benefits of having the procedure to make sure you understand what the procedure involves. You will be asked to sign the consent form. You will be able to ask questions at this point.

Will I have sedation?

The procedure is routinely carried out under sedation. A local anaesthetic is sprayed onto the back of your throat, which makes it easier for the endoscope to pass down. The sedation  will make you drowsy but not unconscious. You will still hear what is being said to you. You need to arrange for someone to collect you from the unit and stay with you for at least 8 hours. 

Your reaction times will be slower and your judgement affected so you will not be able to drive, operate heavy machinery, sign any legally binding documents, or look after small children or vulnerable adults for 24 hours.

Can my relative/friend stay with me?

There is limited space within the department so unfortunately this is not possible. We will advise them of an approximate time for you to be collected.

Will I be in a mixed ward?

There are separate male/female waiting and recovery areas.

Who will be in the procedure room with me?

• A nurse who will monitor and support you.
• The consultant/endoscopist who will do the procedure.
• Another nurse who will assist the endoscopist.

The procedure will be done by a consultant or a non-medical/ clinical endoscopist. In some cases, an endoscopist who is doing further training (a qualified professional) may also be there. They will be learning to perform endoscopy under direct, expert supervision.

If you would prefer not to have your enteroscopy done by someone training, you can tell us before coming into the procedure room. 

Student nurses may also be there and be supervised by the training nursing staff.

What can I expect during the procedure?

When you enter the room, you will be introduced to the team. A checklist will be completed and you will be asked to confirm your details. This is standard procedure to ensure your safety.

You will be made comfortable on a trolley and any monitoring equipment attached. The nurse looking after you will be at your head throughout.

The consultant will spray the back of your throat. You will lie on your left-hand side and a mouth guard be placed between your teeth. We will ask you to remove any dentures or plates. The nurse looking after you will be at your head throughout.

The sedation will be given through the cannula in the back of your hand or arm. Once you are relaxed the procedure will begin.

When the consultant passes the endoscope over the back of your tongue, or through your nose, it is important to stay calm.

Is enteroscopy painful?

It is normal to feel some discomfort during the procedure due to air being introduced into the stomach. You may have a sore throat afterwards, but this will pass.

What happens after the procedure?

You will be taken into the recovery area for monitoring. When you have recovered from the initial effects of the sedation the staff will contact your relative/friend to tell them when you will be ready to go home. Once the throat spray has worn off you will be offered refreshments and your cannula will be removed.

When do I find out the results?

Before you leave the department the results of will be explained to you together with any further tests that may be required.

Biopsies usually take at least 2 weeks to be processed, sometimes longer. You will be told the results by letter or at an outpatient appointment.

How will I feel after the enteroscopy?

Your throat may feel a bit sore. It will settle without treatment, but simple pain medication like paracetamol may help.

You may feel bloated due to air still in your stomach but this should soon settle.

What should I do when I get home?

Rest quietly for the rest of the day. You will be able to return to normal activities after 24 hours. You will be given detailed discharge advice before you leave the unit.

What if I feel unwell or have any concerns after I have been discharged?

If you have any of the following please contact your GP, NHS 111, or go to the Emergency Department and take your results with you:

• a fever
• passing a lot of blood from your bottom or black stools (poo)
• severe abdominal pain
• severe bloating or vomiting

A copy of your results is sent to your GP. You will also be given a copy in case you need to seek medical advice before your GP receives their copy.

If you have any concerns about your test please contact the  helpline. Leave your name, number and a short message: 0117 414 5077.

Date published: 25 March 2026 Review due: 31 March 2029 PI number: BFT002823

From writing your initial proposal to statistical requests and patient & public involvement, here you will find all the documents, forms and standard operating procedures you will need to develop and set up your research idea at North Bristol NHS Trust.

Our Standard Operating Procedures (SOPs) should be used by Chief and Principal Investigators, Research Nurses and all other research personnel. They provide detailed guidance on all aspects of research study management from design through to completion.

If you are an NBT staff member, the current research SOPs should first be accessed via our Managed Learning Environment (MLE) in accordance with the Research Staff Training SOP. This will provide you with an electronic training record to evidence that you have read each SOP.

It is the responsibility of all staff who carry out research to ensure you are using the latest SOP.

Some of the documents are available online below. If you would like a document that is not available online, please contact:  research@nbt.nhs.uk.

Policies & Guidance

Standard Operating Procedures

Templates

Research Ethics

Why do I need another scan?

An ultrasound scan is the best way of finding out whether your pregnancy is developing normally, or whether there is a problem. Sometimes we are not able to get all the information that we need from one scan, so you may need to have another scan a week or two later.

