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Upper gastrointestinal (GI) surgical unit

 

Coronavirus: upper gastrointestinal service update

Due to increased demand on the hospital due to the coronavirus (COVID-19) pandemic we are having to make significant changes to our services which may require cancellation of appointments.

Patients

We are attempting to contact all patients with a future scheduled appointment. In some cases we are changing appointments to a telephone consultation, and in certain circumstances, a video appointment. Some appointments may be cancelled without a future date being arranged at this stage. If we cancel your appointment you will remain on our waiting list and we will contact you in due course. Some patients may be discharged back to their GP and we will write to you if this is the case.

If you have not heard from us within three days of your scheduled appointment please contact us by email UGISurgeryBookings@gstt.nhs.uk. If you are unable to use email or your query is urgent, please call the following number 020 7188 8875. Our phone lines are very busy and there may be a wait for your call to be answered.

If you are an existing patient who has previously been seen in our service and need advice from the clinical team please see below for the appropriate option:

Email

Telephone 020 7188 8875

  • If you don’t have access to email or our website
  • If you leave a message on this number it may be a few days before we are able to respond to your query.

Please click on the following link for a list of FAQ’s. If your query is not covered in the FAQ please either email or call us as detailed above.

GPs

Advice and guidance

We are doing everything we can to support GPs and your patients during the coronavirus (COVID-19) pandemic. Therefore, prior to any referral, we would strongly advise that GPs to seek advice and guidance via e-RS or Consultant Connect (if it is available in your area). Please note that all of our services available on e-RS are set up for advice requests. You can call our emergency general surgery hotline on 07826922963 to speak to our flow coordinator. Our coordinator will be able to direct your call and if you require further information they can submit your request for triage.

Please note this line is operational between Monday to Friday, 7:30am-8pm.

This will enable the clinical team to review your request and provide an interim treatment plan for ongoing management of a patient. They can also advise/provide clarification regarding a patient's test results.

The GP can attach documents to the e-RS advice request, which may include diagnostic results, scanned images (e.g. ECGs). Providers can also respond with attachments.

e-RS referrals

If you feel that a referral is absolutely necessary, please refer via e-RS and use the “defer to provider” functionality for urgent/two-week wait (2ww) referrals. Please attach the referral letter at the point of referral/within 24 hours. For 2ww referrals, please ensure that the patient meets the criteria ahead of referring. Please do not refer urgent patients under 2ww as this will overwhelm the service.

We will vet the referral and either book into a virtual appointment or add the patient to the waiting list if they need a face to face appointment.

Please do not defer to provider routine referrals. Send the appointment request to the patient so they can do this when they are ready to book.

Please consider this before making any referral as our capacity to see new patients is very limited.

For any training issues/technical assistance with e-RS/smartcards, please contact your local commissioning support unit (CSU) or registration authority helpdesk.

Consultant Connect

For south east London GPs, your Clinical Commissioning Group (CCG) has commissioned the Consultant Connect service so you can also use this to seek advice. We are in the process of expanding our Consultant Connect lines – these will be available Monday to Friday 9am to 5pm and the communication will come via your local CCG bulletins. Please share this information within your practice.

See the frequently asked questions we are receiving from our patients.


Our service

Our upper GI surgical unit provides surgical services for conditions of the oesophagus, stomach, duodenum, pancreas and gallbladder. These include cancers, gastro-oesophageal reflux, gallstones, obesity and pancreatitis.

Our unit is the south east regional unit for upper gastro-oesophagealsurgery and specialises in all aspects of upper gastrointestinal disease. We perform surgery for cancer of the oesophagus and stomach as well as a wide range of other conditions. We also perform many laparoscopic procedures and have an oesophageal physiology laboratory.

Clinics

  • 9.30am - 12 noon, Tuesday (alternate weeks), St Thomas’ (Mr A Botha)
  • 9.30am - 1pm, Wednesday, St Thomas' (Prof R Mason, Mr Gossage, Mr Davies)
  • 3.30pm - 5pm, Wednesday pancreatic clinic, King's College Hospital (Mr S Atkinson)
  • 1.30pm - 5pm, Thursday, St Thomas' (Prof R Mason, Mr Gossage, Mr Davies)
  • 9.30am - 12.30pm, Friday, St Thomas’ (Mr S Atkinson)
  • 9.30am - 12 noon, Friday, St Thomas’ (Mr A Botha)

Preparing for your operation

Watch our preparing for your operation film to find out what you can expect during your care with us before, during and after an operation and how you can help your recovery after surgery.

