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Can Endoscopic Ultrasound And Colonoscopy Be Done Without Sedation?

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Posted on Wed, 17 Sep 2014
Question: Hi -

My gastroenterologist has recommended "Endoscopic Ultrasound - EUS" and colonoscopy procedure.

I want to find out if I can have thess procedures done without sedation or short-anesthesia.
Generally doctors prefer that patient is under sedation or anesthesia when doing procedure.

I want to know if the procedure can be done without sedation/anesthesia. If yes, are there any risks/benefits?

I heard that there are some risks associated with sedation or anesthesia.

Will greatly appreciate your opinion on this.

Best Regards

XXXX
doctor
Answered by Dr. Dr Samir Patil (7 hours later)
Brief Answer:
Sedation will prevent discomfort

Detailed Answer:
Hello Mr XXXXXXX
Yes both these procedures are usually done using shot acting sedation or anesthesia. Some centers do not use sedation for colonoscopy, but almost all centers use sedation for endoscopic ultra sound.
I would advice you to get Both these procedures under sedation.
Yes there are certain risks associated with anesthesia. But they are not high enough to advise against their use. Sedation will make the entire experience comfortable.

The risks depend on the type of anesthetic used. Please consult your doctor or anesthetist who will XXXXXXX you about the drugs he will be using and their risks.
In case midazolam is used the common side effects are drop in BP and slowing of respiration, both of which can be managed easily.

Hope this helps

Regards,
Dr Samir Patil
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr Samir Patil (2 hours later)
Hello Dr. XXXXXXX -

Thanks for your response.

I had EGD (Endoscopy for upper GI track) couple of years back without any sedation or anesthesia. It was little discomfort and was having gag feeling
but I was still able to tolerate it.

I don't know how different the upper EUS (upper endoscopic ultrasound) from EGD. If it's not much different then I probably would try doing it without sedation or anesthesia.

I think most doctors use propofol for sedation during endoscopy/colonoscopy procedures in USA.

I heard in XXXXXXX and other asian countries the upper endoscopy is done without sedation/anesthesia. They use some kind of local anesthesia. Is that correct?

1) Do you think, if I was able to tolerate EGD without sedation/anesthesia in past, Can I tolerate EUS (upper endoscopic ultrasound) without sedation/anesthesia too?

2) What is the safest and mildest form of sedation for this procedure in your opinion?

Thanks again for your time and expert advice.

Best Regards

XXXX
doctor
Answered by Dr. Dr Samir Patil (15 minutes later)
Brief Answer:
Would advice sedation for EUS

Detailed Answer:
Hello Mr XXXXXXX
In some centers in XXXXXXX EGD is done without sedation as it is a short procedure.
Some centers also do colonoscopy without sedation and administer sedation on an as required basis.

In My practice we Use midazolam with fentanyl as a sedative and propofol on an as per requirement basis. We use sedation for all EGD and colonoscopies unless the patient doesn't want it. We use sedation for all EUS procedures.

EUS is similar to EGD but the endoscope is thicker and the procedure might take more time than an EGD.
Sedation will make the procedure comfortable for you .
Propofol is a safe option its side effects are fall in blood pressure and slowing of respiration which if they occur can be managed by the anaesthetist or nurse if required.
My advice would be to Go for sedation for both EUS and colonoscopy.
though Colonoscopy could be attempted without sedation.
Hope this helps
Do get back if you have further queries
Dr Samir Patil
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr Samir Patil (36 hours later)
Hello Dr. XXXXXXX -

Thanks for your response.

I had my EGD and EUS both done this morning. I did not get any sedation/anesthesia and It went well. It was tough and painful but I was able to tolerate it.

Doctor took biopsy and I'm waiting on the results.

Wondering, what kind of symptoms I should look for after the procedure to see that there are any complications (perforation, bleeding from biopsy, infection) developing?

Is there anything I need to be watchful about?

I greatly appreciate your time and expert advice.

