Oral (With sedation) v Trans-nasal endoscopy

Posted , 7 users are following.

Hi everyone,

I have 2 endoscopies in the last 1.5 years.  This was due to reflex issues and I was diagnosed with  a hiatus hernia, an ulcer and barrett's.  The ulcer has cleared up and my barrett's they were very happy with, however it's likely this will need monitored over the years.

I opted both times for trans-nasal as I was told by the Doctor it was easier.  You do not have the choice to be sedated for this.  On both occasions I found it pretty uncomfortable.  Trans-nasal is supposed to stop you gagging, however both times as the tube went down, I wretched at least once.

I am due a 3rd appointment for monitoring purposes but I've cancelled it 3 times as I just can't face it.

I've spoken to my Doctor as I wanted it done while asleep, however they said they only really do this as a last resort in a serious situation.  They advised that in my situation they would advise having it done orally with sedation.

What is everyone's experiences with this?  Has anyone had both methods and which did they prefer?  Some people who have sedation can't remember anything and that is what I'd like.

The things I didn't like about the nasal route was the times I wretched, but also felt like I had a garden hose in the back of my throat and it was pretty uncomfortable but I did it because I had to.

Any advice would be much appreciated as I can't avoid this forever and will need to make some sort of decision.

Thanks.

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11 Replies

  • Posted

    Hi Allan,  I have had neither done as I have high anxiety.  I too have been putting it off in hopes that I can heal naturally....my husband just went for an endoscopy a couple months ago, he said he doesn't remember much of it as he was sedated.  They spray the back of your throats with numbing spray, put a mouth guard in, he was awake at the very beginning but was out for the rest.  He said for awhile after he felt dizzy from the sedation but it wore off as the day went on....the thing that bothered him the most was the numbing spray he said you couldn't feel the back of your throat to swallow....it was all quick and over with.  If my symptoms don't improve I am going to go for a upper GI x ray.....you have to drink barium which doesn't sound pleasant either, but it is less invasive and it can see a lot that is going on in the upper GI.....the only problem is if they see something out of the ordinary an endoscopy has to be done.  I wish there was better less invasive tests for this as many people suffer a long time to avoid getting it done.  

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  • Posted

    Hi Allan

    I had an upper endoscopy a couple of months ago.  Although I am really not bothered by most 'procedures', this one had me so worried that I made myself ill!  The thought of the tube in my throat and the gagging really had me worried.  I simply explained my fears to the nurses and doctor and opted for both throat spray and the maximum dose of sedation that they are allowed to give these days.  It was over in such a short time and I knew absolutely nothing about the procedure as I zonked out straight away.  I woke up feeling no discomfort whatsoever, feeling quite happy and went home shortly after.  I felt a fool to have been so worried about it as, for me, it was a breeze.  If you have sedation you cannot drive and need someone around for 24 hours.  I would happily go through the same again - with sedation.

    I wish you the best of luck, but if you have the same experience as I had you really won't need it.

    Regards.

    Jenny

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  • Posted

    Hi Allan,

    If you're under 65 (60 in some regions) I'd say go for sedation. You won't remember a thing about it. Most over-65s have a good experience with sedation too, but there are more likely to be problems with that age group. This is because a) they can only give a half-dose; and b) this age group is more prone to getting a so-called "paradoxical reaction" to the benzos they use (though this is quite rare). I've only had one gastroscopy, by the oral route, at age 69, and I was the exception that proves the rule.

    However, the stuff about being woozy afterwards and being told you must have someone with you for 24 hours isn't universal. I wasn't questioned at all about my plans for getting home afterwards, nor did I feel the least bit sleepy either during or after the procedure. In fact, I was completely wired and stayed awake for about 30 hours afterwards. (But that was probably the paradoxical reaction to the sedation due to my age.) That being said, I certainly wouldn't advise attempting to drive yourself home afterwards!

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  • Posted

    I recently had an an endoscopy, and I opted for the sedation and didn't remember a thing after I was knocked out.  I never felt the scope going down my throat  and woke up feeling very alert.  I had this when I had this procedure another time as well.  I would highly recommend that you have the sedation since you had such a rough go with your last one.

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  • Posted

    I forgot to say that they did not use the numbing spray, but it didn't matter, cuz I was out in minutes.  Also, you might want to ask for something for nausea.  That way you prevent getting sick if you are prone to do so.

