What is a gastroscopy with oesophageal dilatation?

You have been advised to have a Gastroscopy to help find the cause of your symptoms, and dilatation of the oesophagus can help relieve difficulty in swallowing. The doctor thinks that it is possible and appropriate to try to improve your symptoms by stretching the narrow and diseased part of the oesophagus using endoscopy rather than a surgical operation. The commonest conditions that require this treatment are scarring (peptic) strictures associated with stomach acid or following esophageal surgery. Narrowing caused by growths and achalasia (a condition where the lower gullet muscle becomes very tight) are other reasons for this treatment.

A Gastroscopy is a technique to look directly into your gullet (oesophagus), stomach and the first part of the small bowel (duodenum). The instrument used for this procedure is an endoscope. The endoscope is a thin, flexible tube. It has a bright light on the end and is passed through your mouth and down into the stomach. If there is a narrowing of the gullet (oesophagus) it is sometimes necessary to stretch the narrowed area to allow the endoscope (and consequently food) to pass.

What are the risks associated with this procedure?

This is a safe procedure, but problems can arise:

• Perforation of the gullet or stomach (making a hole) is a recognized complication (about 1 in 10,000 without dilatation and about 1 in 40 with dilatation). This may require an operation to repair the damage and it can rarely cause death
• Bleeding is also rare but can be serious enough for you to be admitted to hospital and treated with a blood transfusion
• Mechanical damage to teeth or bridgework
• Sedation can occasionally cause problems with breathing, heart rate and blood pressure. If any of these problems occur they don’t usually last very long
• Aspiration of fluid into the chest causing a cough

Like all tests, this procedure will not always show up all abnormalities and on rare occasions, abnormalities may not be identified. The person doing the test will discuss any questions you may have about the risks.

What are the side-effects of the procedure?

You may have bloating and abdominal discomfort for a few hours as air is used to inflate your stomach. You may have a sore throat for 24 hours. You may have some burning sensation on swallowing for a few days following a dilatation.

What are the benefits of having a gastroscopy and dilatation?

Your swallowing should be improved, at least temporarily, after a successful dilatation of the oesophagus. It is also possible to take samples from the narrowed area and therefore decide on further treatment options.

What are the alternatives to gastroscopy with dilatation?

The gullet can be stretched using a balloon which is passed while you have an x-ray.
This procedure allows the improvement in swallowing, but sampling from the gullet is only possible if gastroscopy is undertaken. The only other alternative is major surgery.

Preparing for a gastroscopy and dilatation

To allow a clear view the stomach must be empty, so follow these instructions:

• Do not have anything to eat for at least 8 hours before the procedure
• Do not drink milk for four hours before the procedure. This is because milk will line the stomach and not allow a clear view of the lining
• You may drink clear fluids (water, black tea or black coffee) up to 4 hours before the procedure.

What about my medication?

Your routine medication should be taken.
If this is your follow-up gastroscopy appointment to check for healing of any ulcer found in the last 2 – 3 months, please continue your acid reducing medications right up to the day before your repeat gastroscopy.
If you are diabetic or are currently taking Warfarin, Clopidogrel (PLAVIX) or if you are pregnant, please inform us timeously.
Please bring any medication you are currently taking (including sprays and inhalers) with you to your appointment.

When you arrive at the endoscopy unit

Please inform us if you think you have a latex allergy or think that you may be pregnant.

• Do not bring any valuables with you
• Please do not wear any nail varnish, lipstick or jewellery. Please note: tongue studs must be removed.

Sedation

This procedure is usually performed with sedation. This improves your comfort during the procedure.
Sedation helps to relax the most anxious people. It will be given through a small needle in your hand or your arm. It will make you relaxed and sleepy and you may not remember the procedure taking place. After sedation, you must remain in the unit to rest for about 2 hours until we are satisfied that it is safe to send you home. It is essential that a responsible adult accompanies you home by car or taxi – public transport is not suitable.

Throat spray – local anaesthetic

Throat spray may be applied to the back of the mouth to numb it and enable you to swallow the gastroscope.

