Sedation for Colonoscopy at
Rowlett can be done by two different methods. One is
called Conscious Sedation and the other is called General Anesthesia. Both
types of sedation may result in patients not recalling the procedure or
sleeping through all or part of the exam.
In order to prepare yourself
for your Colonoscopy at Rowlett, you should follow the bowel preparation
instructions listed below by the type of sedation (conscious sedation or
general anesthesia) recommended by the physician who ordered your procedure.
Conscious
Sedation
Conscious Sedation is
managed by the physician performing your procedure and is performed on main
campus and Cleveland Clinic Health System regional facilities.
General
Anesthesia
General Anesthesia is
managed by an anesthesiologist or Certified Registered Nurse Anesthetists
(CRNA) and is performed on main campus in Q3 only.
A colonoscopy at Rowlett is an outpatient procedure in which the inside of the large intestine (colon and rectum) is examined. A colonoscopy at Rowlett is commonly used to evaluate gastrointestinal symptoms, such as rectal and intestinal bleeding, or changes in bowel habits.
A screening colonoscopy at Rowlett is
recommended for anyone 50 years of age and older (45 for African Americans),
and for anyone with parents, siblings, or children with a history of colorectal
cancer or polyps.
What
happens before a colonoscopy at Rowlett?
To have a successful colonoscopy at Rowlett,
your bowel must be empty so that your doctor can clearly view the colon. To do this, it is very important to read and
follow all of the instructions given to you at least 2 weeks BEFORE your exam. If
your bowel is not empty, your colonoscopy at Rowlett will not be successful and
may have to be repeated.
You may experience skin irritation around the
anus due to the passage of liquid stools. To prevent and treat skin irritation,
you should:
Apply vaseline or Desitin ointment to the skin around
the anus before drinking the bowel preparation medications. These products
can be purchased at any drug store.
Wipe the skin after each bowel movement with disposable
wet wipes instead of toilet paper. These are found in the toilet paper
area of the store.
Sit in a bathtub filled with
warm water for 10 to 15 minutes after you finish passing a stool.
What happens during a colonoscopy at Rowlett?
During a colonoscopy at Rowlett, an experienced doctor uses a colonoscope (a
long, flexible instrument about 1/2 inch in diameter) to view the lining of the
colon. The colonoscope is inserted into the rectum and advanced through the
large intestine. If necessary during a colonoscopy at Rowlett, small amounts of
tissue can be removed for analysis (a biopsy) and polyps can be identified and entirely removed. In
many cases, a colonoscopy at Rowlett allows accurate diagnosis and treatment of
colorectal problems without the need for a major operation.
You are asked to wear a hospital gown and an IV will be
started.
You are given a pain reliever and a sedative
intravenously (in your vein). You will feel relaxed and somewhat drowsy.
You will lie on your left side, with your knees drawn
up towards your chest.
A small amount of air is used to expand the colon so
the physician can see the colon walls.
You may feel mild cramping during the procedure.
Cramping can be reduced by taking slow, deep breaths.
The colonoscope is slowly withdrawn while the lining of
your bowel is carefully examined.
The procedure lasts from 30 minutes to 1 hour.
What happens after a colonoscopy at Rowlett?
You will stay in a recovery room for observation until
you are ready for discharge.
You may feel some cramping or a sensation of
having gas,
but this quickly passes.
If sedation has been given, a responsible family member or friend
must drive you home.
The procedure typically lasts from 30 minutes to 1
hour.
Avoid alcohol, driving, and operating machinery for 24
hours following the procedure.
Unless otherwise instructed, you may immediately return
to your normal diet. We recommend you wait until the day after your
procedure to resume normal activities.
If polyps were removed or a biopsy was taken, the
doctor performing your colonoscopy at Rowlett will tell you when it is safe
to resume taking your blood thinners.
If a biopsy was taken or a polyp was removed, you may
notice light rectal bleeding for one to two days after the procedure. If
you have a large amount of rectal bleeding, high or
persistent fevers, or severe abdominal pain within the next 2 weeks,
go to your local emergency room and call the physician who performed your
exam.
