Please see our list of endoscopy procedural videos below, click play to view the relevant video for your upcoming procedure.
All available endoscopy patient information leaflets can also be found in the resource section of our website.
Endoscopic Ultrasound (EUS)
An endoscopic ultrasound is an examination that allows a trained Endoscopist to see inside your oesophagus (gullet), stomach and small intestine and the organs outside it such as the liver, pancreas, gall bladder, kidneys, adrenal glands and lymph glands, using a specialist EUS endoscope.
This video details your upcoming Endoscopic Ultrasound (EUS) procedure with Consultant Gastroenterologist, Dr Mitra.
Endoscopic Ultrasound (EUS)
Hi, I’m Dr Mitra one of the consultant gastroenterologists in North Tees Hospital. Today, I’m going to talk to you about endoscopic ultrasound in more detail.
You will get an information leaflet through the post and one of our pre-assessment nurses is going to ring you and discuss in more detail about this procedure so what is endoscopic ultrasound well essentially it is a camera test where we pass a flexible tube into your stomach and small bowel and look into your collet stomach small bowel and organs outside it this gives us magnified images of structures by using ultrasound waves.
We may require to take some biopsies if requested by your referring clinician and review it under the microscope in that case we usually get some blood tests checked before your proceeding so are there any alternatives to this examination well most of the time your consultant would have requested this test following a CT or MRI scan. If things were not entirely clear following the scans they would have recommended this test you will have received an appointment from the appointments team on the day of the procedure you will arrive to the unit after fasting for six hours prior to the procedure you will be admitted by one of the endoscopy nurses following which one of the consultant physicians will review you and consent you for the procedure like every other procedure.
This camera test carries risk of complications, they are not frequent but you need to know and be aware of this there is a small risk of bleeding introducing infection pancreatitis oversitation and causing a tear or damage in the lining of the gullet or the stomach details of the complications are outlined in our information leaflet.
For reference the procedure usually lasts between half an hour and 45 minutes.
Following the procedure, you will be transferred to the recovery unit and wait for a couple of hours before being discharged home. At the time of your discharge you will receive a copy of the endoscopy report one of the nurses from the discharge team will go through the endoscopy report with you if you have any further queries do not hesitate to ask a member of the staff you will be followed up by referring clinician in due course. We’ll organise further investigations following your discharge over the course of the next few days. If you develop any symptoms please ring the endoscopy unit for further advice.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
An ERCP is an examination of your pancreatic and bile ducts (drainage tubes from the liver) using an endoscope (a thin, flexible tube) and x-ray. A special dye will be injected down the endoscope so that your pancreatic and bile ducts show up on x-ray.
This video details your upcoming Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure with Endoscopy Fellow, Dr Esmaily.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Hello my name is Dr Esmaily, I’m an endoscopy fellow in the north east. Today I’m going to speak to you about an ERCP procedure so before your procedure one of our free assessment nurses will ring you and have a chat with you about the procedure and what will be involved.
You’ll also receive patient information leaflet and the consent form in the post. Sometimes we ask you to come in for some blood tests before the procedure, we’ll let you know if we need to do that so in the ERCP involves a camera inserted through the mouth going through the gullet the stomach and the small bowel where it reaches where the bile duct is. Once we can see the bile duct under x-ray guidance we were able to get inside and do various treatments such as place a stent or remove the stone. So the common reasons for doing that ERCP procedure are to remove stones from the bile tube if it gets stuck to place the stent and take some samples if there’s a narrowing in the bowel and to place a stent if there’s a leaked plaster of gallbladder surgery.
Normally before we get you down to the procedure we do different scans such as an MRI or at CT to give us some more information so we know exactly what we’re going to do on the day. So what happens on the day of your procedure – beforehand you will have received the time as to when we would like you to come for your procedure normally we ask you to fast for six hours before you come in on the day of the procedure. You’ll come to the reception to the endoscopy unit, a nurse will then take you through to a room and go through your medical history and what medications you think so a doctor will go through the consent form with you.
You’ll have an opportunity to ask any questions at this point in time. You’ll then be taken through to the waiting area where you can relax before your procedure. Once it’s your procedures time will take you through to our endoscopy room.
Like any procedure when we do any ERCP there are some risks and it’s important to emphasise that the risks are rare but because they can have them really collateral risk for pancreatitis which means inflammation or irritation of your pancreas gland is the risk of causing bleeding a risk of perforation or causing impair and there is a risk of introducing the infection into the bowel. There is a small risk of causing a serious life-threatening complication as a result of this procedure which may mean that you need to come into hospital for a period of time. Further information about ERCP related complications are available in our patient information.
There is a possibility that we can remove stones by means of a surgical operation this is not generally more complex but if you wish to speak to a surgeon you can arrange this form. If you decide not to have an ERCP procedure then there is a chance that your symptoms may not resolve.
What happens during and after the procedure for the procedure we will give you a medication conservation – this will help to relax you for the procedure and makes it more comfortable for you important to be aware that you will be conscious during the procedure. The procedure normally lasts between 30 and 45 minutes. After the procedure you’ll be taken to the recovery area where a nurse will keep a close eye on you once you’re a bit more awake you’ll be able to have something to eat and drink. Before you go and one of our endoscopy nurses will go through exactly what’s happened during the procedure and what follow-up is needed. Once you go home if you become unwell you can contact the endoscopy for any advice or out of hours you can contact accident emergency
If you have any questions please ask us.
Colonic Stenting
A Colonic stenting procedure is performed if there is a blockage to the bowel, the stent expands to allow bowel contents to be able to pass more normally.
This video details your upcoming Colonic Stenting procedure with Consultant Gastroenterologist, Dr Dwarakanath.
Colonic Stenting
Hello my name is Deepak Dwarakanath. I’m a consultant gastroenterologist in the Trust and I’m here to talk about colonic stenting.
Colonic stenting is done for one main reason – that’s when the bowel is obstructed due to a colonic cancer. This may well have been diagnosed with a CT scan or a previous colonoscopy or flexible signaloidoscopy.