  • Preparing for your operation – video transcript

    Mr Jonathan Olsburgh (consultant surgeon): In this video we're going to talk about what you can expect during your care with us before, during and after an operation and what steps you can take to assist your recovery and help you to get home as quickly as possible.

    This is often referred to as the enhanced recovery programme.

    These principles apply to any kind of operation. Evidence shows that being prepared for your operation both mentally and physically will help your recovery. You will know what to expect, what you can do to make yourself feel better. This is a key element of enhanced recovery.

    Applying enhanced recovery principles before your operation helps ensure you're better prepared by looking at exercise and diet; if appropriate stopping smoking or reducing alcohol; thinking about your home circumstances and having information on what to expect at each stage.

    Ian Wicks (kidney transplant patient): I spoke to my doctor when I turned out for my regular appointments about what to expect and things like that helped. I'm someone who likes to know information in advance it helps me process it a bit better. Back in the education sessions it was, don't smoke if you smoke, don't drink if you drink.

    Start to manage your diet a little bit differently, which we did, and in terms of the diet I think that was the thing that probably helped the most given guidance on what things would be good for me to eat the things that wouldn't be so good for me to eat. I think having that information and also listening to it is really important.

    Kathryn Chatterton (clinical nurse specialist): When I first meet you I'll be introduced to you by my consultant and then we'll be able to go through before and after what's going to be happening to you during your surgery. You'll also be given the opportunity to ask me any questions and also I'll make sure that you have the appropriate literature for you to have with regards to your surgery.

    Before your surgery you'll attend a pre-assessment clinic or a seminar which will be with a group of patients that are all undergoing the same surgery. Depending on the type of surgery and length of surgery there are a few members of the health care professional team that you may meet.

    You may meet the clinical nurse specialists who will be able to go through any additional questions that you're unsure about regarding your surgery. You will also meet a physiotherapist. They may be able to help you with any exercise to help you for pre and post-surgery and also, perhaps depending on the surgery, a pharmacist.

    Our dietitians can give guidance on nutrition before your surgery and how to look after yourself nutritionally when you're discharged. Some patients may be asked to drink a special carbohydrate drink which will help prepare your body for the operation and will help you with your recovery.

    Anna Mae Salvador (ward manager): The nurses will prepare you for surgery and when you're ready you'll be taken to an anaesthetic room and from there you're going to the operating room. After an operation most patient will wake up in the recovery room where you will be monitored until you're ready to go back to the ward.

    If you have had complex surgery or have complex medical needs you may move to a more specialist unit to be monitored through the initial recovery before being moved to the ward.

    It is important to get up and get moving as soon as you can after your operation. Most patients can start gentle exercises in bed and maybe sit out in a chair with assistance from the nurse on the same day of the operation. Movement will really help your recovery.

    The team looking after you will make sure you start eating and drinking at the right time after your operation, building this up gradually. We will also ask you if you have any pain or nausea and will help you manage this.

    Ian Wicks: I think it was on day one after the operation I should be getting out of bed and sitting up for a little while and I think that gave me the kind of the kick to get up and do it, thinking with that's what I've been told to do that's got to be the right thing to do even if it hurts. So get up, get out of bed and just try and do what the little booklet told me to do.

    I think having like a plan laid out, almost like a diary of what to expect, was really helpful, and I think in some ways you almost want to psychologically to try and beat it a little bit because I think it ran for five or six days, the programme. It was nice to know that I could sit in a chair longer than they expected me to sit in a chair for example. So that was a bit of a challenge almost to try and do better than it was laying out for you.

    Mr Jonathan Olsburgh: The important thing to remember is that every patient we see gets personalised care and is based around giving you the best possible experience and fastest possible recovery. The experience of Ian is an example of enhanced recovery to best support a transplant patient, many of the principles apply regardless of the type of operation you require.

    Ian Wicks: I went home three and a half days after the operation and I felt ready to go.

    Mr Jonathan Olsburgh: We're always happy to answer your questions so please do ask a member of your care team.

