Esophagoscopy & Barrett’s Procedure Instructions
Esophagoscopy is a type of endoscopy (EGD) that doesn’t require incisions. It is performed with an endoscope – a long, narrow, tube-like device with a light and a camera. This procedure allows your doctor to examine your esophagus for abnormalities, take a tissue sample (biopsy) to test for certain conditions, or perform treatments.
Barrett’s esophagus is a change in the lining of the esophagus, typically in response to chronic acid damage. It increases the risk of cancer in a significant percentage of patients. Our physicians are fully trained to treat Barrett’s esophagus using Radio Frequency Ablation. Tissue biopsy using endoscopy (EGD) can determine if you have Barrett’s esophagus. Screening may be recommended for those with uncontrolled gastroesophageal reflux disease (GERD) who have not respond well to acid reflux treatment.
An endoscope is inserted through your nose or mouth to allow your doctor to see the inside of your upper gastrointestinal (GI) tract. This includes your esophagus, stomach and the beginning of your small intestine. It may be performed to determine what’s causing abnormal throat, stomach or intestinal symptoms. It can be used to biopsy tissue to diagnose cancer or other conditions, such as dysphagia or gastroesophageal reflux disease (GERD).
What can I expect for sedation with my procedure?
Oregon Endoscopy Center (OEC) offers two different types of procedural sedation for endoscopic procedures: moderate sedation (also referred to as conscious sedation) and deep sedation. Both are safe for most patients, and your vital signs and breathing are monitored throughout the procedure during both types of sedation. Please note that these types of sedation are NOT general anesthesia that you would expect during surgery but are known as procedural sedation. Your doctor will determine which of these types of sedation is right for you when you are scheduled for your procedure, and it will also be run through your insurance to see which one is covered on your plan. Both modes of sedation aim to keep you comfortable enough to tolerate the procedure and to lie still enough so your doctor can examine your colon or upper GI tract organs (esophagus, stomach, and small bowel) thoroughly and safely. The vast majority of patients prefer deep sedation over moderate sedation due to a much faster recovery from the sedating effects of the sedatives.
Moderate Sedation
If you are scheduled for moderate sedation, you will have medications administered through your IV by a sedation-qualified registered nurse (RN) whose main role is to ensure you are comfortable and safe during the procedure. They will monitor your vital signs and breathing throughout the procedure. All RNs and physicians at Oregon Endoscopy Center are certified in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS).
Moderate Sedation Medications. RNs use a combination of medications that help you relax and decrease pain so you are comfortable during the procedure. The two most common medications used are fentanyl and midazolam, but other similar medications can be used if you have an allergy to these medications. The RN will give you small doses of medication at a time before the start of the procedure to make you drift off to sleep. The RN will administer more medication if you become uncomfortable during the procedure. Near the end of the procedure, they will allow you to wake up naturally. During the procedure, you should be able to open your eyes and respond if your nurse talks to you, and you should be able to follow their directions, i.e., rollover or take a deep breath. However, because of how these medications work, you will most likely not remember being briefly awakened during the procedure.
Breathing and Monitoring. As the medications start to work, they will make you sleepy, and your heart rate, breathing, and blood pressure may slow down or decrease. You will have an oxygen tube in your nose to keep your oxygen levels normal. Your vital signs, including blood pressure, heart rate, breathing rate, and oxygen levels, will be monitored continuously by the RN throughout the procedure.
Recovery. After the procedure, you will be brought back to the recovery area and monitored for another 20-30 minutes by the nursing staff. You will start to wake up near the end of the procedure and then even more in recovery. Conscious sedation medications wear off quickly, but everyone is different; some people are affected longer than others. You may feel sleepy, lethargic, woozy, foggy, forgetful, dizzy, light-headed, or “out of it” for many hours after this type of sedation. It is important to have a responsible driver to drive you home after the procedure and remain with you for a few hours, if possible. You should not drive, operate machinery, climb ladders, do any strenuous activities, drink alcohol, or use marijuana products after receiving conscious sedation. You may drive and return to normal activities the day after your procedure.
Deep Sedation
If you are scheduled for deep sedation, you will have medications administered through your IV by a certified registered nurse anesthetist (CRNA) whose main role is to ensure you are comfortable and safe during the procedure. They will monitor your vital signs and breathing throughout the procedure. All CRNAs are certified in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS).