The procedure is performed for two main reasons – when the bowel is obstructed and the patient is not fit enough or well enough to have surgery to decompress the bowel or it is used as a bridge to surgery when patients get acutely obstructed and do not want to have a course to use a temporary measure.
Before your procedure you will be seen by one of our pre-assessment nurses who will explain the procedure. You may well have some blood tests to ensure that the test is performed safely and with the least possible complications.
You’ll receive a full information pack that will outline the procedure together with any complications that could occur an endoscope is passed through the back passage to the level of the blockage. We then take x-ray pictures to delineate and demonstrate the position of the tumour.
Thereafter a wire is passed through the tumour and the stent pass across the cancer and released this then allows the bowel blockage to be relieved immediately. Prior to the test you’ll have had a CT scan that will have given us more information on the exact position of the tumour.
What will happen on the day of your procedure, prior to the procedure you will have had a detailed appointment letter to tell you where the endoscopy unit is, what time to come to the endoscopy unit. Six hours prior to the procedure you will need to stop eating and drinking. You’ll be greeted at the reception by one of our highly skilled endoscopy nurses who will take you into the booking room and ask you some general health questions and check that you’re fit enough to have the procedure on that day.
You will be asked to wear a gown and some modesty underwear. You’ll be taken into the room, a small cannula plastic tube will be inserted into the veins in your hand and this will allow us to give you sedation. You will be then brought into the room what are the risks associated with the procedure.
Prrior to the procedures being undertaken, the doctor will ask you to read and sign a consent form that will explain the procedure in detail together. The main risks of colonic stenting include bleeding, perforation the after effects of sedation together with pain afterwards. These risks are small and far outweigh the risks of not having the procedure.
In the case of bowel obstruction due to a tumour – if one does not have a procedure such as a colon extent there is a risk of bowel perforation which in itself is extremely serious and may be fatal.
The procedure and what happens afterwards – you’ll be taken into the room, you’ll meet the team we’ll give you some sedation into the cannula in your hand.
On average the procedure takes approximately 60 minutes. Once the procedure has been safely performed you’ll be taken out into the recovery area to relax for approximately two to three hours after you’ve recovered from the sedation you’ll be given something to eat or drink.
Thereafter once we’re happy that you’ve recovered fully you’ll be allowed home. Over the next two or three days the stent gradually opens there may be a little abdominal pain as this occurs but your bowel function should gradually return to normal. You may well be given some laxatives to ensure that your bowel function returns to normal.
If you have any problems over the next few days after the procedure please contact the endoscopy unit. If this is out of ours please contact the A&E department.
Oesophageal Dilatation
A dilatation procedure is performed to widen a narrowing in your oesophagus (gullet) to help relieve any swallowing difficulties you may be experiencing.
This video details your upcoming Oesophageal Dilatation procedure with Consultant Gastroenterologist, Dr Chaudhury.
Oesophageal Dilatation
I’m going to talk to you about the procedure of oesophageal dilatation. Before coming to hospital for your procedure one of our pre-assessment nurses will be contacting you by phone to go over the procedure with you in detail. You will also receive a booklet explaining the procedure and a consent form for you to read.
Patients may require a blood test to be carried out before the procedure and in that case you will receive a form so that this may be performed.
Oesophageal dilatation is a procedure in which narrowing in the gullet is widened. The procedure entails inserting a camera which is a flexible tube through the mouth into the gullet. Having identified the exact area where the narrowing is, it is stretched. Sometimes we use x-ray to guide us to the exact site. Most of the patients would have had some form of imaging before the procedure is carried out.
I’m going to speak to you about the indications for which dilatation of oesophagus is carried out. The indications are narrowing of the gullet due to acid reflux. The other indications are radiation damage to the gullet, inflammation of the gullet called eosinophilic esophagitis and a condition called achalasia which
is an issue with the muscle of the oesophagus.
What happens on the day of the procedure? You have received an appointment giving you the day and the time at which you are supposed to arrive on the endoscopy unit. You’re required to fast for six hours
before the procedure which is to eat or drink nothing. You’ll arrive at the reception of the endoscopy unit, a nurse will formally admit you, will ask you questions about your health conditions and also the medications you are on.
You will give them a gown to where a doctor will formally consent to you again going over the procedures at which stage you may ask any questions that you may have of the doctor wait in the waiting area until your turn comes. Then you will be escorted to the procedure where you will be introduced to the team. Like any procedure which is invasive. Oesophageal dilatation also has its risks the complications of the procedure are pain or discomfort. During the procedure bleeding, perforation or a tear invading the gullet and infection.
There is a very small risk that one of the complications may be potentially serious and life-threatening and it may require admission to hospital for further treatment to be carried out. The details of all these complications are in the booklet. And in any case should you have any questions please feel free to ask the doctor the nurse, who will be quite happy to explain to you.
Are there any alternatives to this procedure? One option is not to do the procedure but in that case your symptoms will not be relieved and the condition will not be addressed. In conditions of achalasia there is a surgical option that is if one is fit to have surgery. But in that case we would be asking our surgical colleague to see you to explain the condition further it.
What happens during the procedure and afterwards?
From the waiting area you will be taken to the procedure room where you will be introduced to the team. The procedure is carried out under conscious sedation. It’s important to realise that this is not an anaesthetic – you will not be asleep. We will give you a sedative called midazolam and an analgesic called fentanyl to make you sleepy and relaxed. The procedure ordinarily takes about 30 minutes. Following the procedure you will be taken to the recovery area where you will be there for a couple of hours. Following that you’ll be able to eat and drink. The nurse will explain what happened during the procedure and what the follow-up arrangements are. You will also have a copy of the report. You will also be given a telephone number to contact should you have symptoms in the days after the procedure –
particularly symptoms of chest pain or difficulty in swallowing. If it is out of hours then you are asked to go to the accident and emergency department.
If you have any questions at any stage of the procedure before or after please feel free to ask us and we’ll be happy to explain to you. One thing to remember that in most of the conditions for which this procedure is carried out generally it requires a repeat procedure which we will explain to you after the procedure.