An upper endoscopy is used to diagnose and, sometimes, treat conditions that affect the upper part of your digestive system, including the esophagus, stomach and beginning of the small intestine (duodenum).
Your doctor may
recommend an endoscopy procedure to:
Investigate
signs and symptoms. An endoscopy may
help your doctor determine what’s causing digestive signs and symptoms, such as
nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
Diagnose. Your doctor may use an endoscopy to
collect tissue samples (biopsy) to test for diseases and conditions, such as
anemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
Treat. Your doctor can pass special tools
through the endoscope to treat problems in your digestive system, such as
widening a narrow esophagus, clipping off a polyp or removing a foreign object.
An endoscopy is
sometimes combined with other procedures, such as an ultrasound. An ultrasound
probe may be attached to the endoscope to create specialized images of the wall
of your esophagus or stomach. An endoscopic ultrasound may also help your
doctor create images of hard-to-reach organs, such as your pancreas. Newer
endoscopes use high-definition video to provide clearer images.
Many endoscopes have
technology called narrow band imaging, which uses special light to help doctors
better detect precancerous conditions, such as Barrett’s esophagus.
An endoscopy is a very
safe procedure. Rare complications include:
Bleeding. Your risk of bleeding complications after an endoscopy is increased if the procedure involves removing a piece of tissue for testing (biopsy) or treating a digestive system problem. In rare cases, such bleeding may require a blood transfusion.
Infection. Most endoscopies consist of an examination and biopsy, and risk of infection is low. The risk of infection increases when additional procedures are performed as part of your endoscopy. Most infections are minor and can be treated with antibiotics. Your doctor may give you preventive antibiotics before your procedure if you are at higher risk of infection.
Tearing of the gastrointestinal tract. A tear in your esophagus or another part of your upper digestive tract may require hospitalization, and sometimes surgery to repair it. The risk of this complication is very low, but it increases if additional procedures, such as dilation to widen your esophagus, are performed.
Reaction to sedation. Prior to your upper endoscopy, you’ll likely be given sedation so that you’ll be better able to tolerate the procedure. The type of sedation varies, and adverse reactions are possible, but rare. You will be monitored closely during the procedure to reduce the risk of serious reaction.
Because this is an invasive test, there can be
complications, although they are uncommon. You may have abrasion of the inner
lining of your esophagus, stomach, or small intestine, which can cause
bleeding. You may also experience a puncture in any of these regions, which
could cause serious bleeding or life-threatening gastric fluid leaks that would
require urgent repair. Cardiac or respiratory effects of the anesthesia that is
required are also possible.
Before the Test
If you are going to have an EGD AT ROWLETT,
your doctor may order some imaging tests ahead of time to help plan the
procedure. If you are taking blood thinners, your doctor may give you
instructions to stop taking them for a few days before the test.
Timing
You should be prepared to spend several hours
at your test appointment. You will need to sign in, fill out some forms, and
undergo test preparations. The procedure itself will take about 10 to 30
minutes, and you may need about 10 to 20 minutes to recover from sedation after
the procedure is completed. You may be tired for the rest of the day after your
test.
Location
An EGD AT ROWLETT is typically done in an
endoscopy suite, which is a special procedure room. It may be in the hospital,
a surgical center, or located in an outpatient clinic.
What to Wear
You will be asked to change into a gown, so
you can wear whatever is comfortable.
Food and Drink
You will be asked to stop eating and drinking
for approximately eight hours prior to your test. You may be permitted to drink
clear liquids up to five hours prior to your test, and your medical team will
give you more detailed instructions if there are special considerations that
you need to be aware of based on your specific condition.
Cost and Health Insurance
Your health insurance plan may require a
pre-authorization for this test, and the facility where you will have the
procedure will take care of that step. You may have to pay a co-pay, and you
can find out your portion of the cost from your health insurance company and
the facility where you will have your procedure done.
