Upper Endoscopy Without Sedation

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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, as I know GERDers have to have this procedure every so often.

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 should something not go right).

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.  I have no idea if that's normal, but I'm glad she did it!

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.  It is one thing to do the procedure well, it is a whole other thing to keep the patient mentally stable at the same time.

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 heart 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 likes, 13 replies

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13 Replies

  • Posted

    Well done Ryan.  I'm facing the same possibility of having to have a second endoscopy and your experience has given me confidence to try and go the non-sedation route for the very reasons you have mentioned.

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    • Posted

      I wouldn't say I "highly" recommend it, but is is certainly something that one can get through.

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  • Posted

    There is no way I could do that. I have the world's worst gag reflex. I can't gargle without nearly puking. When I go to the dentist they have to spray my mouth to numb it and then use kid size films. The last time they got two but by the 3rd I was going to throw up.

    I did have two scopes put up my nose to view my voice box and my sinuses. I refused to be numbed and did fine. I have severe anxiety and the one time they numbed my nose without telling me what they were doing I had a horrible panic attack and couldn't breathe.

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    • Posted

      Understandable, I honestly thought I'd have trouble too, but I was able to handle it.

      I've heard folks gag a bit when they are sedated too, something about being sedated and gagging scares me more.

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  • Posted

    Great recount. Here in the UK, we are encouraged to try without sedation or at least very little. With no sedation, I was in and out of procedure within 10mins. With just a little, I just was told to lie down for an hour after. Ours are within a hospital but a clinic in a department all to itself. They don't hurt, just a little weird. Sometimes there is a lot of gagging but as long as you are aware, it's fine. I've had 4! So just gets lots of throat numbing spray and you're go to go!

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    • Posted

      Geez 4 sounds crazy!  It is certainly manageable without sedation, without question.

      As I told my wife, I wouldn't ask for one again, but I'm certainly less feaked out by the procudure now.

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  • Posted

    In the UK you have the choice of sedation or throat spray. I went for the throat spray - it's much quicker - they tell you what they find, because you can understand - and after a couple of hours it wears off and you can go about the rest of your day without brain fog! Go you for saying no to sedation! It's an unpleasent proceedure - but I actually think I would have found it worse not feeling 'in control'. Well done!!

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  • Posted

    Glad you had a good time. I will NEVER recommend doing this without sedation. It is the most awful feeling and th egagging is terrible. The whole time I could feel this object in my gut moving around and it really made me feel weird. Unless you can control your gag reflex.....get under sedation! 

    I have had one live and one (with the other end at the same time) under sedation. Once you wake up you are checked and if all is well you walk out of there 30 min later unaware of any hassles.

    Subsequently I have not had a Hiatus Hernia repaired with a Nissen Fundoplication. I am 10 days post op and feeling great, Off th eliquids only and on pureed foods for 5 days. Moving onto solids tomorrow.

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    • Posted

      Yes, it was strangest for me when they were taking it out for some reason.  The other time when they were performing the procedure it was relatively managable.

      Unfortunately in the US, it isn't quite as easy in terms of leaving if you were sedated.  You have to wait a minimum of 8 hours unless you have someone there to pick you up and take you home.  

      Glad to hear your surgery went well!

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  • Posted

    I wish I had read this forum earlier. I just had an upper endoscopy today due to trouble swallowing for several years.  It was of course the suspected Schazki ring from scar tissue. 

    I went in with my wife as a driver, fully convinced I was going to be sedated and have an unsure recovery time following the procedure, but the nurse who came in was really cool and was explaining how in different countries, no one uses sedation for the upper endoscopy. So I said "do I even have a choice?" and she said I did, so spur of the moment, I opted for no sedation. Part of the reason was because I didn't want to deal with the hazy half wake feeling afterwards, but also I was hungry from fasting and I wanted to just get out of there and eat something. 

