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Endoscopy

Endoscopy Overview

The Endoscopy Unit within the Day Surgery Unit at London Bridge Hospital has the capability to carry out a wide range of diagnostic and therapeutic endoscopy procedures. Our facilities include the latest advances in endoscopic equipment to aid in the prevention, diagnosis and treatment of disorders of the pancreas, liver, gallbladder, oesophagus, stomach, small intestine and colon. Our Consultants and Day Surgery team provide a fully comprehensive endoscopy service, to carry out further investigations of symptoms including abdominal bloating and pain, change of bowel habit, constipation, difficulty swallowing, heartburn, indigestion, rectal pain and bleeding.

London Bridge Hospital offers more complex procedures than any other UK private hospital and was the first private hospital in the UK to offer Endobronchial Ultrasound Service (EBUS). It is also the first hospital in the UK to use Cellvizio technology for exclusively clinical purposes.

The Endoscopy Unit provides excellent care for patients who are in need of investigations of the digestive tract, which are highlighted in our Patient Satisfaction Survey results:

  • ‘A very simple, easy and efficient experience.’
  • ‘Excellent service, I could discuss my procedure which made me feel in control and able to make my own decisions, based on professional advice.”
  • ‘I was treated with the greatest of respect and did not feel uncomfortable at any time.’

Click on the tabs at the top to find out more information on our services, the symptoms and conditions we treat as well as our dedicated team, patient information and other useful links.

If you would like to learn more about our Gastroenterology services, please visit our dedicated page on the website

Services

The Endoscopy Unit at London Bridge Hospital has technologically advanced facilities to carry out the following services:

Capsule Endoscopy

Wireless Capsule Endoscopy
A Wireless Capsule Endoscopy involves swallowing a capsule the size of a large pill, which wirelessly transmits images of the inside of a patient’s stomach and digestive tract. The capsule leaves the patient’s body naturally once they go to the toilet and pass stools. A wireless capsule endoscopy can often be used to help diagnose cases where patients are experiencing internal bleeding in the small bowel, where an endoscope cannot reach and there is no obvious cause.

Colorectal

Colonoscopy
A Colonoscopy is performed to examine the large bowel and is normally carried out with a small amount of analgesia and sedation (midazolam). It allows the physician to examine the lining of the rectum and by gradually advancing it through the colon, the physician can diagnose colon and rectal problems, perform biopsies and remove polyps.
Flexible Sigmoidoscopy
A Flexible Sigmoidoscopy is a test that is used to examine inside your rectum and the left side of the large bowel. Polyps may be removed and your Consultant may also take a biopsy during the test, which is effective in detecting bowel cancer.
Gastroscopy
An Oesophago-Gastro-Duodenoscopy (OGD) is a test that is used to examine the gullet, stomach and duodenum. This is the most common test performed in the Endoscopy unit and performed for a variety of reasons e.g. haematemesis (blood present in vomit), anaemia (low red blood cell count) and dyspepsia (indigestion / reflux). This procedure can be performed with a minimal dose of sedation (midazolam) or with a local anaesthetic spray to the back of the throat.
Percutaneous Endoscopic Gastrostomy (PEG)
Percutaneous Endoscopic Gastrostomy (PEG) is performed for patients who are unable to swallow, or occasionally for patients who need extra nutritional support. The patient undergoes a Gastroscopy with a small amount of sedation and a feeding tube is placed in the stomach and secured at the abdomen.
Imaging Service - Virtual Colonoscopy
The Endoscopy Unit works with the hospital’s imaging department to offer a virtual colonoscopy, using a CT scanner to look for signs of pre-cancerous growths and other diseases in the large intestine. Images are shown as a three-dimensional view of inside the large intestine.

