Upper Endoscopy Without Sedation

Tests and investigations
1

Hi all,

Just wanted to share my experience of having an endoscopy without sedation yesterday (I'm from the US where sedation is highly pushed on you).  Hopefully, this will allow others to not be afraid!

I am a 26 year old male who lives in California.  Relatively healthy, though I'm a bit overweight (6'2 and 219 pounds).  Went to the office with symptoms of severe upper back pain, chest pain, and swallowing pain/troubles - with the thought that maybe I had progessively bad GERD.  Luckily, post procedure, I was found to have probably just had a bout of stress related reflux.  Otherwise, I look perfect with no issues in my esophagus (thank God!).  For now I am waiting a few months for the biopsy of my stomach (potentially have mild gastritis).

Now, onto the procedure:

I went to the office 30 minutes before my procedure and got my insurance/paperwork squared away.  After waiting 15 minutes, reading this great forum for advice smile, I was brought back and changed into a hospital gown.

Here in the states, we have GI clinics that can do the procedure as an outpatient visit, VERY cost-effective, but also kinda scary because you walk back realizing you aren't necessarily in a hospital setting if something goes wrong (i.e. I would need to be rushed across the street to the nearest hospital).

Once I was changed, I was informed that an IV would need to be inserted, even if I didn't want sedation (which everyone in the office thought I was a lunatic for).  I hate needles, so I would've preferred not doing this, but it is relatively easy for me to handle it if I just don't look.

After the IV is inserted you lay down for roughly ten minutes and wait your turn to be wheeled in.  I'm sure this varies depending on where you get the procedure done.

After being wheeled in, two nurses introduced themselves and asked me if I had any allergies to sedatives.  I informed them that I really didn't want to be sedated, they obliged, but did say they would sedate me if I couldn't handle the procedure.

One of the nurses said she has only had 2 people go through the procedure awake since she's worked there (and she's been there quite some time).  That was a near pants-staining statement smile.  Though in her defense she was super sweet and was just trying to joke with me (I think she thought that I was overconfident, when I was quite the opposite - I was just putting on a brave face).

I was very fortunate that I got the best doctor that works at the clinic, he has nearly 40 years of GI experience.  He is also the highest rated GI in the county I live in.  Seriously, this man is amazing.

With all of the being said, when he came in, I was asked to describe my symptoms. His eyes got really big, so I thought this was more serious than I thought it was.  He said, we'd get to the bottom of it literally, in about 10 minutes.

I then told him that I was foregoing sedation and he said that he wouldn't recommend it, but that he will watch me closely.  If my heartbeat got to hight, I vomitted, or starting moving during the procudure, the nurse would instantly sedate me to protect my inner organs.

The female nurse then used the throat spray 2 times to really hold back my gag reflex and to make sure both sides were thoroughly covered to keep any pain from cropping up and so that they could get the thing in my throat without me vomiting.

Then, the male nurse came over and said I am going to hold you down and keep you from moving.  That got the heart going a bit.

Before I knew it the GI DR had the endoscope in hand and started feeding it down my throat.  I swallowed, gagged, and away he went.  I gagged multiple times throughout the procedure, but felt zero pain.  The nurses were super supportive and gave me time updates and let me know where they were and that my insides looked excellent.  Truly, I had the best team there making sure the procedure was going well and that I was OK.

They took a few biopsies, which I never felt, and then started feeding the camera back out.  For some reason, this was the worst part.  I started gagging hard and my hear beat started racing.  They got the scope out and I was reminded to think positively and that you made it through the procedure!  The male nurse was so funny, he told me to think of my favorite beach to relax me smile

Before I knew it, I was sitting up, IV taken out, and I was told the good news.

The female nurse came out and shook my hand and told me that I was awfully brave and handled it really well.  She was an absolute sweetheart about the whole thing, and I don't think I could have done the procedure without them.

So, in short, about 10 minutes of your time, versus being sedated and losing a whole day.  Plus, you get to know your results sooner and you don't look/feel awful.  Everyone I saw who was sedated seemed so out of it.