 

Patients having surgery for cancer of the oesophagus and stomach 

We understand that having surgery to have part of your oesophagus or stomach removed can be daunting and we hope that this video helps you understand the process better.

  • Enhanced recovery programme – video transcript

    Mr Andrew Davies (consultant oesophagogastric and general surgeon): So you've heard the basics of enhanced recovery we're now going to go into the details of what this involves for patients having surgery for cancer of the oesophagus and stomach.

    Enhanced recovery is about teamwork. It's about all the healthcare professionals involved in your care working together to help you recover quickly and safely following surgery. There are a variety of operations we perform for these cancers and each of them is individually selected for you. Increasingly we're using laparoscopic or keyhole surgery to help you recover quicker.

    During this video you'll meet some of the team that will be involved in your care. We understand that having surgery to have part of your oesophagus or stomach removed can be daunting and we hope that this video helps you to understand the processes a little better.

    Dr Nick Maisey (consultant medical oncologist): Cancers of the stomach and oesophagus are relatively rare. The misconception is that these are cancers that can't be cured but actually a lot of the patients that we see here go through curative treatment meaning that we give various treatments to get rid of the cancer to allow the patient to live a normal life eventually.

    So we try to individualise the treatment for you. So depending on what we decide in our joint meetings with the wider team, everybody's case is discussed individually, but typically patients will have a period of chemotherapy before surgery and then often after you recover from your surgery we may decide to give another month or two of chemotherapy treatment afterwards.

    Along with chemotherapy, quite often radiotherapy treatment may be offered as a treatment for your cancer and that can be given sometimes before the surgery but often can be given after the surgery as well.

    Most of the treatments that we give with chemotherapy is all outpatient based. The chemotherapy that we give to patients is given over at our Cancer Centre on the Guy's campus and when you do have the treatments you'll be in and out in the same day so you won't need to spend a night in hospital.

    We're very keen to always make progress in the way that we treat patients and an integral part of that is being involved in research and development of new therapies and new ways of fighting cancer. You may be asked to be involved in a clinical trial to try to push forward our knowledge of cancer treatment.

    Georgia Mundle (upper GI clinical nurse specialist): The patient journey will include a CT scan or a camera test, following that you'll have a PET scan as well. You will then be discussed at our MDM meetings on a Wednesday morning. Following that we'll meet you in clinic to discuss what the next step is.

    After your day of tests you will be seen by the consultants who will give you information about whether you need to have chemotherapy or primary surgery. When you come in to meet us you will be greeted by various members of the multidisciplinary team, so that includes a physio; a dietitian; your consulting surgeon and also myself as the enhanced recovery nurse.

    Tony Whiffen (oesophageal cancer patient): I saw the consultant surgeon having had a range of different tests. The diagnosis was oesophageal cancer and the recommendation was chemotherapy, surgery, and then some more chemotherapy. The enhanced recovery pathway was discussed at the initial meeting with the consultant surgeon. It sounded quite an attractive idea to optimise or reduce the time in hospital, spent on the ward.

    Mr Andrew Davies: Some patients want to know everything about their proposed operation whereas others prefer not to know the details. Either way your team will be very happy to go through things with you in as much or as little detail as you wish but fundamentally to explain what we're planning to do and why.

    Annie Coombs (senior specialist UGI dietitian): Soon after diagnosis you'll see myself or one of my colleagues. We'll be able to advise you on diet and building your strength and get you ready for your surgery. It's really important that you stay as weight stable as possible to build up your strength. In order to do this you need to have a varied balanced diet. If you are struggling to eat and drink prior to your surgery, we will be able to give you some ways to improve your diet and build your overall strength.

    Gemma Tham (clinical specialist physiotherapist): Physiotherapists teach breathing exercises to patients before operations because one of the most common side effects of these surgeries are chest infections. So it's really important that you are used to doing the breathing exercises and we'll teach you these very early on so that you can practice all the way through your treatment pathway.

    We will do a holistic assessment and then we will give you advice about exercise during your chemotherapy. We'll also give you some advice about managing fatigue.

    We'll try to encourage you to give up smoking because that will also help you in your future recovery.

    We aim to give you a structured exercise programme and although some people don't really like the idea of exercise we'll try to find something that you'll enjoy doing because it's important that you participate in your exercise programme during your treatment.

