Endoscope means looking inside and typically refers to looking inside the body for medical reasons using an endoscope, an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ.
An upper gastrointestinal (UGI) endoscopy is a procedure that allows your doctor to look at the interior lining of your esophagus, your stomach, and the first part of your small intestine (duodenum) through a thin, flexible viewing instrument called an endoscope.
The tip of the endoscope is inserted through your mouth and then gently moved down your throat into the esophagus, stomach, and duodenum (upper gastrointestinal tract).
Are there any complications with having an endoscopic procedure?
There are several complications possible though not probable. Any procedure you have done has a certain amount of risk involved but every attempt is made to make your procedure safe and complication free. Possible GI endoscopy complications include perforation (making a hole in the bowel), infection, bleeding, pneumonia, reaction to medications and pancreatitis (ERCP). Pulmonary endoscopy complications include pneumonia, bleeding, infection, collapsed lung, and reaction to medications. If you have any questions on concerns about your risk for complications, please talk to your physician. After your procedure, you will be given a discharge instruction sheet that will outline signs and symptoms that might indicate a complication. These might include: passing more than a small amount of blood in your bowel movement; vomiting or coughing up blood; increasing pain; chills and /or fever; increasing shortness of breath. Do not hesitate to call our doctor if any of these occur.
Do I have to have someone stay with me at home after my procedure?
It is not mandatory that someone stay with you, but often a good idea. You may be drowsy and your coordination impaired for several hours after your procedure. The need for someone to stay can be assessed prior to your discharge depending on your procedure length, amount of sedation required, your age and pre procedure health status.
Should I take my regular medications before my procedure?
That depends. Certain medications like blood thinners (Coumadin, Lovenox) and other anti inflammatory type medications (aspirin, Ibuprofen), even some herbal medications (St. Johns Wart) are usually discontinued for several days prior to procedure. Diabetic medications (Insulin, Glucophage, Miconase) may be decreased or stopped. Medications taken for high blood pressure or heart disease may be needed. So be sure to tell our physician all the medications you take including over the counter ones, and make sure you have an understanding which one to take or not take.
What can I eat after I leave?
Our physician will advise you what diet she wants you to resume following your procedure. First meals may need to be light but this is determined by what was done during your procedure and physician preference.
What can I expect when I have my throat and/or nose numbed for an endoscopic procedure?
For many GI endoscopy procedures involving the upper digestive tract and for bronchoscopies your throat is routinely numbed with a xylocaine spray (similar to what your dentist uses to numb your gums). In addition, for bronchoscopies you nose is also numbed. This involves spraying and applying various forms of local anesthetics to the back of your throat and/or into your nostrils. As this medication melts and runs to the back of your throat, you may experience a short-lived burning sensation in your throat. You may feel like you have a “lump in your throat” or that you can’t swallow. Don’t let this frighten you. Swallowing takes place as usual it only feels different. This feeling usually lasts for approximately 30 minutes or less. This application of anesthetics allows your physician to pass the bronchoscope with minimal discomfort. What happens after my procedure is complete? Once your procedure is complete, you will be taken to the recovery room where you will stay for 30 minutes to an hour. You will continue to be monitored to ensure no complications arise form your sedation. Once you are sufficiently awake you may receive liquids to drink and your IV will be discontinued. Your physician will speak with you and your family about the results of your procedure. A nurse will spend time with you and your family going over necessary areas of teaching related to your diagnosis. You will receive a written copy of your discharge instructions detailing your activity level, diet, signs to be aware of related to possible complications, and when to call your physician. Return appointments with physician can be made. Once you are up and dressed, one of our volunteers will escort you by wheelchair to the appropriate exit where your family will be waiting with the car.
What if my colon prep makes me sick?
A colonoscopy requires that you take a “bowel prep” or a regimen of laxatives and a liquid diet. This ensures that your colon is clean and clear of stool for better examination. It is very important that you follow the instructions for the bowel prep. Sometimes, a bowel prep can make you nauseated or even cause you to vomit. If you do vomit or are unable to finish your prep, be sure to notify our physician prior to coming in for your procedure. The Go-lytely prep, especially if kept in the refrigerator prior to drinking, can cause you to become very cold. Do not mix any red or orange drinks of any kind with your prep as this looks very much like blood when seen during your colonoscopy.
What should I expect with my procedure?
When you arrive at our office, you will first be registered by one of our secretaries. They will obtain insurance information, have you fill out a medical history form or assist you with it. Be sure to bring your insurance card and a list of your current medications. You will then be escorted to a pre-procedure room where you will be greeted by one of the Endoscopy assistants. They will review the procedure with you and answer any questions you might have. You will then be asked to sign a procedure specific consent form. Our medical assistant will do a short physical assessment including your BP, pulse, listening to your heart and lungs. An IV will be started, as most procedures require an IV for sedation administration and precautionary measures. If your physician orders lab work it will be drawn and pre-procedure antibiotics will be given if ordered. Your doctor will speak to you prior to your procedure. During your procedure your vital signs (BP, pulse, respiration, oxygen level) will be monitored carefully. Depending on your procedure, you will be lying either on your back or left side. Endoscopic procedures can take as little as 10-15 minutes or as long as 1-2 hours depending on the type and complexity of your procedure.
