Gastroscopy with only throat spray ‘sedation’ + anxiety pill

I am going to have an endoscopy in a few weeks and I have said that without sedation (i.e. being asleep!) I won't do it. Sorry, just no!

Ah ha SuperTinny that is not how my hospital endoscopy department functions, and I can see why your time scale works.
I have subsequently had a barium swallow in the X-ray dept and it was a whole different experience because the staff were much kinder.

I've had two gastroscopys, both with throat spray and sedation, and knew nothing about it at all. A friend had it without sedation, and found it, naturally, very unpleasant.
I would insist on sedation if I were you.

Farzanah

SuperTinny

Farzanah

Well done for persevering HooteNanny.
It doesn’t seem very satisfactory to me to put patients on a conveyor belt of “4 an hour”. Not everyone will cope with the procedure and so there may be a few wasted appointments it strikes me. I think everyone should be offered the choice of sedation if they want.

I think 18 months wait is unacceptable, depending on symptoms. When you receive an appt let them know you are happy to take a cancellation. I would also check if there are other NHS centres with shorter waiting lists that you can be referred to.

Farzanah, I'm afraid 4 gastroscopies an hour is standard in any endoscopy department.

The Bristish Society of Gastroenterologists (BSG) recommend 15-20 minutes per procedure. That includes patient coming into the room, safety checks done, a quick chat with the patient (consultoscopy!) administration of throat spray or sedation, procedure completed and report written.

You are correct that some patients take longer, but some are quicker so it usually manages to balance out over a morning or afternoon list.

It is expected that I should be able to complete 10 patients every list. I am part time and only do 2-3 lists a week but my full time colleagues are expected to do 5 lists a week.

I work in an endoscopy department were we have 5 rooms working every day plus a 6th room for an additional 3 sessions a week. We diagnose/treat upwards of 80 patients a day over a variety of specialities/procedures (not just gastroscopy, which is one of the quickest procedures).

This is standard practice across all endoscopy departments whether it is NHS or separate diagnostic centres.

That’s interesting Super Tinny. That must be why I waited 2hrs for mine when my appt was 2pm and I was eventually called at 4pm, after having had no food or fluids all day and by which time BP was raised!
When they were unable to do my procedure I was given IV sedation before they continued, successfully. The procedure must have taken at least 30 minutes to complete.

Do you feel you have sufficient time to talk/reassure patients and administer IV into tricky veins in 15 mins?

In answer to your question, no we don't always feel that enough time is given but like I mentioned for some it takes longer and others shorter so it does balance itself out.

To help manage our patients expectations our Patient Information Leaflets advise patients that they could be in the department for up to four hours and that their appointment time is not a reflection of their procedure time.

The admission process, consent and cannula insertion takes place prior to coming into the procedure room, and can sometimes take up to an hour. The 15-20 minute clock starts from when you enter the procedure room.

We also have to make time for emergencies that arise on the wards. This isn't, thank goodness, an everyday occurance.

There is no getting away from it, an endoscopy department is a process driven environment. It is a diagnostic service, designed to provide a 'diagnosis' or exclude something, in the same way you might have an Xray or a scan or have blood taken.

I'd say that with the problems you encountered you got away quite lightly with your time frame!

I couldn't have the throat spray because I am allergic to bananas. Had mild sedation, the procedure was fibe

Is transnasel when they stick the tube up your nose If so they tried that with me and I nearly hit the roof it felt like they were poking hard into my brain I pulled it out and told them I couldn’t tolerate it that’s when they suggested I needed sedation and then it was a breeze

SuperTinny

Farzanah

Well done for persevering HooteNanny.
It doesn’t seem very satisfactory to me to put patients on a conveyor belt of “4 an hour”. Not everyone will cope with the procedure and so there may be a few wasted appointments it strikes me. I think everyone should be offered the choice of sedation if they want.

I think 18 months wait is unacceptable, depending on symptoms. When you receive an appt let them know you are happy to take a cancellation. I would also check if there are other NHS centres with shorter waiting lists that you can be referred to.

Farzanah, I'm afraid 4 gastroscopies an hour is standard in any endoscopy department.

The Bristish Society of Gastroenterologists (BSG) recommend 15-20 minutes per procedure. That includes patient coming into the room, safety checks done, a quick chat with the patient (consultoscopy!) administration of throat spray or sedation, procedure completed and report written.

You are correct that some patients take longer, but some are quicker so it usually manages to balance out over a morning or afternoon list.

It is expected that I should be able to complete 10 patients every list. I am part time and only do 2-3 lists a week but my full time colleagues are expected to do 5 lists a week.