Gastroenterology

Colonoscopy
A Colonoscopy is performed to examine the large bowel and is normally carried out with a small amount of analgesia and sedation (midazolam). It allows the physician to examine the lining of the rectum and by gradually advancing it through the colon, the physician can diagnose colon and rectal problems, perform biopsies and remove polyps.
Endoscopic retrograde cholangio-pancreatography (ECRP)
An ERCP is performed to examine the hepato-biliary system, providing endoscopic access to investigate the liver, gall bladder and bile ducts. The most common reasons to carry out an ECRP are jaundice (yellowing of the skin and eyes) or abnormal liver blood tests, especially if a patient has pain in the abdomen, or if a CT or ultrasound scan shows a blockage of the bile or pancreatic ducts. Blockages can be caused by stones, narrowing of the bile ducts (strictures) and growths or cancers of the pancreatic and bile ducts. During an ERCP, stents (small plastic or metal tubes) can be inserted into the bile ducts, to allow drainage of bile into the intestine.
Gastroscopy
An Oesophago-Gastro-Duodenoscopy (OGD) is a test that is used to examine the gullet, stomach and duodenum. This is the most common test performed in the Endoscopy unit and performed for a variety of reasons e.g. haematemesis (blood present in vomit), anaemia (low red blood cell count) and dyspepsia (indigestion / reflux). This procedure can be performed with a minimal dose of sedation (midazolam) or with a local anaesthetic spray to the back of the throat.
Endoscopic ultrasound (EUS)
An EUS combines an endoscopy and ultrasound in order to obtain images and information about the digestive tract and surrounding tissue and organs. The ultrasound uses high-frequency sound waves to produce images of the structures inside the body including the liver, gallbladder and pancreas. Samples of the surrounding tissues can be obtained for further testing.
Enteroscopy
An Enteroscopy examines the small intestine (small bowel) with an endoscope, to help recognise diseases of the small intestine.
Bravo pH Study
A tiny pH sensor located in a capsule (Bravo pH capsule: 25mm x 6mm x 5.5 mm) is pinned temporarily to the wall of the gullet at the time of the Endoscopy, which monitors the back flow of gastric acid in the gullet. The capsule transmits data using radio signals to a receiver, which is worn around the waist. The patient will be asked to complete a diary of symptoms and meals/drinks during the 96-hour pH recording. After 48 hours the receiver will stop recording and the pH data stored in the receiver is downloaded onto a computer for data analysis and is returned to the patient for a further 48 hours.

Oesophageal Manometry

Oesophageal pressure and Ph (acid) monitoring
An Oesophageal Manometry measures the pressure activity within the oesophagus. The results determine how well the oesophagus is working and whether contractions are co-ordinated. Ph (acid) monitoring measures the amount of acid refluxing into the oesophagus from the stomach. The monitoring establishes whether oesophageal symptoms are due to acid reflux.
24 Hour pH and Impedance test
24 hour pH + impedance test measures the amount of acid or non-acid that refluxes (back flow of stomach contents) from the stomach into the gullet (oesophagus) and will help to find out if the patients’ symptoms are caused by acid or non-acid reflux.

Pelvic Assessment

Anorectal Physiology/ Pelvic Floor Assessment Clinic
London Bridge Hospital was the first private hospital to offer Anorectal Physiology tests, which are commonly performed for patients with incontinence, prolapsed and obstructed defaecation syndrome. The standard tests show the function and structure of the anal canal and lower rectum.

Respiratory

Endobronchial Ultrasound Service (EBUS)
London Bridge Hospital were the first private hospital in the UK to offer EBUS to patients. An EBUS combines an endoscopy with an ultrasound and bronchoscopy to visualise the airway of the lungs and structures adjacent to it. Fine needle aspiration of adjacent tissue can be taken for investigation at time of procedure.
Bronchoscopy
A Bronchoscopy can help diagnose and treat some conditions of the airways of the lungs. A fibre-optic bronchoscope is usually used, which is a thin, flexible telescope. The bronchoscope is passed through the nose or mouth and down the back of the throat, into the windpipe and into the airways. The fibre-optic allows light to shine around the bends in the bronchoscope, allowing the physician to see clearly inside the airways. For more information, please visit www.londonthoracic.co.uk.

Cellvizio

Cellvizio is used during endoscopy to examine tissue at cellular level. It is a probe-based microscope, providing real-time characterisation of tissue, leading to improved and more accurate detection of diseased tissue. London Bridge Hospital is the first hospital in the UK to provide endoscopies with Cellvizio technology, exclusively for clinical purposes.

