Procedure Information
Please read this leaflet as soon as possible and well in advance of your appointment. If you do not follow the advice on how to prepare for your procedure it may not be possible to do it and you may have to return on another day
Please bring this leaflet and consent form with you when you attend for your appointment
Helpline or enquiries (8.30am to 5.00pm Monday to Friday)
For appointments and general enquiries
Boston 01205 445072
Grantham 01476 464366/01205 445072
Lincoln 01522 573849
Louth 01522 573849 / 01507 631415/631437
For procedure related enquiries (8.30am to 6.00pm Monday to Friday)
Boston 01205 446559
Grantham 01476 464085
Lincoln 01522 573016/01522 512512 ext 458669
Louth 01507 631236
For more information please see: www.ulh.nhs.uk/services/endoscopy
Aim of the leaflet
The aim of this leaflet is to help you make a choice about having a transnasal endoscopy (TNE). It describes how a TNE is carried out and explains the benefits and risks. It will also help you prepare for the procedure.
It is important that you follow the instructions about stopping food and drink before the test. This is for your safety. If you do not follow the advice given it may not be possible to do your procedure and you may have to return on another day.
Introduction
You have been advised by your GP or hospital doctor to have an investigation known as a TNE.
If you are unable to keep your appointment, please notify the department as soon as possible as your appointment may be used for someone else. The booking team will arrange another date and time for you. Please bring this booklet with you when you attend for your appointment.
Enclosed with this booklet is a consent form. Your signature is needed for the test to go ahead.
The consent form is an important document. Please read it carefully together with the information given in this booklet. Please bring both the consent form and booklet with you to your appointment.
We may contact you a few days before your appointment to discuss the procedure and preparation in more detail. You will also be given the opportunity to ask questions in the department when you attend for your appointment.
In case of any problems please contact the relevant endoscopy unit.
What is a TNE?
The procedure is called a transnasal endoscopy, known more simply as TNE.
It involves looking at the upper part of the gut which includes the oesophagus (food pipe), stomach and the first part of your small bowel (duodenum) with a narrow, flexible tube called a transnasal endoscope. The scope is very thin (5-6mm) and is passed through the nose and down into the stomach. The procedure is performed by, or under the supervision of, a specially trained doctor or nurse (endoscopist). A light and camera at the end of the endoscope relay pictures on to a television screen.
Samples of tissue (biopsies) may be taken during the test. This is done through the scope. It does not cause any pain and the samples are kept, to be looked at under a microscope in the lab. Photographs may be taken for your clinical records and may be used for teaching purposes.
The procedure generally takes 5 to 10 minutes.
We aim to make the procedure as comfortable as possible for you. This procedure does not need sedation (medicine injected into a vein), but requires a local anaesthetic nose spray to make it more comfortable. More information about the local anaesthetic spray can be found on page 7.
What are the benefits of having a TNE?
If you have been troubled by symptoms, the cause may be found and help decide if you need treatment or further tests.
TNE can also be done:
- as a follow up check for certain conditions affecting the stomach or oesophagus
- if a scan or x-ray has shown there may be something wrong in the upper part of the gut, to allow a closer look at the area
What are the risks of the procedure?
Possible side effects include a sore nose, a sore throat, abdominal discomfort, wind and bloating.
Complications are rare. These include:
Nose-bleeding may occur. This usually settles quite quickly without any special treatment.
Perforation or tear of the lining of the stomach or oesophagus (about 1 for every 2000 cases). If this happens you may need an operation.
Bleeding may happen when a biopsy is taken. It usually stops on its own, but may need cauterization or injection treatment. In some cases a blood transfusion may be needed.
There is a small chance that a cancer may not be seen.
Sedation can sometimes cause problems with breathing, heart rate and blood pressure. If any of these problems do occur, they are usually short lived. Careful monitoring by a specially trained endoscopy nurse means that potential problems are picked up early and dealt with quickly. The sedation can also cause small food particles to fall into the lungs which can trigger an infection (aspiration pneumonia). This is extremely rare in TNE.
In extremely rare cases the procedure can lead to death. Current evidence suggest this may happen in around 1 in every 10,000 examinations.
What are the alternatives?
