Before and after endoscopy: what to do?

For many people, the thought of an endoscopic examination can be daunting. Uncertainty, fear of the procedure and questions about preparation are all natural. Our aim with this detailed guide is to allay any fears and provide clear, practical advice to help you through the whole process, from pre-examination to post-operative care. Find out what you can expect and how to make your trial as smooth as possible.

Endoscopy, also known as fluoroscopy, is an extremely important diagnostic and therapeutic procedure in gastroenterology. It allows doctors to directly examine the inner surface of the digestive tract, take samples or even perform minor procedures such as polypectomy. Although the idea of a thin, flexible device being inserted into the body may at first seem daunting, modern technology and anaesthesia options minimise discomfort.

In this article, we will go through the most common endoscopic examinations - gastroscopy and colonoscopy - in detail before and after the procedure. We also cover the steps to prepare for the procedure, dietary restrictions, medication, possible complications and the recovery period. Knowledge will give you confidence and help you understand that these tests are for your health. A Endomedix Gastroenterology Centre professionals are committed to providing you with maximum safety and comfort at every stage of the examination.

What is endoscopy?

Endoscopy is an umbrella term covering medical procedures that use a flexible tube with a camera called an endoscope to examine the inside of body cavities, such as the digestive tract. The image transmitted by the camera is displayed on a monitor, allowing the doctor to see the inside of the oesophagus, stomach, duodenum or colon in real time.

The most common endoscopic procedures:

• Gastroscopy (gastroscopy of the stomach): Examination of the initial part of the oesophagus, stomach and small intestine (duodenum), which is introduced through the mouth. It is usually performed with a flexible instrument 6-9 mm in diameter.
• Colonoscopy (colonoscopy of the colon): Examination of the entire large intestine and the final section of the small intestine through the rectum. The endoscope used is thicker, 9-12 mm in diameter.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): A special endoscopic examination with lateral optics to map and treat the bile ducts and pancreatic duct.

These tests are not only diagnostic (e.g. to detect inflammation, ulcers, tumours), but also suitable for therapeutic interventions such as haemostasis, polypectomy, dilatation of strictures or removal of gallstones.

Preparing for the endoscopic examination

Proper preparation is the key to a successful and safe test. The steps may vary depending on the type of test. Always follow your doctor's or nurse's instructions exactly. Endomedix Gastroenterology Centre specific instructions from your colleagues!

Preparations for gastroscopy (Gastroscopy)

A gastroscopy requires relatively simple preparation. The most important thing is that the stomach is empty during the examination so that the doctor can see the mucous membrane clearly.

• Starvation: Before the investigation No eating for 6-8 hours. This means that if the test is in the morning, you should not eat solid food the night before.
• Fluid consumption: Before the test do not drink any liquids (water, tea) after 4 hours. If gastric outlet obstruction is suspected, the doctor may recommend a longer period of fluid withdrawal, up to 8-12 hours.
• Medicines: Discuss with your doctor whether you can take your regular medicines on the morning of the test. Most medicines (such as antihypertensives) can be taken with a sip of water, but there are exceptions.

Preparations for colonoscopy (colonoscopy)

Colonoscopy requires more thorough preparation, as the entire colon must be cleaned of stool. A clean bowel wall is essential for accurate diagnosis and safe removal of polyps.

• Diet before the test:

- 3-4 days before the test: Start following a low-fibre diet. Avoid foods that are high in seeds and fibre (e.g. wholemeal baked goods, muesli, vegetables, fruits with skins, small seeded fruits such as raspberries or kiwis) as these can remain in the intestinal tract and make cleansing difficult. Instead, eat white bread, pasta, rice, boiled potatoes, eggs, fish, chicken.

- The day before the test: On this day, you can only drink liquids. This can be filtered soup (meat soup without pasta and vegetables), fibre-free fruit juices (e.g. apple juice), tea, coffee (without milk and cream), carbonated and non-carbonated soft drinks, water. Avoid red or purple coloured drinks as they may discolour the intestinal wall, making the test more difficult.

• Colon cleansing liquid (laxative):

- The day before the test or the morning of the test (depending on the time of the test), you will need to take a special colon cleansing solution prescribed by your doctor. This is usually a large amount (2-4 litres) of a salty-tasting liquid to be drunk over a set period of time.

