It needs to
be remembered that during endoscopic procedures
(i.e.
colonoscopy) besides diagnosing disease, therapy may be administered
which has to be viewed as being a form of surgery preformed internally.
The most frequent example of this occurs during colonoscopy where after
a polyp is seen it is removed via an electro-surgical technique burning
away its attachment to the wall of the colon. A burn (cautery mark) is
left behind that will heal over a number of days (up to 14 to 18) and on
rare occasions bleeding can occur from the edge of the healing burn and
require follow up medical attention. This is infrequent, though on
average one
patient per year from our practice will require hospital admission for
observation (generally brief lasting 24 to 48 hours) as a consequence of
their colonoscopy. One patient every ten years may require an operation
to fix some problem (for instance bleeding or infection, etc.) that
comes on as a consequence of colonoscopy. While this is a very
infrequent event, for everyone’s peace of mind it makes sense to be able
to obtain medical care the first few weeks after a colonoscopy.
The same
principles apply towards planning for an upper endoscopy, however the
risks are less, probably a quarter to a third of those of colonoscopy.
Thus the advice regarding travel and a planned endoscopic procedure is
really against international travel (Canada and Western Europe are
probably fine) but against traveling to out of the way places.
Midazolam
(Versed) is the most commonly used sedative. It is excellent at
relieving anxiety, suppressing the gag reflex and awareness of
discomfort. It induces amnesia, and interference with memory is
probably the last effect of the drug to wear off, such that
conversations after the procedure with the patient,
who appears
otherwise awake, may not be remembered. In
some upper
endoscopies and most colonoscopies a small dose of
a narcotic
pain reliever such as meperidine (demerol) or
morphine or
fentanyl (trade name) is used. The two agents together often work
nicely to provide a synergistic effect
allowing a
smaller dose of each medicine to be used enhancing comfort and speeding
recovery. Because of uncertainty
regarding
the recovery of memory and reflexes following the use of these
sedatives, it is required that patients not drive or use complex
machinery (lawn mowers, chainsaws, etc.) for the rest
of the
day. Similarly activities requiring precise balance on ladders, roofs,
etc. need to be avoided.
After
undergoing a sedated procedure it is absolutely required
that a
person be driven home by another responsible adult. In addition to
driving, it’s helpful if that person can be present to hear the
preliminary report of the endoscopic procedure (impression of the
doctor) and discharge instructions. As a consequence of the sedative
the patient may very well not remember being given the instructions.
The impaired memory function the sedatives produce can be very subtle
and last some hours after all other apparent recovery from the sedative
has occurred. It is not uncommon for someone not to remember
conversations two or three hours after a procedure when they have been
dressed, walking and engaging in apparently normal conversation. Thus
it’s helpful if the person chosen as a driver is a spouse, sibling, or
other trusted relative, friend, or neighbor
who can
pass on the initial report.
You will be
sent home with a discharge instruction sheet and plan that if findings
were normal or minor may include the final follow-up plan such as seeing
your regular doctor fper his/her previous instructions. The endoscopy
nursing staff will contact you the
next day at
home or at another number you may wish to give.
Our office
will contact you with the results of any biopsy or specimen reports in
about a week. If you have not heard about
a biopsy
(after ten days)or have any other concerns following
your
procedure, please call our office at (607) 272-5011. 5% to 10% of
patients will have findings that warrant a follow-up discussion
in the
office at an appointment 4 to 5 working days after the procedure. If a
new medication treatment is started office
follow up
is usually deferred a number of weeks so as to access
its affect
prior to the appointment.
Yes, you
may, though we feel for a number of reasons that
having a
trusted family member, friend or neighbor bringing you home has numerous
advantages. These include hearing the
initial
medical report and reporting back to later when your memory may be more
reliable, and giving you supportive TLC on your arrival home. The post
procedure observation period time prior to taking a taxi is extended to
allow for these factors.
No, we require that a patient who has had an
endoscopy be released to a responsible adult. A released patient is not
allowed to navigate his/her way on public roadways.
You should
start with a light meal at home taking care to avoid a meal that is too
large or high in fat or spice. Eating at a
restaurant
is not recommended since your system may not be
ready to
handle a large meal dispite the hunger one may begin to feel once the
procedure is done. Additional restrictions may be required short
term if there has been dilation of an esophageal stricture, treatment of
an ulcer, or removal of a large polyp.
