Endoscopy is a minimally invasive diagnostic medical procedure used to assess the interior surfaces of an organ by inserting a thin flexible tube with a camera on the end into the body. It is a key means of examining gastroenterology patients.

We carry out ECRP to diagnose and treat diseases of the bile ducts which might include gall stones and cancer.

Capsule Endoscopy

How does it work?

Capsule endoscopy (also called a ‘pillcam’) uses an electronic, pill-sized photographic capsule that takes pictures of the small bowel. It is approved for use by the National Institute for Health and Clinical Excellence (NICE) and is considered by the British Society of Gastroenterology to be the first-line tool in the investigation of small bowel disease. The capsule is swallowed like a tablet and can take up to 54,000 pictures over eight hours, imaging the entire small bowel. During this process you will be able to move around, walk or even leave the hospital. After roughly eight hours the equipment is removed and the results downloaded onto a computer workstation. You then pass the capsule in the usual way. The files are subsequently reviewed and a report complied.

Who is it for?

If you are often excessively tired you could be suffering from anaemia (low red blood cell count). A common cause of anaemia is bleeding within the gut. This maybe from the stomach, large bowel or small bowel. The bleeding may not always be obvious or visible so tests may need to be carried out to identify the cause. Once the cause is identified, corrective treatment of anaemia is generally successful

The capsule can help to identify the cause of anaemia, diagnose bowel conditions, or identify or exclude conditions such as Irritable Bowel Syndrome (IBS). Pain, diarrhoea or constipation can be symptoms of underlying intestinal problems. Diseases, such as Crohn’s Disease and Ulcerative Colitis, can cause inflammation (or even ulceration) in your bowel. More serious diseases may also need to be ruled out – especially if you have visible bleeding from the back passage, which should never be ignored.

Clinical Guidance

This diagnostic facility is particularly beneficial to patients who display obscure bleeding that persists or recurs, as well as for detection of Crohn’s and Coeliac disease. It is a revolutionary pain-free device which enables us to see far more of the small intestine than ever more. Patients benefit as they no longer need to endure the discomfort of an endoscope, and we are able to offer a swift treatment programme.

Small Bowel Endoscopy

Balloon-assisted enteroscopy 

Until recently it was difficult for doctors to examine very far into the small intestine. A new type of endoscope called a balloon-assisted enteroscope now means it is possible to examine much further into the small intestine and in some cases offer treatment this way.

A balloon enteroscope enables the endoscopist to:

• Visualise the entire small bowel
• Remove tissue for histology (biopsy)
• Remove abnormal growths e.g. polyps
• Treat bleeding problems
• Dilate strictures

Preparation at home

If you take aspirin, warfarin and other blood-thinning medicines you may need to discontinue these and should consult your doctor as to when you should stop taking them. If you are on iron supplements (eg. ferrous sulphate) please stop taking this 1 week before the examination. For this examination to be successful and allow a clear view of your small bowel, it must be as empty as possible. On the day before the examination you may have breakfast and a light lunch (such as soup, pasta, white meat, but avoid salad, vegetables, nuts and grains). From then on consume only clear fluids (including consommé soup, juices etc.) until you go to bed. On the morning of the examination you may have small sips of water only. You can continue to take all your medicines as normal but these should be taken before 8am. Have nothing to drink from 4 hours before the time of your procedure.

What does the examination involve?

You will be given a sedative and analgesia. This is administered through a needle placed in your arm or hand to help you feel more relaxed. It may induce sleep after the procedure. You will be asked to remove spectacles and dentures. A device which monitors your heart rate and breathing will be attached to your finger. While you are lying on your left, a small mouth piece will be placed in your mouth to protect your teeth and gums. An enteroscope will be gently inserted through your mouth into your stomach. This is not painful and will not make breathing or swallowing difficult. However you may experience some retching and feel a little uncomfortable. Gentle, slow breaths through your mouth help to alleviate and settle this. Sometimes you will be given oxygen. Your stomach will be gently inflated with air to expand it thus enabling the lining to be seen more clearly. The air is sucked out at the end of the procedure. It may be necessary for the nurse to clear saliva from your mouth using a small suction tube. The examination may take anything from 5 to 20 minutes.

After the examination

If you have the sedative injection you must:

• have a responsible relative or friend with a car (not public transport) to take you home and stay with you for at least 12 hours.
• You must not drive, drink alcohol, operate machinery or sign important documents for 24 hours following the test.
• You may experience a mild sore throat but this will pass and is nothing to worry about. You may feel a little bloated from some air that can remain in the stomach. Again, this will pass and is nothing to worry about. You may eat and drink as normal.

