Upper GI Endoscopy - no sedation - my experience

Tests and investigations
1

Hi.

I have read many posts here about peoples experience of an endoscopy and so thought it might be helpful to post my experience as someone who was nervous about the procedure.

I have had some abdominal pain since christmas, had blood tests, stool samples, urine samples, an ultrasound and a sigmoidoscopy which is like a colonoscopy but doesn't go as far up (i think).   All had come back normal but the pain still persists an so an endoscopy was the next option.

Today was the day of my endoscopy after my original appointment was cancelled the day before it was supposed to happen.  Basically i've been through the build up to it twice, which when you are apprehensive about something isn't really something you want althought the temporary relief when the first one got cancelled was welcome.

Here's how my day went.

My appointment was at 14:50 at a Living Care facility near Leeds. It's the same place i had my sigmoidoscopy a few weeks ago and so i found going there a bit less daunting as that was part of the whole thing that i knew what to expect.

I went to work this morning rather than sitting at home thinking about it, i had a cereal bar at 8am and then that was it as far as food and drink until after the endoscopy.

I came home and collected my other half and my 6 month old son who was there for moral support, my other half incase i decided to go for the sedation to drive me home.

We left with plenty of spare time, i find being where i need to be in good time gives me chance to compose myself. I play in a band and getting to venues early calms the nerves so I put the same thing in to practice for today.

I checked in and went to the waiting room and was called in to a private room after 10 minutes for a pre-assesment by a healthcare assistant who did my blood pressure, which was sky high due to the nerves, then asked me a few questions about my medical history etc.   I had left my partner and son in the waiting room and didn't see them again until after it was all over.

I was then moved to something like a small hospital ward, 6 curtained off cubicles where i was told to wait for the Clinical Nurse Specialist who would be doing the endoscopy to come and see me to explain the procedure.

I was waiting for a while, maybe 20 minutes, but being there actually helped me calm down....at least i couldn't read all the horror stories from there. By the time the CNS arrived I was quite calm although when the curtain went back the heart rate went up again. 

She went through the procedure and asked if i wanted sedation or just throat spray.  I had contemplated both but with a 6 month old to help look after i decided to be a brave daddy and just get on with it with the throat spray.  The nurse could tell i was nervous and was doing her best to reassure me.   I signed the consent forms and she led me in to the room where i was to have the endoscopy done.... exactly the same room i had my sigmoidoscopy......i hope it was a different camera cheesygrin   She introduced me to 2 other nurses who we also very reassuring.  One of the other nurses stayed right with me the whole way through and the other one was more to help with the procedure. 

I sat on the bed and was given a quick rundown of the equipment, by this point i really just wanted to get on with it.  Now one important point...the tube is not as big as i expected.  I'd say about 10mm thick at the most.

The nurse who was assisting the lead nurse clipped a monitor on my finger to measure oxygen and heart rate (i assume).

The lead nurse then clipped a spray nozzle on to the bottle of lignocaine and asked me to open my mouth and hold my breath. She sprayed 2 or 3 squirts of the liquid into the back of my mouth and then after a couple of seconds told me to swallow.  I'll not lie, it tastes pretty horrible.... not gone off milk bad, but not something you'd order a pint of at the bar. 

She waited a few seconds and then asked me to open really wide and stick my tongue out.  This time she stuck the nozzle right in the back of my throat and squirted a good few times.  This was the worst part for me. I gagged pretty bad but there's nothing to throw up and it was just one heave from the shock.  I imagine if you squirted water down your throat like that it would have the same effect.   

We sat for a minute or two for the spray to kick in....and it does.  It feels like you have a lump in your throat and when you swallow it feels strange, like you know you are swallowing but you just don't feel it.  

My main point about the whole procedure is this; if you can keep hold of your senses and keep calm, telling yourself that everything you are experiencing, despite being new to you, is exactly how it's meant to be then the whole thing is going to be fine.  This came to me on that first gag when she sprayed the lignocaine into my throat.  Expect the gagging and you can cope with it.

So, with the back of my tongue and my throat numb, i was asked to lay on my left side with my chin down, this felt a bit weird.....i was thinking sword swallowers put there head up wink    My right arm was straight down my body and i was told to give myself a hug with my left arm......i already was!

The nurse who was on my team for this match was stood right by my head and had a hand on my shoulder, giving a reassuring squeeze a few times over the next few minutes.    The mouth peice was fitted and I took a couple of deep breaths and closed my eyes.