    Fatigue is a very common side effect of chemotherapy and some people find that the more tired they get, the less they do and the less you do, the less tired you are and you you're less likely to sleep well. So it's important to pace your activities and keep as active as possible.

    Tony Whiffen: I made sure I was fit and well prior to the surgery and that I'd eaten very well for a period of time. I did everything that the leaflets and booklets suggested that I should do.

    Kelsie Gurney (sister): You'll either be admitted the night before your surgery or sometimes on the morning of your surgery. You'll be reviewed by the doctors, by the anaesthetist and the nursing staff when you're admitted. You'll be taken from the ward to the anaesthetics room where you'll be seen by the doctors and nurses there and after the anaesthetics room they'll take you into theatre.

    Tony Whiffen: On the actual day we were consented so they described the operation in detail and what that would entail.

    Dr Charlotte Taylor (anaesthetic consultant): I'm one of the anaesthetists that look after patients having upper GI surgery. Our job is to make sure you're safe when you're asleep having your operation. Whilst you're asleep we put lots of different drips in that will be there when you wake up. Our job is also to make sure that your pain is controlled after the operation. We do this by putting in epidurals before you go to sleep or by a paravertebral block that is put in when you are asleep. We run this along with the patient controlled analgesia pump, a PCA, which is morphine through a drip with a button to press when you need the pain relief.

    Mr Andrew Davies: The day of the surgery is often more stressful for relatives. To some extent you come into hospital have a general anaesthetic and go to sleep and everybody else does the worrying for you. It's after the operation when all of the team kicks into action to start your recovery that your engagement is crucial.

    Kelsie Gurney: After surgery you'll spend one night and overnight intensive recovery and then you'll be moved up to the ward. You'll be reviewed by your regular doctors, nurses, physiotherapists and dietitians. Everyone will be working together to make sure you have the smoothest recovery possible with as few complications as we can.

    You'll have quite a few drips and drains immediately after surgery. Over the next few days you will start to lose those. You will definitely start to feel more like yourself around day four or day five after your surgery when we're able to take some of those out.

    Tony Whiffen: I was on a step-down intensive care ward for a night. I think the first person I saw was a physio on the second day. Obviously I saw doctors and the consultant surgeon and the consultant nurses. The physio took me for a walk around the ward and it was very encouraging actually to be able to have a walk around and feel that you're on the route to recovery already, so soon.

    Annie Coombs: Immediately after surgery you won't be allowed to eat and drink for anywhere between three and five days. After this time you get sent for a test to make sure that you've got a watertight seal.

    Following this, if that's all okay, then we start you on a step by step gradual progression with your oral intake. This usually starts with clear fluids like water and then you progress the next day on to something called free fluids this is things like milk, ice cream, soups, jelly, yoghurts and if that's all okay then you progress the next day on to a level 6 soft and bite-sized diet.

    You'll be provided with all the relevant literature to support this. Your portion sizes will be reduced. The dietitians will recommend that you eat little and often.

    Gemma Tham: The physiotherapy team will come to review you the day after your operation and we will help you to get out of bed that morning. We'll also teach you some breathing exercises and it's really important that you can cough. If you have any pain you must tell us. You must be able to deep breath, cough and move. This will help to prevent chest infections and other complications such as clots in your legs.

    Tony Whiffen: The dietary advice was very clear and carefully developed because there is a change to the stomach capacity and therefore it's fundamentally about eating frequently but smaller portions.

    Gemma Tham: We'll give you personalised advice about returning to all the normal activities that you want to do including returning to sport and returning to work.

    Kelsie Gurney: There is an expected date of discharge with the enhanced recovery programme but everybody's needs are different after having surgery and we'll make sure that we speak with every member of the team and with you and your family to make sure that you're ready to go home at the right time for you.

    Tony Whiffen: I expected a period of two weeks at least and I was discharged after nine days. I thought that the teams of physios, consultant surgeons, are outstanding and world-class and when the NHS works together when someone is sick, it's quite a powerful machine. It really does work and coordinate very well. I'm very impressed with the treatment I got and the standard of care.

    Georgia Mundle: We understand that having surgery can be quite daunting for you and your loved one. We are here to make your journey a bit easier.

 

 
 

Coronavirus

Please visit the main Trust coronavirus (COVID-19) page for more information.