Are there any risks?

This is a safe procedure and complications are rare but include:

• Bleeding after biopsy or removal of a growth (or polyp). This is usually minimal and stops quickly or can be controlled.
• The endoscope can cause a tear or hole in the tissue being examined, which is a serious but rare problem ( · Adverse reactions to medications used in the sedation are possible. You will be carefully monitored throughout the examination by trained nursing staff.

Upper GI Endoscopy

What is a oesophago-gastroduodenoscopy (OGD)?

The examination is performed using a long flexible instrument called a gastroscope which is about the width of your little finger. It is passed through your mouth and into your stomach and duodenum (the first part of your small bowel). It allows the Endoscopist (doctor or nurse specialist who performs these procedures) to look directly at the lining of the oesophagus (gullet), stomach and duodenum. It also allows tissue samples to be removed painlessly which can then be sent to the laboratory for analysis. The test usually takes approximately five minutes to complete, however you may be in the department for up to an hour to allow for admission and recovery time. The test can usually be performed using a spray to numb the throat, many hospitals carry out all their tests in this way, however we do offer a sedative for those who feel they require it. This is not a general anaesthetic, you will not be asleep. You may not remember anything after the test if you have sedation, but this cannot be guaranteed. The sedation can stay in your system for up to 24 hours. If you choose to have sedation for the procedure, you will not be able to drive, drink alcohol, sign legal documents, operate machinery or look after small children. A responsible adult must collect you from the endoscopy unit, take you home and stay with you for 24 hours after the procedure.

What are the risks?

Oesophago-gastroduodenoscopy is an established and safe procedure but very rarely it can result in complications:-
Perforation – A tear or hole in the oesophagus, stomach or duodenum and bleeding (1: 2000 risk); breathing difficulties or heart irregularities – this can happen as a result of reacting to the sedation. To help prevent this from happening, your oxygen levels and heart rate will be monitored. Rarely, a heart attack or stroke can happen if you have serious medical problems. We may advise some patients against sedation and in some cases it may be necessary for us to refuse to do the test under sedation. This would be to maintain your safety; damage to teeth or bridgework – a plastic mouthpiece will be placed in your mouth to protect the camera from your teeth. Do not bite down hard onto this mouthpiece. Inform the nursing staff if you have any loose teeth; incomplete procedure – the gastroscopy may be incomplete due to technical difficuly, food or blockage in the upper digestive system, complications during the procedure or discomfort. Your Doctor may recommend another gastroscopy or a different test such as a barium meal.

On the day of the test
Your stomach needs to be empty to allow a clear view of the lining of the stomach and to prevent vomiting during the procedure. This is important as vomiting during the procedure could allow fluid to enter your lungs.

Morning appointment – before 12 midday
Do not have anything to eat or drink from midnight the night before the test. Do not suck boiled sweets or chew chewing gum. Take any regular medication (except diabetic medication) with a small amount of water.

Afternoon appointment – after midday
Have a light breakfast before 07.30am then nothing else to eat or drink until after your test. Do not suck boiled sweets or chew chewing gum. Take any regular medication (except diabetic medication) with a small amount of water.

What is a Colonoscopy?

A colonoscopy is a test, performed with or without sedation, which allows a doctor to look at the lining of the colon (large bowel)

How is it done?
A colonoscope is a long flexible tube with a bright light at the end, which is passed very carefully through the anus so that the doctor can see the lining of the colon. In some cases, biopsies (small pieces of the bowel lining) may be taken with tiny forceps and sent to the laboratory. It may also be necessary to remove polyps (abnormal growths of tissue) during colonoscopy, which your doctor will want examined more closely in the laboratory. Both taking biopsies and the removal of polyps are painless procedures. The test is simple and takes between 15 and 30 minutes.

Preparation
To allow a clear view of the colon, it must be completely empty. If it is not certain areas may be obscured and the procedure may have to be repeated. Please read the information you have been given regarding your bowel cleansing preparation and make sure you follow the instructions carefully. Please continue to take essential drugs such as steroids, heart tablets etc. as usual on the day of the procedure.

If you are diabetic or take anticoagulants (Warfarin) please inform the department when you receive your appointment. If you are taking iron tablets, you must stop taking them for one week before the test. Please bring a complete list of any medication you are currently taking.