What will I feel after my procedure?
After awakening from sedation, most patients have minimal discomfort. You may feel drowsy and repeat yourself for several hours. This comes from an amnesic effect of one of the medicines you may have received. If you have an upper endoscopy, you may find yourself belching for a short time following awakening. Your throat may be sore but usually will be fine in 24 hours. If you have a lower endoscopy, you may feel bloated immediately after the procedure. You will be encouraged to expel the air. Do not be embarrassed. This air was instilled during your procedure to dilate your colon for better viewing. You will be able to discharge it easily.
When will I know the results of my procedure?
Your physician usually will be able to tell you how well your procedure went and possibly some preliminary findings prior to your discharge. Often, tissue samples are obtained during the exam. These samples (biopsies) are sent to our laboratory and results can take 2-7 days to return to your physician. Your physician or his office will call you or you will be instructed when to call his office for the results.
Why do I have to be at the Endoscopy department 1 1/2 hours before my procedure is to be done?
Many tasks have to be completed before your procedure takes place. Registration, obtaining a history and physical exam, and IV placement must all be completed to ensure your safety and the highest quality of care during your stay. In addition, your doctor may want to obtain lab work or have you receive some antibiotics prior to your procedure. A review of your procedure and what to expect will also take place. You will also have time to ask questions and express concerns.
Why do I need someone to drive me home?
Even though the sedatives wear off quickly after your procedure, they can affect your coordination for up to 12 hours. Technically, you are legally impaired. Therefore, for your safety and the safety of others on the road, please bring someone to drive you home. Your procedure can be canceled if you have no one to assist you.
Will I be “knocked out” for my procedure?
Most endoscopic procedures are done under what is called conscious or moderate sedation. This involves giving you one or more medications through an intravenous (IV) line. This type of sedation causes you to become drowsy and relaxed and usually you sleep during the procedure not consciously aware of what is occurring. In addition, some medications produce a temporary short-term amnesia effect. Therefore, you may not remember anything that occurs during and sometimes for a short time after the procedure. This type of sedation does not really “knock you out.” You will be able to breathe on your own and follow simple commands. For most patients, this sedation is more than adequate for their produce. If you drink moderate to large amounts of alcohol, take sleeping pills, or are on antidepressants or pain pills on a regular basis and have concerns about your sedation, be sure to discuss this with our physician prior to your procedure date.
Will I ever have to stay in the hospital overnight if I am having an ERCP?
If the tiny muscle at the opening to your common bile duct or pancreatic duct has to be cut (Sphincterotomy) there is a chance you will spend the night in the hospital for observation. This is to ensure there are no complications and that prompt treatment would be available if necessary.
Will I have any pain during my procedure?
Most endoscopic procedures have minimal discomfort associated with them. Normally you will be receiving sedation during your procedure. Often with this sedation you may remember little or nothing about your procedure. With upper and lower endoscopy, you may feel some abdominal pressure or distention and have the urge to belch or pass gas rectally. This is very normal and expected. During bronchoscopy you may experience some sinus pressure. Coughing as the airways are anesthetized prior to entry of the scope is also normal. The goal of our physicians and staff is to keep you comfortable during your procedure and at the same time keep you safe.
In order to safely sedate you, your stomach needs to be empty of food for 6 hours and liquids for 2 hours prior to your procedure. This is to decrease any chance of you vomiting or choking. In addition, for any upper endoscopy, your stomach needs to be empty so your physician can get a clear view during your examination.
If you are scheduled for a morning procedure: You should have nothing by mouth (including gum and mints) after midnight. The exception is medication taken with small sips of water.
If you are scheduled for an afternoon procedure: You may continue drinking small quantities of clear liquids up to 6 hours prior to your scheduled arrival time.
CLEAR LIQUIDS: water, apple juice, ginger ale, sprite, beef or chicken broth WITHOUT noodles, coffee or tea WITHOUT cream or milk, most sodas, sherbet, popsicles, and Jell-O that is not red or orange. DO NOT DRINK ANYTHING RED OR ORANGE.
To properly prepare for your procedure, you may need to make certain changes to your daily medication routine.
• If you take insulin, consult with your physician about making any necessary changes in you daily regimen.
• If you take medications that contain aspirin or other anti-inflammatory drugs (such as Motrin, Advil, Indocin, or Feldene), we recommend that you stop taking them seven days before your procedure. They may increase your risk of bleeding after removal of a polyp or a biopsy during your upper GI endoscopy by interfering with the normal clotting of your blood.
• IMPORTANT: IF YOU ARE CURRENTLY TAKING COUMADIN OR HEPARIN, YOU MUST CHECK WITH YOUR PRESCRIBING PHYSICIAN BEFORE CHANGING OR INTERRUPTING YOUR DAILY ROUTINE.
If you have any questions, please feel free to call Dr. Gottesman at (718) 934-4842.