What will the second scan show?

For some, the pregnancy will be developing normally. You will be asked to contact your midwife for ongoing care. 

For others, the second scan will diagnose a miscarriage. 

We understand that waiting for the second scan can be distressing. National guidance recommends two scans, sometimes one week apart. This is to confirm that there is no development of the pregnancy.

What happens whilst I am waiting?

If you feel well, you can continue your normal day to day activities. 

If you develop vaginal bleeding or period type cramping, then we recommend that you seek advice with the Early Pregnancy Clinic. Outside working hours, please contact the Cotswold ward. This ward has nurses with experience giving advice about early pregnancy. Please contact us if you have any concerns.

If you have period type cramping you can take paracetamol if needed. You should avoid ibuprofen as this is not recommended in pregnancy.

Are there any symptoms I should report straight away?

If you have any of the following contact the Early Pregnancy Clinic or Gynaecology (Ward 78) at St Michael’s Hospital.

• vaginal bleeding soaking a pad every hour for more than four hours
• passing large blood clots (bigger than a golf ball)
• feeling unwell, dizzy, or faint
• a high temperature
• smelly vaginal discharge

You can find further information on miscarriage and sources of support available in our leaflet on miscarriage. Please request a copy of this from the nurse or doctor in clinic or on the ward. You could also visit Miscarriage UK - Because every loss matters

Early Pregnancy Clinic - 8:30am to 3:30pm

0117 414 6778

This is an answerphone and we aim to return calls within 24 hours. We are a Monday to Friday service and are not open on bank holidays.

Cotswold Ward - 24 hour number 

0117 414 6785/6/8

If you are unable to contact anyone and feel unwell, call 111

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT003853

This page explains what a vestibular schwannoma (VS) is and what it might mean for you. Your doctors and nurses can tell you more and answer your questions. At the end, there is information about groups that can help.

What is a VS?

A vestibular schwannoma, also called an acoustic neuroma, is a non-cancerous tumour. It grows on the balance nerve that
connects the inner ear to the brain. This nerve sits very close to the hearing nerve and to the facial nerve, which helps you move your face.
Because the tumour is benign, it does not spread to other parts of your brain or body.

What causes a VS?

The tumour starts in Schwann cells, which are cells that cover nerves and help them send messages. Most of the time, doctors do not know why the tumour appears. A very small number of people with a rare condition called NF2 can get tumours on both sides of the head.

Symptoms

A VS usually grows very slowly, so symptoms may take months or years to appear. Some people do not notice any symptoms at first.
As the tumour grows, it may press on nerves nearby. This can cause hearing loss, ringing in the ear, dizziness, or balance problems. If it grows more, it may cause numbness in the face, weakness in the face, pain around the ear, or trouble walking steadily.

Very large tumours can block the normal flow of fluid around the brain and cause something called hydrocephalus. This can lead to strong headaches, sickness, vision problems, nausea, memory troubles, wobbliness, or feeling extremely sleepy.

If you suddenly lose hearing in one ear or suddenly notice weakness on one side of your face, you should get urgent medical help from your doctor or go to an Emergency Department. Steroid medicine may help if it is given quickly.

Diagnosis and tests

A VS is sometimes first noticed after an unusual hearing test result. You may have more hearing tests to check how well you hear sounds and speech. Sometimes, a VS is found on a scan performed for a different reason altogether. 

Most VS tumours are found using an MRI scan. This scan is safe and does not hurt. If someone finds small spaces uncomfortable, they may have be offered a mild sedative. 

Some people cannot have an MRI because of metal in their body, such as a pacemaker. In that case, a CT scan can be used to make the diagnosis.

The care team (MDT)

Treatment options

Hearing loss

Tinnitus

Dizziness

Sudden changes

Driving

Follow-up and recovery

Further support

Date published: 30 June 2026 Review due: 30 June 2029 PI number: BFT003103

Introduction  

This information aims to answer some of the questions you may have about leech therapy. It explains the benefits, risks and alternatives of the procedure, as well as what to expect.  

If you have any questions or concerns, please do not hesitate to speak to one of the team caring for you.  

What are leeches and why are they used?  

Medicinal leeches are worms that suck and feed on blood. Their scientific name is Hirudo medicinalis and Hirudo verbana.  

They have been used in medicine since the dawn of civilization, and recently there has been an increase in using leeches in reconstructive surgery.  

Leeches help to improve blood circulation in congested flaps or other tissue (such as an amputated finger that has been re-attached).  

How do they work?  

