If you are scheduled for an upper endoscopy (EGD) or colonoscopy, here are the answers to some frequently asked questions:
What is “open-access” endoscopy and may I request an office consultation before my scheduled endoscopy or colonoscopy?
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At Tryon Medical Partners, open access to endoscopy (EGD) and colonoscopy is available. This means that your primary care doctor is free to request an EGD or colonoscopy on your behalf without any office consultation.
However, if you are having unexplained symptoms, your situation is complicated, or you just feel uncomfortable with direct scheduling, you may request a consultation appointment. In some cases, our Gastroenterology staff may ask for a pre-procedure consultation to assess the risks and benefits of the procedure or to determine if other testing might be more appropriate.
If you would like a consultation appointment, contact our office. Please keep in mind that pre-procedure consultation may result in a delay in your EGD or colonoscopy procedure being completed.
When should I cancel my scheduled EGD and/or colonoscopy procedure?
If you have an active upper respiratory infection (such as cold or flu), bronchitis, sinusitis, or infection or fever for other reasons, please contact the office and staff to determine if you should cancel your procedure.
If you have an upcoming cardiac (heart) or pulmonary (lung) evaluation and you’re having an elective (non-urgent) EGD or colonoscopy, it is recommended that you complete any cardiac or pulmonary evaluation first. This is important to assess your relative risk of any anesthesia or sedation.
Elective (non-urgent) endoscopy procedures, including an EGD and colonoscopy, should be performed when patients are as healthy and medically stable as possible.
Will I have a needle-stick and an IV (intravenous line) placed?
Yes. All procedures such as EGD and colonoscopy require intravenous line (IV) access for sedation/anesthesia, as well as any emergency medications that may rarely be required.
If you are particularly anxious or nervous about having an IV or needle stick, please alert the nursing staff in the admitting area. Efforts to minimize anxiety can be very helpful. Also, keep in mind that is helpful to not look directly at your arm while the nurse is placing the IV. It is helpful to look away, only expecting to feel a sharp pinch for a second or two.
Also, keep in mind that these procedures require fasting, which can lead to dehydration. Therefore, in some cases, veins may be flat or collapsed making IV placement difficult. While the nursing staff are experts at placing IVs, in some cases, more than one attempt may be required.
Why might I have been scheduled at a hospital for my colonoscopy rather than an outpatient facility?
The relative risk of anesthesia or the need for a specialized procedure determine the safest location for al patient to have a procedure such as an EGD or colonoscopy. If one or more of your doctors feel that you have significant risk related to sedation or anesthesia, it may be requested that you be scheduled at a hospital facility. This determination is the current standard of care and is important for patients’ safety.
In some cases, specialized procedures (manometry, endoscopic ultrasound-EUS, ERCP, for example) are only offered at hospital facilities, and therefore, a patient with a low risk for sedation/anesthesia may be scheduled at a hospital facility. What are the logistics in getting to my colonoscopy or EGD procedure?
Prior to your procedure with Tryon Medical Partners, you will receive information regarding the arrival and procedure time, as well as the location and address of the facility where you will have your procedure. You will also receive a map directing you to the appropriate facility for your procedure.
Although most outpatient EGDs and colonoscopies require a predictable length of time, sometimes individual patients have unexpected findings or technically difficult procedures leading to unpredictable delays.
While we provide a scheduled arrival time and procedure time, please plan to be flexible on the day before and the day of the procedure, so that you can arrive earlier or later if needed to accommodate unexpected changes in the schedule.
Please remember that if you have cancelled and/or rescheduled your procedure appointment, you may have information and directions for more than one date/time and location/facility.
Also note, it is important that you arrive at the scheduled time. You are asked to arrive one hour prior to your procedure time in order for you to be registered, admitted, and prepared for your procedure. Please confirm the time of your procedure when you check in at the registration desk the day of your procedure.
Patients with complex medical histories or unique situations may be asked to arrive more than one hour early.
Keep in mind that you absolutely must have someone to drive you to and from your procedure (see below). This person must be a responsible adult who will ensure that you make it to and from the procedure, and are safe at home once you return home after your procedure.
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Do I need a driver for my EGD or Colonoscopy?
Yes! Any time a patient has sedation or anesthesia, a responsible adult is required to drive to and from the procedure. Many facilities require that the driver or responsible adult remain in the facility and in the waiting room during the procedure.
This person does not have to be a family member, and does not need to know or receive any medical information. However, you should be comfortable with this person driving to and from the procedure, as well as ensuring that you get into your home safely and are safe at home following the procedure.