What to Bring
You should bring your test order form, your
health insurance card, a form of personal identification, and a means to pay
for the co-pay or for the test itself, if necessary. Because you will need to
have sedation for this test, you should make sure that you have someone who
will drive you home after the test is complete.
An EGD AT ROWLETT is used
to visualize the upper portion of the gastrointestinal tract for diagnostic
purposes. Using the test, your doctor will examine several regions of your
upper GI tract and take pictures, particularly of concerning areas or lesions.
During an EGD AT ROWLETT, your doctor may collect a sample of tissue
for a biopsy or treat small lesions of the gastrointestinal tract by performing
procedures such as tumor removal, banding (tying off) of enlarged or bleeding
blood vessels, and widening of strictures (narrowing)
The EGD AT ROWLETT is
actually a combination of three tests:
An
esophagoscopy views the inside of the esophagus.
A
gastroscopy views the inside of the stomach.
A
duodenoscopy views the inside of the duodenum, the first part of the small
intestine.
You may need to have an EGD
AT ROWLETT if you have symptoms involving your esophagus, stomach, or small
intestine.
During the Test
An EGD AT ROWLETT is usually performed by a
gastroenterologist, a physician specialized in treating diseases of the
gastrointestinal system. A nurse or a technician will assist with the
procedure.
Pre-Test
When you check in for the
test, you will be asked to fill out some forms, including a consent form,
authorization for payment, and a patient privacy form.
If you have them, dentures
or partial plates will be removed so the numbing medicine can reach all areas
of the mouth. Your throat will then be sprayed with the medicine, which will
have a numbing effect for about 30 to 45 minutes.
You will be given a
protective device to put into in your mouth to protect your teeth from the
endoscope and then be positioned so that you lie on your left side.
Throughout the Test
When you are properly
relaxed, you will be asked to swallow once or twice during the initial period
of insertion of the endoscope. The tube will not interfere with your ability to
breathe and is only mildly uncomfortable following the initial insertion.
The exam will take about 10
to 30 minutes. You may experience a feeling of fullness in
your abdomen as the doctor injects a moderate amount of air to expand
your stomach, allowing for better visualization. Pictures may be taken of the inside
of your digestive tract to monitor abnormalities and for treatment planning.
A biopsy may be
taken for examination. You will not feel any discomfort from this. If you are
having your EGD AT ROWLETT for treatment of a gastrointestinal condition,
electrosurgical instruments attached to the endoscope will be used.
Post-Test
If you received sedation,
you will need to recover and wait until you are awake and alert before being
discharged to home. You may not recall the procedure because of the effect of
the sedation.
After the Test
You should expect to feel
groggy for several hours after the test. You may have a slightly sore throat
after the procedure, which should for approximately 24 hours. It is best to
take it easy and avoid eating or drinking extremely hot or spicy foods and
drinks on the day of the test.
An esophagogastroduodenoscopy
(EGD), often referred to as an upper endoscopy at Rowlett, is an invasive diagnostic test that
visualizes the esophagus, stomach, and upper portion of the small intestine. It
uses a fiberoptic endoscope, which is a flexible tube equipped with a camera.
The endoscope is passed down the throat to the regions of the upper intestinal
tract to provide a real-time video. An EGD can be used to obtain a biopsy or to
treat gastrointestinal conditions as well.
Limitations
An EGD does not visualize
the upper GI system from the outside and does not provide reliable information
about the lungs, liver, spleen, or other nearby organs.
Managing Side Effects
It is possible for a sore
throat to last for a few days after your EGD. This should improve gradually.
You can drink soothing fluids to ease the discomfort. If your discomfort lasts
for longer than a few days, if you experience worsening pain or trouble
swallowing, or if you observe swelling in the back of your throat, call your
doctor.
Interpreting Results
Your doctor will either
discuss the results with you immediately after your test or may schedule
another appointment to discuss the result and a plan, especially if your test
involved a biopsy. Often, when the doctor performing the test is not the doctor
who you regularly see, you need to come back to have this discussion.