What happens ?
You must tell the nurse or doctor if you have any allergies, or have had bad reactions to drugs and/or other tests. They will also want to know about any previous endoscopy you may have had. You will be asked to undress and put on a hospital gown, also to remove any jewellery or metal objects in case special pieces of equipment are used. If you wish, you may bring your own dressing gown and slippers to help you feel more comfortable. The staff want you to be as relaxed as possible for the test, so if you have any worries or questions at this stage, don’t be afraid to ask. If you come to the endoscopy unit alone we will need the contact number of the person taking you home.

The test

In the examination you will be made comfortable on a couch, resting on your left side with your knees slightly bent. A nurse will stay with you throughout the procedure. A small needle called a cannula will be inserted into your hand or forearm, this is to enable the doctor to give you a small injection to make sure you are relaxed.

When the tube has been inserted through the anus into the colon, air will be passed through to distend it and give a clear view of the lining. This may give you some wind like pains, but these will not last long. You may also get a sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. You may pass some wind, but although this may be embarrassing please remember the staff do understand what is causing it. The procedure usually takes about 30 minutes. When the examination is finished, the tube is removed quickly and easily.

After the test
You will be moved to the recovery room where a nurse will look after you before you return to your room. Any discomfort from wind will soon settle and no medication is normally needed. If you have had sedation a resposible adult should drive you home and accompany you for at least 12 hours. You should not operate machinery or sign important documents for 24 hours.

What is a flexible sigmoidoscopy?
A flexible sigmoidoscopy is a test which looks directly at the lining of the left side of the colon (large bowel). A long flexible tube about the width of your finger is inserted into the back passage (anus). The tube is passed around the lower part of the colon and pictures are displayed on a television screen to detect any abnormal areas. Tissue samples (a biopsy) can be taken and sent to the laboratory for analysis. Polyps (abnormal growths) can also be removed during the procedure and sent for analysis.

The test takes approximately 10 to 15 minutes to complete but it can take a little less and in some cases longer than this. You could be in the department for around 1 hour to allow for check in and the recovery period following your procedure.

The test can be uncomfortable at times as air is blown into the bowel; most people tolerate the procedure well without the need for sedative medication. However, there is the option to have a sedative for those people who think they may need it. This is not a general anaesthetic therefore you will not be asleep. The sedative will help to relax you but you will still be able to feel sensations, hear what we say to you and follow simple instructions during the test. You may not remember anything about the test afterwards due to the sedation, but this cannot be guaranteed. The sedation can stay in your system for up to 24 hours. You will not be able to drive, drink alcohol, sign legal documents, operate machinery or look after small children during this time. A responsible adult must collect you from the endoscopy unit, take you home and stay with you for 24 hours after the procedure.

What are the risks?
Flexible sigmoidoscopy is an established and safe procedure but very rarely it can result in complications. Some of these can be serious though rare. Breathing difficulties or heart irregularities, as a result of reacting to the sedation or the bowel being stretched. To help prevent this from happening, your oxygen levels and heart rate will be monitored. Making a hole in the colon (risk: less than 1 in 1,000). The risk is higher if a polyp is removed (risk: less than 1 in 500). This is a serious complication. You may need surgery which can involve forming a stoma (bowel opening onto the skin). Bleeding from a biopsy site or from minor damage caused by the endoscope (risk: less than 1 in 1,000). This usually stops on its own. Bleeding, if a polyp is removed (risk: 1 in 100). Bleeding usually stops soon after a polyp is removed. Sometimes bleeding can happen up to two weeks after the procedure. Let Dr Maiden or the nurse know if you are on Warfarin, Clopidogrel or other blood-thinning medication. You may need to stop your medication before having a polyp removed. Incomplete procedure. This can happen due to a technical difficulty, blockage in the large bowel, complications during the procedure or discomfort. Your doctor or Dr Maiden may recommend another procedure or a different test.

This is a service provided by the IBD team for patients with Ulcerative Colitis or Crohn`s disease who have symptom flare. The service is specifically for patients under the follow up care of Gastroenterology at Maidstone and Tunbridge Wells NHS Trust.

The advice line is an answer phone service, staffed Monday to Friday 9am to 5pm (excluding bank holidays). The IBD Clinical Nurse Specialists will triage your message and return you call within three working days, but usually within 24hrs.

• Tunbridge Wells Hospital: 01892 635137 email mtw-tr.ibdnursetwh@nhs.net
• Maidstone Hospital: 01622 224084 email mtw-tr.ibdnurse@nhs.net

The service is not for urgent attention – for this you should consider NHS111 or Emergency Department.