Colonic Dilatation
A colonic dilatation procedure is performed to widen a narrowing in your colon (large bowel) or small intestine, which may have become blocked.
This video details your upcoming Colonic Dilatation procedure with Consultant Gastroenterologist, Dr Dwarakanath.
Colonic Dilatation
We perform colonic dilatation when there is narrowing in the large bowel the colon or at the end of the small bowel which is called the terminal ion. The main reasons behind this are inflammatory structures caused by crohn’s disease or bowel ischemia or at sites of previous surgery.
Prior to the procedure you will see one of our pre-assessment nurses to go through the procedure in detail with you. You’ll receive an information leaflet with diagrams that will explain the procedure and any risks associated with it. You also have some blood tests to ensure that the procedure is done safely and with a minimal complication.
What is colonic dilatation?
Prior to the procedure you will have a CT scan or an MRI scan to delineate the stricture and show the position of this. The endoscope is then passed into the rectum and to the level of the stricture. Thereafter a balloon is used to open up the narrowing in the bowel during this time you will have had sedation and some pain relief to ensure this is as comfortable as possible. X-rays are used during the procedure to ensure that the procedure is done safely and with a minimal complication.
You’ll be greeted at the endoscopy reception area, meet one of our admitting nurses who will ask you some simple basic questions about your general health. You’ll be asked to fast for six hours prior to the procedure. The doctor who will do the procedure will go through your consent with you to explain the benefits of having this procedure done as well as the small risks that occur with any endoscopic procedure. You will then wait in the waiting room prior to entering the endoscopy room.
Like any endoscopic procedure cloning dilatation does carry risks. These risks are small are and are far
Outweighed by the benefits of the procedure. The main risks are bleeding perforation pre-stenosis. That means re-narrowing of the area, also the adverse effects of sedation should a complication occur. These do occasionally occur. You may require surgery to repair any perforation or bleeding. These risks are very very small.
One of the other issues that can occur with colonic dilatation is that the stricture reforms and the patient requires further dilatations in the future.
You’ll be taken into the endoscopy room and greeted by the endoscopy team. We will give you some sedation and pain relief to make the procedure as comfortable as possible. The procedure overall takes about 30 minutes. We use x-rays to position the balloon in the safest possible way to perform the diversation.
After the procedure is performed you will recover in the recovery area for a few hours. You’re given something to eat and drink and then when safe you’re allowed home. You may well be given some laxatives to take to ensure that your bowel habit is regular afterwards.
Should there be any further abdominal pain that concerns you please contact the endoscopy department or if it’s out of hours please contact the A&E department.
Endoscopic Mucosal Resection (EMR) Polypectomy
An EMR procedure is performed to remove a lesion (growth) from your oesophagus (gullet), stomach, or small bowel (duodenum). The procedure is performed using a gastroscope.
This video details your upcoming Endoscopic Mucosal Resection (EMR) Polypectomy procedure with Consultant Gastroenterologist, Dr Beintaris.
Endoscopic Mucosal Resection (EMR) Polypectomy
My name is Doctor Beintaris. I’m one of the consultant gastroenterologists at North Tees. Today, I’m going to walk you through your upcoming polypectomy procedure.
So, what happens before your procedure? One of our pre-assessment nurses will contact you to discuss the procedure with you and you will also receive your appointment in writing with details on the date and time. We will also post you the relevant procedure information leaflet together with the consent form for your reference to peruse before you attend on the actual day of the procedure.
Sometimes we may need to ask you, or organise for you, to attend the hospital or your surgery to submit some blood samples as part of preparation for your procedure. Rarely, we may also deem that a scan is appropriate for you to help us assess your pathology before actually removing it.
We will send you laxatives for you to drink the day before your procedure. In rare cases where patients have a constipation history, this laxative regimen may be extended to a few more days.
So what is the EMR technique? EMR stands for endoscopic mucosal resection. This technique essentially involves injection of a specialised fluid underneath the polyp with the use of a particular very thin needle. This allows the polyp to be detached from the bowel wall, subsequently allowing us to slowly resect the polyp or remove it with the help of a metallic snare.
So what is a polyp? A polyp is an abnormal growth that may develop inside your bowel, usually what we call the large bowel or colon.
So why do we need to remove polyps from your bowel? Polyps are abnormal growths that may have the potential to become cancers if left behind in the future. They also have the potential to cause symptoms that may cause you trouble, such as diarrhoea, constipation or even bleeding and anaemia.
Therefore, if you have been deemed appropriate to have your polyp removed, you should strongly consider it to mitigate those risks.
So what will happen on the day of the procedure? Once you have arrived, you will inform our reception that you are at the endoscopy unit and you will be greeted by one of our endoscopy nurses who will lead you into what we call an admission room. This is where we will take some time to go through your comorbidities, medical issues and medications before proceeding to the consenting process.
During the consenting process, either your doctor or one of the qualified nurses will walk you through details about the procedure including risks and if you’re happy to proceed, you will be asked to countersign the form.
Once this process is over, you will be asked to wait in one of our waiting rooms until your endoscopy room is ready for the procedure to start.
So what are the risks involved in a polypectomy procedure? And with any procedure, especially an interventional one, there are always some risks which you need to be aware of. It is worthwhile noting that these risks are not common but they do occur.
Risks that we may encounter during a polypectomy procedure might involve pain during the procedure, bleeding, a tear in the bowel or in medical terms a perforation and some sedation risks in case you opt to have sedation for the procedure.
It is important to know that these complications are not common but if they occur, they may potentially have serious implications, in which case we may opt to keep you in the hospital overnight for monitoring and further management.
You will have the chance to go through more details on these complications in the patient information leaflet that will be posted to you when the procedure is booked.
Are there any alternatives to the polypectomy procedure?
One option is not to remove the polyp by accepting the risks that this polyp entails. As mentioned earlier, polyps do have the potential to grow in size and also give rise to cancers. Therefore, if you opt to have your polyp not removed but left in your bowel, this is a risk you may need to accept.