Symptoms

The following symptoms are often a sign of Gastrointestinal (GI) problems, which may suggest you require an endoscopy to investigate the symptoms further:

  • Abdominal bloating
  • Abdominal pain
  • Burping
  • Change of bowel habit
  • Cramping
  • Constipation
  • Diarrhoea
  • Difficulty swallowing
  • Flatulence (gas)
  • Indigestion
  • Nausea and vomiting
  • Rectal pain
  • Heartburn
  • Reflux   
 
  • Fistulas - An abnormal connection between the lining on the inside of the anal canal and the skin near the anus
  • Jaundice - Yellowing of the skin and eyes
  • Polyps - Bowel polyps are small growths on the inner lining of the colon or rectum, caused by an abnormal production of cells. The lining of the bowel continuously renews itself and a faulty gene can cause the cells in the bowel lining to grow more quickly
  • Rectal bleeding - Rectal bleeding is a term used to describe any blood that is passed out when passing faeces

If you have any symptoms listed above then please visit your GP who can then refer you to a Gastroenterologist or relevant specialist.

Conditions

Click on the headings below to read more about the conditions we treat at London Bridge Hospital:

Diseases of the Oesophagus

- Achalasia
Achalasia is a disorder of motility of the lower oesophagus, where the smooth muscle layer of the oesophagus has impaired muscle contractions and failure of the sphincter to relax causes a functional oesophageal stricture.
- Barrett’s oesophagus
Barrett’s Oesophagus affects the lower oesophagus and the cells that line the affected area become abnormal. Having regular endoscopies can detect precancerous changes to the affected cells in the oesophagus.
- Oesophageal cancer
Oesophageal Cancer is a malignant growth which starts on the wall of the oesophagus. A cancer in the oesophagus can stop food going down, causing difficulty swallowing or the feeling of food sticking (dysphagia).
Oesophageal cancer can be treated surgically by removing part of the oesophagus and stomach or by undergoing chemotherapy or radiotherapy to shrink the cancer and kill off cancer cells.
- Oesophageal spasm, non-cardiac chest pain
The heart and oesophagus are in very close proximity, therefore distinguishing oesophageal pain from cardiac pain can be difficult. An Oesophageal spasm can cause episodes of severe pain, which is usually felt in the anterior chest, throat or epigastrium (the central upper part of the abdomen) and can radiate to the neck, back or upper arms, similarly to cardiac chest pain.

Diseases of the Small Intestine, Nutrition

- Coeliac disease
Coeliac disease is an autoimmune diseases, where gluten, which is found in foods containing wheat, barley and rye, triggers an immune reaction. Eating gluten with coeliac disease damages the lining of the small intestine.
- Malabsorption of nutrients
Malabsorption can ocur when nutrients are not properly extracted and absorbed from food during digestive process. Malabsorption can result in a deficiency of vitamins, proteins, minerals, carbohydrates and other nutrients, which are important for growth and regulation of symptoms.
- Short bowel syndrome
Short bowel syndrome can be identified as any disease, traumatic injury or vascular accident, which leaves less than 200cm of viable small bowel or results in a loss of 50% or more of the small intestine.
- Ulcers and bleeding
A stomach ulcer may develop if there is an alteration in the balance between the amount of acid the stomach makes and the mucus defence barrier. Acute or chronic ulcers may enlarge and erode through a blood vessel and can cause the lining of the stomach or small bowel to bleed.
The London Bridge Hospital Endoscopy Unit offers small bowel and nutrition services, including feeding tubes, parenteral and enteral nutrition.