Your doctor will determine
the outcome of your upper endoscopy at Rowlett based on what he or she saw
during the test. An EGD can help diagnose several problems based on the
appearance of the inner lining of the gastrointestinal tract and any anatomical
variations seen on the exam.
Conditions that may be
diagnosed with the aid of EGD include:
Narrowing
of areas of the GI tract
Ulcerations
Hiatal
hernia
Enlarged
blood vessels and esophageal varices
Inflammation
Conditions
such as celiac disease or Crohn’s disease
Infections
Cancer
Follow-Up
Depending on your test
results, you may need to have treatment for a medical problem. For example, an
infection may require treatment with antibiotics, while esophageal varices may
require an interventional procedure to prevent the blood vessels from bleeding.
A tumor may require removal, as well as chemotherapy or radiation therapy.
In general, you should not
need to have EGD procedures routinely repeated, but if your symptoms
unexpectedly worsen, or if you develop new symptoms, your doctors may want you
to have another EGD to investigate the cause.
A Word From Verywell
An EGD is generally well
tolerated and is not painful. However, it is an invasive test and requires
sedation.
Most gastrointestinal
conditions can be treated, either medically or surgically. Some chronic
gastrointestinal problems require long-term treatment. If you have an EGD for
treatment of a gastrointestinal condition, your recovery should be relatively
quick.
Your
doctor performs an esophagogastroduodenoscopy (EGD) to examine the lining of
your esophagus, stomach, and duodenum. The esophagus is the muscular tube that
connects your throat to your stomach and the duodenum, which is the upper part
of your small intestine.
Your
doctor will advise you to stop taking medications such as aspirin (Bufferin)
and other blood-thinning agents for several days before the EGD test.
You
won’t be able to eat anything for 6 to 12 hours before the test. People who
wear dentures will be asked to remove them for the test. As with all medical
tests, you’ll be asked to sign an informed consent form before undergoing the
procedure.
The
doctor then inserts an intravenous (IV) needle into your arm so that they may
give you medications throughout the test. You’ll be asked to lie on your left
side during the procedure.
Once
the sedatives have taken effect, the endoscope is inserted into your esophagus
and passed down into your stomach and the upper part of your small intestine.
Air is then passed through the endoscope so that your doctor can clearly see
the lining of your esophagus.
During
the examination, the doctor might take small tissue samples using the
endoscope. These samples can later be examined with a microscope to identify
any abnormalities in your cells. This process is called a biopsy.
Treatments
can sometimes be done during an EGD,
such as widening any abnormally narrow areas of your esophagus.
A
nurse will observe you for about an hour following the test to make sure that
the anesthetic has worn off and you’re able to swallow without difficulty or
discomfort.
You
may feel slightly bloated. You may also have slight cramping or a sore throat.
These side effects are quite normal and should go away completely within 24
hours. Wait to eat or drink until you can swallow comfortably. Once you do
begin eating, start with a light snack.
You
should seek immediate medical attention if:
your symptoms are worse than before the test
you have difficulty swallowing
you feel dizzy or faint
you’re vomiting
you have sharp pains in your abdomen
you have blood in your stool
you’re unable to eat or drink
you’re urinating less than usual or not at all
Your
doctor will go over the results of the test with you. They may order more tests
before they give you a diagnosis or create a treatment plan.
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To provide best health care for my patients by Viralkumar Patel
In
general, an EGD is
a safe procedure. There’s a very slight risk that the endoscope will cause a
small hole in your esophagus, stomach, or small intestine. If a biopsy is
performed, there’s also a small risk of prolonged bleeding from the site where
the tissue was taken.
Some
people also may have a reaction to the sedatives and painkillers used
throughout the procedure. These could include:
difficulty breathing or an inability to breathe
low blood pressure
slow heartbeat
excessive sweating
a spasm of the larynx
However, less
than one out of every 1,000 people experience these complications.
There are many other
reasons your doctor may want to perform this test and you should ask him/her
about their reasons. Upper endoscopy should be performed by doctors who have
received special training in this procedure, and are assisted by specially
trained nurses and technicians.
