Our services | Investigative tests
Investigative tests
A wide range of advanced investigations are carried out at the Endoscopy Unit at The Royal London Hospital.
Urine, faecal and blood tests
Samples of these are used to help with the diagnosis of many digestive conditions.
A faecal occult blood test helps to diagnose bleeding disorders of the gut. It detects traces of blood in your stools that you wouldn’t normally see.
There are several disorders that could cause bleeding including ulcers and bowel cancer.
Biopsy
This involves the removal of cells or tissues for examination under a microscope. Many digestive disorders including, hepatitis, cirrhosis and celiac disease, can be diagnosed in this way.
Different types of biopsy are used to test different parts of the body.
A biopsy of the large intestine is taken using forceps which are inserted through a tube called an endoscope. However, a biopsy of the liver is taken using a syringe-type needle.
GI physiology
This involves a series of pictures being taken of the oesophagus, stomach and small intestine. Usually the tests are used to diagnose problems like ulcers, acid reflux, serious vomiting or bloody stools.
Anorectal/Colorectal testing
These are tests on your lower bowel or back passage to show how your bowel is working. The results will help plan the best course of treatment for your bowel condition.
You will not need to stay in hospital for these tests and you can eat and drink as normal before your appointment.
The tests can be embarrassing and a little uncomfortable but our professional staff will put you at ease and ensure any discomfort is kept to a minumum and that your privacy is maintained at all times.
The tests help to assess the capacity of your back passage, whether the muscles are functioning and also nerve or muscle damage.
For more information about the tests click on the links below.
Download Anorectal physiology testing.
Download Colorectal physiology testing.
Hydrogen breath tests
This is used to diagnose or discount various digestive problems. You’ll be asked to brush your teeth and then breathe into a tube which takes a first breath sample.
You will then be asked to drink a sugary solution which causes the bowel to release hydrogen. Breath samples continue to be taken for up for the next two hours.
Oesophageal manometry and acidity measurement This is a test to measure how well the muscles and nerves in the oesophagus (gullet) work and how much acid is there. The gullet is the tube that takes food from the back of the mouth to the stomach, and the muscles here squeeze rhythmically to push food downwards.
A catheter (clear, plastic tube) is inserted into your digestive system through your nose and fluid is flushed through it to copy what happens when you eat or drink.
The nerves and muscles start working to squeeze the fluid through your digestive system. This activity is picked up by sensors contained in the catheter and recorded on a machine.
The test takes about an hour and is carried out in the GI physiology unit. Sedative medication can be used to relax patients, particularly children, throughout the procedure.
Click here for more information on the GI Physiology Unit based at Barts and The London School of Medicine and Dentistry.
Neurophysiology
Neurophysiology is the study of electrical activity of the sensory and autonomic, central and peripheral nervous system functions, dysfunctions of which are common in many neurological and general medical conditions.
There is a range of techniques available to study the brain, the somatic, hearing and visual systems, these are electroencephalography (EEG), somatosensory (SSEP), auditory (AEP) and visual (VEP) evoked potentials, respectively, as well as nerve conduction studies (NCS), which indicates the time for the signal to travel along a nerve, electromyography (EMG), which records the activity of the muscles.
Some diseases affect the autonomic nervous system and there are a number of procedures that allow quantitative assessment of both sympathetic and parasympathetic function. These include evaluation of cardiovascular and sudomotor function, such as heart-rate variability, the Valsalva maneuver and galvanic skin response.
Bowel Cancer Screening
Screening started at The Royal London Hospital in March 2007 as part of a programme to significantly reduce the occurrence of the disease.
All 60 to 69-year-olds in the area are sent a test kit and asked to return a small stool sample by post. Those whose samples show traces of blood are invited to the screening centre for a colonoscopy to remove polyps before they become cancers, and to detect bowel cancers before they cause symptoms.
For more information click here to visit our dedicated cancer website.
Endoscopy
A flexible tube is inserted into the body to take photos of the gullet, stomach and large intestine (colon).
The doctor is also able to take samples of abnormal tissues using this method.
Most people have the test as an outpatient, either while they are awake or under sedation. If you don’t have a sedative, a spray will be used to numb your throat to make it easier for you to swallow the endoscope down your throat.
Children will often be sedated for this test and very young children will be given a general anaesthetic.
You will be advised not to eat or drink for about eight hours before the test so your stomach is empty. Once the test is over, you’ll need to rest for a while but should be able to leave the hospital on the same day.
The results will not be given straight after the test. Instead a full report will be sent to the doctor who referred you.
Types of endoscopic tests include:
Colonoscopy
This test is used to examine the inside of your large bowel. Adults should not need to stay in hospital.
Children may need to stay in overnight as the procedure is normally carried out under general anaesthetic.
A colonoscopy is similar to an endoscopy. The main difference being that the flexible tube is inserted through the anus rather than swallowed through the gullet.
A fibre-optic camera enables ulcers or polyps to be identified. It also allows biopsies or samples to be taken which can then be studied under a microscope.
Video capsule
Originally developed at Barts and The London, this groundbreaking capsule allows the small intestine to be examined without the need for surgery.
The capsule is a small camera which after being swallowed takes photos every two minutes on its journey through the gut.
It doesn’t replace a colonoscopy or an upper endoscopy nor does it take tissue samples like an endoscopy but it does reach further inside the small bowel. An ideal non-invasive test for both adults and children.
Combined endoscopy/x-rays
Endoscopic Retrograde cholangio-pancreatography (ERCP) is an x-ray which is aided by an endoscope to diagnose problems affecting the bile ducts like gallstones etc.
A die is sometimes injected so that organs like the gall bladder and bile ducts show up on the x-ray.
CT/MRI scans
CT scanning involves using x-rays and computers to produce images of internal organs.
The CT scanners at The London Chest Hospital, Barts Hospital and The Royal London Hospital all specialise in different scans. For example, The London Chest specialises in trauma and lung scans and The Royal London specialise in biopsies, steroid injections under CT scan control and scans for children.
Each patient is reviewed on an individual basis and referred to the most appropriate site.
Sometimes you will be asked not to eat anything for four hours prior to your appointment. You may also need to have a dye injected into a vein in your arm to show the blood vessels and organs.
MRI scanning uses magnetic and radio waves to take detailed pictures of the soft tissue parts of the body.
For abdominal and pelvic scans you can’t eat or drink for six hours before your appointment. You’ll be informed if this is the case.
The length of your scan may vary depending on the area of your body being scanned. Allow at least two hours for your appointment.
You will not be given the results of your scan immediately. The radiologist will examine the scans and send a detailed report through to the doctor who referred you. The results will then be discussed at your next appointment.
