GASTROSCOPY. Travelling to London Bridge Hospital A GUIDE FOR PATIENTS. Please ensure you read this booklet as it contains important information

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1 Travelling to London Bridge Hospital Directions: London Bridge Hospital is situated on the south side of the River Thames. We are next to London Bridge mainline and underground stations with easy access to the City. Train: London Bridge Station is serviced by trains from Kent and Surrey and offers direct connections to Charing Cross, Cannon Street, Waterloo East and Blackfriars Stations. Trains also connect directly on the Thameslink line. Underground: London Bridge Station is on the Jubilee Line and Northern Line (Bank Branch). Please take the Tooley Street exit, located opposite the London Dungeons. By Car: There are no car parking facilities available at the hospital. There is limited parking nearby. Patients can be dropped off and collected by car or taxi outside the main door of the hospital, where 15 minutes parking is available. Taxi: The hospital reception can book taxis for patients and visitors through our local taxi company, alternatively black cabs are available at London Bridge Station. GASTROSCOPY A GUIDE FOR PATIENTS Buses: There are numerous buses that pass by the hospital on Tooley Street, from London Bridge, or from outside the main entrance of the London Bridge Station Tooley Street, London SE1 2PR Tel: Web: Please ensure you read this booklet as it contains important information

2 Welcome You have been advised to have a investigation on the upper gastrointestinal tract (Gastroscopy). This booklet gives information about the procedure. We will do everything we can to make your stay as comfortable as possible and prepare you for your visit. Please take the time to read this booklet, as it contains important information about: How to prepare yourself for your procedure. What to expect during your stay. Being discharged home. Advice for carers Your formal consent is required before carrying out this examination. This booklet explains how the examination is carried out and what the risks are. This will help you to make an informed decision in agreeing to the examination and having sedation. If there is anything you do not understand, or anything further you wish to discuss please call either your Consultant or the Endoscopy Department. The purpose of this information booklet is as a guide for your procedure. Your Consultant may have given you specific instructions to follow. Please then follow your Consultant s requests.

3 Before you come into hospital Please bring in with you: You will have already seen a doctor in an outpatient clinic and they have decided that you require this procedure as a day case. If you have been sent a Patient Self Assessment form, or admission/registration form, please complete it making sure all details are correct. If you do not think either document will reach us in time for your admission, please bring the form with you. Prior to admission, it is imperative that you advise your insurance company of your admission to gain pre-authorisation. If you are self-funding, full payment must be made prior to admission. If you have any questions about your insurance or payment methods, you can contact our Pre-Admissions Officer on If the intended operation or procedure is being carried out under general anaesthetic or sedation, you must make arrangements in advance for somebody to take you home and also stay with you overnight. Your procedure may not go ahead if you have not made suitable or safe discharge arrangements. If you have any queries about your admission date or time, please contact your Consultant, your Consultant s secretary or our Reservations Department. Telephone or /2180. Privacy and accommodation In the Day Surgery Unit, all rooms are shared. Each room will accommodate two to four patients. The bed spaces are separated by curtains and partitions to provide some privacy. Each room will only ever be single-sex. All tablets, medications, inhalers that you are currently taking in the original packaging or any prescriptions you have. Please do not bring in your dosette box. Any toiletries you require. Glasses/contact lenses, cases and solutions. Something to help you pass the time, such as books, magazines, puzzles etc. X-rays, scans and any other appropriate reports or letters. Insurance documents. HCA Hospital ID Card if you have been a patient of an HCA hospital before. Credit/debit card or other payment method. Valuables Please do not bring jewellery or large sums of money. If this is unavoidable, please ask a relative or friend to look after them. London Bridge Hospital cannot be held responsible for any loss or damage to property brought into the hospital. In the Day Surgery Unit, you will have a locker next to your bed space for your personal possessions. This will be locked and the nurse will look after the key for you whilst you are having your procedure. This space is limited; please only bring with you what you will need. What should I wear? Wear loose, comfortable clothes, cotton underwear and flat or low-heeled shoes. 2

