• 1Gastroscopy
  • 2Preparation
  • 3Procedure
  • 4Post Procedure
  • 5Tips

Why Gastroscopy ?

To look for Oesophageal / Gastric / Duodenal disorders

Useful in reflux disease , Hiatus hernia, Barrett’s Oesophagus, Ulcers , bleeding, polyps, Helicobacter Pylori, Cancers, Coeliac disease, amongst others.

It allows direct visualisation of the upper gastrointestinal tract and allow sampling (e.g. Biopsies), therapy (Injection) or Polypectomy. Any sampling is painless.

Alternatives

Tests such as Barium swallow and CT scan are alternatives, but these are not as good as an endoscopy and do not allow sampling.

The above tests are therefore reserved for special cases and frail patients.

Preparation

Often done under local anaesthetic (like Dental spray) – to reduce the sensation of gagging.

Anxious patients can be given sedation – called conscious sedation. This will not make you unconscious, just drowsy.

Patients who opt for sedation should not drive, operate machinery, do anything dangerous or make important decisions for 24 hours or even sign legal documents, since you will still be technically under the influence of sedation. Patients will need someone to keep an eye on them overnight and for 24 hours.

You will have the test on an empty stomach, in order to allow best views – patients should ideally be nil-by-mouth for 6 hours.

Please liaise with the unit regarding consuming medications on the day of the procedure. If you are on anticoagulants or diabetes medications, please inquire beforehand, since you will need specific advise regarding this.

All patients have a consent taken – you will need to sign a form prior to undergoing the procedure, usually done on the day of the procedure. This will ensure that you have understood the procedure and will give you a chance to ask any questions.

Risks & Complications

Though the risks of the procedure with modern equipment and current techniques is small, the risks are present.

Complications can arise from the sedatives or from local or distant injury due to the procedure itself.

There is also a small risk of bleeding or perforation (tear in the lining of the lumen).

How will it work ?

Patients who opt for sedation will need a cannula insertion which is a small plastic tube placed in the vein.

Patients for local anaesthetic will have a throat spray performed. The spray is quite strong in taste and will make the mouth go numb

You will usually be given oxygen for the procedure (via the nose).

You will be asked to remove any dentures or bridges that you may have. Do inform us if you have any loose teeth. Similarly, it is recommended that you remove your glasses and left sided hearing aids – these can be collected in the endoscopy theatre by the nurse looking after you.

The nurse will then put a small plastic mouthpiece between your teeth to protect them.

Dr. Kothari will put a thin gastroscope tube via the mouth into your gullet. The first few seconds are a bit uncomfortable whilst the tube passes the throat.

He will then go though the Oesophagus to the stomach and then the duodenum. He will look for any abnormalities and treat these (if detected)

He can also do biopsies e.g. of the duodenum or test for Helicobacter Pylori and do a variety of procedures if needed.

A simple diagnostic scope can take from 3 to 7 minutes to do, a therapeutic procedure can take double this time.

What will I feel ?

The camera is a thin tube, about the size of your little finger. It has a bright light at it’s end and patients like to initially close their eyes just prior to the camera being inserted.

The first 15 seconds are more difficult for you, when the camera goes past your throat.

You will be able to breathe normally via your nose.

The procedure will not be painful at any time, but the discomfort felt by some patients is from the sensation of feeling nauseous.

There will be air pushed down the tube, to allow Dr. Kothari to have a good look. This will be sucked out towards the end of the procedure.

You may feel a bit ‘windy’ after the test, but this is normal.

Any saliva that you may produce will be removed by your nurse via a small tube.

The camera is removed after the examination is finished and the nurse will give you some tissue and ensure that you are comfortable.

is the test unpleasant ?

Yes – though different patients have different experiences and tolerance of the procedure.

Anxious patients tend to find it more difficult to tolerate than patients who are calm.

Some patients find the local anaesthetic very strong and may feel that they cannot swallow. This is not the case, but it merely indicates that the local anaesthetic is working.

Post Procedure

Patients are observed and vital parameters checked

Once safe, you will be offered well deserved refreshments. If you have had throat spray, this will be about an hour after the end of your procedure i.e. after your ‘gag reflex’ has returned. If you have sedation, this is usually after half an hour.

Your report and any abnormality seen will be discussed with you.

If any biopsies are done, or polyps removed – these will be sent to the lab for analysis and the result of this may take some time to be available.

You will be sent home once you are considered safe.

After going home

It is recommended that you take it easy for the rest of the day.

You may get a bit of sore throat after the procedure and usually lasts no more than a few hours.

You can restart your medications as soon as you go home.