Public transportation services such as buses, taxis, Uber, or other public transportation services are not considered “responsible adults” for the purposes of transportation following a sedated procedure. How will I learn of my results following my procedure? Day of procedure: In many cases, your driver will be a close family member — such as a spouse, sibling, or child — so that you will be comfortable with this person receiving medical information. However, the designated driver does not have to receive any medical information. The driver does not need to know which procedure you’re having or why you are having it. They also do not need to know the results. Patient privacy is always respected. You will be given the opportunity to let the staff know whether any medical information should be communicated to the driver or other persons with you. You will also have the option to have any critical medical information communicated to a trusted family member or friend over the phone if necessary.
Following your procedure, your nurse in the recovery room will communicate results to you directly. In some cases, you will have the opportunity to speak with your physician following the procedure to communicate any important results.
Keep in mind, medical records are your own. While many patients prefer not to see medical images, you are able to see any pictures from your procedure if you wish. Your recovery nurse will provide you with paperwork and a patient letter detailing results, initial recommendations, and emergency instructions at the time of discharge from the facility.
You are allowed to request a copy of your procedure notes prior to going home if you would like. Also, please remember, all pictures, reports, and medical information are available to you at any time in the future, if you require them. In general, this information will also be available through the electronic medical records and the Tryon Medical Partners Patient Portal.
In the days following the procedure: In many cases, biopsies or other pathologic specimens may be obtained. Pathology results will be directly communicated to you through either a phone call from a nurse or other staff member, a letter to arrive via U.S. mail or email, or communication through our Patient Portal. At the time of discharge from your procedure, staff will let you know how to expect to receive any follow up results.
If the results of your procedure suggest additional evaluation or testing is recommended, you may be contacted by nursing or other staff to arrange the additional appointment(s).
Why is NPO status (“nothing by mouth”) so important? One of the important risks for any form of sedation or anesthesia is “aspiration.” Aspiration refers to any process, such as reflux, regurgitation, or vomiting, leading to stomach contents or other fluids getting into the lungs. Aspiration can compromise breathing and lower oxygen levels, and can cause pneumonia. In rare cases, aspiration can lead to hospitalization and further complications.
Keep in mind that some anesthesia staff regard chewing gum as a violation of NPO status.
If you accidentally break the NPO recommendations, please notify the staff immediately. We will work with you to determine when and how your procedure can be safely completed.
UPPER ENDOSCOPY (EGD)
What preparation should I expect for my scheduled upper endoscopy (EGD)?
Compared to a colonoscopy (see below), preparation for an EGD is relatively simple. Primarily, it’s important that you have nothing by mouth (NPO) before the procedure for six to eight hours for solid foods, and a minimum of two to four hours for liquids.
Important or critical medications can typically be taken with a sip of water prior to the procedure if necessary. However, for most patients having upper endoscopy, medications can be held for a few hours until the procedure is completed.
If you are diabetic or require anticoagulation medications, management of these situations will need to be discussed with your nurse several days prior to the procedure.
What do I do if I have slow stomach emptying (gastroparesis) or frequent nausea and vomiting? This situation is common in patients with diabetes or other Illnesses, and should be discussed with your nurse prior to the procedure. Commonly, it may be suggested that you have clear liquids for 24 to 48 hours prior to the upper endoscopy, and extend the period of nothing by mouth (NPO) for eight to 12 hours prior to the procedure.
Will Ihave a dilatation (esophagus stretching) with my EGD?
Dilatation may be indicated in patients with difficulty swallowing or food getting stuck (dysphagia) when a narrowing or stricture is found. Commonly, this narrowing may represent scar tissue from acid reflux disease. Your gastroenterologist will determine at the time of (during) your procedure whether or not a dilatation is medically indicated or necessary.
COLONOSCOPY
What should I expect in preparation for my colonoscopy?
Once you are scheduled for your colonoscopy, you should plan to review the instructions at least one week prior to your scheduled appointment. If you are delayed or late in reviewing your instructions, you may wish to contact the office to discuss the best way to proceed.
How should I change my diet in advance of my colonoscopy preparation? In general, approximately five to seven days prior to colonoscopy, you should minimize or eliminate nuts, seeds, whole kernel corn, and popcorn. You should also minimize high-residue foods such as large amounts of salad or raw vegetables.
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During the 24 hours prior to your colonoscopy, you are asked to maintain a clear liquid diet. Keep in mind that not all liquids are considered clear. For example, while black coffee — with or without sugar — is considered a clear liquid, the addition of milk or cream is not. Lemonade, iced tea, soup broth (without vegetables, noodles, or meat), Gatorade, seltzer water, sodas, and water, are all considered clear liquids. Keep in mind that for most anesthesiologists, juices (orange, grapefruit, lemonade) with pulp are not considered clear liquids.
