Combined gastroscopy/colonoscopy

Your doctor has requested an endoscopic procedure for you. You have been explained what this procedure entails and possible complications that may arise. You have also been asked whether you are taking any form of anticoagulants (blood thinners), aspirin or clopidogrel. You have been instructed to continue, discontinue or temporarily replace those medications. Please contact your doctor if you have questions about the instructions.

• You will have to bring a companion / driver. Please organize this prior to the procedure
• You will receive specific instructions for the bowel prep in a separate flyer
• For procedures in the morning hours, you will have to start fasting from midnight onwards. You have to finish drinking the bowel prep two hours before the procedure starts. If the procedure takes place in the afternoon, it is allowed to have a “small breakfast” before 8 o’clock in morning (please check the dietary instructions in the bowel-prep flyer). You are permitted to take your medication with some water. Fasting means: do not drink, eat or smoke.

When your doctor requested the endoscopic procedure, the decision is made that you will undergo the procedure under conscious sedation. We use a combination of a hypnotic drug (midazolam) and a painkiller (fentanyl) to make you comfortable. This is not general anesthesia! We do not promise you falling asleep or feeling or hearing nothing at all during the procedure. We expect to perform the procedure without problems, with you being comfortable; most people do not remember anything or very little after the procedure.

Because people tend to breathe more superficial, we will connect you to a monitor to cover your heartbeat, blood pressure and saturation.

By law, you are prohibited to engage in traffic or make important decisions (like signing a notarial deed) after receiving conscious sedation. You are strongly advised not to drink alcohol after the procedure.

Upper endoscopy lets your doctor examine the lining of the upper part of you gastrointestinal tract, which includes the esophagus, stomach and duodenum (first part of the small intestine). Your doctor will use a thin, flexible tube called endoscope, which has its own lens and light source, and will view the images on a video monitor. You might hear your doctor or other medical staff refer to upper endoscopy as gastroscopy of esophagogastroduodenoscopy.

Before starting the procedure, you will usually get a very small drink with anti-foam medication. This allows for better vision of the lining of the stomach. If you have dentures, we ask you to take them off. Also, some local anesthetic is sprayed in your throat. After all this, the nurse places a plastic ring between your jaws (this protects you teeth and our endoscope).

You’ll then lie on your left side as  the doctor passes the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn’t interfere with your breathing. Most patients consider this procedure only slightly uncomfortable.

Colonoscopy enables your doctor to examine the lining of your colon (large intestine) for abnormalities by inserting a flexible tube as thick as a finger into your anus and slowly advancing it into the rectum and colon. You will lie on your left side while the physician advances the colonoscope through your colon (and possibly the last part of the small intestine). The doctor will examine the lining carefully as she or he slowly withdraws the colonoscope. The procedure itself usually takes 15 to 30 minutes.

Colonoscopy is well-tolerated and rarely causes much pain. You might feel pressure, bloating or cramping during the procedure. Sometimes the doctor will ask you to turn to your back or right side during the procedure in order to pass the endoscope easier through the colon and make you more comfortable. At times, a nurse will support your abdomen from the outside to prevent looping of the endoscope.

In some cases, the doctor cannot pass the colonoscope through the entire colon to where it meets the small intestine. Sometimes it is necessary to do another procedure or scan instead. Your doctor will tell you and your companion about this directly after the procedure.

If your doctor thinks an area needs further evaluation, he or she might pass an instrument through the endoscope to obtain a biopsy (a sample of the lining) to be analyzed. This will usually not cause any pain, but may lead to some blood loss. If the doctor finds polyps during the examination, they can usually be removed in the same procedure. This is done by cutting them loose with a wire loop or using a technique called “snare polypectomy”. That technique involves passing a wire loop through the endoscope and removing the polyp by using an electrical current. You should not feel pain during the polypectomy.

The Maastricht University Medical Center is a teaching hospital. It may be possible that the endoscopic procedure is performed by a trainee under supervision of a certified gastro-enterologist. At times, medical students are present to watch; your permission will then be specifically asked.