Upper Gastrointestinal Endoscopy : Will You Prefer To Be Sedated Or Not?
Endoscopy of the digestive tract is the way that doctors can examine your gut with a tube device, connected to a processor, which transmits the video images from inside your body onto a monitoring screen.
The procedure is used to examine upper gastrointestinal tract, i.e. the esophagus (or the food pipe), the stomach, and the duodenum ( the first few inches of the small bowel next to the stomach).
The endoscope is introduced through the mouth and advanced slowly down to the duodenum.
The manipulation of the endoscope, is done under direct vision through the monitoring screen.
Gastroscopy, also called upper gastrointestinal endoscopy, and colonoscopy, or the lower gastrointestinal endoscopy, are both indicated to search for diseases of the gut.
The doctor can make the diagnosis by observing any abnormal or unusual appearance of your gut. It’s also possible to obtain specimens (biopsies) to be analyzed in the lab if necessary.
What Is The Procedure For An Endoscopy?
Furthermore, endoscopy is an effective tool to implement some therapeutic procedures within the gut that may vary from cauterizing a small bleeding capillaries, to removal of large polyps.
If your doctor decides that you should have upper gastrointestinal endoscopy , to look for any explanation for your symptoms, it’s essential that you should be thoroughly informed about the procedure details, and whether it will be done under sedation or no.
People differ significantly in the way they cope with this experience, and how they react during the procedure, the reason why some may require deep sedation and others may not receive any kind of sedatives (tranquilizers).
How can you, or your doctor, decide if sedation is needed or just a throat spray of local anesthetic is sufficient?
Upper gastrointestinal endoscopy is a quick procedure. It may take no more than 2 minute in skillful hands, unless a therapeutic intervention, like removing a polyp, is planned.
Sedation is optional in upper gastrointestinal endoscopy . When you choose not to be sedated, you are going to have a spray of lidocaine (a local anesthetic) into your throat, to make the passage of the tube through the throat into the pharynx and then the esophagus, less unpleasant.
The effect of lidocaine is to suppress sensation in your throat, so that the passage of the tube (the endoscope) will be barely felt, and better tolerated.
How does it feel like without sedation?
When you are not sedated, the feeling will be like something slides over your tongue, which is then turns to enter the pharynx, when you start feel some gagging.
You will be asked by the doctor to swallow while he/she is gently pushing the tube further into your pharynx. Once you swallow, and the device is pushed, things will go more easier, and you should only breath normally.
The process will not compromise your airways and you can breath normally during the examination.
As the tube is entered into your stomach, the doctor will start pumping air to distend the stomach for proper visualization, as the stomach during fasting is like a collapsed bag.
This may cause some discomfort in your tummy, though it will be quickly eased as air is sucked when examination is complete.
During the procedure, the doctor may keep talking with you to keep you calm, and to explain what he/she finds on examination, aiming to reassure you, to get relief of apprehension.
When all the upper gastrointestinal tract is examined (typically reaching the first few inches of the small bowel (the duodenum), the doctor will start pulling the tube slowly while sucking air gradually from your stomach.
The stage of withdrawing the endoscope out from your body is much less unpleasant than introducing it.
When the tube is out, you will be asked to spit all secretions in your mouth, and not to attempt to swallow them, as your throat is not yet recovered from the local anesthetic effect, which makes the mechanism of swallowing partially impaired by the loss of sensation.
Then it’s done! You may be able to eat after one hour, or once you resume your normal throat sensation.
How does it feel like with light sedation?
Light sedation is also called conscious sedation.If you choose to be sedated during endoscopy, then things are different.
The commonly used intravenous sedative medication, midazolam, makes the procedure more comfortable in most of the cases.
You may be awake but somewhat apathetic. Many patients will drift into sleep and even snore.
With midazolam, you can tolerate longer procedures with minimal discomfort, although a throat spray with lidocaine is still needed.
When the examination is over, and when you regain your alertness, you may feel lightheaded, and you are likely to have amnesia of the events shortly following the administration of intravenous midazolam.
In other words, you will not remember what actually happened, and you may wonder if the the procedure was done or not, even if you are awake during endoscopy and, even communicating with the staff.
When you are fully alert (this may take up to 30 minutes), you may feel slightly dizzy all the day, that's why it's recommend not to drive or operate heavy machinery.
How does it feel like with deep sedation:
Deep sedation is effectively general anesthesia, but without paralyzing the respiratory muscles. If you don't like to have endoscopy without sedation or with even light sedation (midazolam), then your doctor has the choice of using a stronger sedative called propofol, which act as a deep sedative. It’s classified as general anesthetic as well.
Having your endoscopy done with propofol intravenous infusion, you won’t feel any thing at all.
Using propofol makes the procedure easy for both the patient and the endoscopist.
Which one you prefer? No sedation? Light sedation? Or deep sedation?
The decision depends on many factors . If you are going just to have endoscopy for a diagnostic purpose with average duration of 2-5 minutes, then you can decide whether to be sedated or no.
If the procedure is expected to take longer time or any kind of therapeutic intervention is planned, then sedation is needed, preferably with propofol, and this will be explained to you.
In this case you won't tolerate it without sedation, and you may move or resist, or even try to pull the endoscope out from your mouth. This will make any therapeutic procedures difficult and dangerous.
So the decision, either yours, or the endoscopist’s decision, or both, depend simply on what actually is going to be done.
But even though when you are asked to decide, you should know additional two the differences (apart from the above mentioned), between being not sedated, lightly sedated, or deeply sedated, to make the decision that suits you best.
These additional differences are:
The cost is not the same.
The cost of deep sedation is higher than the cost of light sedation.
Non-sedation is the least costly.
the rate of complications with deep sedation is higher than that of light sedation.
Non-sedation has the lowest risk of complications , which is actually very low.
The complications related to sedation are mainly related to the heart and lungs, therefore they are more frequent in patients with coronary artery disease or chronic lung diseases particularly chronic obstructive pulmonary disease (COPD).
Elderly people are more likely to have sedation-related complications than younger people.
The rate of complications related to the use of deep sedation is about 12%, with the decrease in blood pressure and Oxygen blood saturation, being the main adverse events and the most serious.
Nevertheless, recent studies, proved that sedation with propofol is still considered safe with optimum conditions of monitoring of breathing and blood pressure, and with prompt action to manage any complications effectively. once you resume your normal throat sensation.
Endoscopy with no sedation :
Is less tolerated
Is associated with lower risk of complications
Endoscopy with light sedation:
Is better tolerated
Increases the risk of complications
Endoscopy with deep sedation:
Is the best tolerated
Is associated with the highest rate of complications.