Frequently asked questions

Colonoscopy is an examination of the colon, also called the large intestine, which is the last 5-6 feet of the intestinal tract. The examination is performed with a long flexible and steerable tube (colonoscope). The tip of the tube lights the interior of the colon and projects a color image on video monitors. A variety of instruments may be passed through the colonoscope, allowing the doctor to sample tissue, remove small growths, and perform a variety of treatments.

Once you've completed the cleansing preparation the rest of the procedure is generally easy. You will need to check in at least 45 minutes before your actual planned colonoscopy "start" time to allow for registration and admission to Granite Peaks Endoscopy Center or Alta View Hospital Endoscopy Center. Please bring the following:

• A complete list of your medications, dosages, and frequency of administration.
• A list of your allergies.
• A list of your medical conditions and previous surgeries.
• Your insurance information.
• A responsible adult to take you home.

Once you have registered with the front desk, you will change into a medical gown in a private preparation area. A nurse will review your medical history, medications, and allergies. An IV line will then be placed to allow administration of sedatives during your procedure.

When all pre-procedure preparations have been completed you will be taken by stretcher to the procedure room, where a variety of monitoring devices (electrocardiographic skin electrodes, blood pressure cuff, finger oxygen sensor) will be placed. A nasal cannula will be secured into position to provide oxygen during the procedure.

Once it is time for your endoscopy, you will be transported to a procedure room, where your physician will review your medical history, review the procedure, and address any questions that you may have. Once everything is ready and your gastroenterologist is in the room, the registered nurse assigned to your sedation and monitoring will administer a sedative under the doctor's direction. A technician will assist the doctor. Colonoscopy usually takes about 15 minutes of actual instrument-in-the-body procedure time, though technically demanding procedures may occasionally take twice this long. Most patients sleep through their procedure and begin to awaken shortly after being transported to the recovery room. While the procedure itself is typically painless, some abdominal discomfort and distension from the air used to hold the colon open for examination is common. This sensation usually subsides in a few minutes with some passing of odorless gas, which we require of our patients, regardless of usual social considerations.

Most of our patients are ready to be discharged home about 20 minutes after the completion of their procedure, after reviewing their written procedure report and any necessary instructions with your physician.

Both upper endoscopy and colonoscopy can be undertaken without sedation when a patient is highly motivated to do so and is willing to bear temporary discomfort. Our experience is that most individuals we see in our practice have a strong preference to experience as painless a procedure as possible. If you have a preference regarding your sedation it is important to convey your feelings about this to the gastroenterologist who will be performing your case and who can fully discuss the management options which may best meet your needs.

Most patients feel a little bloated, relaxed, and relieved. Many are hungry and anxious to find some food. We recommend that you eat a light meal to start with, and take it easy for a few hours. Many patients can then resume most of their activities right away, though driving should be restricted until the following day. You should expect to resume all of your normal activities the next day.

This depends on your underlying bowel habit and your diet after the procedure. Most patients return to normal bowel function within 1-3 days.

The most common and important risks of colonoscopy are the risk of missing something, the risk of a perforation, the risk of bleeding, the risk of diverticulitis, and the risk of heart or lung problems related to sedation. Colonoscopy performed by an experienced gastroenterologist is the most and accurate means of detecting abnormalities such as colon cancer or colon polyps, but no test is 100% accurate in this regard.

Possible side-effects from colonoscopy include mild cramping, abdominal pressure and/or a small amount of bleeding. Serious risks with colonoscopy are very uncommon. These may include, but are not limited to, heart or breathing problems which occur in 0.02% of exams, excessive bleeding occur in 0.09% of exams, a perforation, or tear in the colon can occur 0.12% exams or death which is extremely rare, occurring is less that 0.006% of exams. If a polyp is removed, the risk of perforation occurs in 0.3% of exams and bleeding in 1.7% of exams. These complications may require hospitalization, transfusion and, rarely, surgery. Any questions you have about this examination or possible side effects for complications should be thoroughly discussed with your doctor before the exam begins. In rare instances, a tear in the lining of the colon can occur. These complications may require hospitalization and, rarely, surgery.

In most cases, the risks of a serious complication of colonoscopy are easily outweighed by the benefits of cancer prevention and early cancer detection for cure. While events such as perforations are uncommon, they do occur occasionally in the context of a properly and carefully performed colonoscopy. When complications do occur early diagnosis is important to an optimal outcome. If you are having any unexpected symptoms after an examination, such as bleeding, increasing abdominal pain or fever, it is important to contact Granite Peaks Gastroenterology Perforations and similar serious injuries may require surgery for treatment. While sending an otherwise healthy patient for an operation because of a colonoscopy complication is always a very difficult matter, doctors and family members of individuals who have succumbed to colon cancer know that the risk of a very uncommon and fixable problem is much easier to bear than the risk of missing an opportunity to prevent a relatively common and often fatal disease.

No. For decades we have administered IV or oral antibiotics prior to performing some colonoscopic procedures, but practices have changed. In April 2007 the American Heart Association updated its guidelines. The new guidelines state that "the administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GU or GI tract procedures, including diagnostic esophagogastroduodenoscopy and colonoscopy." The guidelines, which were published in the April 2007 edition of the journal Circulation, can be viewed here.

Your full procedure report with photos will be provided to you and reviewed before you are discharged from Granite Peaks Endoscopy. If your procedure is performed at Alta View Hospital, only photographs can be provided because the notes are dictated and have to be transcribed. If any tissue (biopsies, polyps) was removed during your examination it will be forwarded to either Caris or Intermountain Health Care Labs for examination by a pathologist. You will be notified of the pathology results by letter or phone within 7-14 days. A copy of these reports will be provided to your referring provider.