Another alternative if the polyp is eventually deemed appropriate for a section is a surgical operation that can be done either with upper surgery or a keyhole surgery. Obviously, surgery is a more invasive technique and if you contemplate this option, there will be a different assessment pathway for you before the procedure is undertaken.
So what happens during and after your procedure? Before the procedure is started, we often administer what we call conscious sedation. This is usually a combination of a mild sedative together with a painkiller to prevent you from having significant discomfort during the procedure.
The EMR polypectomy technique may take anywhere from half an hour to a full hour, depending on the complexity of your polyp.
After the procedure is completed, you will be transferred to our recovery unit where your observation will be taken. We will ensure you’re feeling okay to have a snack and a drink before we start your discharge process.
Just to assure you that before your discharge from the hospital, you will receive a lot of information about what happened in your procedure, including details of who and when to contact if you experience any problems or side effects as a result of your procedure.
Endoscopic Submucosal Dissection (ESD) Polypectomy
ESD involves removing dangerous growths (polyps) from the wall of your bowel, using an endoscope and an electrically heated knife. Such growths in the bowel may be cancerous, potentially cancerous or harmless (benign).
This video details your upcoming Endoscopic Submucosal Dissection (ESD) Polypectomy procedure with Consultant Gastroenterologist, Dr Beintaris.
Endoscopic Submucosal Dissection (ESD) Polypectomy
My name is Doctor Beintaris, I’m one of the consultant gastroenterologists at North Tees. Today, I’m going to walk you through your upcoming polypectomy procedure.
So, what happens before your procedure?
One of our pre-assessment nurses will contact you to discuss the procedure with you and you will also receive your appointment in writing with details on the date and time. We will also post you the relevant procedure information leaflet together with the consent form for your reference. Please read through them before you attend on the actual day of the procedure.
Sometimes we may need to ask you, or organise for you, to attend the hospital or your surgery to submit some blood samples as part of preparation for your procedure. Rarely we may also deem that the scan is appropriate for you to help us assess your pathology before actually removing it.
We will be sending you laxatives for you to drink the day before your procedure. In rare cases where patients have a constipation history, this laxative regimen may be extended to a few more days.
So what is the technique for polyp removal? ESD stands for endoscopic submucosal dissection. It is different to the DMR technique with regards to the fact that instead of using a snare to remove the polyp, we have the means to use an electrosurgical knife in order to start cutting underneath the polyp and eventually remove it as a single piece.
So what is a polyp? A polyp is an abnormal growth that may develop inside your bowel, usually what we call the large bowel or colon.
So why do we need to remove polyps from your bowel? Polyps are abnormal growths that have the potential to become cancers if left behind in the future. They also have the potential to cause symptoms that may cause you trouble, such as diarrhoea, constipation or even bleeding and anaemia.
Therefore, if you have been deemed appropriate to have your polyp removed, you should strongly consider it to mitigate those risks.
So what will happen on the day of your procedure? Once you have arrived, you will inform our reception that you are at the endoscopy unit and you will be greeted by one of our endoscopy nurses who will lead you into what we call an admission room. This is where we will take some time to go through your comorbidities, medical issues and medications before proceeding to the consenting process.
During the consenting process, either your doctor or one of the qualified nurses will walk you through details about the procedure, including risks, and if you’re happy to proceed, you will be asked to countersign the form.
Once this process is over, you will be asked to wait in one of our waiting rooms until your endoscopy room is ready for the procedure to start.
So what are the risks involved in a polypectomy procedure? As with any procedure, especially an interventional one, there are always some risks which you need to be aware of. It is worthwhile noting that these risks are not common but they do occur.
Risks that we may encounter during a polypectomy procedure might involve pain during the procedure, bleeding, a tear in the bowel or in medical terms of perforation and some sedation risks in case you opt to have sedation for the procedure.
It is important to know that these complications are not common but if they occur, they may potentially have serious implications in which case we may opt to keep you in the hospital overnight for monitoring and further management.
You will have the chance to go through more details on these complications in the patient information leaflet that will be posted to you when your procedure is booked.
Are there any alternatives to your polypectomy procedure?
One option is not to remove the polyp by accepting the risk that this polyp entails. As mentioned earlier, polyps do have the potential to grow in size and also give rise to cancers. Therefore, if you opt to have your polyp not removed but left in your bowel, this is a risk you may need to accept.
Another alternative if the polyp is eventually appropriate for a section is a surgical operation that can be done either with upper surgery or a keyhole surgery. Obviously surgery is a more invasive technique and if you contemplate this option, there will be a different assessment pathway for you before the procedure is undertaken.
So what happens during your ESD procedure? Before the procedure, the endoscopist will administer some sedation for you. Usually this suffices for most cases of ESD.
In particular situations where the polyp is too complex or is in a difficult location that may cause you a lot of discomfort, we might need to offer you what we call deep sedation or general anaesthesia.
This is delivered with the help of the anaesthetist and further detail will be given to you if that is your case.
The actual ESD procedure is a bit lengthy. It may take anywhere from two to four hours depending on the complexity of your polyp, basically the size of it and the location in your bowel.
After the procedure is finished, you will be transferred to our endoscopy recovery unit where our qualified nurses will monitor your observations to ensure you’re well and fit to be discharged to go home.
Rest assured that before your discharge, you will receive plenty of information with regards to what actually happened during the procedure, including our phone details with instructions on who and when to call if you develop any symptoms or side effects following the procedure.
Gastrointestinal (GI) Bleed
If you have been advised by your doctor to have an upper gastrointestinal (GI) endoscopy this procedure will to help find the cause of your symptoms or, will be used as part of a routine screening programme to find disease or abnormalities (unusual areas) at an early stage.
This video details your upcoming Gastrointestinal (GI) Bleed procedure with Consultant Gastroenterologist, Dr Beintaris.
Gastrointestinal (GI) Bleed
My name is Doctor Beintaris, I’m one of the gastroenterologists from North Tees Hospital. Today, I’m going to walk you through your upcoming endoscopy procedure. Your medical team or surgical team has referred you to endoscopy because they feel you may be experiencing a gastrointestinal bleed.