The procedure

Sometimes, this procedure requires the use of x-ray pictures by using a small x-ray machine in the endoscopy room. You will be asked to remove any dentures at this point. Any remaining teeth will be protected by a small plastic mouth guard, which will be inserted immediately before the procedure commences. If you are having local anaesthetic this will be sprayed onto the back of your throat. It has a bitter taste and may feel hot on the back of the throat when you are asked to swallow it. The effect is rapid and you will notice loss of sensation to your tongue and throat. You will be given oxygen during the procedure though small plastic tubes which sit just inside your nostrils. A small plastic cannula (tube) will be placed into a vein in your hand or arm. 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. This measures the amount of oxygen in your blood and also your heart rate.

The sedative will be given at this time. Any saliva or other secretions produced during the procedure will be removed using a small suction tube, like the one used at the dentist. The endoscopist will introduce the endoscope into your mouth, over your tongue, down your oesophagus (gullet) and into your stomach and then into your duodenum. Your windpipe is deliberately avoided and your breathing will not be affected. If dilatation of the oesophagus is carried out a thin wire will be passed through the endoscope into your stomach and then the endoscope will be removed. One to three other tapered tubes will then be passed using the wire as a guide so as to widen the narrowing, it can be uncomfortable when the narrowing is stretched but this discomfort does not last long.

Alternatively, a special type of balloon dilator may be used. This is positioned using x-ray equipment and gently inflated to stretch the affected area. Following the dilatation procedure, the endoscope etc, you may be sent for a chest x-ray after the procedure is finished. 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 taken will
be recorded in your notes. The whole procedure takes between 10 and 25 minutes.

Going home after the procedure

After the procedure, you will remain in the unit to rest for at least two hours. When nursing staff consider you to be safe for discharge and you have swallowed a drink you will be discharged home. At home you should rest for the remainder of the day. It is essential that a responsible adult accompanies you home by car or taxi – public transport is not suitable. This person should stay with you overnight. It is advisable to have the next day off work. During the first 24 hours following sedation you must not:

• Drink alcohol
• Drive any vehicles (including riding a motorcycle or bicycle)
• Take sleeping tablets
• Operate machinery or electrical items (including a cooker or kettle)
• Sign any legally binding or important documents
• Work at heights (including climbing ladders or onto chairs)

Please note that sedation can impair your reflexes and judgement for up to 24 hours even when you feel wide awake.

When will I know the results?

Before discharge, you will be given a brief outline of the test results. If a biopsy or polyp has been removed, the laboratory results will take longer, about 10 days.. You will be given a copy of the endoscopy report to take to your GP and a copy for your own information. You will also be offered a copy of your consent form.

Following the procedure, if you have any problems with persistent abdominal pain or bleeding please contact us immediately.

What is a gastroscopy?

You have been advised to have a gastroscopy to help find the cause of your symptoms. A gastroscopy is a technique to look directly into your gullet (oesophagus), stomach and first part of the small bowel called the duodenum. This is to help find out what is causing your problems.
The instrument used for this procedure is a gastroscope. The gastroscope is a thin, flexible tube. It has a bright light on the end and is passed through your mouth and down into the stomach.

What are the risks associated with this procedure?

• Perforation of the oesophagus (making a hole) is an extremely rare complication of approximately 1 in 10000 cases. If a perforation does occur, there is the possibility that surgery may be required.
• Aspiration of fluid from the stomach into the lungs may cause a cough.
• Sore throat may occur for up to 24 hours following the procedure.
• There is a small possibility of damage to teeth. Please ensure you inform staff of any dentures, loose teeth and caps or crowns.
• Sedation can occasionally cause problems with allergic reactions, respiratory problems, heart rate and blood pressure. If any of these problems occur, they are usually short lived.
• In approximately 10% of people it may not be possible to complete the procedure. This can be for a variety of reasons, including unsatisfactory emptying of the stomach, mechanical failure or toleration of the procedure. Like all tests, this procedure may not always show up all abnormalities and on rare occasions, abnormalities may not be identified.The person doing the test will discuss any questions you may have about the risks.

