Enteroscopy with and without argon plasma coagulation (APC)

Before your appointment

• All medications should be taken as normal with a little water.
• If you take Warfarin or Clopidogrel or other blood thinning medication please contact the Endoscopy Nurses when you receive this information on 01223 216515. You may need to stop your medication prior to your procedure. If you take Aspirin only please continue.
• If you have implanted cardiac device such as a Pacemaker or Implanted Cardioverter Defibrillator please contact the endoscopy unit on 01223 216515.
• If you have any questions about the procedure or find that you cannot keep this appointment, please contact the endoscopy office between 9:00 and 17:00 Monday to Friday on 01223 257080.

On the day

• Have nothing to eat for six hours and nothing to drink for four hours before your appointment.
• Please ensure you have arranged an escort home. We cannot sedate you if you do not provide details of your escort.

At the hospital

• Please come to the endoscopy department on level 3 of the Addenbrooke’s Treatment Centre (ATC).
• Use the ‘Car Park 2’. The car park is busy early in the morning; please allow yourself enough time to arrive in time for your appointment. Take your parking ticket to the Endoscopy reception desk to have your ticket stamped; this will enable you to have discounted parking.
• Please note you need to arrive 30 minutes prior to your appointment time for your pre procedure check. The length of time you will be here will vary enormously but may be anything from two to four hours or more. Please ask your admitting nurse for further information during your admission check.

What is an enteroscopy?

Your doctor has requested this procedure to help investigate and manage your medical condition.

An enteroscopy is a procedure that allows the endoscopist to look directly at the lining of the upper gut in particular the area beyond the stomach known as the small bowel or small intestine. The procedure involves passing a narrow flexible instrument through your mouth, into the gullet (oesophagus) and then into the stomach, duodenum and beyond to examine the lining. This allows us to see if there are any problems such as ulcers or inflammation. The procedure can take between 5 and 15 minutes.

Sometimes a more specialised instrument called a ‘balloon enteroscope’ is required. It looks almost identical to other enteroscopes; but has a special attachment to allow the enteroscope to be passed further into the small intestine; this procedure takes longer.

Enteroscopy is useful in treating bleeding problems with Argon Plasma Coagulation (APC), which is like a laser, dilating strictures (stretching parts of the small bowel that have narrowed) and removing polyps.

Sometimes it is helpful to take a sample (biopsy) of the lining of the gut. A small instrument, called forceps, passes through the enteroscope to ‘pinch’ out a tiny bit of the lining (about the size of a pinhead) which is sent to the laboratory for analysis. Most people find this painless.

Getting ready for the procedure

Wear loose fitting washable clothing and leave valuables at home.

On arrival to the department

Please register your arrival with the receptionist, they will ask for your pre-procedure questionnaire. Some patients may arrive after you but be seen quicker; we have seven procedure rooms all undertaking different procedures therefore patients are not seen in arrival order.

Before your procedure you will meet one of the nurses who will ask you some health questions and explain the procedure to you.

Once this is completed, you will be escorted to a single sex changing area. You are able to wear your own clothes for this procedure. Your escort cannot wait with you from this point and can leave the department until you are ready to go home.

You can change your mind about having the procedure at any time.

Sedatives

Enteroscopy is performed under sedation. You may also be offered anaesthetic throat spray to that you are as comfortable as possible during the procedure.

The sedation will be administered via a plastic tube called a cannula which is inserted into a vein, and will make you feel relaxed and sleepy but not unconscious (this is not a general anaesthetic). This option means you may not be aware of the procedure. As you will receive sedation:

• You will need to stay whilst you recover which may take up to an hour or more.
• You will need to be escorted home; your procedure will be cancelled if you do not have an escort.
• The injection will continue to have a mild sedative effect for up to 24 hours and may leave you unsteady on your feet for a while.

What happens during the procedure?

You will be collected from the changing room by the endoscopist and taken to a private bay to complete your consent form, when this has been completed they will escort you to the procedure room. The team in the procedure room will introduce themselves and ask you some questions; this is to confirm you are ready and prepared to continue with the procedure.

In the procedure room, we will ask you to remove false teeth, glasses and hearing aids in the left ear. We will make you comfortable on a couch lying on your left side. The Endoscopist will give you the injection or throat spray. We will put a plastic guard into your mouth so that you do not bite and damage our instrument. We will also put a plastic ‘peg’ on your finger to monitor your pulse and oxygen levels. A sticky pad will be placed on your upper thigh to connect you to the APC equipment if required.

For your comfort and reassurance, a trained nurse will stay with you throughout.

When the endoscopist gently passes the enteroscope through your mouth you may gag slightly, this is quite normal and will not interfere with your breathing. During the procedure, some air is put into your stomach so that the endoscopist will have a clear view and this may make you burp and belch a little. Some people find this unpleasant. The air is removed at the end of the procedure.

Minimal restraint may be appropriate during the procedure. However if you make it clear that you are too uncomfortable the procedure will be stopped.

After the procedure

We will take you to a recovery area while the sedation wears off. When you are sufficiently awake, we will give you a drink before you get dressed. You can then go home; this may be up to an hour following the procedure.

We advise you not to drive, operate machinery, return to work, drink alcohol or sign legally binding documents for a 24-hour period after the procedure. We also advise you to have a responsible adult to stay with you for the next 12 hours. You can eat and drink as normal.

Afterwards, the back of your throat may feel sore for the rest of the day and you may feel a little bloated and have some wind-like pains because of the air in your gut; these usually settle down quickly.

We will always do our best to respect your privacy and dignity, e.g. with the use of curtains. If you have any concerns, please speak to the department sister or charge nurse.

When will I know the result?

The endoscopist or endoscopy nurse will tell you about the procedure in the recovery area when you are awake. If you would like more privacy, we will take you to a private room.

The sedation can affect your ability to remember any discussion. If you would like someone with you when you talk to the endoscopist or endoscopy nurse please inform the nurse looking after you who will arrange for you to be seen in a private room with your escort when they arrive.

If you had a biopsy the final result will be given to you by either the healthcare professional who requested the procedure at a clinic appointment or by letter. These results can take several weeks to come through. You should discuss details of these results and any further treatment with that person or your GP.

After discharge

We will provide you with an information sheet on discharge which will detail who to contact if you require any assistance after the procedure.

Alternatives

In some cases, depending on individual factors such as the symptoms present and the condition being investigated, there may be alternatives to having an enteroscopy. These may include:

• barium studies,
• a CT scan,
• an MRI scan
• video capsule enteroscopy

For more information

• Contact the endoscopy office between 09:00 and 17:00 on 01223 257080