Endoscopy is a procedure indicated in the majority of these situations in order to assess and treat for potential bleeding spots from either your gullet, your stomach or the first part of your small bowel.
You need to be aware that gastrointestinal bleeding is a potentially serious situation that may require emergency treatment.
So what will happen before your procedure? Your medical team will kindly ensure that you have remain fasted for at least six hours before the procedure starts.
It is also important, and the medical team will ensure, that you have received acute emergency medical treatment in order to feel and be as stable as possible before you undergo endoscopy.
So what happens during your endoscopy procedure? We will be using a camera in order to inspect your gullet, your stomach and the first part of your small bowel, medically called duodenum, for a potential cause for your bleeding.
We normally administer local anaesthetic, what we call throat spray, in order to make the procedure easier for you and, upon discussion with your doctor at the endoscopy unit, you will also be offered the option of conscious sedation. This is a medication to make you feel a bit more relaxed and make the procedure easier for you and more efficient for the operator – your endoscopist.
The procedure normally takes anywhere from five to 10 minutes.
There are several reasons that may cause bleeding from your upper gastrointestinal tract, your gullet, your stomach or your small bowel.
Some of the most common reasons might be an ulcer or what we call oesophageal viruses – these are dilated veins that may need treatment. About nine out of 10 times, endoscopy is in position to stop your bleeding.
There are some occasions where we are not able to do so, mainly because the bleeding spot may not be accessible by the camera or it may be too advanced for us to treat it by means of an endoscopy, a camera procedure.
In that case, we might need to escalate your treatment with one our colleague surgeons or even discuss other minimally invasive options for you such as a scan with potential interventional radiology treatment.
So what are the risk involved in you having an endoscopy in order for us to be able to stop your bleeding? As with any procedure, you should be aware there are risks that, although they’re not that common, they do occur.
Risks involved in endoscopy for bleeding purposes involve further bleeding during the procedure or inability for us to stop your bleeding, a small risk of a tear in the bowel leading to what we call a perforation, as well as a risk of a chest infection as a consequence of your procedure.
So what will happen after your procedure? Following your procedure, you will be escorted to a recovery area where one of our qualified nurses will assess you and ensure you remain as well as possible after your endoscopy procedure.
We will go through steps after endoscopy to continue your bleeding treatment with you and your medical team, or surgical team if appropriate, in order to ensure that adequate treatment has been definitively offered to you.
There is always a small chance that your bleeding recurs. These are rare occasions but you need to know that if that is the case, we may need to discuss again with your consultant and your team to see if repeating an endoscopy or escalating to different treatment modalities is appropriate for you.
Oesophageal Stenting
A oesophageal stent is placed in patients who may be struggling to swallow their food because of a narrowing in the oesophagus (gullet).
This video details your upcoming Oesophageal Stenting procedure with Consultant Gastroenterologist, Dr Hancock.
Oesophageal stenting
Hello, my name’s Dr John Hancock, I’m a consultant gastroenterologist at North Tees Hospital. Today I’m going to talk about an oesophageal stenting procedure.
Before coming into the hospital, a pre-assessment nurse will contact you and explain what the procedure involves. You will receive an information leaflet and a consent form for you to read. This will be sent through the post.
Sometimes you may need to have blood tests checked before you attend for your procedure.
Oesophageal stenting is a procedure to place a metal stent through the narrowing or stricture in your gullet. By doing this, it should help relieve most of your symptoms of swallowing difficulty.
During this procedure, a camera or flexible tube is passed through the gullet down into the stomach. Initially, we will identify where the narrowing is. We will then, using x-ray guidance, pass the stent across the narrowing.
There are a number of reasons why we may need to place an oesophageal stent. For some patients it’s because they have a cancer within the oesophagus and this is narrowing the lumen and preventing swallowing.
For other patients, it may be the cancer is outside the oesophagus but is pressing on the wall of the gullet and that is also restricting the ability to swallow.
For a few patients, it may be due to a benign cause – that’s a non-cancerous cause. For example, acid damage to the gullet may have led to scarring.
You will receive an appointment letter about when to attend for your procedure. We will ask you to fast for six hours prior to the procedure.
On the day of the procedure, you will arrive at the reception area in the endoscopy unit. A nurse will meet you and they will go through your history and ask you relevant information about your medical problems and what medications you are on.
A doctor will go through the procedure and answer any questions or queries you may have. They will then ask you to sign your consent form.
It is quite likely you will then return to the waiting area and when it is time for your procedure, you will be invited to go into the endoscopy room.
Like any procedure, there are risks involved in doing an oesophageal stenting. It is important to emphasise that complications are rare but unfortunately they can occur. And when they do occur, they can actually be serious. We have a duty to explain these procedures to you but we do also want to reassure you that for the vast majority of patients, the procedures pass without significant complications.
The most important complications are pain and it is quite common that a number of patients, after the stent is placed, will have some pain or discomfort. Usually, this can be managed with simple painkillers but occasionally patients may need stronger painkillers and be admitted for observation. Bleeding can occur but this is usually self-limiting.
An important complication which can be serious is a perforation or tear. Very rarely, infection may also occur.
Whilst there is a very small risk of you developing a complication, we also have to recognise that occasionally these complications can be life-threatening.
Are there any alternatives? There is the option of not undergoing the procedure. The key problem here is obviously you will continue to have swallowing difficulties.
The other alternative is that we stretch the gullet and dilate it. The main problem here is the problem is likely to return. If the underlying problem is a cancer, there is also a significant risk that there may be a perforation through stretching it.
For the procedure we will administer a sedative which is midazolam and also an analgesic which is a painkiller. These tend to make you feel relaxed and sometimes can make you quite drowsy.
Procedure length will vary but typically it will be between 30 and 45 minutes. After the procedure, you will be taken into the recovery area where the nursing staff will continue to monitor you. When you’ve had a chance to recover, you will hopefully have something to eat and drink.
