One of the commonest reasons why people come to see one of our doctors at the London Gastroenterology Centre is because they may need an endoscopy. Endoscopy is part of the investigation of a wide variety of disorders including acid reflux, stomach ulcers and Barrett’s oesophagus. In patients who have what we call alarm symptoms such as vomiting, anaemia or unexplained weight loss, endoscopy is again needed as part of the investigations to rule out cancer.
One of the biggest problems with endoscopy however is that it has quite a bad name. Many people find it a very unpleasant test and they tell their friends. Not surprisingly the friends are not keen to have the test done! Let’s face it, who wants to have a tube pushed down their throat and make them feel as if they want to gag.
On the NHS the vast majority of endoscopy tests are done without sedation. A local anaesthetic is simply sprayed on the back of the throat and this is deemed to be adequate. Sadly for many people this is simply not the case and they find the test quite distressing. I have had it done myself and I know how it feels.
It is however quite possible to make the test acceptable and possibly even a pleasant experience. The way to do this is to use a sedative drug.
The standard sedation is performed with a drug called midazolam. This makes the patient a little sleepy and may also help them to forget the experience. When midazolam is given however the dose used is often very limited because of the worries the doctor has that the patient may become too sleepy and have suppression of breathing. The truth is that if it is managed correctly this is an extremely unusual occurrence. The trick is to titrate the dose to ensure that the patient is lovely and relaxed but not deeply asleep. This is pretty straightforward to do.
Another thing that is worth doing is combining drugs so one gives less of each drug and therefore has less side effects but because the drugs have different effects the overall benefit is greater.
For example if one adds a small amount of the opiate drug fentanyl the dose of midazolam used is much lower but the benefit to the patient is very much greater.
Furthermore a local anaesthetic sprayed on the back of the throat just before the procedure will numb the throat and make the requirement for sedation significantly less.
If you are having an endoscopy London please feel free to ask our consultants about how we sedate our patients. Our success rate is very high and our complication rate is extremely low.
No one wants to have an endoscopy but if you are going to need one then at least the experience should be as pleasant as possible.
It is worth pointing out that some people really do not need sedation and they usually know who they are ahead of time. If you think that you are quite comfortable having an endoscopy done whilst fully awake that it is perfectly reasonable and indeed this is the way it is done on the NHS for most patients. For many people however a well judged dose of sedative can make the whole procedure so much more pleasant.