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Endoscopic Procedures

1. What time should I arrive at the endoscopy unit?

We recommend patients arrive at least one hour prior to their scheduled appointment, to be checked in and assessed.  To view maps and directions to the different hospitals, click here

2. Will I be “put right out”?

In order to maintain safety and comfort, ‘conscious sedation’ is utilized, which allows for patients to be sleeping without the necessity of a breathing tube or respiratory support. Vital signs (heart rate, oxygen saturation, blood pressure) are monitored throughout the procedure.  In the rare case of over-sedation, there are reversal agents that can be administered to block or reverse the effects of the sedation.

The degree of sedation is variable, some patients remember parts or the entire procedure, while others have no recollection.  The goal of sedation is twofold: patient safety and patient comfort.

3. Will I have any dietary restrictions after the procedure?

There are no specific dietary restrictions recommended.

4. Why am I unable to drive after the procedure?

Given the nature of the medication used for sedation, it is our policy that individuals not drive for 24 hours as they are considered impaired, and if any collision was to occur, they would be considered impaired and thus not eligible for insurance.

 PDF link to policy

5. What is the preparation for colonoscopy?

We require patients to consume only clear fluids the day prior to the examination (starting 24 hours prior – the previous am).  Clear fluids are those liquids you can ‘see through’ such as 7-UP, ginger ale, apple juice, and chicken broth.  In addition to this, a laxative should be taken the day prior to the exam.  This is a very important part of the test, as it allows for good visualization of the colon.  If there is stool remaining in the colon, the test is significantly limited.

There are some variations in preparation, depending on patient tolerance, and patient and physician preference.  The most commonly used prep is polyethylene glycol or Colyte.  This is ‘balanced electrolyte’ solution used to lavage or clense the bowel. It is safe and effective, but has the disadvantage of being large volume (4 litres).

The 2nd commonly used prep is Pico-salix which is a salt-based laxative that contains magnesium with no phosphate. These are likely as effective but are smaller volume.  They are not used for patients with kidney disease because of potential risk of electrolyte (blood salt) imbalance.  The packet is mixed with 150ml or 1.5 cups of water, taken in the morning and then 8-10 hours later again, with 2 laxative tablets (Dulcolax).  To maintain fluid status, it is important to drink between 1 and 2 litres of water or other clear fluid (not pink or purple) after each dose.

For more information on procedure preparation, click here

6. When should I start the colonoscopy preparation?

Clear fluids should be started upon rising the day before the test.  The bowel preparation should be initiated in the early afternoon, with an aim to complete it by 4 or 5pm as the later the onset of completion, the greater the likelihood there will be night-time wakening with stool passage.

Some patients have found applying Vaseline or a barrier cream to their bottom protects the skin and increases the comfort associated with multiple stool passages.

7. What if I am unable to finish my colonoscopy preparation?

This does happen and because it is very important to complete the entire preparation for adequate visualization of the colon, you need to inform either the physician’s nurse clinician or the endoscopy unit.  If you are unable to tolerate a significant amount of the preparation, your colonoscopy may have to be cancelled and rescheduled.

8. Will I be uncomfortable during my colonoscopy?

Most patients find this to be a well-tolerated examination.  We insufflate or infuse the bowel with air in order to see all the walls so there is a sense of bloating or fullness.  Sometimes, navigating the scope around corners can cause cramping but the procedure should not be painful.  However, some patients expect not to “feel anything” and this is unlikely. Most patients have some awareness throughout the procedure and some discomfort is expected.

9. What are the risks of colonscopy?

Colonoscopy is routinely performed test that is safe, however like all invasive procedures, there are risks.  The risk of a serious complication is 1:1,000 tests.  Among the most serious risk is that of a perforation, or a tear in the bowel.  This occurs between 1:1,000 procedures and may result in need for surgical correction.  If polyps or growths are removed, the risk of causing a hole or perforation in the bowel is slightly higher (1 per 500 procedures), but this may be managed conservatively, including having nothing by mouth and intravenous antibiotics or through surgical correction.  The risk of this depends on polyp size and the need for surgery depends on the size of the hole in the wall of the bowel.  Bleeding may occur from biopsy or polyp removal that may require transfusion or surgery (risk of bleeding after routine colonoscopy is 7 per 10,000 procedures and following polypectomy is 1.2 per 100 procedures).

The medication for sedation rarely causes serious heart or lung complication, there are reversal agents that can be used.  Allergies to medications do exist in some patients. 

The bowel prep can cause dehyration and in rare cases abnormalities in blood chemistry and there are reports of kidney failure and muscle spasm.  The intravenous line insertion can be tender, with bruising or lumps resulting, that can be treated symptomatically.

Death is an extremely rare possibility, but can occur.  Heart attack, lung problems or irregular heartbeat is more likely to occur in the context of pre-existing medical problems.  These are also very rare.

9. How long will the colonoscopy take?

You are asked to arrive an hour in advance of your test, the test itself will take between 30-45 minutes or longer, and you will need between 30-45 minutes to recover or fully wake up.  Then, you will be given some juice and cookies and will be able to go home, accompanied.

10. During my gastroscopy, will I choke or gag? Will I have pain in my throat after the procedure?

Patients often have a sense there is something present in the back of their throat, however we use sedative medication to reduce the likelihood you will gag, feel like you are choking or resist the presence of the scope.  This procedure can be done quite easily with no sedation, and it is important to remember you have supplemental oxygen, we monitor your oxygen level throughout the test. The scope is in your swallowing tube or esophagus, not the breathing tube (trachea). There is generally no discomfort after the procedure.

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