Glad I could handle it and I hope more folks consider this as a viable option!

 

2

Thanks for sharing, Ryan.

I have collected numerous accounts of patients' experiences of oesophageal procedures, which I've made available via my charity's website to help others about to undergo them for the first time. www BarrettsWessex org uk

In UK we have the choice as to whether sedation or not. If we opt not to have it, they don't bother with IV or wheeling you into the procedure room. You walk in, lie down and it's over in minutes. I've had numerous scopes in the 23 years since my Barrett's was discovered. Not pleasant but tolerable and most of the endoscopists are very good. I agree the worst part is when the scope comes out but that's all over very quickly and I can cycle home afterwards.

3

Yes, I find it very strange that they IV us here!  I'm sure there are some legality issues at hand.

4

Yesterday I had my endoscopy wihut sedation. In the UK, more patients tend to go without sedation than in the US. I was very nervous after having read a number of posts about gagging etc. I have mytonic dystrophy type 1 mildly, but this can cause a problem with sedation so that was not really an option for me.Basically the procedure took less than 5 minutes and was much easier than I had feared.It is worth noting that in photographs of endoscopy units there are 2 tubes from the endoscope device that the doctor is holding, the larger tube, like a hosepipe is not for your throat, it goes to the monitor. The one for my throat was 8-11mm (as stated in the leaflet sent to me), and it was the 8mm end that goes down first, about the width of a slim pencil. Before they started I had 3 requests:

1. To ensure I was breathing ok   ( I could throughout, absolutely no problems)

2. If I wanted them to stop I would signal by waving my hand (I never felt I could not handle it).

3. To encourage me and speak to me like a child ( the nurses were fantastic!)

The throat spray tasted of bananas, was quite pleasant, and starts to work immediately so you feel something in your throat, but it was not uncomfortable.

I lay down on my left and was given the mnouthguard. I was unsure where to put my tongue, and was informed to put it under the guard.  The tube was inserted, I sort of half gagged, bit nothing dramatic, swallowed twice and it was in, it was not painful. It did feel a bit odd having a tune inside, but not painful nor unpleasant. They took a sample, and this was done amazingly quickly. The whole thing was over in less than 5 minutes. I had not been sick and had hardly gagged. To be honest, if they said I'd need one tomorrow I would not worry. I've had worse at the dentist.

5

Hello Ryan,

Thank you much for your helpful post!  Like you, I am also from California and have been searching for a GI who is willing to perform an endoscopy without sedation. I need to have one done, but I'm I'm thinking about canceling since I do not wish to be sedated. Would you be willing to send me the site's address or any contact information about the clinic and the GI's name? Thank you kindly.

6

I chose to have Upper endoscopy without throat spray or sedation. It was unpleasant, I did gag...but would have done with spray. I kept taking deep breaths and held the nurse's hand. It did not hurt. I did feel very emotional later that evening, but all in all over in 5 minutes.

7

Hello Ryan,

I am in California too! Could you also recommend the doctor you saw as well? I also want no sedation for this procedure smile

8

Hi,

I also had endoscopy three times without sedation.  I have also had a problem with pain in my stomach; and in the 1990s, decided to get an endoscopy after a bad bout with food poisoning.  I lived in Europe at the time, and the GI asked me if I wanted sedation.  I asked him if his patients usually got sedation and he said no.  That settled it and I said I would forgo sedation as well. 