Upper endoscopy is performed to evaluate the esophagus, stomach and duodenum for a variety of disease processes. Common diseases we evaluate and in some cases treat with upper endoscopy include:

Once you've completed the cleansing preparation the rest of the procedure is generally easy. You will need to check in at least 45 minutes before your actual planned colonoscopy "start" time to allow for registration and admission to Granite Peaks Endoscopy Center or Alta View Hospital Endoscopy Center. Please bring the following:

• A complete list of your medications, dosages, and frequency of administration.
• A list of your allergies.
• A list of your medical conditions and previous surgeries.
• Your insurance information.
• A responsible adult to take you home.

Once you have registered with the front desk, you will change into a medical gown in a private preparation area. A nurse will review your medical history, medications, and allergies. An IV line will then be placed to allow administration of sedatives during your procedure.

When all pre-procedure preparations have been completed you will be taken by stretcher to the procedure room, where a variety of monitoring devices (electrocardiographic skin electrodes, blood pressure cuff, finger oxygen sensor) will be placed. A nasal cannula will be secured into position to provide oxygen during the procedure.

Once it is time for your endoscopy, you will be transported to a procedure room, where your physician will review your medical history, review the procedure, and address any questions that you may have. Once everything is ready and your gastroenterologist is in the room, the registered nurse assigned to your sedation and monitoring will administer a sedative under the doctor's direction. A technician will assist the doctor. A plastic mouthguard will also be positioned between your teeth to provide protection of your teeth and the endoscope. An upper endoscopy usually takes about 10 minutes of actual instrument-in-the-body procedure time. Most patients sleep through their procedure and begin to awaken shortly after being transported to the recovery room. Most of our patients are ready to be discharged home about 20 minutes after the completion of their procedure, after reviewing their written procedure report and any necessary instructions with your physician.

Gastroenterologist-directed Propofol Sedation. Gastroenterologist-directed propofol sedation consists of the intravenous administration of individualized doses of a single sedative-hypnotic agent (propofol) under the continuous direction of the gastroenterologist by a trained registered nurse.

The principle advantages of propofol sedation compared to traditional sedation include:

• A very rapid onset of action, allowing accurate dose adjustments as needed during the procedure
• A higher likelihood of full relief of discomfort during the procedure, even for patients who may be difficult to adequately sedate with traditional sedation consisting of fentanyl and versed.
• Very rapid recovery, without lingering amnesia or a sense of being sedated throughout the day.
• Nausea during recovery rarely occurs
• Higher patient and physician satisfaction with the quality of sedation

Safety. Propofol has been shown to be as or more safe than traditional sedation when administered by gastroenterologists and nurses who have undergone specific training in its use and who follow propofol-specific deep sedation protocols. As with any sedative, a small risk of allergic or cardiopulmonary complications exists, even with proper use by experts.

Breastfeeding mothers are understandably concerned about the effects their sedation may have on their breastfeeding child. Research into the safety of drugs typically used for endoscopic sedation in the breastfeeding mother is limited, but the available data are reassuring. For further details pertaining to propofol and breast feeding, please refer to:

Analgesia and Anesthesia for the Breastfeeding Mother: Clinical Protocol of the Academy of Breastfeeding Medicine

Most patients feel relaxed and relieved. Many are hungry and anxious to find some food. We recommend that you eat a light meal to start with, and take it easy for a few hours. Many patients can then resume most of their activities right away, though driving should be restricted until the following day. You should expect to resume all of your normal activities the next day.

The most serious and important risks of EGD are the risk of missing something, the risk of a perforation (which is rare), the risk of bleeding and the risk of heart or lung problems related to sedation (which are very uncommon). EGD performed by an experienced gastroenterologist is the most accurate means of detecting abnormalities such as Barrett's esophagus, ulcers and cancers in the upper GI tract, but no test is 100% accurate in this regard.

In most cases, the risks of a serious complication of EGD are easily outweighed by the benefits. While events such as perforations are rare, they may occur in the context of a properly and carefully performed procedure. When complications do occur early diagnosis is important to an optimal outcome. If you are having any unexpected symptoms after an examination, such as increasing pain in your throat, neck, chest or abdomen, black or bloody bowel movements, vomiting, or fever, it is important to contact Granite Peaks Gastroenterology immediately and confer with your gastroenterologist or with the doctor who is providing coverage if your gastroenterologist is not available. Perforations and similar serious injuries may require surgery for treatment.

No. For decades we have administered IV or oral antibiotics prior to performing some upper endoscopic procedures, but practices have changed. In April 2007 the American Heart Association updated its guidelines. The new guidelines state that "the administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo GU or GI tract procedures, including diagnostic esophagogastroduodenoscopy and colonoscopy." The guidelines, which were published in the April 2007 edition of the journal Circulation, can be viewed here.

Your full procedure report with photos will be provided to you and reviewed before you are discharged from Granite Peaks Endoscopy. If your procedure is performed at Alta View Hospital, only photographs can be provided because the notes are dictated and have to be transcribed. If any tissue (biopsies, polyps) was removed during your examination it will be forwarded to either Caris Labs or Intermountain Health Care Labs for examination by a pathologist. You will be notified of the pathology results by letter or phone within 7-14 days. A copy of these reports will be provided to your referring provider.