A gastroscopy through the mouth is an alternative test which is usually offered with sedation. Sometimes this test is needed if larger tissue samples (biopsies) are required. A barium meal x-ray is another alternative, but this involves some radiation exposure. It does not give the same information as a TNE and biopsies cannot be taken.
Preparing for the investigation
Eating and drinking
For your safety to reduce the risk of complications and give clear views, your stomach must be empty. Do not have anything to eat for at least 6 hours before the test and only have a light meal before this time. You may have small amounts of water up to 2 hours before your appointment time. Other fluids such as milk are NOT allowed (even in tea and coffee) as they coat the stomach. You should have nothing to drink for at least 2 hours before the test. If you do not follow this advice, your procedure will be rearranged.
If you are having a bowel examination at the same appointment as your TNE please follow the bowel preparation instructions given in the colonoscopy booklet. You may drink water up to 2 hours before your appointment time.
What if I take regular medication?
Your routine medication should be taken as usual, with a small amount of water.
Acid reducing medication (PPIs)
It is sometimes useful if you stop taking tablets that reduce the acid in your stomach for the 2 weeks before the TNE.
If your symptoms make this difficult or if you are having a follow-up endoscopy to check the healing of an ulcer or Barrett’s Oesophagus, please continue your acid reducing medication right up to the procedure.
Blood thinning medication (anticoagulants)
Sometimes these medications need to be stopped and if this is the case the person who referred you for the test should have given you clear instructions. If you are unsure, please contact your Consultant’s secretary. For your safety, if the correct instructions are not followed, it may not be possible to do the TNE and you may have to return on another day.
Warfarin: unless you have been advised to stop this medication, continue taking it and have your INR checked within the week before the test. The procedure may be cancelled if your INR has not been checked within the last 7 days. It should be within your target range. If you have been advised to stop your Warfarin, you should do so for 5 full days before the procedure (take your last dose 6 days before the procedure) and have your INR checked the day before the procedure. It needs to be less than 1.5 for the procedure to go ahead. IMPORTANT: Please bring your yellow Warfarin book to the appointment.
Dabigatran, Rivaroxaban, Apixaban, Edoxoban: please do not take on the morning of the procedure. If you have been advised to stop taking this medication you should take the last dose 3 days before the procedure.
Clopidogrel (Plavix), Prasugrel, Ticagrelor: these medications can generally be continued but if you have been advised to stop, you should do so for 7 full days before the procedure (take your last dose 8 days before the procedure)
Pregnancy
TNE is safe in pregnancy.
We can use local anaesthetic spray but we cannot use the nasal decongestant if you are pregnant, or think you may be pregnant. Please tell the nurse when you first arrive if you are pregnant or could be pregnant.
Diabetes
If you have diabetes controlled on insulin or tablets, please make sure the endoscopy appointments’ team is aware, so that the appointment can be made towards the beginning of the list. You will find more advice later in this leaflet.
Nose spray and conscious sedation
Anaesthetic nose spray is available to improve your comfort during the procedure.
Local anaesthetic nose spray numbs the nose and back of the throat. It has an effect very much like a dental injection.
You can go home on your own almost immediately after the procedure. You are allowed to drive and may carry on as normal, but must not eat or drink for about an hour afterwards until the sensation in your throat is back to normal.
Intravenous conscious sedation
Sedation is not usually needed for the procedure but is an option if desired.
The sedation is administered into a vein in your hand or arm just before the start of the procedure. This will not make you go to sleep but should help you to feel more relaxed. It is important that you are awake for the procedure so that you are able to follow simple instructions.
Please note if you have sedation into the vein, you will need someone to accompany you home and stay for at least 4 hours and if possible overnight. You are not allowed to take part in the following activities for 24 hours afterwards:
- drive a vehicle
- go to work
- look after children on your own
- operate heavy / dangerous machinery (including a cooker)
- drink alcohol
- sign legally binding documents
What happens when I arrive?
When you arrive for your appointment please book in at reception.
It is our aim for you to be seen as soon as possible after your arrival. However, if the department is very busy, your appointment may be delayed. The department looks after emergency patients who will be seen first if needed.
A nurse will take you through to the admission room and ask you about your general health, to check if you are fit to have the procedure. You will also be asked about your plans for getting home afterwards.
