Endoscopy

Private Endoscopy London

The procedure is usually done to make a diagnosis, but treatments can be also be carried out. The doctor will tell you whether you are having the gastroscopy for diagnosis or treatment before starting.

Sedation Options for Your Endoscopy

Endoscopy is a simple procedure that can be carried out while you’re awake. If you are having a private endoscopy in London, you may be able to choose whether to remain fully awake or have a sedative to help you relax. You should consider the options carefully and discuss them with your doctor before the procedure.

Endoscopy without a sedative

It isn’t always necessary to have a sedative, so you may decide to remain awake when you have a private endoscopy at the London clinic. If you are having the procedure without a sedative:

An anaesthetic spray will be used on the back of your throat. It will make the back of your throat feel numb and prevent you from feeling any pain. The spray should help you to swallow the endoscope more easily. You will be asked to lie down on your side.

The endoscope will then be passed into your mouth and down your throat. You will feel this happening, but it shouldn’t be painful. The doctor will ask you to swallow as the tube moves down your throat.

Once the investigation is complete, the endoscope will be removed. Your throat will feel numb and you should avoid eating or drinking anything for about an hour until the anaesthetic wears off.

Having a sedative

If you feel uncomfortable having the procedure while you are fully aware or your doctor recommends it, you may be given a sedative before your private endoscopy. The sedative is a drug that will help you to feel sleepy and relaxed during the procedure.

You will be given an injection of sedative before the endoscopy begins. It will take a few minutes for the drug to start working. The sedative will make you feel drowsy and less aware of what is happening, but you will still be awake during the procedure.

When the endoscopy is over, you will rest for a while as the sedative wears off. You should arrange for someone to pick you up and take it easy for the rest of the day. Your memories of the procedure may be a bit hazy afterwards.

Gastroscopy is a common test with very few side effects or complications. However you should be aware of the following potential complications:

Overall, the risks of haemorrhage (bleeding) or perforation (a hole in the lining of the bowel) are very low at about 1 in 15,000 (British Society of Gastroenterology). If treatment is carried out, the risks are higher but are still low. The doctor will give you specific information about the risks in your case.

Sedation causes breathing problems in about 1 in 200 cases although these are usually mild (British Society of Gastroenterology). You will be monitored through out the procedure and the sedation can be reversed if necessary.

What are the alternatives?

Barium Swallow or Barium Meal: These are X-ray tests. They are not as accurate as gastroscopy for most conditions although for a small number of people with swallowing problems, a barium swallow can be useful.

Abdominal Ultrasound: This test is useful for detecting gallstones and abnormalities in the liver and kidneys. It cannot easily examine the stomach, however.

Manometry and pH studies: These tests are sometimes very helpful for patients with swallowing difficulties and may be used in addition to gastroscopy.

Abdominal CT scan: This test can examine the entire abdomen. It involves X-rays, however, and no biopsy samples, so it is generally used as a follow up test, for example to determine the size of a growth seen during gastroscopy.

What is it?

Helicobacter pylori is a bug which is commonly found in the human stomach. It is not found in any other animals. It used to be very common in all humans. It was even found in Tutankhamun, the Egyptian mummy’s, stomach! It is found much less now in developed countries, although it is still common in Southern Europe, Africa and Asia.

How is it acquired?

It is believed that H. pylori is transmitted from parent to child. It only happens in close proximity, so with smaller families and larger, cleaner homes, transmission rates have fallen dramatically in the last 50 years. Helicobacter is rarely acquired in adulthood. This is important, because if it is found and successfully eradicated, it almost never returns.

What problems does it cause?

H. pylori is known to increase the risk of duodenal ulcers, stomach ulcers and stomach cancer. Until 20 years ago, almost all duodenal ulcers were caused by H. pylori. This has changed now, both because the bacteria is found far less often and also because of the increasing use of non-steroidal anti inflammatory drugs such as aspirin and ibuprofen. Ulcers are increasingly due to use of these medicines.

How is Helicobacter detected?

There are a number of ways of testing for this bacteria.

• Blood test: this used to be used widely. It is not a good test, however. The accuracy is only around 60% and if a person has previously had eradication treatment, the blood test still remains positive for up to 5 years after the bug has been successfully treated.
• Stool sample (Helicobacter faecal antigen): This is a simple and cheap test. It is now the test of choice for most people as it can be done at home. The only problem is that one has to collect some stool and people are not fond of doing this! This test has an accuracy of 97%.
• Breath test: Although easy to do, this test is more expensive than the stool sample. It requires the patient to take a drink of a very slightly radioactive orange juice. A breath sample is collected 30 minutes later. If H pylori is present, the levels of radioactivity contained within the drink are detected on the breath. This test also has an accuracy of 97%.
• Endoscopy: A small tissue sample can be taken at endoscopy and analysed for the presence of H pylori. If an endoscopy is being done anyway, this is a simple and rapid way of detecting it. With rapid test kits now available, the result is usually ready before the patient leaves the private endoscopy unit.

Why should it be eradiated?

If a person has an ulcer, removing the H. pylori will almost certainly result in permanent cure.

Many doctors eradicate this bug in the hope that it will reduce the risk of the patient getting stomach cancer. Although this seems like a good idea, there is no evidence that the strategy works!

How is it eradicated?

The bug is highly resistant to treatment. Two antibiotics and medicine to reduce stomach acid are needed for 7-14 days. Eradication rate is about 80%.

How can you check for successful eradication?

All the tests outlined above, except for the blood test, will show if the Helicobacter has been eradicated.

There is one little catch, however. A false negative test result may result in patients who are taking acid suppression medicines such as proton pump inhibitors. Test accuracy is much higher if the patient stops taking these medicines for at least a month.

What happens if it is not eradicated?

There are second line treatments for people who fail to respond to the initial antibiotic regime. However, once a person has failed to eradicate the bug with the initial treatment, further treatments are less successful.

It is possible to take special biopsy samples at endoscopy to check for sensitivity of the bug to specific antibiotics. This allows the doctor to tailor the treatment specifically to that patient.

At our private endoscopy facilities, we are able to offer this service to people who need it.

A word of caution:

It is not necessarily true that H pylori must be eradicated in everyone. This needs to be discussed on a case-by-case basis. Our highly experienced private gastroenterologists would be very happy to talk to you about your specific needs.