They latch to the skin with their tiny sharp teeth and their saliva contains a number of chemicals to aid them to suck and feed on blood. These chemicals include a local anaesthetic (to reduce pain) and blood thinners.  

Am I going to feel pain?  

Leech bites are typically painless because they have a  local anaesthetic in their saliva.  

What are the benefits of leeches?  

In some cases where blood is congested and needs to be released release, leech therapy can help. 

Leeches can suck a large amount of blood relative to their body. Each leech can suck between 5 - 15 millilitres of blood in one feed. The bite mark can still bleed a little for up to 72 hours after the leech has detached, due to the blood thinners in the leech’s saliva which act only locally (on this area). This often resolves the problem with the circulation.  

Why was I chosen to be offered leech therapy?  

You have been offered leech therapy because we believe it would be the best treatment for your congested flap or other tissue.  

If there is not enough outflow of blood in this area and it is left untreated, it may lead to the flap or other tissue dying.  

What are the side effects and risks of leeches?  

• Leech therapy is often associated with bleeding and commonly transfusion of blood / blood products during or after treatment. We will do blood tests every day to see if you need a blood transfusion. Leech therapy will not be started unless you are comfortable with the possibility of blood transfusion. If you cannot or would not like to have blood transfusion, leech therapy will not be started.  
• Leeches contain bacteria that sometimes cause infection. You will be started on an oral antibiotic to prevent this. The leech site will be monitored daily by the nurses and doctors. If you are allergic to any of the antibiotics started, please tell your medical team and you will be offered an alternative antibiotic. 
• Rarely, people may develop an allergic reaction to leeches. Leeches will not be used on you if you have any history of allergic reactions to them.  
• Leech therapy may not be suitable if you have an immunodeficiency, bleeding disorders, heart problems, unless you and your consultant decide the benefits of using leeches outweighs the risks.  
• eeches can sometimes migrate into dressings. Nurses will be closely looking after your leeches when they are used.  
• It has been reported that some patients may have some psychological difficulties in dealing with leeches. If that is the case, our psychologists will be happy to offer their advice and help.  
• Leeches in our department are never used between patients and are disposed of humanely and safely. Transmission of blood borne diseases is not a risk.  

Is there an alternative?  

Usually, if your doctor has decided to use leech therapy, it means it is the last resort to save your congested flap. If you choose to do nothing, blood may clot and prevent blood flow to the flap. This may lead to some or all the tissue dying and the flap will need to be removed.  

How do I give my consent?  

If you agree to go ahead with leech therapy, you will be asked to sign a consent form.  

What happens next? 

• The nurse will clean the area and apply the leech. Sometimes the nurse will scratch the area to allow the leech to latch on.  
• We will closely monitor the leeches and the area to check its response to treatment. The number of leeches used and how often we use them depends on the response. 
• You will have daily blood tests. 
• After each feed, leeches are disposed of safely and according to trust policy.   

What do I need to do?  

You will be asked to stay in a position that allows the leech therapy to work.  

You will be asked to avoid eating or drinking any caffeine- containing food or drinks (such as tea; coffee or cola) and to avoid the use of nicotine-containing products (such as cigarettes or nicotine replacement therapy), during your hospital stay. 

What do I need to be aware of after the leech therapy finishes?  

There are no specific aftercare instructions. However, if you feel unwell (for example, if you have a fever, increased redness, or pain in the area) please let the team caring for you know.  

Contact us  

If you have any questions or concerns about leech therapy, please talk to your clinical team, including your plastic surgeon, plastic clinical nurse specialist, nursing team or pharmacy staff.  

You can also speak to the ward sister or nurse in charge of Ward 33A on 0117 414 3100.  

Feedback 

If you would like to give us any feedback on your care or treatment please see this page Feedback | North Bristol NHS Trust 

Further information 

• For online information about health visit nhs.uk 
• NHS 111 offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. 
• References available on request. 

© North Bristol NHS Trust. This edition published June 2026. Review due June 2029. NBT002763  

Azithromycin prophylaxis

Azithromycin is an antibiotic. It can be used for a few days to treat certain infections. 

Azithromycin can also be used for a long period (months) to help protect people with some types of lung disease. This leaflet is about long term use of azithromycin for people with lung disease. This is called azithromycin prophylaxis.

Why have I been prescribed long-term azithromycin (azithromycin prophylaxis)?

You have been prescribed long term azithromycin to prevent chest infections and to improve your chest symptoms. 

Azithromycin does not work for everyone with lung disease but it may help you in two ways:

1. it is an antibiotic and can kill some of the bugs (bacteria) that could cause chest infections
2. it can reduce inflammation in the airways so it can help to relieve cough, sputum production, and breathlessness

Azithromycin used in this way, is “off-label” and is different to what described in the patient information leaflet that comes with the medication. Using it like this is endorsed by the British Thoracic Society. It is important to take the medication as your Respiratory Consultant has advised.