Before being discharged, one of the nurses will explain to you what has happened and what to expect in the few days following the procedure. The medical staff will explain any follow-up that is needed.
If you have any symptoms over the next few days, you will be able to contact the endoscopy unit if it’s within working hours. After hours you may need to go to the accident and emergency department or contact your GP.
Of course, if you have any questions or concerns, we’d encourage you to contact us and ask.
We understand this may well be a stressful time for you but we look forward to seeing you on the day.
Duodenal Stenting
A duodenal stent is placed where there may be narrowing between your stomach and small bowel to help food to be able to pass through the digestive system.
This video details your upcoming Duodenal Stenting procedure with Consultant Gastroenterologist, Dr Hancock.
Duodenal Stenting
Hello, my name is Dr John Hancock, I’m a consultant gastroenterologist at North Tees Hospital. Today I’m going to talk to you about duodenal stenting.
Before coming to the hospital for your procedure, a pre-assessment nurse will contact you. They will explain what your procedure involves. You will receive a consent form and an information leaflet through the post. Sometimes you may need to have blood tests checked before you attend.
A duodenal stent is used to overcome a narrowing that may have developed either in the far end of the stomach, what we call the pylorus, or at the beginning of the small bowel – the duodenum.
Patients who have these narrowings often have vomiting, pain and may be losing weight. By overcoming the narrowing, hopefully these symptoms should be relieved.
During the procedure, a flexible camera or endoscope is passed down the gullet and into the stomach. First of all, we will identify exactly where the narrowing is. Then, using X-ray, we will pass the stent across the narrowing and deploy the stent. This should open up the narrowing and allow food to pass.
There are a number of reasons why we may need to place a duodenal stent. For example, it may be there is a cancer within the stomach that is causing a narrowing or blockage. It may be that the cancer is outside the stomach or duodenum but is pressing on the gut itself, for example pancreatic cancer. Sometimes the cancer is within the duodenal wall.
For some patients, it may be that there is not a cancer but there is acid or bile-related damage that has led to scarring and narrowing of the lumen. (2:01)
You will receive an appointment letter for when to attend for your procedure. It should also give you instructions on where to go and how to find the endoscopy unit.
We will ask you to fast before the procedure. Typically this may be six hours, but in some cases we will ask you to fast for a longer period of time. The clinicians will talk to you about this.
For some patients, because emptying of the stomach is very difficult, we may even need to arrange for admission to hospital so that a fine tube can be passed down the nose to allow fluid to be removed from the stomach itself.
On the day of the procedure, you will arrive at the endoscopy unit. A nurse will meet you and they will go through questions regarding your health and the kind of medications you are on.
A doctor will then explain the procedure and go through the issues of consent with you. They will then ask you to sign the consent form.
A doctor will meet you and go through the procedure. If you have any questions regarding the procedure itself, you will be able to ask and discuss the situation with the doctor.
Once you are happy, you will sign your consent form. You will then wait in the waiting area until it is time for your procedure.
As with any therapeutic procedure, there are risks involved. It is important that we explain them to you but we would like to emphasise these risks are quite rare.
One of the most common problems is bleeding. Usually this is self-limiting but occasionally it can be severe and may require blood transfusion.
Perforation can occur. By perforation, we mean a tear or hole through the gut itself. Again this is a serious complication but fortunately is quite rare.
There is a small risk of infection and for patients undergoing this procedure this is typically a pneumonia.
The risk of developing a complication is small but for a minority of patients, these complications can be serious or life-threatening. It is important that we emphasise the benefits of doing the procedure in the vast majority of patients really outweigh these very small risks.
For a minority of patients, we may be able to temporarily relieve the obstruction by doing a dilatation. Your clinician will advise whether this is a realistic option.
We administer a sedative called midazolam and a painkiller or analgesia prior to the procedure. This should keep you comfortable and may make you drowsy.
Normally the procedure lasts for 45 minutes. Sometimes it may be a bit longer and sometimes a bit quicker.
After the procedure, you will be taken to the recovery area where the nurses will continue to monitor you.
After several hours, hopefully you should be able to have something to eat and drink.
Before being discharged, the nurses will explain what has happened and what to expect over the next few days. They will answer any questions or queries that you have.
If you are having any symptoms after the procedure, if it’s within working hours you can contact the endoscopy unit and ask. If it’s out of hours, you may need to go to the accident and emergency department or contact your GP.
We understand this may well be a stressful time for you but we look forward to seeing you on the day.
Gastroscopy
A gastroscopy is a procedure to look at and assess your oesophagus (gullet) and stomach and small intestine (duodenum) by using a thin, flexible tube call an endoscope.
This video details your upcoming Gastroscopy procedure with Nurse Endoscopist, Lesley-Anne Gibb.
Gastroscopy
Hello, my name is Lesley-Anne Gibb, I’m one of the nurse endoscopists at North Tees and Hartlepool hospitals. Today I’m going to talk to you about a gastroscopy procedure.
A gastroscopy is a procedure to assess your gullet, stomach and the first part of your small bowel. During this procedure, a flexible camera is passed through your mouth and into your stomach. We will have a careful look at these areas and may take some biopsies if required.
You’ll receive an appointment letter through the post about when to attend for your procedure. We ask you to stop eating six hours before your procedure.
On the day of your procedure, you will arrive at the reception of the endoscopy unit. One of the endoscopy nurses will go through some questions about your health and any medications that you may be taking.
A doctor or nurse will go through the procedure with you and complete a consent form. You will then wait in the waiting area. Following this, you will be taken into the room where you will meet the team.
Like any procedure, there are risks in doing a gastroscopy. It’s important to emphasise that procedure-related complications are not common but you do have to be aware of them, such as pain or discomfort during the procedure, bleeding, perforation or a tear, lung infection and sedation-related side effects.
Are there any alternatives to this procedure? We can consider a barium meal or a CT scan – neither of these tests provide as much information as a gastroscopy does and neither of these tests allow for biopsies to be taken.