- It is important to consume the full amount prescribed, even if it is unpleasant. The effect will be severe diarrhoea, leading to complete evacuation of the intestinal contents. Eventually, only clear, yellowish liquid will be left. This indicates successful bowel cleansing.

- Tip: The laxative liquid is easier to drink when it is cooled. You can also flavour it with a little lemon juice if your doctor's instructions don't say not to.

• Medicines and other things to do:

- Anticoagulants: If you are taking an anticoagulant (e.g. Syncumar, Warfarin) or antiplatelet (e.g. Aspirin, Plavix), be sure to tell your doctor well in advance of the test. Your doctor will decide whether you need to stop or change the medicine you are taking. This is particularly important if you are planning a polypectomy.

- Copper products: Iron tablets should be stopped at least 5 days before the test because they blacken the stools and make it difficult to clean the bowel and the test.

What happens during the test?

From Endomedix Gastroenterology Centre uses modern procedures to ensure that the examination is as uncomfortable as possible. Most endoscopic procedures are now performed under general anaesthesia.

• Arrival and preparations: On arrival, your details will be checked and you will be prepared for the test. An intravenous cannula will be inserted into your arm, through which you will receive sedatives and painkillers.
• Picking: A specialist anaesthetist or assistant will administer the medicine through a cannula, which will make you relax, feel drowsy or fall asleep completely. The depth of the sedation will be adapted to the type of intervention and your condition. In most cases you will not remember the test.
• The investigation: While you are asleep or in a stupor, your gastroenterologist will carry out the test. You will feel no pain when the endoscope is inserted and moved. The doctor will carefully examine the mucous membrane, take a biopsy or perform any other necessary procedure (e.g. polyp removal).
• Monitoring: Throughout the test, an assistant will monitor your vital signs (blood pressure, pulse, oxygen levels) to ensure that the procedure is carried out in maximum safety.

The post-investigation period

After the procedure, you will be placed in a comfortable recovery room where you can rest under supervision until the sedatives wear off completely. This usually takes 1-2 hours.

What to do immediately after the test

• Observation: During the wake-up period, staff will monitor your condition. When you are fully alert and stable, you can wake up.
• Findings and consultation: The examining doctor will inform you of the results after the rest period. You will receive a written report and the next steps will be discussed. If a histological sample has been taken, you will usually have to wait a few weeks for the result.
• Eating and drinking: You can usually eat and drink 1-2 hours after a gastroscopy, unless your doctor tells you otherwise. You can also return to normal eating soon after a colonoscopy, so it is a good idea to start with light meals.
• Escort and return journey: It is very important that you arrive with an escort after the examination in the sedation room and that he/she takes you home! On the day of the test driving, drinking alcohol, making important decisions or operating dangerous machinery, because medicines affect reaction times and judgement. Plan to spend the rest of the day relaxing at home.

Possible side effects and complications

Endoscopic examinations are extremely safe procedures, but like all medical interventions, they can have side effects or, rarely, complications.

Common, mild side effects:

• Bloating, abdominal cramps: It is common after a colonoscopy, as air is blown into the bowel during the examination to improve visibility. This usually disappears within a few hours as the wind passes.
• Sore throat, hoarseness: It can occur after gastroscopy and usually goes away within a day.

Rare but serious complications that require immediate medical attention:

• Severe, persistent abdominal pain: Especially if it gets worse.
• Significant bleeding from the rectum: A small amount of blood may be seen in the stool after polyp removal, but continuous bright red bleeding is abnormal.
• Fever, chills.
• Black, pitchy stools.
• Vomiting (especially if bloody).
• Chest pain, difficulty swallowing.

If you experience any of the above symptoms in the hours or days after the test, contact the investigating institution, your GP or the nearest emergency department immediately.

When the diagnosis is made

Endoscopy helps to understand the causes behind the symptoms. Whether it's reflux disease, inflammatory bowel disease (IBD), ulcers or polyps to prevent colon cancer, an accurate diagnosis is the first step to effective treatment and cure.

From Endomedix Gastroenterology Centre experienced specialists not only perform examinations using the latest technology, but also provide support and detailed information throughout the process. Our goal is to make you feel safe and as comfortable as possible while we work together to improve your health.

Don't delay the necessary tests because of your fears! With the right preparation and professional care, endoscopy is a routine, painless procedure that can be a key benefit for you.