What to expect during your procedure

Before we begin

Prior to the procedure, you will be asked to sign a consent form granting the doctor permission to perform sedation and the endoscopy or procedure. Once you are in the pre-op holding area, an IV will be started. You will then go into the procedure room where monitors will be placed, and the CRNA will give you medication through a vein to make you relaxed and sleepy. The procedure is usually well tolerated and rarely causes pain or discomfort.

Our staff goes to great lengths to ensure that sedation is adequate and that discomfort during the procedure is minimal. With the medications used for sedation, most patients have no pain and very little recall of the procedure.

Upper Endoscopy (EGD)

An upper endoscopy, or EGD, is a very safe procedure that gives your doctor information other tests may not be able to provide. The test involves passing a small lighted instrument that allows the physician to see the inside of the esophagus, the stomach, and the duodenum.

Indications for upper endoscopy:

• Persistent nausea and vomiting
• Upper abdominal pain
• Heartburn or acid reflux symptoms
• Acid or burning sensation in the throat or chest
• Gastrointestinal (GI) bleeding (vomiting blood or blood found in the stool)
• Difficulty swallowing
• Abnormal or unclear findings on an x-ray
• Removal of a foreign body
• Follow-up on previously found polyps (growths), tumors, or ulcers
• To stretch or dilate narrowed areas

If the doctor sees a suspicious area, an instrument can be passed through the endoscope to take a small piece of tissue, a biopsy. Biopsies are taken for many reasons and do not necessarily imply cancer.

Preparing for upper endoscopy

These instructions are designed to maximize your safety during and after the examination and to minimize possible complications. EGD is a safe procedure associated with low risks. It is important that you read your instructions ahead of time and follow them carefully.

Notify your doctor if:

• You are taking a blood thinner, insulin, or a GLP-1 agonist. Your physician's office will give you specific instructions about your medications and what to take the morning of your procedure.

For the best possible examination, the stomach must be completely empty. Your doctor will specify the time to begin fasting, depending on the time of day your EGD is scheduled.

Colonoscopy

A colonoscope is a long, flexible tube that is inserted through the rectum into the large intestine (colon) and allows the doctor to carefully examine the lining of the colon. The colon can be seen in great detail. If the doctor sees a polyp or area that needs to be evaluated, an instrument is passed through the colonoscope to remove the polyp or biopsy tissue for examination in the laboratory. Biopsies and polyps are taken for many reasons and do not necessarily mean that cancer is suspected.

Indications for colonoscopy:

• Blood in the stool or rectal bleeding
• Dark or black stools
• Persistent diarrhea
• Anemia
• Weight loss associated with gastrointestinal symptoms
• Family history of colon cancer
• Abnormal imaging studies such as CT scan or barium enema
• Previous history of colon polyps or cancer
• Surveillance for inflammatory bowel disease
• Chronic unexplained abdominal pain

In a small percentage of cases, passage of the colonoscope through the entire colon cannot be achieved. Other imaging studies may be ordered to complement the colonoscopy when this rare situation arises.

Preparing for colonoscopy

It is imperative that your colon is very clean to allow adequate visualization, maximize your safety, and minimize possible complications.

Notify your doctor if:

• You are taking a blood thinner, insulin, or a GLP-1 agonist. Your physician's office will give you specific instructions about your medications and what to take the morning of your procedure.

For the best possible examination, the stomach must be completely empty. Your doctor will specify the time to begin fasting, depending on the time of day your colonoscopy is scheduled.

Preparation happens in two ways:

1. Restricting what you eat. A clear liquid diet: as a general rule, do not eat any solid food for at least one day before the examination. If you consider yourself constipated, with bowel movements every two or three days or less often, avoid a high-fiber diet for three days.
2. Laxatives. There are several prep options. Your physician's office will provide the specific instructions for the prep chosen for you.

Polypectomy

During the course of the colonoscopy examination, a polyp may be found. Polyps are abnormal growths of tissue that vary in size from a tiny dot to several inches. You should feel no pain during the removal of a polyp.

Polyps are usually removed because they can cause rectal bleeding or contain cancer. Although the majority of polyps are benign (non-cancerous), a small percentage may contain an area of cancer or may develop into cancer. Removal of colon polyps is an important means of prevention of colon cancer, which is a leading form of cancer in the United States.

Sedation & monitoring

As a service to our patients, anesthesia services are performed by an experienced practicing CRNA (Certified Registered Nurse Anesthetist), who administers medication to permit the safe performance of the procedure. Since anesthesia providers may not participate in all insurance plans, patients remain responsible for payment. The anesthesia providers will complete insurance forms listing their usual and customary fees. If you do not wish to use this service, please let us know so you can be scheduled appropriately.

See Billing & Insurance for how anesthesia professional fees relate to your facility fee.

After-procedure care

You will be kept in the center until most of the effects of the medication have worn off. With the medications used, you will feel the effects wearing off very soon after the completion of the procedure. You may feel bloated for a few minutes right after the procedure because of the gas that was introduced into your colon. You will be able to resume your diet after the procedure unless you are instructed otherwise.

Possible complications

From upper endoscopy (EGD)

Complications of an upper endoscopy are very rare; you may experience a mild sore throat. Bleeding and perforation are extremely unusual in diagnostic procedures. Death is an extremely rare occurrence.

Contact your physician if you experience any of the following:

• Abdominal or chest pain
• Fever
• Vomiting blood or blood in stool
• Persistent nausea or vomiting
• Difficulty swallowing
• A crunchy feeling under the skin

From colonoscopy and polypectomy

Colonoscopy and polypectomy are safe and are associated with very low risk when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. Although complications such as bleeding or perforation can occur, they are very rare. Death is an extremely rare occurrence.

You must contact your physician if you have any of the following:

• Severe abdominal pain
• Fever
• Blood in stool

Flexible Sigmoidoscopy

What is a flexible sigmoidoscopy?

Flexible sigmoidoscopy is an examination of the rectum and lower bowel.

Preparing for a flexible sigmoidoscopy

A clean, empty colon is essential for a successful examination. Your physician's office will instruct you to do two small enemas to clean out the lower bowel before your procedure.

During the exam, if the doctor sees a polyp or area that needs to be evaluated, an instrument is passed through the scope to remove the polyp or biopsy the tissue for examination in the laboratory. Biopsies and polyps are taken for many reasons and do not necessarily mean that cancer is suspected.

Possible complications of a flexible sigmoidoscopy and biopsy

A flexible sigmoidoscopy is safe and is associated with very low risk when performed by physicians who have been specially trained and are experienced in this procedure. Complications can occur but are rare.

Bleeding may occur from the site of biopsy. It is usually minor and stops on its own or can be controlled by cauterization (application of electric current) through the sigmoidoscope.