You must seek help if you have severe pain, vomiting, fever or redness at the site of your cannula insertion.

Tips

  • During the procedure, the patients can occasionally have a feeling of being sick. It is helpful to try and concentrate on breathing slowly.
  • Patients of nervous disposition should opt for sedation, as this would help relax you better.
  • The calmer you are, faster is the procedure time.
  • 1Colonoscopy
  • 2Preparation
  • 3Procedure
  • 4Post Procedure
  • 5Tips

Why Colonoscopy ?

To look at disorders of the lower gastrointestinal tract.

Flexible sigmoidoscopy looks only till the very ‘tail-end’ of the bowel typically from the rectum to the Sigmoid flexure.

Colonoscopy looks from the rectum to the Caecum, and occasionally at the small bowel – called the terminal lleum.

It is done to investigate conditions like diarrhoea, bleeding, polyp detection and cancer detection, amongst others.

Alternatives

CT Colonography, barium enemas and X Rays – these are considered to be inferior to a Colonoscopy for diagnosis of many disorders and are often used to rule out large pathology in frail patients.

The alternatives do not permit sampling or biopsies, or therapy.

Preparation

You will need to clear out the bowels before the procedure, so that a clean field is available for the test. Most patients find this to be the most difficult part of the procedure. The best type of bowel preparation includes about 2 litres of fluid; ideally, all of this should be consumed since an inadequate examination would require the procedure to be repeated.

It is advisable to have a lot of clear fluid on the day before the procedure and to avoid taking items containing small seeds, like seeded bread 2 days before the procedure.

Procedure is usually done under sedation, along with strong pain killers.

Patients who opt for sedation should not drive, operate machinery, do anything dangerous or make important decisions for 24 hours or even sign legal documents, since you will still technically be under the influence of sedation. Patients will need someone to keep an eye on you overnight and for 24 hours.

Please liaise with the unit regarding consuming medications on the day of the procedure. If you are on anticoagulants, diabetes medications or have artificial heart valves or pacemakers, or need antibiotics for any reason, please let the Unit know. If you suffer with Glaucoma, please let us know – since we will have to avoid certain medications for the procedure.

All patients have a consent taken – you will need to sign a form prior to undergoing the procedure, usually done on the day of the procedure. This will ensure that you have understood the procedure and will give you a chance to ask any questions.

Risks & Complications

Though the risks of the procedure with modern equipment and current techniques is small, the risks are present.

Complications can arise from the sedatives or from local or distant injury due to the procedure itself.

There is also a small risk of bleeding or perforation (tear in the lining of the lumen).

How will it work ?

Patients who opt for sedation will need a cannula insertion which is a small plastic tube placed in the vein. Most patients opt for this.

You will usually be given oxygen for the procedure (via the nose) and be connected to monitors to check your vital signs.

You will be placed on your left side and Dr. Kothari will examine the back passage – called Rectal examination

He will then introduce the scope to examine the bowels.

He can also do biopsies i.e. take small samples of tissue or remove polyps, or any other procedures as necessary. These are painless.

Colonoscopy - a simple diagnostic scope can take from 20 to 60 minutes to do, a therapeutic procedure can rarely take more time.

Sigmoidoscopy – diagnostic scope can take upto 10 minutes, therapeutic scope can take a bit longer.

What will I feel ?

The camera is a thin tube, about the size of your middle finger. It has a bright light at it’s end.

You could choose to look at the TV screen to watch the procedure or close your eyes and sleep.

Some patients like to talk to the nursing staff during the procedure, to distract them.

You will be asked to change your position a few times to aid the passage of the scope.

You may experience transient discomfort, especially when the scope is negotiating a sharp bend in your bowel. This is usually very transient.

The nurse may also press your tummy gently in some instances, again to help with the scope passage.

The camera is removed after the examination is finished and the nurse will ensure that you are comfortable.

You will then be moved to the recovery area and subsequently to your room.

is the test painful ?

No, but it is uncomfortable – though different patients have different experiences and tolerance of the procedure.

Anxious patients tend to find it more difficult to tolerate than patients who are calm.

There is a spasmodic discomfort, particularly when the scope goes through some tight bends. This is often very short-lasting, but if you find that it is particularly uncomfortable, please let us know and we can change tact.

It is perfectly acceptable for you to let some of the wind (that we have pumped in) out – this will reduce the sensation of bloating and discomfort.

Patients who have had a lot of pelvic surgery may have a slightly more difficult to manoeuvre colon.

Post Procedure

Patients are observed and vital parameters checked.

Once safe, you will be offered well deserved refreshments.