    So I went in and swallowed this really nasty lidocaine sludge.  It was disgusting and very thick. It definitely helped numb everything, but it didn't seem to do much for my gag reflex.  The scope itself was quite a bit thicker than I had imagined. I never really did much research going into it, but I imagined the scope being about the thickness of a TV coaxial cable.  However, this thing had the diameter of a nickel.  It was flexible, but very heavy duty. I had expected maybe a little tickle in my throat, but this was way more intense than I had imagined, even though I went confidently into it. Honestly, it was a very tough experience. I don't regret it per se, but it was not easy.  I have a killer gag reflex and I was burping and gagging and forcing up mucus the whole time. My gag reflex was making my eyes water and my sinuses fill up, so their suggestion to focus on breathing through my nose was out. I tried focusing on breathing the best I could, but everytime the scope moved, I gagged.  It felt like air was going into my stomach when I uncontrollably swallowed, so when I gagged, a lot of air would come up.  The procedure lasted about 4 minutes.  And luckily, as hellish as it was, it didn't really feel like more than 4 minutes.  They were able to scope me, insert balloon and stretch the Schazki ring, and also collect a biopsy. The nurses said I did great. I didn't feel like I did great though, although they said many people flail their arms and try to pull the scope out. 

    After leaving, I was happy it was over and done with and I could go eat, but I left telling myself if I ever had to get that done again, I would choose sedation over that.  Then I came home and started reading things online, and soon realized that during sedation, many patients do freak out and doctors and nurses have to hold them down.  It's not necessarily a peaceful process just because there is sedation, the only difference is, you don't remember it.  After doing a little more reading, it reassured me that my choice to not be sedated was the right one.  And now I am considering that if I ever needed it to be done again, I would again choose no sedation.  However, it is not easy. It's more than a tickle in your throat.  It's pretty intense and I definitely would warn anyone that going into it with a good mindset about it is essential, but also don't expect it to be comfortable.  I have heard stories about doctors who had to stop the procedure everytime a gag happened and continue when it stopped. Luckily, my doctor kept going and reminded me the whole time I was doing great.  I was even looking forward to watching it on the screen, I saw my teeth, then the inside of my mouth and my tongue, and then when he pushed it in, I was immediately overcome with the sensation and I couldn't focus at all on the screen. It took every bit of my concentration and focus to keep calm and not gag, and even then, I gagged a lot.  Make sure also you have a pretty thick towel under your mouth because you will drool a ton.  It left a huge wet mark on my shoulder. Luckily I had brought another button down shirt I could throw over it. 

    Well this was my experience.  I don't intend to necessarily encourage or discourage either one. Just know that no matter whether you choose sedatives or not, your body has a hard time deepthroating a huge plumbers snake, and if you are sedated, many times doctors and nurses have to hold you down and sometimes you are even harder to control because you aren't fully aware of what's going on. When you are awake and unsedated, it is very uncomfortable, but it is a good thing to know that you are aware of what's going on, and even though you're gagging like crazy, if you just lay there and take it, without completely freaking out, you're doing quite a bit better than the rest.  Hope this experience can give a little insight into anyone going in for one.

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    • Posted

      I have just had this procedure done today in the U.K. Without sedation and your post is exactly as it felt for me. The gagging was horrendous and I did start to panic a bit in the middle of it but the nurses were fantastic and calmed me down. When I came out I was adamant you couldn't pay me to have it done again however I'm still so glad I didn't have sedation as I could wait 15 mins have a cup of well needed coffee and drive myself home while the other poor people had to wait for the sedation to wear off. I would like to say to anyone nervous that I felt no pain during the spray was disgusting but worked completely. It is just the gagging/burping that was not pleasant at all but it won't hurt you and it thankfully only lasts 5 very quick minutes. The nurse also told me a lot of people who are sedated are still aware of everything going on and gagging just more relaxed so in opinion unless I didn't have a clue it wouldn't be worth it.

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