If my memory serves me right, I believe the nurse sprayed the endoscope with lidocaine and that was the only lidocaine I got.  The worst part was the gagging, and I remembered gagging a few times and feeling extremely nauseous.  It wasn't a small gag but it felt like my body was doing a dry heave and I wanted to throw up but I couldn't because my stomach was empty.  I remembered gagging pretty badly from swallowing the tube hard.  I remembered thinking this was just awful;however, the procedure only lasted about 5 minutes and it was over.  The second time I had to go back after the GI treated me for H. pylori and wanted to take another biopsy.  It wasn't great but it wasn't as bad as the first time.  Perhaps I knew what to expect.  I really made sure my head was angled in a way the tube went down in an unobstructed way and concentrated on my breathing the whole time.  This time when I had to swallow, I found swallowing slowly and gently helped.  I remembered gagging a few times but it wasn't as bad as the first time.  The third time was today.  Instead of spraying the endoscope (I believe they usually spray the throat) as my last GI did, this GI gave lidocaine to me to gargle and swallow.  He gave me two vials.  I made sure I gargled as long as I could and swallowed as slowly as I could.  I don't know if it's because the GI gave me a lot more lidocaine than my previous GI, but I felt a lot better this time. I kept my head titled in a comfortable angle and concentrated on my breathing.I gagged once but it was a small gag.  I thought this third time was a lot longer, perhaps 10 minutes but very, very bearable.  

If I could give any advice it's to concentrate on your breathing and don't swallow the tube like you just ate some food.  Swallow the tube as gently as you can so as not to evoke the gag reflex.

9

I had colonoscopy last year with sedation and found it so much easier than Friday when I had endoscopy without sedation and just the throat spray.  I if I ever get asked by anyone would recommend sedation.  It as other posters have said doesn’t take long but heck when it was in my stomach and I was gagging like mad I wished it to be over. They didn’t encourage sedation I honestly believe as this takes more time to monitor and look after you rather than being able to walk out the building right away.  When I got off the bed I was in shock and couldn’t walk slowly and felt dizzy and blood pressure had dropped.  I was proud that I had gone through with it but would opt for sedation the next time.  I closed my eyes and made sure my breathing was correct that’s how I got through it.

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I have just had an endoscopy and biopsy without sedation, but using just the 'banana' spray which is the strongest banana flavour I have ever tasted, but weirdly nice! I would like to reassure anyone about to have this not to worry AT ALL. It is over before you know it and while it is uncomfortable, and you will find yourself gagging and burping a lot, there is no pain, and they talk you through every step of it. I was on the bus and back to work within an hour and am going the gym tonight.I would  even go as far as to say that I drifted off a bit during the procedure and sort of enjoyed it (weird?!). So please don't be put off, I have found the dentist worse than this and am so relieved I have had it done after putting it off for years!

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Hello nathan23349, was the endoscopy  done in California? If so, would you be willing to send me the site's address or any contact information about the clinic and the GI's name? Thank you kindly.

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12

Thank you for sharing ur story! I live in vancouver Canada and today I had my endoscopy without sedation! I was given IV and i was told that I Am a big guy so it’s better not to give sedation as usually for big guy they have to give a big amount and it’s better to do it just by freezing sprays! 

My blood pressure was high, the nurses in the room were angels and super supportive. The doctor was clever and did his thing and left immediately. Now the procedure was a horror movie coming true! The smell and taste of spray is something that  will never forget! The feeling of choking was horrible! And thats all before even inserting the tube! Gaging with every time they push air was tough and i was so glad that i didnt eat for more than 12 hours before the procedure so basically there was nothing to vomit! The procedure itself was quick 3 minutes( three minutes from hell) the doctor gave me the option to see the procedure on screen but i chose to close my eyes and concentrate on breething from nose! When he pulled out the tube , i felt as if he is pulling out my soul from my body! 

When i was told i am done , i felt like crying

I DONT RECOMMEND IT AT ALL WITHOUT SEDATION 

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I am in CA (Kaiser Permanente), I chose to try the endoscopy today without sedation.  They had me hooked up to an IV in case I couldn't handle it.  The doctor didn't seem confident that I could go without the meds but the 2 nurses in the room were very kind and positive, they kept telling me "you can do it!"  I closed my eyes when it began so that I didn't have to see the actual tube or the size of it and also to drown out the hospital room setting.  I just kept my eyes closed and kept pinching my finger to distract myself as they put the tube in.  It felt a little uncomfortable but not a huge deal by any means.  I focused on breathing through my nose and before I knew they were quickly pulling the tube out and it was over.  They said it took about 3 minutes but it felt much faster to me.  I really don't understand why they automatically assume everyone needs sedation to do this procedure.  It was not a big deal.  You can do it!

