Before having an endoscopy

Depending on what part of your body is being looked at, you will probably be asked to avoid eating and drinking for several hours before you have an endoscopy.

You may be given a laxative to help clear your bowels if you're having a colonoscopy to examine the large intestine, or a sigmoidoscopy to examine the rectum and lower part of the bowel. You will usually also be asked to eat a low-fibre diet in the days before you have a colonoscopy.

In some cases, you may also need antibiotics to reduce the risk of an infection.

If you're taking a medicine to thin your blood, such as Warfarin, Clopidogrel, Rivoroxiban or Apixiban you may need to stop taking it for a few days before having an endoscopy. This is to help prevent bleeding during the procedure.

However, do not stop taking any prescribed medicine unless a GP or specialist tells you to.

During an endoscopy procedure

An endoscopy is not usually painful, but it can be uncomfortable. Most people only have mild discomfort, similar to indigestion or a sore throat.

The procedure is usually done while you're awake. You may be given a local anaesthetic to numb a specific area of your body. This may be in the form of a spray or lozenge to numb your throat.

You may also be offered a sedative to help you relax and make you less aware of what's going on around you. (Link to sedation and pain relief options)

The endoscope will be carefully put into your body. Depending on the part of your body being looked at, it may be put into your:

• mouth and down your throat
• bottom (anus)

An endoscopy usually takes between 10 and 45 minutes, depending on what it's being used for. You can usually go home the same day and do not have to stay in hospital overnight.

After an endoscopy

If you have a sedative, you'll probably need to rest for about one to two hours after having an endoscopy.

If you have a sedative, a friend or relative will also need to take you home after the procedure and stay with you for 24 hours.

If you do not have a sedative, you can go home soon after you have had an endoscopy.

All endoscopic procedures can be associated with some discomfort but there are a number of options to minimise this. Your patient information leaflet explains these options in more detail and there is information below.

If you have any questions or want to discuss your options please contact the pre assessment team or you can discuss them with the nurses or the endoscopist on the day of your procedure.

Throat spray

This is a spray that numbs the back of the throat and therefore minimises the discomfort you may feel while the scope is being passed in the throat during Gastroscopy.

You will be fully conscious during the procedure and you will be aware of the scope going down. You may feel slightly bloated due to the air insufflation, whilst this can be uncomfortable, it is not painful. A diagnostic gastroscopy usually takes less than 10 minutes and the spray wears off after approximately 60 minutes.

The benefit of having throat spray is that you are able to go home sooner, you do not require a friend or family to accompany you and you can drive a car or operate machinery straight away after. For this reason many people choose throat spray for diagnostic gastroscopy.

Conscious sedation

With conscious sedation you receive an injection of one or a combination of drugs to relax and reduce discomfort. Commonly at our Trust, we use a drug called Midazolam (a sedative or relaxing drug). Sometimes this may be combined with a strong painkiller called Fentanyl or Pethadine. 

The doctor or nurse providing the conscious sedation will discuss with you what is best on the day. These medications are designed to make you feel comfortable and relaxed but are not anaesthetics and it is not intended to put you to sleep.

Conscious sedation may provide a more comfortable procedure but has the disadvantage of requiring a more prolonged recovery in hospital. If you have conscious sedation, you will need to be accompanied home and have someone to stay with you for 24 hours. You should not use public transport to return home and you are not permitted to operate machinery or computers associated with work or drive a car for 24 hours after conscious sedation.

In addition, certain patient groups may be more at risk from the effects of conscious sedation such as patients who are elderly/Frail, have sleep apnoea or breathing problems including asthma or COPD. If you have any of these, they will have to be taken into consideration when the conscious sedation drugs are being chosen and administered and it may be necessary to use lower doses or not at all. This will be discussed with you by the referring doctor and the endoscopist on the day.

Gas and air (Entonox)

If you are having a colonoscopy or sigmoidoscopy, you will be offered gas and air which is commonly used to relieve labour pain. You inhale the gas using a hand held mouth piece. This provides very rapid pain relief but also wears off quickly. You are entirely awake during the procedure and can go home rapidly after. No other precautions are required so many people find this a more convenient approach.

Deep sedation (Propofol) is medicine given during procedures or treatments to keep you asleep and comfortable. It will also prevent you from remembering the procedure or treatment. You cannot be easily woken up during deep sedation, and you may need help to breathe. Deep sedation can be given as an IV injection. Deep sedation or even anaesthesia is given to patients requiring complex or prolonged endoscopic procedures such as Endoscopic Submucosal Dissection (ESD), Endoscopic full thickness resection (EFTR), Therapeutic Endoscopic ultrasound (EUS), Bronchoscopy and Endobronchial Ultrasound (EBUS), endoscopic retrograde cholangiopancreatography (ERCP), and device-assisted Enteroscopy (DAE), it is also used for patients who have disabilities where conscious sedation would not be appropriate.

How do I prepare for deep sedation?

Your healthcare provider will talk to you about how to prepare for deep sedation. He or she may tell you not to eat or drink anything for 8 hours before deep sedation. You may be able to drink clear liquids up until 2 hours before deep sedation. Tell healthcare providers if you have any allergies, heart problems, or breathing problems. Arrange for someone to drive you home and stay with you for 24 hours after deep sedation. You may feel sleepy and need help doing things at home.

What will happen during deep sedation?

• Your healthcare provider will give you enough medicine to keep you asleep and comfortable. Your healthcare provider will monitor your blood pressure, heart rate, and breathing. You will be on a heart monitor and a pulse oximeter. A heart monitor is a safety device that stays on continuously to record your heart's electrical activity. A pulse oximeter is a device that measures the amount of oxygen in your blood.
• You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. If you cannot breathe well on your own during deep sedation, you may need an endotracheal tube. An endotracheal tube is a thin, plastic tube that is inserted through the nose or mouth and into the lungs. It is attached to a ventilator. A ventilator is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own.

What are the risks of deep sedation?

• You may get a headache or nausea from the medicine. You may have problems with your short-term memory. Your skin may itch or your eyes may water. You may not get enough sedation, or it may wear off quickly. You may feel restless during the procedure or as you wake up.
• Too much medicine can cause you to be unconscious. Your healthcare provider may have trouble waking you, and you may need medicine to help you wake up. Your breathing may not be regular, or it may stop. You may need a ventilator to help you breathe. Your risk for problems with sedation is higher if you have heart or lung disease, a head injury, or drink alcohol.

More information about diseases and disorders of the stomach and oesophagus

• Acute pancreatitis
• Achalasia
• Barrett’s oesophagus
• Chronic pancreatitis
• Coeliac disease
• Dysphagia (difficulty in swallowing)
• Dumping syndrome
• Faecal incontinence
• Gall stones
• Hiatus hernia
• Heartburn and reflux
• Helicobacter pylori
• Indigestion
• Liver cancer
• Oesophageal cancer
• Pancreatic cancer
• Peptic ulcer

More information about diseases and disorders of the Bowel

• Beating Bowel Cancer
• Bowel Cancer UK
• Coeliac UK
• Core Charity
• Macmillan Cancer Support
• Pancreatic Cancer UK
• The Bowel and Bladder Foundation
• Crohn's and colitis
• Helicobacter-pylori
• Irritable Bowel Syndrome