Diseases of the Colon (Large Bowel)

- Rectal Bleeding
Rectal bleeding is a term used to describe any blood that is passed out when passing faeces. The causes of rectal bleeding can include haemorrhoids (piles), anal fissure, diverticula, crohn’s disease, ulcerative colitis, polyps, cancer of the colon, cancer of the rectum, abnormalities of the gut and stomach ulcers. In order to determine the cause of rectal bleeding, a colonoscopy or sigmoidoscopy may be required.
- Colon polyps
Colon polyps are small growths on the inner lining of the colon, caused by an abnormal production of cells. The lining of the bowel continuously renews itself and a faulty gene can cause the cells in the bowel lining to grow more quickly.
- Cancer of the colon
Cancer of the colon is an abnormal growth that starts in the wall of the colon (large bowel). Colon cancer can cause bowel habits to change and the cancer can eventually cause your bowel to become blocked and can also bleed, causing anaemia, where the body does not provide enough healthy red blood cells. There are several different options for treating colon cancer, which include surgery to remove the cancer along with part of the colon either side of it and chemotherapy to shrink the cancer and kill off cancer cells left after the operation.
- Rectal cancer
Rectal cancer is an abnormal growth that starts on the wall of the rectum, which is the final part of the large bowel, just above the anus. Cancer in the rectum can bleed slowly. The cancer can cause discomfort during and blood may be seen after passing a motion. It can also cause a feeling that the bowel cannot be emptied, it often causes bowel habits to change and the cancer may eventually cause the bowel to become completely blocked. There are many different choices of treatment for rectal cancer, including surgery to remove the cancer along with part of the bowel either side of it. Radiotherapy may be used before, after, or occasionally instead of an operation. If the cancer is too large to operate on straight away, it may be best to have a six-week course of radiotherapy to try and shrink the cancer. Chemotherapy may be used to shrink the cancer before the operation and kill off any cancer cells left after the operation.
- Constipation
Constipation is a common condition that can affect people of all ages. It can mean not being able to pass stools regularly or being unable to completely empty the bowel.
- Crohn’s disease
Crohn’s disease causes inflammation of the bowel. The disease most often affects the end part of the small bowel, however it can affect any part of the bowel. Crohn’s disease causes the bowel wall to thicken, which can block food from passing through and the affected area of the bowel can also fail to absorb nutrients from your food. Crohn’s disease can be treated either through medication or having surgery to remove the diseased part of the bowel.
- Diarrhoea
Diarrhoea is passing loose or watery faeces more than three times a day and can commonly be caused by gastroenteritis, an infection of the bowel. Gastroenteritis may be caused by a virus, bacteria often found in contaminated food or a parasite. Diarrhoea can also be brought on by anxiety or drinking too much coffee or alcohol.
- Diverticulosis and diverticulitis
Diverticular disease is the name given to a condition where bulges form in the lining of the colon (large bowel). Diverticular disease becomes more common with age and most people have few, if any, symptoms. A small proportion of people do have enough problems to need surgery to remove the affected portion of the bowel. Diverticular disease can be caused by too little fibre in the diet over many years.
- Faecal incontinence
Faecal incontinence, often referred to as bowel incontinence, is an inability to control bowel movements, which means stools can leak uncontrollably from the rectum. Bowel incontinence is not a condition, but is a symptom of an underlying problem or medical condition such as muscle and nerve damage.
- Inflammatory bowel disease
Inflammatory bowel disease (IBD) describes two diseases, Crohn’s disease and ulcerative colitis which both involve inflammation of the gastrointestinal tract (gut). Crohn’s disease can affect the entire digestive system, from mouth to anus and ulcerative colitis only affects the colon. The main IBD symptoms include abdominal pain, a change in bowel habits, weight loss, extreme tiredness, along with occasional additional symptoms including nausea and fever. IBD can be treated with medication; however surgery to remove the inflamed section may be required in cases which do not respond to medication.
- Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a common functional disorder of the gut. where a function of the gut is upset and there is no abnormality in the gut’s structure and it looks normal when viewed under a microscope. IBS causes various symptoms including pain and discomfort in the abdomen, bloating, diarrhoea and constipation. Other symptoms may include nausea, headaches, belching, feeling full quickly after eating, poor appetite and tiredness.
- Pouchitis
People with a serious form of ulcerative colitis can often have their diseased colon removed, and the bowel is surgically reconnected with an internal pouch from the small intestine, which holds waste before it is eliminated. Pouchitis occurs when the lining of this pouch becomes inflamed. Symptoms of Pouchitis can include abdominal cramps, increased number of bowel movements and a strong feeling of the need for bowel movement.
- Ulcerative colitis
Ulcerative colitis is a long-term condition which affects the colon. Symptoms, which can flare up and disappear, can include abdominal pain, bloody diarrhoea and a frequent need to go to the toilet. Treatment to help relieve symptoms during a flare-up includes medication. Mild to moderate flare-ups can usually be treated at home, however a more sever flare-up would need to be treated in hospital.