Why is there such a complicated preparation and laxative treatment for my colonoscopy? Unfortunately, colonoscopy preparation is inconvenient and, for many patients, difficult. However, adequate preparation is critical to ensure adequate examination leading to colon cancer prevention and an accurate prognosis and diagnosis.
Your doctor and nurse team will advise you as to the available and recommended laxative preparation options. For some patients, some of the available preparations are not considered safe. If you have a certain type of laxative preparation that you would like to use, please discuss this with your nurse.
Recent research studies have confirmed that splitting the laxative preparation into two separate sessions (with the second session coming just a few hours prior to the actual examination) is critical to maximizing the quality of the examination. Unfortunately, this does mean that many patients will have to wake up in the early morning hours to complete the second half of the preparation. What do I need to do if I experience constipation or slow bowel movements?
Patients with slow bowel movements or a specific history of constipation may need to use a gentle laxative such as MiraLAX for a few days prior to beginning the formal colonoscopy preparation. This will make the preparation easier and less uncomfortable, as well as help to ensure a fully adequate preparation for a high-quality examination. If you feel this applies to you, alert your nurse when confirming your scheduled appointment.
What do I do if I am on aspirin therapy?
Most patients on aspirin therapy may remain on their aspirin therapy. This is particularly true for patients who are taking aspirin for history of cardiovascular disease such as a cardiac stent placement or stroke.
If aspirin is being taken as if purely preventative medication, it may be held for seven days prior to the colonoscopy to minimize the chance of any bleeding.
What do I do if I take anticoagulants (blood thinners) such as warfarin, Xarelto, Plavix, or others? Most patients will need to hold anticoagulation therapy for an appropriate number of days to ensure that their blood has adequate clotting. Typically warfarin or Coumadin is held for approximately five days. Plavix may be held for five to seven days. Other agents may only need to be held for one to three days.
Stopping anticoagulants needs to be tailored to individual patients based upon their relative risk and the indication for the anticoagulation therapy. In some cases, your doctor may decide that you should remain on anticoagulation therapy, if the risk of stopping it is substantial. In other cases, your doctor may recommend “bridge” therapy with a drug called Lovenox, to minimize the length of time that you are off of anticoagulation therapy.
You will have an opportunity to confer with a nurse regarding management of anticoagulation therapy. In some cases, you may be asked to contact your cardiologist, neurologist, vascular surgeon, or primary care doctor to help direct this decision making process.
How do I manage my diabetic medications prior to my colonoscopy? Adjustments to diabetic medications are determined on an individual patient basis. You will have the opportunity to speak to a nurse to confirm the appropriate adjustments for you. In many cases, patients are advised to take approximately half of their normal medication dosage.
During the day of preparation and the day of the colonoscopy itself, it is important to check blood glucose frequently.
I am having a colonoscopy for colon cancer screening. What determines how soon I have to come back for another examination?
Appropriate intervals for colon cancer screening are determined by an individual patient’s relative risk. There are “low-risk” and “high-risk” patients.
Low-risk: Low-risk patients are typically those patients having their initial colonoscopy at age 50. These patients do not have any family history of colon cancer or colon polyps. They also do not have any risk factors such as blood in their stool, positive stool cards with blood, or other symptoms.
Low-risk patients, who have a normal colonoscopy and fully adequate initial examination including a high-quality laxative preparation, may not need to return for colon cancer screening by colonoscopy for as long as 10 years.
However, if polyps are found, earlier examination (typically three to five years rather than 10 years) may be recommended.
In addition, if the gastroenterologist determines that the quality of the laxative preparation prevented a high-quality examination, an earlier initial follow-up colonoscopy maybe recommended.
High-Risk: High-risk patients are screened at more frequent intervals to prevent the development of colon cancer.
High-risk patients include those with a family history of colon cancer or colon polyps, particularly with family members below the age of 60. High-risk patients also include those with a previous history of pre-cancerous colon polyps.
High-risk patients also include those with a history of some gastrointestinal diseases, such as inflammatory bowel disease, including Crohn’s disease and ulcerative colitis. These patients are generally recommended to have colonoscopy for evaluation, and colon cancer screening purposes at more frequent intervals.
Rarely, patients have genetic syndromes, such as FAP (familial adenomatous polyposis) or Lynch syndrome, requiring these patients to have frequent colonoscopies.
If you have additional questions about the procedures for EGD or colonoscopy, please contact our Gastroenterology department at 704-489-3410.
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