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  • Posted

    I am 71 and have had two endoscopies. I am an anxious person so worried a lot before the procedure but had decided not to have sedation but just have the spray.  I kept practicing having something down my throat by poking my finger to the back of my throat or using my toothbrush to try and get over the gagging complex but it was a total waste of time because it's nothing like that.  I was determined to stay as calm as possible and as the endoscope started to go down I made sure I swallowed and it was down. The procedure took about five minutes and it was all over, the worst part being the taste of the throat spray.  I had the second endoscopy about a month ago and just had the spray again.  The difference this time was that it was a student doctor doing it and it took a lot longer, about 30 minutes but still wasn't bad. I swallowed when it went in, much better than resisting as that's when you're likely to gag and even when it came out I didn't gag.  As I had only had the throat spray I was given a cold drink and was able to leave about 15 minutes after unlike with sedation where you are kept in longer and can't drive etc. for quite a while after.  I would definitely recommend an endoscopy down the throat rather than the nose and with no sedation.

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    • Posted

      Hi Spindles,

      With you all the way on throat spray vs. sedation if you're over 65. I had my one and only gastroscopy at 69, albeit under slightly special circumstances. I'd swallowed my very spiky denture, and it had been stuck in my throat for three weeks, during which time I was thrown out of one hospital after another, and told I'd imagined the whole thing. (It didn't have any metal parts so wasn't radio-opaque.) At the end of three weeks, by which time I'd lost 7kg/15lb, was badly dehydrated and coughing up blood, a friend took me back to one of the hospitals that had thrown me out and insisted I was seen. A female doctor screamed at me that the denture was in my head not my throat, but luckily my friend held his ground - I was unable to speak at all by this time.

      They grudgingly slotted me into that afternoon's gastroscopy list to "prove" I'd imagined it, while all the staff told me I was a time-waster, taking the slot from another patient who badly needed it.

      I wasn't consulted re sedation, but was given a very small dose of throat spray (just two puffs) plus IV sedation. As a former nurse, I was well aware that they only ever give a half-dose of sedation to seniors, as there's a theoretical danger of cardiac or respiratory arrest in old age (cf. Jo@n Rivers).

      I think the half-dose of sedation was the problem. It was enough to suppress my higher centres, which would have helped me to cooperate, but not enough to suppress the animal-like limbic system, which put me into fight-or-flight mode, struggling violently. It took six people to restrain me. I kind of knew what was going on and why, but just couldn't control myself. I'd have gouged the nurse's eyes out if she hadn't been kneeling on my arm. The procedure was a difficult one - even without my struggles - as the denture had become deeply embedded in the tissues at the entrance to the oesophagus, with severe infection and ulceration. Unlike patients who are given a full dose of sedation, I retained full recall of the whole procedure too. Worst 20 minutes of my life!

      This is why I occasionally come on these boards advising seniors not to have sedation for endoscopy. Some seniors do find it's sufficient, and come out of the procedure with no memory of it, but they're much more likely to have a bad outcome with sedation than a younger person.

      On the other hand, I wouldn't hesitate to recommend sedation for anyone under the age of 65 - or 60 in some areas. They'll come out of it with no memory whatever of the procedure, and all the stuff about being groggy for ages and not being alone for 24 hours afterwards is nonsense. (Though it is of course true that you mustn't drive yourself home after sedation.) The only exception to this is younger people who have a pre-existing heart or lung condition, as they might also be given a half-dose.

      I never got an apology, though the hospital behaved impeccably afterwards, keeping me in for 24 hours on IV antibiotics. (Probably scared of litigation.)

      The experience has put me off ever having a gastroscopy again, but if I did have to have another one at my age (73) I'd certainly opt for full throat spray while retaining my mental faculties.

      Once again - none of this applies to any nervous under-60s who might be reading this. Don't hesitate to go for sedation if you'd rather not remember the experience. Equally, if you decide to go for throat spray alone, you'll be fine. It's the half-dose of sedation that is best avoided at all costs.

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    • Posted

      Hello  Spindles

      I am writing because I have an endoscopy tomorrow morning and I am terrified.  I suffer from anxiety and as I am 65, they won't give me a proper dose of sedative.  I have heard that they hold you down.  Please do you have any advice?  Thank you

      Nada

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    • Posted

      Hi, I'm sorry that I haven't replied earlier so you may have had your endoscopy but in case you haven't all I can say is that if you don't struggle they won't hold you down.  The first one I had I was on my own but I was very calm even though I had been stressing terribly before, in fact the doctor said he wished he had done a video of me to show the more nervous patients!   I just made sure that when they started to gently insert the endoscope and told me to swallow I made sure I swallowed and it went down with no problem.   The second endoscopy I had took longer but I made sure I swallowed again but this time I had a nurse behind me with her arms across my body, just resting there but obviously there in case I tried to pull the endoscope out.  I have read that people have been thrashing about and trying to get up and I suppose that's when they are held down but as long as you tell yourself to be calm and swallow when told you should be OK and actually I found it rather comforting to have the nurse "holding" me and keeping up a conversation.  I know it's easy to say but the lead up to the actual procedure is far more nerve wracking than actually doing it.   Hopefully you have either had or are going to have a comfortable procedure and if it's any consolation, you are more likely to do damage to yourself if you struggle so calmness is the way to do it.

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