Diseases of the Pancreas

- Acute pancreatitis
Inflammation of the pancreas, which causes abdominal pain and nausea.
- Ampullary carcinoma
Ampullary carcinoma is the cancer of a structure called the ampulla of Vater, which is a small muscle located where the common bile duct empties bile from the liver and secretions from the pancreas into the small intestine. Treatment of Ampullary carcinoma is through surgical removal of the cancer.
- Cancer of the pancreas
The pancreas is an organ in the abdomen which lies close to the liver, stomach and duodenum (small intestine) It produces enzymes which help when digesting food and the hormone insulin, which works to move glucose from the blood into the cells to provide the body with energy.
Pancreatic cancer is an abnormal growth in the pancreas. It can cause many symptoms including weight loss and malnutrition caused by food not being digested properly, jaundice, or abdominal pain. Other symptoms can include indigestion, tiredness and feeling bloated.
Pancreatic cancer can be treated through surgery or chemotherapy, to either remove the cancer or kill off the cancer cells.
- Chronic pancreatitis
Chronic pancreatitis is a condition where the pancreas becomes inflamed and lasts for many years. Symptoms include repeated episodes of abdominal pain.
- Cysts of the pancreas
Pancreatic cysts are often found through abdominal ultrasounds or a CT scan of the abdomen. There are three common types of pancreatic cysts:
Pseudocysts are benign cysts which are a occasionally a result of acute or chronic pancreatitis. Pseudocysts usually resolve on their own without treatment.
Serous cysts are benign cysts and do not usually require treatment unless they grow large enough to cause symptoms.
Mucinous cysts can often become malignant at diagnosis or they may become malignant at a later time. Mucinous cysts should be treated by being surgically removed.
- Islet cell cancer
Islet cells, often referred to as endocrine pancreas cells, make several kinds of hormones, including insulin to control blood sugar. They cluster together in many small groups throughout the pancreas. Islet cell cancer is tumour of the pancreas which starts from the islet cell.
The Endoscopy Unit at London Bridge Hospital can offer pancreas services including endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), genetic testing.