4 What to expect during your stay Waiting time Although you will have been given a provisional time for your procedure, the order of the operating list is not confirmed until the day of admission by the Consultant. Any investigation time may also be subject to change. On the day of your procedure, you must allow time for the admission process, procedure and your recovery time. You should expect to spend up to three hours with us. If you feel that you want to discuss your proposed treatment in a more private place, ask the nurse assigned to you. Please do not hesitate to contact us if you have any questions you wish to discuss further with a nurse prior to your admission. Do I keep taking my normal medication? Your routine medication should be taken. If your appointment is in the morning your medication should be taken at 6am with a little water, however if your appointment is in the afternoon your medication should be taken by 8am. If you are presently taking tablets to reduce the acid in your stomach please discuss this with your Consultant. Your Consultant may wish for you to discontinue them. If you are having a follow up gastroscopy to check for healing of an ulcer found during the last two-three months, then please continue your acid reducing medications right up to the day before your repeat endoscopy. If you are diabetic and taking medication (either tablets or insulin), you will have to reduce/modify your tablets or insulin dose when you start avoiding solid food as below. You should test your blood or urine for glucose before you start your bowel preparation, and then at least every four hours until you leave home for your appointment. If the result is higher than 10mmol/L, continue with your medication. You may drink sugary drinks to maintain your blood sugar level up to two hours before your appointment time. If it is lower than 10mmol/L, delay your medication until you start eating again. You may need to take just your normal dosage of medication according to blood sugar level. If you take Warfarin, Aspirin, Clopidrogrel (Plavix), any anti-inflammatory tablet or Heparin, you may continue them. However, you should discuss this with your consultant. For example if you have a known colonic polyp which will need to be removed then you must discontinue the blood thinning medication. Please remember to tell the staff about the drug before your test. Dietary Advice You must not have anything to eat for six hours before and drink two hours before the procedure; it is essential that your stomach is empty, as you may be sedated. If your stomach is not empty there is a risk of aspiration (vomit inhaled into the lungs). This can be a very serious complication. Furthermore having your stomach empty allows a clear view during the procedure. Intravenous Sedation Please note that if you are given sedation a responsible adult must accompany you home and you must have someone to stay with you overnight. You may wake up fairly quickly or more slowly each person reacts differently. You will probably remain on the unit for about two hours, but the effects of the sedation will last for much longer, up to 24 hours. Your thinking processes and movements will be slower than usual. It is very likely that you will not remember anything about the examination afterwards.

5 What happens when I arrive You will be asked to arrive at London Bridge Hospital one hour before your scheduled procedure time to allow the administrative and nursing staff ample time to complete your admission and any pre-test tasks. You will see a member of staff from the accounts team. They will check your admission and account details with you. You will then be sent up to the appropriate ward area, where you will be greeted by a member of the nursing team. They will show you to your room or bed space. A nurse will complete the admission process with you. This will include confirming your identity, completing paperwork, asking you questions about yourself and your health, (this is made shorter if you complete the Self Assessment Booklet), taking your blood pressure, pulse and temperature. You will be given two hospital identity bracelets with your name and details on them. If you are allergic to anything such as some foods, types of medication or latex, please tell your nurse and a red allergy bracelet will be used. You will be asked to wear a hospital gown. You will see your Consultant prior to your procedure. Feel free to ask any questions at this time. You will then sign a consent form, unless you have already done so in your outpatients clinic. You will be given a copy of the consent form for your own records by your Consultant or nurse. The nurse will also ask you about your arrangements for getting home reminding you of the importance of having someone accompanying you if you have had sedation. What is a Gastroscopy? This test is a very accurate way of looking at the lining of your upper digestive tract: the oesophagus (gullet), stomach and duodenum (first part of the small bowel), to establish whether there is any disease present. The instrument used in this investigation is called a gastroscope. It is flexible and has a diameter less than that of a little finger. The end of the gastroscope contains a light which enables light to be directed onto the lining of your upper digestive tract and a camera which relays pictures back to the endoscopist onto a television screen. During the investigation, the doctor may need to take some tissue samples (biopsies) from the lining of your upper digestive tract for analysis: this is painless. The samples will be retained and sent for analysis. A photograph of the inside of your bowel may also be taken. It will be kept in your medical records and sent with your biopsy and can be shown to you later to help you understand the findings of your test. Why do I need a Gastroscopy? A Gastroscopy is usually carried out to investigate symptoms such as: swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain or chest pain or as a follow-up inspection of a previous known disease/problem. The results will help your consultant to decide on the best treatment for your problem or whether to carry out any further examinations The nurse will check your personal details again before taking you to the endoscopy room. Why do you keep asking me the same questions? We have to confirm certain details are correct as part of our checking procedure. This is standard practice for any patient having a procedure as we have to ensure the correct procedure is carried out. We do know who you are and why you are in hospital, but we want to double check our information.