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Hello rachel30396,

I absolutely agree with you. I can't understand why doctors automatically want to put people under sedation for this procedure. I've been told that in Europe, Asia, and other parts of the world gastroenterologists perform endoscopies without sedation, and it's not a problem.

Would you please be kind enough to send me the doctor's name and contact information? Or, perhaps the name and Kaiser Permanente where he practises? For over a year, I have been looking for a gastroenterologist who is willing to perform an endoscopy with out sedation. With your help, I think I can finally end my search. Thank you kindly. 

15

Hi, no I am in the UK so mine was done in London.

16

Hello,

Sure!  It was San Jose GI Department.  Phone # (408) 972-6530  I believe the doctor was Dr. Alan Chin.  I believe any of the doctors in the dept will do it without sedation if you request it.  I was originally scheduled with a different doctor in the dept, Dr. Ali and she said she would do it but didn't think I could handle it.  Proved her wrong!

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I am glad u had a good experience!

I’ve had many surgeries in my life and i fought cancer! This procedure was the most painfu most horrible procedure ive been theough! It was invasive, painful and traumatizing.

In middle east , it was banned without 

Sediation and in ny opinion, it should be banned here too

With all respect to ur experience 

18

Hello rachel30396,

I apologize for the delayed response. Thank you so much for the information! I'm glad you proved the doctor that you could handle and endoscopy without sedation. 

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Hi Everyone,

I just thought I'd write to let anyone who is considering this how my experienced went.  

I was somewhat worried when the dr. suggested I have this procedure done, but I was determined to do it without sedation.  

I was scheduled an appointment for pain in the stomach which had been going on for some time.   There was concern it may have been an ulcer.  

Today was my appointment.  I read that some people were given an option for a throat spay.  I asked but they said they don't do that there. The nurses strongly recommended that I take the sedation and doctor stopped in later saying the same.  Not to scare anyone but he said he had been doing the procedure for 20 years without a successful sedation-less outcome.  He said it was the sedation reduces the gag reflex and if there's gagging it's hard to get a clear picture.  I told hime I'd like to try it anyway.  The scheduling person said that if I couldn't handle it I would have to pay for the procedure regardless.  They decided there was no need for an IV and wheeled me back on the gurney.  I rolled over to the side and they put a plastic piece that had a hole in the middle that went in my mouth.  The had some leads on my to get vitals the whole time.  The doctor put the scope in and initially it was somewhat uncomfortable.  I could feel it wiggling around going down to my stomach.  It seemed like it was in for several minutes.  There was a bit of gagging and drooling.  If you do this you need to focus on breathing out of your nose - it is possible to get air around the scope and I did take a few breaths through the mouth, but I'd suggest focusing on breathing through the nose.  The doctor told the nurses he was doing a couple biopsies and I could see him slipping something that runs inside the scope - probably from a slot inside of it.  The was no pain at all with the biopsy.  If you're fairly strong-willed then you can do this.  It's not that painful, more uncomfortable than anything.  The anticipation for days was worse than the procedure.  There is a bit of wrenching and I was belching a lot because apparently they shoot air into your stomach through the scope and it comes right back up. The do that so they get a better view I guess.  When I was done the doctor gave my results right away (reflux was all).  The biopsy results take longer though.  I would do it without the sedation again if I am scheduled another.  I also get my dental work done without novocaine and it's a similar experience.  When it's over you're on your way.  Today though I did feel a little queasy in the legs which may have been due to nerves.  My esophagus feels a bit tender even still 2 hours later.  That won't keep me from eating.  Good luck to anyone who decides to do it.

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Hello brian80829, thanks for sharing. Was your procedure done in California?