Disease of the Liver and Bile Ducts

- Bile duct cancer
Bile duct cancer, also known as cholangiocarcinoma, starts in the lining of the bile duct. Cancer in the bile ducts can block the flow of bile from liver into the intestine, which causes bile to flow back into the blood and body tissues, causing the skin and whites of the eyes to become jaundiced. Other symptoms can include abdominal pain, loss of appetite, fever and weight loss. The main treatment is surgery to remove the cancer, however radiotherapy and chemotherapy are also treatment options to help destroy the cancer cells.
- Bile duct stones
Common bile-duct stones are gallstones that move out of the gallbladder and get caught in the common bile duct, which is a tube that connects the gallbladder to the intestine. Gallstones are ‘stones’ that form in the gallbladder. An ERCP can be performed to examine the bile duct. If there are gallstones in the bile duct, they can be removed through surgery.
- Cancer of the liver
Primary liver cancer is an abnormal growth that begins inside the liver. Cancer of the liver does not usually cause noticeable symptoms until it has reached a more advanced stage. Symptoms can include weight loss, loss of appetite over a period of more than seven days, feeling easily full after eating, nausea, vomiting, abdominal swelling, jaundice, itchy skin and a high temperature.If liver cancer is detected at an early stage, treatment options include surgery to remove a section of the liver, a liver transplant or radio frequency ablation, where a small electrical current is used to destroy the cancerous cells. Secondary liver cancer means that cancer from another part of the body (the primary cancer) has spread through the blood stream to the liver. The secondary cancer in the liver is made up of the same abnormal cells as the primary cancer. Secondary liver cancer can be detected through a CT or MRI scan. In the early stages of secondary liver cancer, symptoms can be mild. These include pain and tenderness in the upper abdomen, weight loss, tiredness, nausea and fever. Secondary liver cancer can be treated through surgery, to remove the cancer and part of the liver affected by the cancer. Chemotherapy can help control the cancer and reduce its size.
- Cirrhosis
Cirrhosis is a condition where normal liver tissue gets damaged and is replaced by scar tissue and the structure and function of the liver are badly damaged. Many liver conditions can lead to cirrhosis and severe cirrhosis can lead to liver failure.
- Hepatitis (A, B and C; non-alcoholic steato hepatitis)
Hepatitis is a term used to describe inflammation and swelling of the liver. Hepatitis can occur as a result of viral infection or due to the liver being exposed to harmful substances including alcohol. Hepatitis A is caused by the hepatitis A virus, which is the most common type of viral hepatitis. It is usually a short infection and symptoms do pass within three months. Hepatitis B is caused by the hepatits B virus, which can be found in blood and body fluids. Most people who are infected with hepatitis B can fight off the virus and fully recover from the infection within a few months. However a small minority of people develop a long term infection, chronic hepatitis B. Hepatitis C is the most common type of viral hepatitis in the UK. It is caused by the hepatitis C virus, which can be found in the blood. Hepatitis C often causes no noticeable symptoms, or only symptoms which can be mistaken for the flu, so many people can be unaware they are infected. Non-alcoholic steatohepatitis (NASH) is a condition where excess fat in the liver cells causes inflammation of the liver.
- Liver Disease
The liver can stop working due to severe acute damage of the liver, leading to acute liver failure. Liver failure also occurs to due to chronic injury or insult to the liver, which is known as chronic liver disease.
- Non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease (NAFLD) describes a variety of conditions caused by a build-up of fat within liver cells. NAFLD can be divided into four stages. The majority of people have simple fatty liver, where excess fat accumulates in liver cells. and is not caused by excessive amounts of alcohol. The other three stages include, non-alcoholic steatohepatitis (NASH), where the excess fat in the liver cells causes liver inflammation; fibrosis, which is a result of any form of persistent hepatitis eventually causes scar tissue and cirrhosis, a condition where normal liver tissue gets damaged and is replaced by scar tissue.
- Primary biliary cirrhosis
Primary biliary cirrhosis slowly damages the bile ducts in the liver, which damages the liver cells. In some cases, the damage to the liver cells can lead to cirrhosis.
- Primary sclerosing cholangitis
Sclerosing cholangitis refers to swelling (inflammation), scarring, and destruction of the bile ducts inside and outside of the liver.

Patient Information

Please read the below preparation and discharge information we would like you to consider:

Preparation Information:

Discharge Advice:

Intravenous Sedation

Please note that if you are given sedation a responsible adult must accompany you home and you must have someone to stay with you overnight.

You may wake up fairly quickly or more slowly – each person reacts differently. You will probably remain on the unit for about two hours, but the effects of the sedation will last for much longer, up to 24 hours. Your thinking processes and movements will be slower than usual. It is very likely that you will not remember anything about the examination afterwards.

Furthermore you should avoid the following activities for at least 24 hours after the procedure:

  • going to work
  • driving
  • operating machinery
  • drinking alcohol
  • signing any legally binding documents
  • carrying out any activities involving heights
  • caring for young children (sole responsibility)

Queries and Concerns:

If you have problems you wish to discuss following your procedure, please telephone your Consultant or call the Day Surgery Unit on 020 7234 2631.

If you require advice out of hours (between 9pm and 7am), please telephone 020 7407 3100 and ask to speak to the Duty Nurse (on extension 48000). This connects you to the senior nurse in charge of the hospital who can assist you.

If you feel you need to be seen by a doctor in an emergency, please contact your Consultant, GP or go to your nearest Accident and Emergency Department.

Disclaimer: If your Consultant's advice differs from what has been outlined here, please follow your Consultant's advice.

Meet the team

On admission and registration, patients are greeted by the Day Surgery Team. Patients are then looked after by our specialised Endoscopy Team, these include:

Opening Hours: Monday to Friday 9am to 6pm
Contact:
Telephone:020 7234 2009
Email: Gpliaisonlbh@hcahealthcare.co.uk