What do I need to know before I take azithromycin?

Do not take this medication if you are allergic to azithromycin, any of its ingredients, or any other macraolide antibiotic such as erythromycin or clarithromycin.

To make sure azithromycin is the best choice for you your consultant/respiratory nurse specialist will:

1. ask you to provide phlegm samples, to check for non tuberculosis mycobacterium. If this bacteria is present, azithromycin cannot be used
2. check your heart’s rhythm using an electrocardiogram (ECG); this is also known as a heart tracing
3. take some blood tests and check your liver function before and one month after starting azithromycin

Azithromycin will not work if you are a current smoker. You should have stopped smoking completely before we prescribe it. Azithromycin can also make you more prone to sunburn and we recommend using sun block on hot sunny days or when on holiday. Speak to your doctor or pharmacist to see how we can support you to stop smoking.

How long will I be on this medicine? 

Usually for 6 to 12 months. This gives enough time for you and your doctor to see if it works for you. If you get less chest infections or have less cough, sputum production, and breathlessness then it may be useful to stay on it for longer.

What are the common and important side effects? 

Most people have no troublesome side effects.

• Some people have tummy upset, feeling sick (nausea), getting sick (vomiting). 
• Some people get light headedness, dizziness, or fast heart rate (palpitations) and may need to get their ECG (heart tracing) checked. 
•  A small number of people get jaundice (yellow colour of the skin or whites of your eyes) or itching because of liver upset. 
• A very small number of people get hearing problems (ringing in the ears or poor hearing). If you notice a change in your hearing, it is important you stop the medication and seek medical advice 
• A very small number of people get poor balance (unsteady on their feet). 
• Some people get diarrhoea caused by overgrowth of a bacteria known as C diff (Clostridioides difficile). 

If you think azithromycin is causing you troublesome side effects at any time you should talk to your doctor. You may need to stop taking it.

What dose do I take? 

The usual dose of azithromycin is 250mg tablets (one capsule) three times per week; normally taken on a Monday, Wednesday, and Friday. In certain situations, your doctor may prescribe you a higher dose of 500mg. Occasionally, it may be prescribed for you to take every day. 

Take your dose 1 hour before food or at least 2 hours after food. Swallow whole with a glass of water.

What if I forget to take my dose? 

This should not cause any problems. Take your next dose at the normal time.

Will azithromycin interfere with any other medicines that I am taking? 

• Azithromycin can interfere with many other medicines and herbal remedies. 
• Tell your doctor or pharmacist if you are taking any other medicines or herbal remedies before you start taking azithromycin. 
• Tell your doctor or pharmacist before you star t on any new medicines or herbal remedies while on azithromycin. 
• If you are prescribed another antibiotic, check with your doctor whether you should continue to take azithromycin.

What should I do if I have a flare-up of my lung condition? 

Although azithromycin is an antibiotic, you may still need to take other antibiotics for any chest infections or flare-ups of your lung condition. You may need to stop your azithromycin when starting a course of antibiotics and your team will advise you.

Can I drink alcohol when taking azithromycin? 

Yes, within the government guidance of no more than 14 units of alcohol per week. Azithromycin does not interact with alcohol. 

More information 

If you have any other questions, please speak to the doctor or nurse who prescribed you the azithromycin.

© North Bristol NHS Trust. This edition published May 2026. Review due May 2029. NBT003626

Access in AAC means the way a person makes their communication system work. Directly touching a screen with a finger is the easiest way to make a device work, but for people who are unable to do this there are different access methods that can be explored.

Direct touch access

Direct touch access means using your finger to select icons on a touchscreen device, such as a smartphone or tablet. This is a common AAC access method because it is the easiest way to make a selection. 

To make touch access easier, the device accessibility settings can be used. For example, press and holding for a set time to select, ignoring accidental touches or making the text bigger. 

Some AAC users use a keyguard, which is a thick plastic cover with holes that sits on the screen. Keyguards can help guide your finger to the right place and make it easier to select what you want without errors.

Partner assisted scanning (PAS)

Pointer control

Pointer control works like a computer mouse, where the cursor freely moves across the screen of a communication device using tools such as:

• joystick
• trackball 
• mouse
• trackpad
• head mouse (allows you to control the cursor by moving your head)

This access method allows AAC users to navigate a communication aid without needing to touch the screen directly. Pointer control tools come in a range of size, shapes and sensitivities, to suit different needs. 

