Gastroscopy with oesophageal stent inserted

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 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 eight hours or drink for four hours before your appointment.
• Please ensure you have arranged an escort to take you 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.
• You may be required to stay overnight in hospital, please ensure you bring anything required for an overnight stay in hospital.

What is an oesophageal stent?

Your doctor has requested this procedure to help you with eating and drinking. A stent is a flexible tube that put into your oesophagus (gullet) to keep it open to help you eat. We use a gastroscope which is a long flexible tube (thinner than your little finger) with a light at the end.

If part of your oesophagus is narrow, i.e. has a stricture, it may need to be stretched before the stent is placed. We use a balloon called a dilator before the stent is put into position. We will use X-ray screening to help us do this safely.

The procedure can take between 10 to 45 minutes.

Sometimes it is helpful to take a biopsy – a sample of the lining. A small instrument called forceps passes through the gastroscope to ‘pinch’ out a tiny bit of the lining (about the size of a pinhead). This is sent to the laboratory for analysis.

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

This procedure will be undertaken with sedation. This 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).

In addition, we will also give you some pain relief.

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

As the gastroscope goes through your mouth you may gag slightly, this is quite normal and will not interfere with your breathing. During the procedure, we will put some air into your stomach so that we have a clear view; this may make you burp and belch a little. This is also quite normal but some people find this unpleasant. We will remove the air 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.

Potential risks

Gastroscopy procedures carry a very small risk (one in 10,000 cases) of haemorrhage (bleeding) or perforation (tear) of the gut following which surgery may be necessary. Placement of a stent increases this risk to approximately one in 100. These complications will become evident within a few hours.

Occasionally a stent can migrate (slip) in which case it may be necessary to place a second stent. Stents can become blocked; this would require another endoscopic procedure to clear it.

There may be a slight risk to teeth, crowns or dental bridgework. You should tell the nurses if you have any of these. Other rare complications include aspiration pneumonia (inflammation of the lungs caused by inhaling or choking on vomit) and an adverse reaction to the intravenous sedative drugs.

Like all tests, this procedure will not always show up all abnormalities and, on very rare occasions, a significant abnormality may not be identified. If you have any questions about this please ask either at the time of the procedure or the person who referred you.

After the procedure

Following the procedure we will take you to a recovery area while the sedation wears off. It is quite likely that your throat and oesophagus will feel slightly sore particularly where the stent is. Please tell the staff if it becomes too uncomfortable.

You will normally be admitted at least overnight after a stent insertion. If however you go home on the same day you are advised not to drive, operate machinery, return to work, drink alcohol or sign any legally binding documents for the next 24 hours. We also advise you to have a responsible adult stay with you for the next 12 hours.

We will give you an information sheet with advice on ‘eating and drinking’ and ‘how to look after your stent’.

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.

The final results from biopsies will be given to you either by 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.

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:

If you are unable to contact your GP: during working hours (08:00-18:00) contact the endoscopy department on 01223 216515, outside of these hours please attend your nearest emergency department informing them that you have had a gastroscopy and insertion of oesophageal stent.

For more information

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