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Dual Procedure - Gastroscopy and Flexible Sigmoidoscopy (West Mid Site)

What is a gastroscopy?

The first procedure you will be having is a gastroscopy, also known as an OGD. This is a test in which a long flexible telescope called an endoscope is passed through the mouth allowing the endoscopist to look directly at the lining of the oesophagus (gullet), stomach and duodenum (small bowel).

What is a flexible sigmoidoscopy?

The second procedure you will be having is called a Flexible Sigmoidoscopy.  This is a test in which a long flexible telescope called an endoscope is passed into the anus (back passage) allowing the endoscopist to look directly at the lining of the last part of the large bowel.

For both test sometimes a biopsy - sample of tissue – is taken for analysis (testing) in the laboratory. The tissue is removed through the endoscope using tiny forceps. This is not painful. Some people will require treatment through the endoscope to treat/prevent bleeding, or to dilate up the oesophagus. If this is needed the procedure will be explained and may take longer.

What options are available for the procedure?

General anaesthesia is not required. The procedure is safe but may be unpleasant and at times uncomfortable.

Throat spray

If you chose this option you will be fully awake during the examination. The endoscopist and nurses will talk you through it. A local anaesthetic spray will numb the back of the throat, helping the endoscope to go down.

Sedation via a needle 

If you chose this option we will give you a sedative via a needle in your arm. This is not a general anaesthetic but will make you relaxed and may make you feel sleepy; we will do our best to make you as comfortable as possible. If you have sedation you will need to rest on a trolley here for at least an hour afterwards until the effects of the sedation have worn off. The nurses will give you written discharge information. This includes the advice that for 24 hours after sedation you should not drive, ride a bicycle, operate machinery, take sedatives or drink alcohol, or sign legal documents.  If you are having sedation, you must organise for someone to take you home after the test and be with you for 24 hours.

What should I do before I come in?

Drugs

If you are taking any of the following medicines please stop taking them accordingly 7 days before procedure:

  • Omeprazole (Losec), Lansoprazole (Zoton), Esomeprazole (Nexium)
  • Bulking agents (Fybogel or Regulan) 

2 days before procedure

  • Ranitidine (Zantac),  Cimetidine (Tagamet)

Unless you have been advised otherwise, you should take any other usual medicines normally (with a few sips of water). If you are diabetic please let us know in advance.

If you are taking any of the following medicines, please inform the pre-assessment nurse or a member of the Endoscopy team for further instructions:

  • Warfarin, rivaroxaban, apixaban, dabigatran, edoxaban
  • Clopidogrel, prasugrel, ticagrelor
  • Aspirin and any other medication used to thin the blood (anti-coagulant)

You will need to take an enema approximately 1 – 2 hours before attending for your procedure, which you will need to administer it at home.

The enema is available over the counter at a chemist. It is called Phosphate Enema and it usually costs about £2. Alternatively, you can attend the Endoscopy Unit in advance of your appointment and collect the enema from the department. Please call us in advance if you would like to collect your enema from our unit.

Enemas are safe and easy to use. You use them to clean the lower half of your large bowel (sigmoid colon) so we can get a clear view of the area when you have your flexible sigmoidoscopy. Most people find it convenient to use the enema at home. 

If do not think you can do this yourself, please ring the Endoscopy Unit on 020 8321 5191 and we will arrange for you to come in earlier on the day of your test to have it here. 

Please speak to a member of staff if the following applies to you:

  • If you have been diagnosed with an inflammatory or ulcerative bowel condition like Crohn’s or Colitis.
  • Your doctor has asked you to limit your sodium (salt) intake.

You will need the following:

  • Phosphate Enema
  • Jug or bowl of warm tap water
  • Towel
  • Bed or sofa to lie on

How do I get ready to use the enema? 

  • Do not eat for at least 30 minutes before using the enema.
  • Make sure you can get to a toilet easily.
  • Find a comfortable place to lie down.
  • Have a towel to lie on.
  • Warm the enema in a bowl or sink of warm water.
  • Read the instructions on the packet/tube carefully.
  • Use the enema even if you have diarrhoea or have recently passed a bowel motion. 

When do I use the enema

  • Use it at least one to two hours before leaving home for your test.
  • It will work after a few minutes but stay near a toilet for the next hour because you may need to open your bowels more than once.
  • The effects of the enema will wear off after one hour at most.

How do I use the enema? 

  • Once you have warmed the enema in a bowl or sink of warm water, pull the lid off the nozzle. Hold the bottle upright so the contents do not spill.
  • The nozzle is already lubricated, but you can put on more lubricating jelly if you like.
  • Lie on your left hand side, on the towel, with your knees bent up toward your chest as far as comfortable.
  • Gently push the nozzle about 7cm (3in) into your back passage (anus). This should not be painful, if you feel any resistance or pain please do not continue
  • Slowly squeeze the bottle until all the contents are in. Remove the nozzle once you have finished and stay lying down.
  • Try to hold the liquid in your bottom for as long as you can – ten minutes, if possible.
  • Go to the toilet when you can no longer hold it and you really feel like emptying your bowels.
  • Stay near the toilet for the next hour, you might need to open your bowels more than once.
  • Some people have stomach cramps for a short time after using the enema.
  • Occasionally, you can feel faint or dizzy. If this happens, lie down until you feel better.
  • If you have no response to the enema – do not worry. Come into hospital normal and we can always give another enema if necessary.