Eye pointing

Eye gaze

Switch access

A switch is something you press, touch or move near to make an electronic device do something. For example, to turn on a light, control your TV or to access a communication aid. There are many different kinds of switches. They work in different ways, need different amounts of pressure and can be used by different parts of the body. The photo below shows a small selection of switches and examples of how people might use them. 

Photo description: 

1. Ping-pong switch: Only requires light action. Is water and moisture resistant. Ideal for use as a head switch. 
2. Buddy button with softy top – Durable and highly responsive switch. Gives auditory and tactile feedback with a click on activation. Using a softy top can reduce discomfort and improves tactile feedback.
3. Wobble switch – Sprung switch that activates with light touch in any direction. 
4. Finger mouse – Handheld mouse that can be used as a switch. Also used as a pointer for computer access. 
5. FingerButton switch – Highly responsive with small activation area and very little force required to activate. Can be wraped around a finger.
6. Pal pad switch – Ultra-sensitive and low-profile. Is durable and rigid. 
7. Puff switch – Can be used hands-free. Use a puff (breath) to activate. 
8. Pillow switch – Soft and smooth suitable for head or cheek activation.

To use a switch with a communication aid the switch can be used to move the highlight around the screen and then select what you want. To see how this works watch the video below. 

WAMS is a specialist service supporting people living with obesity who are motivated to explore behavioural, medical and/or surgical management of their weight.

We are a friendly team offering support and guidance to help you lose weight and improve your health and wellbeing. 

The team includes consultant endocrinologists (medical doctors), dietitians, psychologists, a pharmacist, and office staff. 

How does the service work?

WAMS is a 12 month service where you will be offered an assessment appointment followed by a support plan. This will be tailored to you. 
As you progress through the service, the team will discuss your care to find the best way to continue supporting you.

Our approach

We hope that you feel respected and valued during your time in our service. We are not here to shame or blame. Our approach is to view obesity as a complex, long-term health condition. 

Please be reassured that we would like to hear about what is actually happening in your life, rather than what you think we might want to hear. We are here to listen and help you to achieve the most positive outcomes that you can, and this is only really possible if you feel able to be open and honest about your situation.

What can you expect at your initial assessment?

At your first appointment you will speak with a consultant endocrinologist who will check for any medical causes for obesity and check other medical problems that may need treatment. You may be referred for further tests if considered necessary. These may include: blood tests, CT scans, camera investigations (endoscope). 

You will speak to a dietitian to understand your eating habits and explore your relationship with food, both now as well as in the past. We understand this can be difficult, but we encourage you to share what you can so that we can help you as best as possible. 

You may also see a psychologist who will ask about your wellbeing and help you to identify how your thoughts and feelings may be affecting your weight. They might make some suggestions to help you with your mood and work towards making changes.

What can you expect after your initial assessment?

After these first meetings, we will agree on a weight management plan for you. Sometimes we will need to signpost people onto other services before we can offer support. This is so that they are ready and able to work on their goals with our team. 

Most of our interventions are offered in an online group format, for example:

The Mood and Food programme

A blend of nutrition advice and support with the psychological aspects of eating – jointly run by dietitians and psychologists.

Our Coping with Emotion programme

A space in which to develop coping strategies for emotional eating behaviours – run by the psychology team.

Quotes from people who have attended sessions:

• “The group sessions I have attended have been excellent and very informative.”
• “Positive environment, non-judgemental, non-prescriptive. Lots of really useful advice and tips.”

There is the possibility of 1-1 sessions if the team feel that there are strong reasons for this. These may be online, via the phone, or in-person, depending on the situation.

Medical management of weight

Some people may be able to have medication to support weight loss. When available, this will be prescribed in line with local and National Institute for Health and Care Excellence (NICE) guidelines. 

People who are being prescribed medication for weight management by our team are able to receive this support for up to two years. 

Bariatric surgery (‘weight loss surgery’)

We work closely with members of the bariatric surgery service which is made up of surgeons, dietitians, psychologists and a nurse specialist.
Some people in the weight management service are interested in bariatric surgery, others are not, and some people are unable to have it for various reasons. 

It is normal for people to need support and preparation to make sure that they are ready for surgery. Our aim is to prepare people for the significant dietary and psychological changes which are required for surgery to be effective and safe.
Please note that completing your weight management plan in the WAMS service does not necessarily guarantee that you would be eligible for bariatric surgery. 

It is our policy that people who miss appointments without giving any notice, or cancel more than two consecutive appointments, may be discharged back to the care of their GP.

© North Bristol NHS Trust. This edition published May 2026. Review due May 2029. NBT002960.