6 What are the risks? According to the British Society of Gastroenterology the main risks for Gastroscopy are: Perforation: a tear of the linings of the stomach or oesophagus which could entail you being admitted to hospital. Although perforation generally requires surgery to repair the hole, certain cases may be treated conservatively with antibiotics and intravenous fluids. Bleeding: this may occur at the site of a biopsy. This is usually very minor and stops of its own accord. Damage to teeth, crowns or bridgework: utmost care is taken to protect any teeth or dental work by use of a mouthguard. This occurs very rarely. Reaction to sedation: problems with breathing, heart rate and blood pressure happen occasionally. If any of these problems do occur, they are normally short lived. Careful monitoring by a fully trained endoscopy nurse ensures that any potential problems can be identified and treated rapidly. These risks do increase for elderly patients and those who have significant health problems. Allergic reactions to sedation are very rare. Aspiration pneumonia: Vomit inhaled into lungs. This occurs very rarely in patients. What happens during a Gastrosocopy?. You will be taken to an examination room for the procedure. Once sat on the trolley the nurse or doctor may spray your throat with a local anaesthetic. This makes your throat go numb quite quickly and you may start to feel as if you can t swallow. Don t panic, you can swallow just not feel it. The nurses will ask you to lie down in the correct position resting on your left side with your knees slightly bent. A nurse will stay with you throughout the test. To keep your mouth slightly open, a plastic mouthpiece will also be placed between your teeth. A sedative drug will be injected via the cannula into your arm. This is not a full anaesthetic but it will make you very relaxed and sleepy. You may also be given analgesia (pain relieving drugs) via the cannula to ensure any discomfort you might feel during the procedure is minimised. Alternatively, a throat spray can be used to make the back of your throat numb, but you will have an opportunity to discuss this with your Consultant when you attend. A fine soft tube will be placed into both nostrils to give you a little extra oxygen to breathe and a small device will be attached to you finger or thumb to monitor your pulse rate and oxygen levels during the test. Once you are sedated or had throat spray the test will be carried out as follows: 1. Firstly, the endoscope is gently passed through your mouth into your stomach. This will not cause you any pain nor will it interfere with your breathing. 2. The lining of the oesophagus (gullet), stomach and duodenum (small bowel) will then be examined closely. Air will be passed through to distend the stomach to give a clear view of the lining. This air is sucked out at the end of the test. 3. If the doctor finds any change in tissue, a tiny piece may be removed (biopsy) using instruments passed through the endoscope. Any samples of tissues removed are sent to the laboratory for specialist examination. When the procedure is complete, the tube is removed quickly and easily. You will then be returned to the ward for your recovery.