Your report and any abnormality seen will be discussed with you.

If any biopsies are done, or polyps removed – these will be sent to the lab for analysis and the result may take some time to be available.

You will be sent home once you are considered safe.

After going home

It is recommended that you take it easy for the rest of the day and someone keeps an eye on you at least for 24 hours post procedure.

You can restart your medications as soon as you go home.(except for anticoagulants - Dr. Kothari will advise you about this)

You must seek help if you have severe pain, vomiting, fever or redness at the site of your cannula insertion.

If polyps are removed, you may experience small amount of rectal bleeding, but this is minimal. In case of larger amount of bleeding, please approach for Medical help.

Your bowel functions may be disturbed for the next 2-3 days – this is expected.

Tips

  • Some patients choose not to have any pain killers or sedatives for the Colonoscopy. This is perfectly okay, since about 1/3rd patients do not really need pain killers.
  • It is however advisable to introduce a cannula in your hand, in case you need pain killers during the procedure. It also permits introducing antispasmodics towards the end of the procedure.
  • The better the bowel prep, faster is the procedure. It is helpful if you have a lot of fluid in the days preceding the test. Please do not consume seeds or seeded bread 3 days before the procedure. (Seeds within the bowel interfere with scope function)
  • Do not feel embarrassed to let any wind out during the procedure - this will greatly improve your comfort levels.

For what symptoms do I get referred to a Gastroenterologist?

  • Gastroenterologists / Herpetologists look after patients with symptoms of
  • Diarrhoea, constipation, abdominal pain, rectal bleeding
  • Problems with swallowing, vomiting, heartburn, reflux
  • Polyp detection / surveillance
  • Inflammatory bowel disease, bowel infections
  • Jaundice, viral hepatitis, drug-induced liver disease
  • Problems with Pancreas and biliary system
  • Alcohol related problems

What should I prepare for the visit?

Your GP would have sent a referral to Dr. Kothari, which would include all relevant details of previous investigations and /or relevant blood tests / images or endoscopies. In case this has not happened, it would be useful if you could bring any relevant details for the consultation.

  • A repeat prescription (if available) is helpful.
  • Any relevant information such as brief details of (for example) weight loss, etc as an aid-memoire would come handy.
  • If you are Insured, it is best to check with the Insurer as to what is covered and what you would need to pay for.
  • If self funding, you would likely have been asked for relevant details of payment.

What to expect on the first consultation?

  • The initial consult is a chamber / office based discussion.
  • Dr. Kothari will ask you details of your present and past history, in addition to medication, personal and family history.
  • He would go through any relevant investigations or consults which you may have had elsewhere and any recent tests such as blood tests done at your GP practice.
  • If there is any information / tests that have not been performed (for example specialised blood tests), he may order them for you. Please inquire with the clerical staff at the reception counter as to what the cost of these is likely to be – you will have to pay for these separately.
  • Dr. Kothari may also order tests such as X rays or CT scans or consider an endoscopy for you. He will discuss the merits and potential complications of these with you.
  • The date for any of these tests can be arranged at the time of the consultation – however, endoscopy tests and scans are not usually organised for the same day, but at a subsequent visit.
  • A discussion regarding follow up (if necessary) will be discussed.
  • Dr. Kothari will communicate with your GP about your consultation, unless expressly denied by you.
  • Dr. Kothari will update you about your tests, etc in any follow up appointments.

Will there be any procedures done?

  • Dr. Kothari will examine your tummy and do a general examination.
  • A chaperone is available to be present for this and can be available for the whole consultation, if requested – please let us know.
  • Rarely patients may have an initial rigid sigmoidoscopy at the first consultation - this will be discussed with you prior to any procedure being done.
  • With the advent of Flexible Sigmoidoscopy, the need to do an initial rigid sigmoidoscopy for Gastroenterology patients is reducing.

What are the common investigations ordered?

  • If you have had recent tests e.g. bloods, ultrasound, CT scans or MRI – these would not need repeating
  • If none of the above have been done or results are not available, these could be organised on the day of your appointment.
  • Tests like Gastroscopy / Colonoscopy can be organised for a future date.
  • Most of the tests are available in-house at Fawkham Manor Hospital, however, some specialised tests may be organised outside.

Will I need a follow up?

  • Many patients would need testing done and prefer to have a follow up to go through these and to start treatment.
  • Some patients need follow up to check how they respond to the treatment initiated.
  • Other patients can be discharged back to their GP after advise is given at the initial consultation.
  • A few patients request that the results of their tests is communicated to them, rather than scheduling a follow up. Please let us know if this is your preference.