What are the side effects of the procedure?

You may have bloating and abdominal discomfort for a few hours.

What are the benefits of this procedure?

Gastroscopy is the only test that allows direct inspection and sampling of the bowel wall.

What are the alternatives to this procedure?

Barium Meal, Barium Swallow or CT scan can show the stomach lining but cannot take biopsy samples. Even though you are having a gastroscopy, you may still require one of these other procedures at a later stage.

Preparing for a gastroscopy

Please bring a complete list of all the medicines that you take when you come for your procedure.
Please inform us if you think you have an allergy or think that you may be pregnant.

To allow a clear view, the stomach must be empty so please follow these instructions:
• Do not have anything to eat/drink for at least 8 hours before the test
• Do not drink milk for 4 hours before the test as this will line the stomach and prevent clear views
• Drink clear fluids (water, black tea, black coffee, squash) for up to 4 hours before the time of your appointment

If you have diabetes

If you are diabetic and use insulin or tablets, please inform us so that you can be offered an appointment at the beginning of the list.
There are two options we can offer to help you with this procedure:

1. Throat spray
This procedure is usually carried out using a throat spray which numbs the back of the throat. It has a bitter taste and may feel hot when you swallow it. It has a very rapid effect and you will notice a loss of sensation to the back of the throat and the tongue. Choosing the throat spray means that once you have recovered and feeling well you can leave the unit and make your own way home or back to work. You will not be able to have anything to eat or drink for about an hour following the procedure, until the effects of the spray has worn off. After this, you can eat and drink normally.

2. Sedation
If you choose to have sedation, an intravenous sedative is usually given through a small needle in your hand or arm. Sedation will make you relaxed and you may not remember the procedure. You will not be put to sleep. If you opt for sedation, you will need to have a responsible person to accompany you home and you will need someone to stay with you for 12-24 hours after the procedure. Advice about the care following the procedure is discussed later in this booklet.

The procedure

You will be taken into the procedure room. If you have opted for sedation, a small plastic cannula will be inserted into a vein in your hand or arm. You will be asked to lie on your left side The sedation will then be given. If you have chosen throat spray, this will be administered. A nurse will stay with you throughout the procedure. To help minimise any damage to your teeth or the scope, a small plastic mouthpiece will be placed between your teeth.
The endoscopist will pass the scope over the back of your tongue and down into your stomach. This procedure will not interfere with your breathing. The test is not painful, but the tube presses on the back of the throat and can make people retch during the procedure and a slight sore throat often follow lasting about 24 hours or so. The air that is blown into the stomach can provoke belching and bloating which wears off very quickly after the procedure. The procedure will usually take between 5 and 10 minutes. Once completed, you will be transferred to our recovery area where you will be
monitored until you are ready to leave.

Going home after the procedure

If you have had sedation, it is essential that a responsible adult accompanies you home by car or taxi – public transport is not suitable.
When you get home, you should rest for the remainder of the day. Someone should stay with you for the rest of the day and overnight. During the first 24 hours following sedation you must not:

• Drink alcohol
• Drive any vehicles (including riding a motorcycle or bicycle)
• Take sleeping tablets
• Operate machinery or electrical items (including a cooker or kettle)
• Sign any legally binding or important documents
• Work at heights (including climbing ladders or onto chairs)

Please note that sedation can impair your reflexes and judgement for up to 24 hours even when you feel fully awake. Once the effects of the throat spray wears off, you are free to eat and drink as normal and carry out any normal activities that you choose.

When will I know the results?

Before discharge, you will be given a brief outline of the test results. If a biopsy or polyp has been removed, the laboratory results will take longer, about 10-14 days. You may be offered a copy of the endoscopy report for your own information, and a copy will be posted to your GP surgery, or you may take this copy to hand deliver to them yourself.

General points to remember

If you are having sedation, please arrange for a responsible adult to collect you and stay with you overnight