7 What happens after the procedure? After the test you will return to the Day Surgery Unit on your trolley to continue your recovery. The nursing staff will check your pulse, blood pressure and oxygen levels, and generally assess how you have recovered from the test. You may feel a little bloated and experience wind pains, due to the air passed into the stomach, please don t feel embarrassed if you need to belch, this will help relieve the discomfort quite quickly. If you are in pain, please inform your nurse as soon as possible. You will be given something to eat and drink about an hour after returning to the ward. Your Consultant will explain what was seen during the examination either before you leave or in your follow up appointment. If you haven t already got a follow up appointment this is when you will discuss this with your Consultant. Discharge Advice Side effects The effect of the sedative can last up to 24 hours. It can make you forgetful and drowsy even though you may feel fully alert. Once home, it is important to rest quietly for the remainder of the day. You may suffer from a sore throat which should last no longer than hours. Furthermore you should avoid the following activities for at least 24 hours after the procedure: going to work driving operating machinery drinking alcohol signing any legally binding documents carrying out any activities involving heights caring for young children (sole responsibility) Queries and concerns If you have problems you wish to discuss following your procedure, please telephone the ward where you were cared for. You will be given this number on discharge. If you require advice out of hours (between 9pm and 7am), please telephone and ask to speak to the site bleep holder (on 000 ). This connects you to the senior nurse in charge of the hospital who can assist you. If you feel you need to be seen by a doctor in an emergency, please contact your Consultant, GP or go to your nearest Accident and Emergency Department.

8 Fire At London Bridge Hospital we take the safety of our patients, visitors and staff very seriously. Our staff undergo regular training, we have the latest evacuation equipment, our buildings are constructed to the very highest standards and are subject to frequent and regular external inspection. Test and drills Alarms are tested every Tuesday starting at 10.00am, and drills are conducted annually. Your nursing staff will inform you when a drill is taking place; you will not be expected to participate. In the unlikely event of a fire, we would like you to observe the following procedure: On discovering fire raise the alarm by either informing a member of staff or by using a break glass alarm and shouting fire, fire. Then contain the fire by shutting the nearest fire rated door and evacuate the immediate area. On hearing a continuous alarm this indicates that the fire is in your area. Your visitors and non-essential personnel will be evacuated to an assembly area outside the hospital. You are to remain in place until a member of the nursing staff evacuates you to a place of safety. On hearing the intermittent alarm this indicates that the fire is in your building but not in your area. Again, your visitors and non-essential personnel will be evacuated to an assembly area outside the hospital. Remain in your room until a senior member of the nursing staff tells you what to do. PLEASE DO NOT ATTEMPT TO LEAVE THE BUILDING UNLESS DIRECTED TO DO SO BY A MEMBER OF STAFF. Visitors and Escorts There are no restrictions on visiting times, but please remember that other patients may wish to rest or sleep. However, in consideration for other patients, please restrict your visitors to a maximum of two at any one time. Children are welcome to visit, but must be supervised by an adult at all times. Calls from friends or relatives can be made to the private phone by your bed. Please ask your callers to call the ward you are staying in, and a nurse will put them through (see useful telephone numbers at the back of this booklet). Alternatively, they can call the main switchboard on and ask to be put through to the room. The person taking you home is welcome to phone the hospital to check what time you will be ready to go home. Telephone: Comments, suggestions and complaints We welcome your views on our services to help us meet patients needs. We hope that your hospital visit will be a pleasant one and our staff will do all they can to ensure that this is the case. If you have a comment, suggestion or complaint about any aspect of our service, please approach a member of staff in the department and they will attempt to resolve things as quickly as possible. You will be given a Patient Feedback booklet to complete and we encourage your participation. Useful telephone numbers Main Reception Patient Accounts /2395/2061/2946 Day Surgery Unit /2631 Middle East Department X-ray Outpatients

9 Diagram of Digestive Tract Oesophagus Stomach Transverse colon Ascending colon Caecum Duodenum Small Intestine Descending colon Sigmoid colon Rectum Anus