The sedation
For a colonoscopy or gastroscopy I give you sedation through a drip in your hand or arm. The main medicine is propofol, often with a small dose of a pain-relief medicine. You go into a deep sleep quickly, and most people remember little or nothing of the procedure.
This is different from a full general anaesthetic for an operation. You keep breathing for yourself, and no breathing tube is needed. I stay with you for the whole procedure, give you oxygen through soft prongs in your nose, and watch your breathing, oxygen level, heart rate and blood pressure throughout. The amount of medicine is adjusted continuously so you stay comfortable.
If you have significant heart or lung disease, sleep apnoea, a very high body weight, or have had problems with anaesthesia before, please tell the rooms early so the plan can be tailored to you.
Before your procedure
Bowel preparation (colonoscopy)
Your gastroenterologist or surgeon gives you the bowel preparation and the diet to follow beforehand. Follow those instructions exactly. A clear view of the bowel is what makes the test worthwhile, and a poor preparation can mean the test has to be repeated.
- Clear fluids are important while you take the preparation, to avoid becoming dry and light-headed.
- Stop drinking at the time your hospital gives you, even if you are still thirsty or still passing fluid.
- If you cannot finish the preparation, or are vomiting, call the hospital or your specialist's rooms.
Fasting
Your stomach needs to be empty so that nothing can come back up into your lungs while you are sedated. This matters most for a gastroscopy, where the camera passes through the stomach. Work out your fasting times here, then follow the times your hospital gives you.
Medicines
Keep taking most of your usual medicines with a small sip of water, unless you have been told otherwise. Some need special care before a camera test.
| Medicine | What to do |
|---|---|
| Diabetes medicines called SGLT2 inhibitors (Jardiance, Forxiga, Steglatro, and combinations such as Jardiamet, Xigduo XR, Glyxambi and Qtern) | With bowel preparation: stop them for the 2 days before and on the day of your procedure. For a gastroscopy only, with no bowel preparation: do not take them on the day. These medicines, together with fasting and bowel preparation, can cause a serious condition called ketoacidosis. |
| GLP-1 medicines (Ozempic, Wegovy, Mounjaro, Trulicity, Saxenda, Victoza) | These slow the emptying of your stomach. Follow the GLP-1 medicines guide and tell the rooms you take one. |
| Insulin and other diabetes tablets | Doses usually need to change while you are on a clear-fluid diet and bowel preparation. Ask your GP, diabetes team or specialist for a plan, and check your sugar levels more often. |
| Blood thinners (for example warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel) | Your gastroenterologist or surgeon decides whether to stop these, because polyp removal can bleed. Do not stop them without being told to. |
| Iron tablets | Your specialist may ask you to stop these before a colonoscopy, as they make the bowel harder to see. |
The medicine planner can work out dates for other medicines.
On the day
- Bring a list of your medicines and allergies, and wear comfortable clothes.
- Arrange for a responsible adult to collect you. Your procedure may be cancelled if no one can take you home.
- I meet you before the procedure to check your health, answer your questions and confirm the plan.
- A small drip is placed in your hand or arm. For a colonoscopy you lie on your left side. For a gastroscopy a plastic mouthguard protects your teeth and the camera.
- Most procedures are short. How long depends on what your specialist finds and does.
After the procedure
- You wake in recovery. Many people do not remember the procedure at all.
- Bloating and wind are common after a colonoscopy, because air is used to open the bowel. Passing wind helps.
- A mild sore throat is common after a gastroscopy and settles quickly.
- Your specialist usually talks with you before you leave. Because the sedation can affect your memory, it helps to have your support person there, or to ask for the results in writing.
The next 24 hours
The sedation affects your judgement and reactions for longer than you might expect, even when you feel normal.
- Do not drive, ride a bike, use machinery or work at heights for 24 hours.
- Do not drink alcohol, sign legal documents or make important decisions for 24 hours.
- Have an adult with you overnight if you can.
Risks of sedation
Sedation for a camera test is very commonly given and serious problems are rare. Your specialist will also discuss the risks of the procedure itself.
| Risk | What it means |
|---|---|
| Drop in blood pressure | Common, and usually treated easily with fluid or medicine through the drip. |
| Slowed breathing or low oxygen | Watched for throughout. It is usually corrected by lifting your chin, adjusting the oxygen or giving less medicine. |
| Feeling sick or drowsy afterwards | Uncommon with propofol, and treatable. |
| Stomach contents going into the lungs | Rare. This is why fasting matters and why you must tell us about GLP-1 medicines. |
| Damage to teeth | Rare. A mouthguard is used for gastroscopy. Tell me about crowns, bridges, loose teeth or dentures. |
| Awareness | Some people have brief memories of the procedure. This is not usually distressing, and you will be comfortable. |
| Allergic reaction | Very rare. Tell me about any allergies you have. |
When to get help
Contact your specialist or the hospital straight away, or call 000 in an emergency, if after you go home you have:
- severe or worsening tummy pain, or a swollen, hard tummy
- a fever or feel very unwell
- more than a small amount of blood from your bottom, or black stools
- vomiting, vomiting blood, chest pain or trouble swallowing
- difficulty breathing.