I work in an endoscopy department were we have 5 rooms working every day plus a 6th room for an additional 3 sessions a week. We diagnose/treat upwards of 80 patients a day over a variety of specialities/procedures (not just gastroscopy, which is one of the quickest procedures).

This is standard practice across all endoscopy departments whether it is NHS or separate diagnostic centres.

That’s interesting Super Tinny. That must be why I waited 2hrs for mine when my appt was 2pm and I was eventually called at 4pm, after having had no food or fluids all day and by which time BP was raised!
When they were unable to do my procedure I was given IV sedation before they continued, successfully. The procedure must have taken at least 30 minutes to complete.

Do you feel you have sufficient time to talk/reassure patients and administer IV into tricky veins in 15 mins?

Of course you’re not a ‘wuss’! You’re rightly concerned that they won’t be able to complete the procedure if you can’t control your gagging reflex. Your needs should be assessed individually. You’re not wasting the NHS’s time to make sure you’ll be able to have the procedure.

There may be medical reasons why they prefer not to do the endoscopy under heavy sedation, if someone would explain it to you, it might help!

I hope you can speak to a doctor before you have the procedure.

Dont forget you are the customer. You dont have to fit in with what these people say in a sheep like manner. I try to limit my interactions with doctors and hospitals. However I am quite able to advocate for myself and have refused several medical procedures in the last year.

I would threaten a formal complaint in your situation. I insisted upon sedation when I had an endosccopy and colonoscopy in the same session. However as I dont drive I was taking a taxi home and had my nephew with me. So there was no question of driving.

Farzanah

Well done for persevering HooteNanny.
It doesn’t seem very satisfactory to me to put patients on a conveyor belt of “4 an hour”. Not everyone will cope with the procedure and so there may be a few wasted appointments it strikes me. I think everyone should be offered the choice of sedation if they want.

I think 18 months wait is unacceptable, depending on symptoms. When you receive an appt let them know you are happy to take a cancellation. I would also check if there are other NHS centres with shorter waiting lists that you can be referred to.

Farzanah, I'm afraid 4 gastroscopies an hour is standard in any endoscopy department.

The Bristish Society of Gastroenterologists (BSG) recommend 15-20 minutes per procedure. That includes patient coming into the room, safety checks done, a quick chat with the patient (consultoscopy!) administration of throat spray or sedation, procedure completed and report written.

You are correct that some patients take longer, but some are quicker so it usually manages to balance out over a morning or afternoon list.

It is expected that I should be able to complete 10 patients every list. I am part time and only do 2-3 lists a week but my full time colleagues are expected to do 5 lists a week.

I work in an endoscopy department were we have 5 rooms working every day plus a 6th room for an additional 3 sessions a week. We diagnose/treat upwards of 80 patients a day over a variety of specialities/procedures (not just gastroscopy, which is one of the quickest procedures).

This is standard practice across all endoscopy departments whether it is NHS or separate diagnostic centres.

Marydoll

Grandmafrench

Blossoming

Marydoll

It is nothing to do with heroics. For some of us, GA or sedation is deemed too risky by our clinicians.

Same for me Marydoll. It isn’t pleasant but I have no option.

But, unless that includes the Original Poster, that's not an entirely helpful response.

Neither was the comment about heoics.

Or even heroics. 😊

Grandmafrench

Blossoming

Marydoll

It is nothing to do with heroics. For some of us, GA or sedation is deemed too risky by our clinicians.

Same for me Marydoll. It isn’t pleasant but I have no option.

But, unless that includes the Original Poster, that's not an entirely helpful response.

Neither was the comment about heoics.

Blossoming

Marydoll

It is nothing to do with heroics. For some of us, GA or sedation is deemed too risky by our clinicians.

Same for me Marydoll. It isn’t pleasant but I have no option.

But, unless that includes the Original Poster, that's not an entirely helpful response.

Marydoll

It is nothing to do with heroics. For some of us, GA or sedation is deemed too risky by our clinicians.

Same for me Marydoll. It isn’t pleasant but I have no option.

It is nothing to do with heroics. For some of us, GA or sedation is deemed too risky by our clinicians.

The only person who understands properly how you feel about something like this - and what reaction you are likely to have - is you!

It's not meant to be an ordeal, surely, or a test of courage or mental strength. The person to speak to you about not just fears but facts is the Consultant/Anaesthetist, pre-op. Just loading people onto a conveyor belt for such outpatient treatment is hardly going to fit everyone.