Best Regards

XXXX
doctor
Answered by Dr. Dr Samir Patil (9 hours later)
Brief Answer:
Complication rates are low

Detailed Answer:
Hello Mr XXXXXXX
Glad to hear thant you got through the procedures without any major problems. Complications can occur in about 1 in 50 procedures.

They depend on whether an FNAC or a trucut biopsy was taken and the site of the biopsy.

Infection rates are very low and fever is more common in biopsies from pancreatic cysts(.you must have received an antibiotic before the biopsy)
In worst case scenario the bleeding rates are 2 % and are mor common in pancreatic cysts.

Perforation if they occur are minor and do not need surgical intervention.

Pancreatitis can occur if the biopsies were taken from the pancreas.Is usually mild

None of these are likely to cause major problems.

I would advise to watch out for upper abdominal pain, black colours stools, vomiting, and fever, contact your doctor if any of these occur

Hope this helps do get back if you have further queries
Regards
Dr Samir Patil
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr Samir Patil (50 minutes later)
Hello Dr. XXXXXXX -

The doctor did biopsy from esophagus and stomach during EGD.
He did not do FNAC.
Is the EUS very accurate to rule out tumor of pancrease and other organs?

Thanks and Regards

XXXX





doctor
Answered by Dr. Dr Samir Patil (15 minutes later)
Brief Answer:
Accurate for tumors of the pancreas

Detailed Answer:
Hello Mr XXXXXXX
EUS is very good to detect small tumors in the pancreas. It is also a less invasive and a safe way to take biopsies from the pancreas and the region around the esophagus( mediastinum). It is also useful to identify and take biopsies from submucosal nodules in stomach and esophagus.
Hope this answers your query.
Regards
Dr Samir Patil
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr Samir Patil (21 hours later)
Hello Dr. XXXXXXX -

Thank you very much for your response.

I'm still waiting on my reports for EUS and EGD but after the procedure doctor told me that I have a pancreatitis. Is it easily treatable? What cause it and what is the treatment for it?

BTW, I have my colonoscopy scheduled for next week. Since I was able to tolerate EUS/EGD well without sedation, I will also try colonoscopy without sedation too.

Best Regards

XXXX
doctor
Answered by Dr. Dr Samir Patil (11 hours later)
Brief Answer:
Alcohol and gall stone cause pancreatitis

Detailed Answer:
Hello Mr XXXXXXX
The treatment of pancreatitis is Symptomatic medications.
Analgesics for pain, enzyme supplements for mal absorption( which can occur by reduced digestive juice secretion by the pancreas). And treatment of diabetes if present.

Surgery is required if one has gall stones or intractable pain. The common causes of pancreatitis are alcohol and gall stones.
Hope your colonoscopy goes smoothly
Regards
Dr Samir Patil
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Dr Samir Patil (39 hours later)
Hello Dr. XXXXXXX -

Thank you very much for your time, help and expert advice!
I greatly appreciate it!

Best Regards

XXXX
doctor
Answered by Dr. Dr Samir Patil (22 minutes later)
Brief Answer:
Good health

Detailed Answer:
Hello Mr XXXXXXX
It was a pleasure to help you.
If no further clarifications you can close and rate the query.
Hope you get well soon
Regards
Dr Samir Patil
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
Answered by
Dr.
Dr. Dr Samir Patil

Gastroenterologist

Practicing since :1997

Answered : 551 Questions

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Can Endoscopic Ultrasound And Colonoscopy Be Done Without Sedation?

Brief Answer: Sedation will prevent discomfort Detailed Answer: Hello Mr XXXXXXX Yes both these procedures are usually done using shot acting sedation or anesthesia. Some centers do not use sedation for colonoscopy, but almost all centers use sedation for endoscopic ultra sound. I would advice you to get Both these procedures under sedation. Yes there are certain risks associated with anesthesia. But they are not high enough to advise against their use. Sedation will make the entire experience comfortable. The risks depend on the type of anesthetic used. Please consult your doctor or anesthetist who will XXXXXXX you about the drugs he will be using and their risks. In case midazolam is used the common side effects are drop in BP and slowing of respiration, both of which can be managed easily. Hope this helps Regards, Dr Samir Patil