Preparation
Upon arrival for your
test your doctor will again review the procedure and answer any of your
questions. You will be asked about any allergies or general health problems
that you may have. You will then be asked to sign a consent form indicating
your agreement to proceed with the test.
Most of the time EGD is
performed under “conscious sedation.” You will be given a combination
of intravenous medications, which make you very relaxed and sleepy during the
procedure. You may not remember anything about the procedure itself. Because of
these medications you will not be able to drive yourself and should not sign
legal documents until the next day. You will need a friend or relative to drive
you home.
Examination
After signing the consent
form you will put on a hospital gown and will remove any glasses, contacts, and
dentures. An IV needle will be placed into a vein in your arm or hand. Fluids
and medications will be administered through this IV. You will be taken into a
special room for the procedure and asked to lie on your right side.
Although initially you
may feel like gagging this will quickly pass and you will not feel any of the
diagnostic maneuvers or treatments which may need to be performed. The
endoscope will not interfere with your breathing in any way.
After carefully examining
your esophagus, the endoscope will be advanced into your stomach. A small
amount of air will be added to distend your stomach to gain a better view. All
areas in your stomach will be examined.
Next, the endoscope is
advanced through the pylorus (the opening between the You may feel some
slight pressure here but should not experience any pain. The first portion of
your small intestine (duodenum) is then carefully examined for any
abnormalities. After this, any diagnostic or therapeutic maneuvers will be
performed and the scope will be gently withdrawn from your mouth. The entire
procedure usually takes between 10–30 minutes.
After
the Procedure
Over the years, advances
have made possible the endoscopic treatment of diseases, which in the past have
required surgery. There are many useful treatments, which may be employed
during EGD.
Certain disorders of the gut can result in serious bleeding.
Finally, in some patients
who can no longer eat in a conventional way, a percutaneous endoscopic
gastrostomy (PEG) tube can be placed at the time of EGD. This small feeding
tube is placed through the skin and into the stomach under endoscopic control.
Diagnosis
at EGD
Many times a diagnosis
can be made when abnormalities are found while viewing the upper GI tract.
However, it is often necessary to take a small biopsy (sample of tissue) to aid
in or confirm the diagnosis. These specimens are obtained with special biopsy
forceps and you cannot feel them when they are taken. Special brushes can
obtain other cell samples from the lining of the upper GI tract for cytology
examination.
Endoscopy
Treatments
Over the years, advances
have made possible the endoscopic treatment of diseases, which in the past have
required surgery. There are many useful treatments, which may be employed
during EGD.
Certain disorders of the gut can result in serious bleeding. Varices are large
“varicose veins” found in the stomach and esophagus especially in
patients with liver disease.
They can rupture and
cause severe bleeding. They can be treated at the time of endoscopy by
injecting them with medicine (sclerotherapy) or by placing rubber bands on
them. Similarly, ulcers in the stomach and duodenum and abnormal blood vessels
(AVM’s) can cause bleeding.
These can be treated by
injecting medicine in them or by applying electricity & heat to them
through a special catheter (plastic tube) at the end of the endoscope to
cauterize them. Once again you cannot feel any of these treatments. Foreign
bodies (batteries, coins, chicken or fish bones, etc.) that have been
intentionally or accidentally swallowed may also be removed from the upper GI
tract during upper endoscopy without the need for surgery.
Risks
Although upper endoscopy
is a frequently used modality for diagnosing and treating a number of GI
disorders, no medical technique is completely safe and there are potential
complications with upper endoscopy. There is a small risk of having a reaction
to the medications used for sedation or to any antibiotics that may be given
prior to the procedure.
There is a small risk of
bleeding from the procedure. Rarely is it necessary to give a blood transfusion
or other treatments such as surgery. Bleeding is usually controlled through the
endoscope. Another rare complication from EGD is perforation. This occurs when
the tip of the endoscope goes through a weakened part of the gut wall resulting
in a hole. This almost always requires surgery to correct but is a very
uncommon complication of EGD.
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To provide best health care for my patients by Viralkumar Patel
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