The nurse will make sure you understand the procedure and discuss any further concerns or questions you may have. If you have not already done so and you are happy to go ahead, you will be asked to sign your consent form.
Your blood pressure and heart rate will be checked.
The nurse will administer a decongestant with or without local anaesthetic into your nose before taking you into the procedure room. If you are pregnant or unsure, you cannot have the decongestant. You must tell the nurse when you first meet.
What will happen during the procedure?
The nurse will take you through to the procedure room where you will be able to ask any final questions. If you have any dentures or tongue piercings you will be asked to remove them.
A local anaesthetic spray will be sprayed into the nose. It works quickly and will make your nose, tongue and throat feel numb.
You will be asked to sit up straight or lie on your left hand side and a probe will be placed on your finger to monitor your oxygen levels. Any saliva or other secretions produced during the procedure will be removed using a small suction tube, like the one used at the dentist.
The endoscopist will pass the endoscope into your nose and down your throat. It will pass down the oesophagus into your stomach and then into your small bowel. Your wind pipe is deliberately avoided, so you will be able to breathe and talk normally throughout.
If we are unable to proceed through the nose, due to the nasal passages being narrow or other reasons we will need to perform the procedure orally (through the mouth).
What will happen after the procedure?
You will be taken to a recovery area where your heart rate, oxygen levels and blood pressure will be monitored. Before you leave the department, the nurse or doctor will explain the findings and if any medication or further tests are required.
You must not have anything to eat or drink for about an hour after the procedure until the sensation in your mouth and throat has returned to normal.
It is strongly advised that your first drink after the procedure is cold and that you sip it to ensure you do not choke. You will be given more detailed advice about this after the procedure.
You may see a small amount of blood especially if you blow your nose. You may also have a sore throat from the insertion of the tube which can last up to 48 hours. This will wear off but simple lozenges will help. You may also feel bloated if some of the air has remained in your stomach. To help this, sit upright and if possible walk around.
Pain relieving tablets, such as paracetamol, may be taken at home according to the manufacturer’s instructions.
If no sedation is given, most people feel able to return to work immediately after the procedure but some may feel they need to rest for a few hours afterwards at home.
Guidance for people with diabetes
Treatment by diet alone
If you control your diabetes with diet alone, you simply need to follow the instructions given earlier in this booklet to prepare for your TNE.
Treatment with tablets and/or insulin
You should inform the endoscopy appointments team about your diabetes and ask for a morning appointment.
Adjusting your diabetes medication to prevent hypoglycaemia
You may need to adjust your diabetes medication on the day of the procedure to reduce the risk of hypoglycaemia (‘hypo’ or low blood sugar level). As a result your blood sugar may be a little higher than usual, but this is only temporary to maintain your blood sugars during the procedure. You should be back to your usual level within 24 to 48 hours. If needed please contact the Specialist Diabetes Nursing Team on 01522 573074 well in advance of the appointment for advice.
Carrying glucose to treat hypoglycaemia
On the day of the procedure carry glucose tablets in case of hypoglycaemia. These are absorbed quickly through the tissues of the mouth and if sucked they will not interfere with the procedure. If you have symptoms of low blood sugar, suck 4 to 6 tablets initially, followed by a further 4 to 6 if your blood sugar is still low after 10 minutes. Please tell the nurses immediately.
Blood glucose monitoring
If you usually test your blood sugar level, check it as usual on the morning of the procedure and bring your equipment with you to the appointment. If you do not usually test your blood, do not worry, your blood sugar will be checked when you arrive for the procedure.
Please report to the nursing staff if you have needed glucose before arriving for your appointment and tell them immediately if you feel ‘hypo’ at any time during your visit.
What must I remember?
- If you are unable to keep your appointment please notify the endoscopy department as soon as possible. Telephone numbers are given on page 2 of this booklet
- Follow the instructions about food and drink given or your procedure may be postponed
- It is our aim for you to be seen as soon as possible after your arrival. However, the department is very busy and your appointment may be delayed. If emergencies occur, these patients will be seen before less urgent cases
- The hospital cannot accept any responsibility for the loss or damage to personal property during your time on the premises
If you have any questions or concerns, or are worried about any symptoms you experience after the test, you may ring the enquiry numbers on page 2 of this booklet. Out of hours please contact the NHS non-emergency service on 111.