I could feel the tube on the end of my tongue ,obviously going towards the back of my throat, but i didn't feel it touch when it got there.

Then there was a deep breath from everyone in the room as they prepared for the next bit.  'I need you to take a deep breath in and then a big swallow'  I had to swallow twice and again this made me gag. This time when i gagged i was much more in control. I knew there was nothing i could do to stop this reflex and i just let it happen and then took a good breath in and relaxed.   At this point the nurse said that i could really relax now, the worst bit was done.  And she was right too. The rest of it was pretty comfortable.  I was very wide eyed and had to really concentrate on my breathing to stay relaxed but you can just tell that the more you relax the easier it is.

As the pipe went further down, you can't really tell, i could just see the nurse pushing it further in.  There was one more gag when she blew some air in to inflate my stomach but this one was much less troubling as i'd now got myself under complete control and just rode it out.

I was told there might be one more bit of a push at the very bottom but i didn't feel that one, i now had my eyes closed and was reciting the bass line in my head for a new song we've been working on in the band. 

The nurse then said she was going to start bringing the tube back up slowly and was going to get a biopsy to test for Helicobacter pylori whilst she was there but that my insides were very clean looking and that there was nothing to report.

To do the biopsy the assisting nurse passed a long thin wire to the lead nurse who then fed it down the tube. You know nothing about this unless you are watching. When it got to my stomach i imagine she put it against the lining of my stomach, then she asked the assisting nurse to do something which i assume was to operate whatever the mechanism is to take the biopsy. The lead nurse then gave the wire a swift tug to pull the sample away.   Now, she did this twice with the same wire down so i don't know if she missed first time or if she took two biopsies.  I only felt a very small tug as she pulled the wire. If i hadn't been watching I doubt I would have noticed it.

The nurse then said she was all finished and to relax as she brought the camera back up. She slowly pulled the tube back out, stopping to look at varous bits on the way back.  Right at the very end as the tube came out I had a feeling of wanting to gag but I managed to hold it back.  There was a distinct feeling of relief that it was over but not because of the procedure itself but more that I didn't need to worry about it anymore.

I stayed laid down for a couple of minutes and let out a couple of burps from the air that had been pumped in and then sat up for a few seconds on the bed before getting to my feet.

We sat back down away from all the equipment and the other two nurses came and gave me some info on what to do for the next couple of hours and also hooked me back up to the monitor for a minute or two just to check i'd survived.

I was told everything looked great and knowing what other tests i'd had done that it may well be a case that my GP looks at lifestyle etc. next.

I went back out to the waiting room to see my lovely partner and son sat waiting for me.  It's always good to see them but this was a bit 'gooder' than usual. smile

Sorry this was such a long post, but I found the details in other posts helped.

To sum up, try to relax, it helps with the actual procedure. It's not painful at all and the worst bit for me was probably the first gag.

I'll keep checking back so if you have any questions, leave them in a reply.

2

'Expect the gagging and you can cope with it.'

Not true. You may have coped with it, but many will not. It is not fair to say, that you coped with it, everyone else will be fine. Anyone with a bad gag reflex will have a truly horrendous time if they are not sedated.

3

The whole write up above is my perspective/experience.  When i wrote 'Expect the gagging and you can cope with it.' it was meant to read as if that's what i had told myself.

I have no idea what anyone elses experience would be but what i can say is that i saw 3 people come out after the procedurewithout sedation before all smiling and talking to the staff.

 

4

Also, i understand you had one under sedation (i've seen your comments on this site).  Did you have one without sedation ever?

5

No, mine have either been as an inpatient under anaesthetic or as an out patient under sedation. I am a regular at my local hospital for various things, so I took a stroll around to the endoscopy dept and they gave me a quick tour and showed me the scopes. I knew there was no way in the world that they would get that down my throat.

I have had dental fillings and stitches in my leg without anaesthetic in my lifetime. Painful but you can control the pain. You cannot control a gag reflex.

6

Thanks for this. I love the detail! Getting this procedure tomorrow and I wanted to read a positive experience.

7

For anyone else getting this procedure and deciding whether to to get sedation or not: the nurse at my endoscope today said she and all her colleagues would do it with the throat spray and not the sedation because in her experience it helps to be alert and able to respond quickly to instruction. Under sedation, she explained you are always a step behind the instructions.

I found the procedure thankfully quick and bearable even though I retched for most of the 5 minutes it took. Took it with no sedation and was delighted to be able to leave asap!