A gastroscopy procedure can be performed using lidocaine throat spray and we can also give the midazolam. That is a sedative that will make you feel more comfortable and relaxed.
Normally the procedure lasts five to ten minutes. After the procedure, you’ll be taken into the recovery area where the nurses will monitor you for up to an hour. You will then have the opportunity to have a drink.
Before being discharged, one of the nurses will explain to you what happened during the procedure and if any follow-up is required.
If you have any symptoms that concern you in the few days after your procedure, then please contact the endoscopy unit or attend the accident and emergency department.
If you have any questions, please ask.
Colonoscopy
A colonoscopy is an examination that allows an Endoscopist (a Doctor or Nurse trained to do endoscopies) to see inside your large intestine (bowel or colon). This is the most accurate way of looking inside your bowel.
This video details your upcoming Colonoscopy procedure with Nurse Endoscopist, Beverley Hind.
Colonoscopy
Hello, my name is Bev Hind, one of the nurse endoscopists at North Tees Hospital. Today I’d like to talk to you about a colonoscopy procedure.
A colonoscopy is a procedure to assess your large bowel. A flexible camera is inserted through your back passage into the large valve after taking bowel preparation. You will receive this from the hospital.
We will have a careful look at the bowel and may take some biopsies as required. We may also remove growths, known as polyps, from your bowel.
Before coming to hospital for your procedure, a pre-assessment nurse will contact you and explain what the procedure involves. You will receive an information leaflet on bowel preparation through the post for you to read.
Sometimes you may need blood tests checked before your procedure.
You will receive an appointment letter through the post about when to attend for your procedure.
On the day of the procedure, you will arrive at the reception of the endoscopy unit. One of the endoscopy nurses will go through some questions about your health and what medications you are taking. A doctor or nurse will then go through the procedure with you and complete a consent form.
You will then be asked to wait in the waiting area until it is time for your procedure. Following this, you will be taken into the room where you will meet the team.
Like any procedure, there are risks involved with doing a colonoscopy, such as pain or discomfort during the procedure, bleeding, perforation or tear and sedation-related side effects.
It’s important to emphasise that procedure-related complications are not common but you do have to be aware of them. Further details of the procedure-related complications and how we manage them are outlined in the patient information leaflet.
Are there any alternatives to this procedure? We can consider doing a CT scan of your bowel, however this won’t allow us to take biopsies or remove polyps at the same time.
So what can you expect to happen during and after the procedure? We can do the test by administering a sedative called midazolam and a painkiller called fentanyl. Or we can use gas and air. This will make you feel relaxed and comfortable.
Normally the procedure lasts for about 30 to 40 minutes. After the procedure, you will be taken to the recovery area where the nurses will monitor you for an hour. You will then have a chance to eat and drink. Before being discharged, one of the nurses will explain to you what happened during the procedure and any follow-up that may be needed.
If you have any symptoms in the few days following your procedure, please contact the endoscopy unit for further advice or attend the accident and emergency unit.
If you have any questions, please ask us.
Percutaneous Endoscopic Gastrostomy (PEG)
A PEG procedure involves fitting a feeding tube directly into the gastrointestinal tract as a temporary or permanent treatment for patients who are unable to eat orally and need long term nutritional support.
This video details your upcoming Percutaneous Endoscopic Gastrostomy (PEG) procedure with Consultant Gastroenterologist, Dr Wells.
Percutaneous Endoscopic Gastrostomy (PEG)
Hi there, my name is Chris Wells I’m a consultant gastroenterologist at North Tees and Hartlepool NHS Foundation Trust. I’m going to talk to you about having a PEG or a percutaneous endoscopic gastrostomy.
Your doctor has suggested that a feeding tube under your tummy called a PEG may be helpful for you. The reason the doctor may have decided this is because you may have a problem swallowing, such as after a stroke or perhaps because of another neurological problem such as MS or motor neurone disease. Other people may require artificial feeding because there is a blockage to either the oesophagus or the mouth due to a growth, cancer or perhaps previous surgery.
Before coming for your PEG procedure, you will be contacted by one of the PEG nurses who will explain the procedure to you and show you what the device will look like. These nurses may visit you on the ward, may telephone you or you may come for a pre-assessment. Alternatively, you may see one of the doctors in clinic.
So what is a PEG? A PEG is an endoscopic procedure where a device is inserted from the abdominal wall into the stomach. This device allows a connection from the outside world into the patient’s stomach. Through this device, you can pass nutrition such as food or hydration to allow a patient to be nourished. As well as putting through feed, we can also put through medication.
From the patient’s perspective, a PEG procedure involves having a gastroscopy – which is explained on one of our other videos.
During the gastroscopy, a small operation is performed that passes the tube from the outside world into the abdominal cavity. Before your procedure, you will be admitted to hospital.
Normally a patient would go to one of the base wards and be admitted by one of the junior doctors. On the ward, they’ll be prepared for the procedure by being placed in a gown and also given some antibiotics beforehand. The reason we give antibiotics is to reduce the risk of an infection during the procedure.
The pre-assessment team will contact you and will send out some written information in the form of a patient information leaflet about a PEG. The pre-assessment team will also take some blood tests to make sure that it’s safe for us to do the procedure for you.
Most people who have a PEG procedure are already inpatients in hospital. If they’re not inpatients, they’re often admitted the day before. Some people will come to the endoscopy unit on the day of the procedure.
Before the procedure, it’s important that your stomach is empty of food and fluid and this will mean that you will need to have a period of time without eating or if you’re being fed through a tube, the feeding will be stopped for a short time beforehand.
Before you’re taken down to the endoscopy unit, the nurses on the ward will give you some antibiotics to reduce the risk of infection during the procedure. The nurse on the ward will also prepare you for the procedure by putting you into a gown and preparing all the necessary paperwork.
The porters will come to the ward and they will take you down to the endoscopy unit where you’ll be received into the endoscopy recovery area. In the recovery area, the nurses will go through the procedure with you and you’ll be required to sign your consent form to say you agree to go ahead with the PEG procedure.