Fortunately, here in France, nobody worries about heroics. I have just had two cataract surgeries - one week apart - when my lifetime phobia about eye-related things was really tested. Surgeon almost fell over when I said that I couldn't even consider it without general anaesthesia. His response was that nobody would ever want to inflict trauma on a patient - especially when they needed someone to be quite still and cooperative, in order to do a proper job!

The whole experience was fine once I knew that I would be fast asleep. Next week I shall be discussing an endoscopy. Again, a gag reflex which prevents me from coping with someone even examining my throat, or checking my teeth, without tears pouring down my face and the prospect of just heaving and heaving! The embarrassment and anxiety is awful.
So, Endoscopy under GA. I'd undergo it otherwise if humanly possible, but it's not and we all must recognise our limitations.

Don't give in OP. Don't put yourself through something awful just because ..... Good luck!

"Have you asked why sedation will not be an option for you? Sod being a nuisance, as you call it. I would insist on sedation or referral to another hospital. Don't take No for an answer and good luck"
This is good advice from Sarnia, Hootenanny.
They knocked me out.
I don't know for sure but this sounds like the NHS saving money and it's OK for people who don't care whether they are sedated or not but you do care!!
Sometimes these doors open really easily with just a little push. NHS is just seeing if you'll accept it without challenge?
Challenge it !
I'm a terrible pain Wuss. I won't let a dentist within 10 yards of me without local anasthesia(is that spelt right?) I compensate by sometimes being brave in other areas.
Good luck.

Well done for persevering HooteNanny.
It doesn’t seem very satisfactory to me to put patients on a conveyor belt of “4 an hour”. Not everyone will cope with the procedure and so there may be a few wasted appointments it strikes me. I think everyone should be offered the choice of sedation if they want.

I think 18 months wait is unacceptable, depending on symptoms. When you receive an appt let them know you are happy to take a cancellation. I would also check if there are other NHS centres with shorter waiting lists that you can be referred to.

I'm glad you've managed to stand firm, but what a long wait!!!

I have had two with throat spray. It wasn’t what I would choose for an afternoon entertainment but it really was perfectly bearable and over quite quickly.

I had this procedure with throat spray. As I have a very strong gag reflex and felt I was choking I pulled out the tube in a panic. The consultant tried again with the same result. I asked if sedation would help and she said no you will need to have a general anaesthetic as you have a very strong gag reflex. You need to discuss this with your doctor. A pill for anxiety will not remove your gag reflex.

I had a gastroscopy a few years ago without sedation with no
problems. However a few months ago I had one, done by someone in training and just couldn’t cope with, so had IV sedation and wasn’t then aware of the procedure. In future I would definitely opt for sedation.

I’m definitely not a wimp and cope with most procedures but not that!

SuperTinny, I am currently booked in for a telephone ‘appointment’ next week (my Dr works part time), however I have written her a letter which I will drop off at the surgery. I feel I can explain more fully on paper prior to our conversation.
I spoke to the Community Centre for Endoscopy and have cancelled my appointment. It appears to be a dedicated centre that isn’t actually part of the NHS, and is run by GP’s with special interests in Gastroenterology. They do 4 procedures per hour, which I assume is why they only provide the throat spray, and procedures are charged to the NHS. It was suggested to me by the lady I spoke to that I ‘insist’ on sedation and ask to be put on the waiting list (which apparently is 18 months where I live in our main hospital ). She said the last thing they need is for a patient to be over anxious as the consultant would not go ahead with the procedure, so would be a wasted appointment.
Thank you for your advice and opinion. As many of the GN’s on here say I will have to put ‘my big girl’s pants on’ when I speak to my Doctor and not be bullied into backing down!!
Hetty58, I am hoping that refusing the option without sedation will allow me to be put on the list for the procedure with!
MissAdventure, I certainly will let you know if I manage to get the appointment with sedation, although if I have to wait 18 months to find out get a diagnosis, I may possibly have to contact you via seance . Thanks again to all who have replied.

You may not need to see your GP. Having a telephone consultation will be just as effective.

Before you arrange this if there is a telephone number on the appointment letter phone that and ask why you can't have sedation. At least then you will be able to have that information to hand when you speak to your GP. He may have to re-refer you back in.

It may be, as you suspect, that the community hospital does not offer sedation but the main hospital should still be able to offer this.

I'm a nurse endoscopist (and I wouldn't entertain the idea of a gastroscopy without sedation ). My department trialled offering a non-sedation list a few years ago. We rang every patient and offered it, but it was very labour intensive and the uptake was so low the effort was greater than the gain.

We then trialled just sending an appointment letter out with no choice, but again so many patients refused the appointment unless it was sedation that we eventually gave up on our 'throat spray' only lists.

If you cancel and refuse the option without sedation, you will find that you're offered it.