8

In my experience, under sedation, you are not a step behind, you are out for the count and unaware of the whole process. Nurses will always want non sedated, because it makes the whole job much quicker.

I went to see the gastroscopy dept. before my endoscopy to have a look around and both the nurses said to me, there would be no way that they would have an endoscopy without sedation.

9

Are you talking about uppergastro endoscopy? Because that is the total opposite of what I was told today.

Sedation is very standard in lower gastro endoscopy (colonoscopy) and I had it myself when I had one a few weeks ago.

Like I said in my experience I found the upper gastro endoscopy totally bearable without sedation. And I retched for most of it so it wasn't an easy ride but very short and not painful just uncomfortable. And it was so nice to be able to leave immediately afterwards and not have a cannula put in.

10

As far as I remember, gastroscopy covers both, but when you say endoscopy it means down the throat and if it is at the other end, it is a colonoscopy.

So I mean down the throat, having had it both as an inpatient and as an outpatient, I was out every time, don't remember a thing. Believe me, you wouldn't get a hosepipe down my throat. It was only about 5 years ago, I stopped chopping tablets in half so that I could swallow them.

Once you've been in hospital for two months, with a cannula in, that they have to change each week for hygiene reasons. But that is nothing compared to having a catheter fitted, an ascites drain and enemas. That makes cannulas small potatoes.

11

I had a gastroscopy yesterday. Having had one with sedation 16 years ago (a very traumatic experience) I was terrified about going through it again. (It almost wrecked my holiday in Italy as I was counting the days and hours!) My husband suggested just having the throat spray as - for me - the sedation doesn't work very well and the feeling of loss of control makes the anxiety worse. All I can say from yesterday's experience is that it was a whole lot easier than last time. For me the initial gagging as they push the tube down your throat was terrifying on my first test. This time the throat spray was great (yes it does taste yuck!) as I hardly felt the tube go down. I didn't even gag, just belched when the air was blown in (embarrassing). Previous comments about focusing on breathing I totally agree with. I suffer from anxiety and have been learning meditation recently to help with this. Once that tube was in I focused on my breathing and nothing else. It didn't hurt, just felt a bit weird obviously. The nurses were great and just told me to keep focusing on mybreathing, and this really is the key. The gag reflex is involuntary and of course you can't help it, but the throat spray helped me hugely with that. Oh, I did have a bit of gas and air too to help me relax before they started (loved it!). This for me was much better than sedation. I felt much more in control, just a bit high 😉 What I'm trying to say is don't assume you won't be able to cope with it. I'm the world's most panicky person, reacted really badly to it last time but this time with throat spray and a few more faculties, totally bearable!😊 Hope this helps.

12

Without trying to get in to an arguement here, I really think you ought not to comment. You've never had the procedure without the sedation and if yours looked a hosepipe then either the sedation messed with your eyesight or you are using a cr@ppy hosepipe.  The endoscope is 12mm diameter.    Your constant repetition of the horrors of an unsedated endoscopy, which you've not had, are not helpful.

 

13

This is the problem with people commenting who go rushing in. The British (and this is a British forum) garden hosepipe is half an inch. You can look up the conversion to mm if you don't know it.

14

Hi, thanks for your clear explanation. I have had 3 endoscopies. All under sedation and spray! The first two I was out for the count but the last one I must have had less sedation as they were running late and wanted to close up shop. Anyway, the last one I was aware all the way through even when they were removing the polyps. The only uncomfortable bit is the camera passing the back of your throat when you start to gag and the same coming back out. As long as you continue to breathe and try to relax it's ok. It's mind over matter. I am going for another one tomorrow and I am going to try it with no sedation. I need them every two to three years for barretts oesphagus so have to get used to it. I like the fact that you can get up and go if you are not sedated. I can't believe I am saying this as the last 3 I have had someone with me, I have been near to tears and ready to run out the door with fear. Now I am going on my own and the only thing worrying me is them knocking my front teeth out. Ha!

15

I am in Leeds which was in the uk last time i checked and the smallest standard diameter of a hose is 1/2inch (12.7mm). The important point is that that is the internal measurement on a hosepipe. 

16

I had an endoscopy yesterday and was terrified so opted for sedation- glad I did as am happy to report that it was nowhere near as bad as I'd imagined and although I was sedated still felt quite with it and was able to go home within the hour. For anyone who is frightened go for sedation and you will be fine - trust me I'm the worlds worst coward and I would happily go through it again.