Note: If you feel that you cannot give the enema yourself then please inform the Endoscopy unit.

On the day of the OGD and flexible Sigmoidoscopy examination

Your stomach must be empty for us to perform the gastroscopy. Therefore it is essential you have nothing to eat for at least six hours before the examination. You may drink small sips of clear fluids (water, black tea or black coffee) until two hours before the procedure.

What will happen when I come in?

On arrival to the endoscopy unit please report to reception where the receptionist will check your personal details. You will be asked to take a seat in the waiting area until you are collected by a nurse, and taken through to one of our admission rooms.  You do not need to bring anyone with you to your appointment, unless they are acting on your behalf e.g. interpreting for you.  Please leave any valuables at home, as we cannot be responsible for any valuables lost whilst you are in the unit.

On admission a nurse will review your pre-assessment form (Medical history and current medications) that you should have completed online or over the telephone.  We will take your blood pressure, pulse and ask you to get changed into a gown and dignity shorts. Dignity shorts are specially designed to maintain patient modesty before, during and after a procedure.

Prior to the test you will be seen by the endoscopist. This is an opportunity to discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.

What will happen during the test?

In the procedure room you will lie on a trolley (narrow bed), on your left side. Two nurses and the endoscopist will stay with you throughout both tests. During the test you may be given oxygen through little prongs that fit just inside your nostrils. Your blood pressure, pulse and oxygen levels will also be monitored.

OGD

You will be asked to bite on a small plastic mouthpiece to help keep your mouth open. This will also help to protect your teeth during the test. Dentures have to be removed if they are loose. When the endoscope is passed through your mouth it is likely to be uncomfortable. It may make you feel sick or you may retch. The endoscope will not interfere with your breathing.

During the test air is passed down the endoscope into your stomach to get a clear view. This may make you burp. The air is sucked out at the end of the test.  If you get a lot of saliva in your mouth, the nurse will clear it using a sucker (the sort of tube that is used when you go to the dentist).

Flexible Sigmoidoscopy

The doctor will perform the flexible sigmoidoscopy immediately after the OGD by passing the endoscope into your bottom. During the test air is passed down the endoscope into your bowel to expand it, so the doctor has a clear view of the lining of your bowel. This may give you some wind like pains and may also make you need to pass wind.

Although this can be embarrassing, remember the staff do understand what is causing it and the air is sucked out at the end of the test. You may also get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. This sensation is normally due to the air we have pumped in.  If you need treatment given through the endoscope, this may take longer. If this applies to you it will be discussed when your appointment is made.

What are the benefits and risks?

The benefit is that this procedure will help us to investigate your symptoms and it may help us to treat you.

OGD

There is an extremely small risk of bleeding or a tear in the lining of the gut (perforation 1 in 9000), which may require urgent treatment, blood transfusion or an operation. Gastroscopies also involve a slight risk of damage to crowned teeth or dental bridgework.

Flexible Sigmoidoscopy

It carries an extremely small risk of bleeding or a tear in the lining of the bowel (perforation 1 in 2500), which may require urgent treatment, blood transfusion or an operation

Do I need to be escorted home?

If you have sedation, your escort must collect you from the unit, take you home and be with you for the next 24 hours. Please ensure the nurses have the contact details for your escort prior to the procedure. A nurse from the unit will call your escort once you are ready for collection.

Please note: You will not be able to have sedation if you do not have an escort arranged to collect you. We cannot escort you home.

What happens to my medication?

We will talk to you before you go home about any changes/additions to your medications.

How long will I be in the endoscopy unit?

Both procedures are usually completed between 30–45 minutes; however please expect to be in the department for 1-2 hours – having pre-procedure checks, the procedure and for recovery after the procedure. 

Please note: Your appointment time in Endoscopy is approximate because some procedures may take longer than expected and emergency procedures need to take priority.

After you go home

You may experience bloating and abdominal discomfort for a few hours after the test. This is because of the air that is used to expand and inflate your stomach and bowel during the test. These symptoms are often relieved by the passing of wind.

If you have had a polyp removed or a biopsy, you may experience a little bleeding from your back passage.

Some patients have told us that they experience discharge from their back passage or an urgent need to open their bowels after the procedure. You may therefore like to bring a change of underwear with you.

If the pain continues or are passing large amount of blood, or you have concerns or questions, please contact the Endoscopy Unit from 8am–6pm on 020 8321 2585/5191 - after 6pm call 020 8560 2121 and ask for the on call gastroenterologist.

This leaflet has been written by the staff working in the Endoscopy Unit at West Middlesex University Hospital. We hope you find it useful. If, after you have read it, you have any questions or concerns; please contact us on 020 8321 2585/5191.

If you would like to change your appointment time or date please contact the endoscopy booking team on 020 8321 5752 or email us chelwest.endoscopy.westmid@nhs.net

How to find us

The Endoscopy Unit is located on the ground floor of the Main Hospital Building in the East Wing.