Introduction
This leaflet is designed to help you prepare for your transnasal gastroscopy and answer any questions you may have.
Checklist
Please read this leaflet before your appointment and follow the instructions carefully.
• Do not eat anything for 6 hours before your appointment. Continue to drink water for up to 2 hours prior to appointment time and this should be used to take any critical medications.
• Please contact us before your appointment if you are taking any medication to thin your blood. If you are taking aspirin, you do not need to stop this before your appointment.
• Please bring a list of all your medication with you on the day. • Please leave valuables and jewellery at home where possible as we unfortunately are unable to look after these.
What is a transnasal gastroscopy?
Transnasal gastroscopy is an examination of the lining of the oesophagus (gullet), stomach and duodenum (small intestine) using a flexible scope.
An ultra slim endoscope is passed through your nostril and down the back of your throat into the oesophagus.
Transnasal gastroscopy has been shown to improve patient comfort, as it avoids the gagging sensation, which commonly occurs when the scope is passed through the mouth as in a standard gastroscopy. The procedure is done without sedation. Your doctor or nurse will spray the nose with local anaesthetic to numb the area before the procedure. You will be able to speak to the staff throughout your procedure. If necessary, biopsies (small samples of tissue) may be taken during the examination and sent to the laboratory.
Are there any alternatives to this test?
The main alternatives to the test are:
– Transoral endoscopy (OGD) where the flexible scope is passed through the mouth, rather than through the nose. This can be done using the transnasal scope and may be offered to you on the day, if the transnasal procedure is unsuccessful.
– Barium studies. During this procedure, you drink a special liquid (barium) which allows images (pictures) of your oesophagus and stomach to be seen using x-rays. It is less accurate than endoscopy at detecting inflammation, ulcers and tumours of the oesophagus, stomach and duodenum. Unlike an endoscopy, you cannot take biopsies during a barium study.
Are there any risks associated with transnasal gastroscopy?
Complications are rare. There is a 0.2 per cent risk of the following happening after a transnasal gastroscopy:
Sometimes:-
• Sore throat
• Epistaxis (nosebleed)
• Sinusitis
• Abdominal discomfort and/or bloating due to air insufflation during the procedure
Rarely:-
• Chest infection
• Missed pathology
• Reaction to the local anaesthetic spray
• Aspiration pneumonia – inflammation of the lungs, caused by inhaling the contents of the stomach. This is why it is important that you follow the instructions about not eating or drinking (refer back to the Check List on Page 3)
Rarely bleeding (about 1 in 2000) or perforation (< 1 in 10,000) may occur – in certain cases a standard Gastroscopy, Hospital admission and/or an operation may be necessary to treat these complications.
Very rarely if a complication occurs a blood transfusion may become necessary.
When should you not have a transnasal gastroscopy?
A transnasal gastroscopy may not be suitable for you if you have:
• Allergy to local anaesthetic (lidocaine) spray
• Past broken nose or nasal surgery such as a rhinoplasty
• Deviated nasal septum
• History of nasal polyps
• Known to suffer from recurrent nose bleeds
• Patients on Anticoagulants/Antiplatelets who are unable to discontinue prior to procedure
• Patients with known Hereditary Haemorrhagic Telangiectasia (HHT)
• Known Long Segment Barrett’s Oesophagus
• Prescribed blood thinning medication (anti-coagulants/antiplatelets)
• Facial injury or surgery within the last 6 weeks
• Suffers from involuntary movements
• Major nose bleeds within the last 6 weeks
The procedure can still go ahead but the endoscopist may insert the ultra-thin scope through the mouth instead. If on the day of the procedure it is felt that it is safer not to proceed with TNG then a standard Gastroscopy may be offered depending on availability of slots
Local anaesthetic spray
For the procedure, you will be given a local anaesthetic spray to numb your nostrils. The spray wears off after 30 minutes and then you can eat and drink again.
The advantages of having the local anaesthetic spray are that:
• you can go home immediately after the test
• you do not need a relative or friend to take you home
• you will be able to drive yourself home after the test
• you can return to work after the test
If you have diabetes please contact the Endoscopy Booking Assessment Nurse or your Diabetes Specialist Nurse, Practice Nurse or General Practitioner for personalised diabetes advice.
What happens on the day of the test?
You must have nothing to eat for 6 hours before your TNG appointment (except medication). Your stomach needs to be empty to ensure a clear view and to reduce the risk of a chest infection. You may continue to drink water and take medications for up to 2 hours before your appointment time.
The procedure will be done as close to your appointment time as possible. Every effort is made to keep waiting times to a minimum, but it is not possible to say how long individual procedures will take. You may like to bring something to read with you.
Please wear loose-fitting clothes to your appointment, because during the procedure, the endoscopist will put air into your stomach; inflating the stomach with air improves the views of the oesophagus, stomach and duodenum, however it can cause bloating afterwards.
The bloating will go down, but wearing tight-fitting or tailored clothes will make you more uncomfortable.
Your endoscopy team will discuss the procedure, any treatment, possible risks, expectations and side effects with you before asking for your consent, in our pre-assessment room.
We will then ask you to lie on your back or your left-hand side for the procedure to take place.
The local anaesthetic nasal spray will be sprayed into your nose in advance of the procedure.
We will place a small probe on your finger to monitor your pulse, oxygen levels and blood pressure.
The endoscopist will then place the ultra thin endoscope (a long, flexible tube) into your nostril, down your throat and into the oesophagus into the oesophagus/stomach and duodenum.
They will slowly put air into your stomach, which will help them to see inside.
If any saliva collects in your mouth, the nurse will clear it with a small suction tube like that used by dentists.
The endoscope will not interfere with your breathing or cause you any pain. The test can take up to a maximum of 15 minutes to complete.
Please be aware we are a Teaching Hospital and may have trainees in any areas of your pathway. They will always be supervised and they will always be working at an appropriate level for their training stage. If you would rather not have a trainee involved in your care please let the staff know your wishes. This will not affect your care.
What happens after the test?
After the procedure you will be able to go home. Do not have anything to eat or drink for half an hour after the test, as your throat may still be numb from the anaesthetic.
When will I get the results?
We will give you a copy of the report and discuss the findings.
Details of the results including biopsy results will be communicated to you by whoever referred you for the test.
The endoscopy department will not be able to give you any biopsy results.
Is there anything I need to watch out for at home?
Please do not worry if you have a sore throat for the rest of the day. It is normal to experience bloating and mild abdominal (tummy) discomfort for a few days after having a transnasal gastroscopy. However, if you experience any severe pain or persistent bleeding after your tests, please contact the Gastroenterology & Endoscopy Unit within working hours (7:45am to 6pm) and ask to speak to the nurse in charge. If urgent out of hours advice required please contact Ward 2 on 01253 953402.
Gastroenterology & Endoscopy Unit Location Map
Access from the main hospital multistorey car park
We are located in Area 6 - Gastroenterology & Endoscopy Unit, highlighted in orange on the main hospital map. Follow the signs for the Main Hospital up the escalator/lift towards Area 6, second corridor on the left. Follow the signs down the link corridor, exit to the right via the side door (external) which is signposted for Patient Entrance to Reception.
Access for drop off/collection only & disability parking
Enter via East Park Drive and follow the road up the hill, take the second left signposted for Gastroenterology & Endoscopy Unit Drop Off Only, follow the road round to the right.
