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ENDOSCOPIC PROCEDURES
ENDOSCOPIC ULTRASOUND (EUS)
Endoscopic Ultrasound enables the physician to look inside the esophagus, stomach and duodenum as the upper endoscopy does. It allows the physician to also inflate a balloon on the end of the scope and see outside the walls of the esophagus, stomach and duodenum. The physician can view the pancreas, common bile duct, gallbladder, liver and lymph nodes. He can also do needle biopsy through scope if it is needed.
When your physician orders this procedure in our office, your GI nurses will spend time with you to explain the examination and to schedule a time convenient for you. The following points will be discussed and your questions carefully answered.
HOW DO I PREPARE FOR THE PROCEDURE?
For a thorough and safe examination, it will be essential for you to follow every step carefully.
Your stomach and duodenum must be empty for the procedure, therefore you will not be able to eat or drink anything for at least 8 hours beforehand. This will often mean you will be fasting from midnight until the following morning.
SHOULD I TAKE MY USUAL MEDICATION?
If you are taking Aspirin or Coumadin, your GI nurse will generally ask you to discontinue them for three days before your endoscopy. You will usually be asked not to take your regular medicine in the 8 hours preceding your examination except for your heart or blood pressure medication. Special instructions will be given for patients with chronic conditions like Diabetes.
SHOULD I TAKE AN ANTIBIOTIC BEFORE MY PROCEDURE?
The most recent (Sept. 2000) recommendations from A.S.G.E. are as follows: It is only necessary to take a prophylactic antibiotic before upper endoscopy is you have been diagnosed with endocarditis, have a prosthetic valve, a pulmonary shunt, or a synthetic vascular graft less than one year old. It is no longer deemed necessary to take antibiotics if you have mitral valve prolapse. For other procedures and conditions antibiotics could be recommended on an individual basis.
WILL I BE ABLE TO DRIVE MYSELF HOME?
Definitely not. You must have a relative or friend drive you because of the after effects of the sedation. You will not be able to return to work or school that day and need to spend the remainder of the day resting. Most patients are able to resume normal activities the day after the procedure.
WHAT ARE THE RISKS OF THE PROCEDURE?
Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more that a mild sore throat after the procedure. Your physician and/or nurse will go over possible complications with you and answer any questions before you sign your permission form.
WILL MY INSURANCE COMPANY PAY FOR THE PROCEDURE?
GI nurses are usually well aware of the insurance requirements for payment. Most insurance companies, as well as Medicare and Medicaid, will pay for Upper Endoscopy for the reasons your physician orders it. All procedures are carefully precertified with your insurance company before your scheduled date. If there are any problems you will be alerted. For patients without insurance coverage, arrangements can be made by contacting Coral Fournier, Patient Accounts Manager.
WHAT WILL HAPPEN THE DAY OF MY PROCEDURE?
On the day of your procedure one of the Center nurses will greet you and escort you to our new unit adjacent to the office. Once in the comfortable preparation room you will be asked to put on a gown, and relax on the stretcher. Then an IV will be started by one of the nurses who will put you at ease with her confidence and sense of humor and you will be hooked up to the monitor. The state of the art monitoring equipment will carefully record your blood pressure, pulse, oxygen level, and heart rhythm throughout your procedure and recovery time.
When the physician is ready to begin, you will be wheeled into the procedure room. Right before the procedure the GI nurse will spray your throat with a special numbing agent that helps to numb the gag reflex. You will then be made comfortable on your side and given pain medicine and a sedative to keep you free of discomfort and to help you to relax. Many patients will sleep right through the procedure except to rouse long enough to change position if asked by the physician. You will swallow a thin, flexible, lighted tube called an endoscope. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach. The physician can see abnormalities, like ulcers or bleeding, through the endoscope that don’t show up well on x-rays. Abnormal findings can be biopsied or sometimes completely removed. Bleeding lesions can be injected with medications, coagulated with heat, or even encircled with a rubber band-like device to stop bleeding. Upper gastrointestinal endoscopy usually takes 20 to 30 minutes.
You will then be wheeled back into the recovery area where the nurse will stay with you, monitoring your vital signs until you wake up. As soon as you are alert enough, you will be given something to drink and will be allowed to dress, however, you will need to stay in the physician‘s office for 30 minutes to 1 hour until the sedation wears off. You will then be discharged. Your GI nurse will give you a list of instructions to follow at home and will usually call the next day to check on you and be available to answer any further questions.
WHEN WILL I FIND OUT ABOUT THE RESULTS OF MY PROCEDURE?
The results of the procedure will be explained briefly to you and your family after the procedure; however, most patients do not remember clearly what was said due to the sedation. Because of this your physician will want you to make a follow-up appointment to discuss the results of the examination as well as any biopsies that may have been taken. During this visit you and your physician will discuss a plan for further gastrointestinal care as necessary.
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