You have been scheduled for an Upper Endoscopy at Riverside Community Hospital
Please go to the main lobby and ask for directions.
Upper Endoscopy involves passing a floppy tube with a “lens and light” system through the mouth into the stomach and upper small intestine. The purpose is to examine the insides of the esophagus, stomach and duodenum to look for abnormalities including ulcers and cancer. We might take small pieces of tissue for analysis or may need to cauterize blood spots. Sometimes we may have to dilate narrowed areas as well. Remember that while this is the best test to examine the upper part of your digestive system, it is not perfect and there is a small possibility that significant lesions may be missed.
Usually we do the procedure with “moderate sedation” in which you are awake but in “la-la land” - jelly may be applied to the rectum for lubrication and sedative medicines (usually Morphine, Demerol or Fentanyl, Atropine or Phenergan and Versed) are given before (often by Intramuscular injection - if you prefer not to have the Intramuscular Injection and wish to get all the medicine by vein, please let us know) and during the procedure. The test can take anywhere from 20 minutes to an hour and a half. While our aim is not to “knock you out”, the medications usually induce a degree of amnesia and many patients have no recollection of the test and often say they were completely out. A small percentage of patients will find the procedure unpleasant with moderate sedation.
The other way to sedate you is called "deep sedation" (also called “MAC” – Modified Anesthesia Care) with Propofol which requires an Anesthesia specialist. This will ensure that you are “completely out” but may involve a greater expense. The moderate sedation method is probably a bit safer for many patients. However, for some patients Dr. Ravi might suggest “deep sedation”.
In addition to the sedation, local anesthesia to the throat is achieved by spraying a strong “numbing spray” which tastes bad but numbs well. We also coat the tube with numbing jelly (Lidocaine). When a person wants to swallow, a message goes from the brain to the throat, asking the throat to swallow. As one swallows, a message goes back to the brain that in effect is the throat saying “I am swallowing as ordered”. When the throat is numbed, this message does not go back to the brain and it is not uncommon for the patient to think he/she cannot swallow. Actually, you need to go through the motion of swallowing when asked to – and you will swallow even if you can’t feel yourself swallowing. In a similar way, since you cannot “feel” the air rustle through the numbed throat on its way to the lungs, it is not unusual to think that you cannot breathe when you really can and we will closely monitor your heart and lungs.
You will be in the hospital for about 1 to 2 hours or more before and about 1⁄2 to 1 hour after the test. You should not plan to work the day of the test and importantly not drive or operate machinery or make important decisions for 24 hours, because of the effect of the medications. You MUST bring someone close to you – preferably a spouse, child, parent or sibling – to the hospital to drive you home. Have this person stay with you if possible or be available by phone since Dr. Ravi usually will talk to him/her BEFORE the test. Because the sedation medicine “plays tricks with your mind,” Dr. Ravi will try to talk to this person after the procedure as well if a serious condition is obvious, but if he can't of if he has to wait for the results of biopsies, he will speak with you at the follow-up appointment. Some patients will erroneously think they have been given bad news or even that the procedure was not done, etc. You just cannot go by what you think you were told or what you think happened!
No test or procedure is free of risk. The decision to do any procedure requires careful assessment and Dr. Ravi would have examined you before doing the test. The risks of an upper endoscopy are in part related to the effects of the sedative medication on the heart or lungs and the possibility that the tube will cause a bleed or a tear (which can cause pain, fever and sepsis). There is also the small possibility of an infection caused by bacteria entering the blood stream during the endoscopy. A sore throat and change in taste of varying duration are not uncommon. The probability of a life-threatening complication is usually relatively small (under 1%) but not zero, even when everything that can be done to keep that risk as low as possible is done. Since there is always a risk, it is important that a careful deliberation be made to decide if the potential benefits of the test outweigh the risks.
1. The only preparation needed is to not eat or drink after the previous night’s dinner (except for medications, which you can take with water).
2.If you have Diabetes, speak with Dr. Ravi about this, and unless otherwise instructed, do not take any Insulin or Diabetes pills the evening before and the morning of the test.
3. As soon as you read this sheet (but not for more than a week before the test) discontinue (after speaking to Dr. Ravi) Iron pills and Aspirin, Plavix, Effient, Coumadin or other blood thinners and Advil and other pain medications other than Tylenol.
4. If you are taking medicines for high blood pressure, continue as you normally would, even on the morning of the test.
5. Riverside Community Hospital GI Lab will call you on or before the working day before the day of the procedure (e.g. Wednesday for a procedure to be done Thursday) and let you know what time to be in the hospital for the procedure. They usually give you a time about 1 1⁄2 to 2 hours before the likely time of the procedure. This is necessary for the staff to get the paperwork ready and to start an IV and to give you some of the medications. Because of the many variables that we cannot control, it might take many hours of waiting before the test is done. Please be prepared for an extended wait. If the time you are asked to be at the hospital is 11AM or later, it is OK to have a clear liquid (liquids like clear pulp free orange juice) breakfast before 7AM
6. If you have not heard from the GI Lab by 12 noon of the working day before the procedure (e.g. Wednesday for a procedure to be done Thursday), please call 951-788-3419.
PLEASE FOLLOW THE INSTRUCTIONS EXACTLY, REGARDLESS OF WHAT OTHER INSTRUCTIONS YOU MAY HAVE READ ABOUT OR ADVISED BY SOMEONE ELSE. IF YOU NEED A CLARIFICATION EMAIL US.
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The videos below will give you a sense of what an Upper Endoscopy entails. Please note that some information in the videos may vary slightly from what Dr. Ravi has described above. In that case, please follow Dr. Ravi's instructions exactly.