Once you’ve signed your consent form, you will be taken into the procedure room where you will meet the staff performing the procedure for you. You’ll be faced by the endoscopist and also an assistant.
Two people need to do the procedure to make it safe and effective for you. As well as the two people doing the operation, there will be some nurses to help make you feel comfortable.
Before the procedure, you always get generous sedation to make sure you’re nice and relaxed for the procedure.
Are there any complications for having a PEG procedure? Like any procedure in hospital, there are some risks. The three main risks of a PEG procedure are infection, bleeding and risks relate to the sedation that we give you to make you feel comfortable for procedure.
We minimise the risk of infection by giving you some antibiotics beforehand and we minimise the risk of causing bleeding by checking how well your blood clots beforehand. The sedation risk is also minimised by using a safe level for yourself. Should you wish to have any more information about these complications, you can read about them in the patient information leaflet or speak to your nurse or doctor.
Your peg procedure will normally take between 20 and 30 minutes.
After the procedure, you will be taken back to the recovery area where the nurse will check that you’ve had the procedure performed successfully and there’s no immediate complications. Once the nurses in endoscopy are happy that you’re safe, you’ll be transferred back to the base ward by the porters.
It is expected that you will be a little bit uncomfortable in your tummy after the procedure and the nurse on the ward will be able to give you some painkillers to help relieve this.
Once the nurses are happy, they will start your feeding through the PEG tube, initially with some water and then using the PEG feed.
Once you’re back on the ward, you will normally stay in hospital for two to three days. During this time you will be trained to use the PEG feeding device to deliver the food and nutrition and medication that you need to keep yourself healthy.
Sometimes the training is delivered to either a relative or a healthcare professional who will be delivering the feed for you in the community.
Once we’re happy that there’s been no delayed complications from the PEG and you’re feeding adequately and everything’s all set up for home, a plan will be made to get you home on day three after the procedure.
Once everything’s been deemed safe and you’ve gone home, you’ll be visited by the community PEG nurse just to make sure everything’s going all right.
If there are any problems, you can report them to her. Or alternatively, if you get home and find there’s a problem with your PEG feeding, you can contact the endoscopy nurse.
If you have any urgent problems that need to be answered, you can contact the endoscopy unit during the week and one of the nurses will get back to you with some information on what to do.
Nasojejunal (NJ) Tube
A Nasojejunal (NJ) tube procedure involves passing a tube through the nose and into the small bowel. It allows food and medicine to be directly carried into the stomach.
This video details your upcoming Nasojejunal (NJ) Tube procedure with Consultant Gastroenterologist, Dr Wells.
Nasojejunal (NJ) Tube
Hello, my name’s Chris Wells. I’m a gastroenterologist at North Tees and Hartlepool NHS Foundation Trust and I’m going to talk to you about having a nasojejunal feeding tube.
So what is a nasojejunal tube? A nasojejunal tube is a tube that’s passed through the nose and through the stomach into your small bowel. To insert this nasojejunal tube, you are required to have a gastroscopy – which is explained on our other videos.
A nasojejunal tube can be needed for patients in hospital when their stomach doesn’t empty properly.
This can be due to a neurological problem such as related to diabetes or sometimes due to an inflammatory problem in cases such as pancreatitis.
If your doctor feels a nasojejunal tube will help you while you’re in hospital, the procedure will be booked and an appointment will be made for you. On the day of your procedure, you’ll be asked not to eat anything or to have anything placed through any feeding tubes that you may be using.
The porters will come to the ward and collect you and take you down to the endoscopy unit where you’ll be admitted. And the doctor doing the procedure or one of the nurses will go through the consent for the procedure for you.
Are there any risks of having a nasojejunal tube? The nasojejunal tube is placed with a gastroscope and you’ll therefore require a test called the gastroscopy which is explained in one of our other videos. There are some risks with the procedure which you can look on the patient information leaflet.
In terms of the nasojejunal tube itself, it is a fairly risk-free procedure and a risk-free device. Sometimes the feeding device can be dislodged and pulled back, and there is a risk the procedure would need to be repeated so you get some long-term secure feeding.
Are there any alternatives to this procedure? In most cases, a nasojejunal tube is placed endoscopically. The tube can also be placed via an X-ray and sometimes the doctors and nurse looking after you may choose or recommend this route to you.
When a nasojejunal is placed endoscopically, it’s normally placed on inpatients. On the day of the procedure, the patient will be asked not to eat or take anything through any feeding tubes that may be in place on the ward.
You’ll be taken by the porter down to endoscopy and a consent form will be signed when you get to endoscopy. The nurses and doctors in endoscopy will be able to explain any questions that you have at the time.
When you come into the procedure room, the doctor or nurse who will be doing your procedure will welcome you into the room and you’ll also be introduced to the staff that will be helping them do the procedure. You’ll be given some sedation to make you feel very comfortable for the test and the gastroscopy will be inserted through your mouth into the stomach and then the small bowel. The feeding tube will be delivered through the gastroscope into the small bowel and the gastroscope will be removed.
The doctor or nurse doing the procedure will then have to do an exchange through your nose and mouth using a bright light and a set of forceps called the McGill’s forceps. This can sometimes be a little bit uncomfortable and make you feel a bit chokey and gaggy but the procedure lasts only a few seconds and is normally very well tolerated.
After the procedure, you’ll be left with a tube coming out of your nose through which we can feed you directly into your small bowel.
When the feeding tube is being placed, you’ll be taken back to the ward and the nurses will start the feeding regime outlined by the dietitian to give you the nutrition that you need.
Most people who require a nasojejunal tube only have to use the tube while they’re in hospital.
Sometimes patients are discharged with a nasojejunal tube. Those patients, when they’re discharged home, will have training about how to use the device and what to do if any complications arise.
They’ll be supported by a community feeding nurse who will visit them at their home and the patient also has the chance to contact hospital if there are any problems that arise.
If any emergencies arrive, such as the tube getting pulled back or becoming blocked, then it is important to contact the endoscopy unit and the department made for the tube to be reviewed and, if necessary, replaced.