CRNAs are registered nurses who have received higher education focusing on anesthesia. They are not medical doctors.
Deep sedation. CRNAs mainly use a medication called propofol that will allow you to sleep during the procedure. Occasionally, the CRNA may give other medications, such as a strong narcotic, sedative, or medication to decrease pain at the IV site, in addition to propofol. It is not the norm in most cases, but it may be necessary in some cases to make sure you are comfortable. The CRNA will administer a dose of propofol to get you to sleep quickly to achieve deep sedation, then give you more throughout the procedure to keep you asleep. Near the end of the procedure, they will stop giving you the propofol, so you wake up naturally. You will be unaware of the procedure or discomfort while under deep sedation.
Breathing and Monitoring. Deep sedation will make your heart rate, breathing, and blood pressure slow down or decrease, but typically only a small and inconsequential amount. However, you will be breathing on your own, as breathing tubes/machines are unnecessary, and you will have oxygen tubing in your nose to assist with oxygen levels. Your vital signs, including blood pressure, heart rate, breathing rate, and oxygenation status, will be monitored continuously by the CRNA throughout the procedure.
Recovery. After the procedure, you will be brought back to the recovery area and monitored for another 20-30 minutes by the nursing staff. You will start to wake up near the end of the procedure and even more in recovery. Propofol wears off quickly, but everyone is different; some people are affected longer than others. Propofol is known to have people feeling back to normal much quicker, unlike other types of sedation, but it is still quite individualized. You may feel sleepy, lethargic, woozy, foggy, forgetful, dizzy, light-headed, or “out of it” for many hours after this type of sedation. However, all patients do not experience these effects after propofol. It is important to have a responsible driver to drive you home after the procedure and remain with you for a few hours, if possible. You should not drive, operate machinery, climb ladders, do any strenuous activities, drink alcohol, or use marijuana products after receiving propofol sedation. You may go back to normal activities the day after your procedure.
An esophagoscopy comes with only minor risks. Most complications are temporary and resolve quickly. Possible risks include sore throat, minor difficulty swallowing for a few days and, rarely, injury or tearing (perforation) of esophagus tissue.
Many methods have been investigated to eliminate (or ablate) Barrett’s esophagus: freezing (cryotherapy), laser, electrical burning (cautery), and radio-frequency energy.
The best treatment is Radio Frequency Ablation (RFA), which is energy delivered to precisely destroy (or ablate) the Barrett’s tissue. The advantage of this method over others is the very precise depth of energy penetration, which decreases the frequency of complications.
The physicians of Eugene Gastroenterology Consultants are fully trained in using Radio Frequency Ablation to treat Barrett’s esophagus in those patients in whom ablation (or destruction) of Barrett’s esophagus is felt to be appropriate. At this time, not every patient with Barrett’s esophagus needs to undergo Radio Frequency Ablation. If you are interested in this treatment but are not sure if you are an appropriate candidate, please make an office appointment to discuss this option in detail.
Pre-Procedure
When your procedure is scheduled, you will be given specific instruction for preparing for your exam. The prep instructions vary, depending on the time of your appointment, as well as other factors. If you have any questions regarding your prep, contact us.
Post-Procedure
You may experience a sore throat following the procedure, which may last several hours. You may find warms drinks soothing. You may also take Tylenol for minor discomfort. If your pain becomes severe, please contact us.
After ablation of Barrett’s esophagus, it is common to experience significant chest pain that may last for several days. Sometimes, the pain is severe enough that even drinking water may be very uncomfortable. Your physician has provided prescriptions for pain control and stomach acid control. Please use these medications, as directed by your physician. The chest pain should gradually resolve. If your pain is not responding to pain medications, lasts longer than 5 days, or is worsening instead of improving, contact us.
You should consume only liquids for the first 24 hours after the ablation. Liquids, such as Carnation Instant Breakfast, Ensure, Boost, and Slim Fast are encouraged for balanced nutrition. It is recommended that you consume only soft foods for the first few days after your procedure, then a regular diet as your pain subsides. Avoid highly acidic foods, such as citrus, carbonated beverages, and spicy foods that may worsen the pain.
You may experience uncomfortable gas pain, due to the stomach having been inflated with air during the exam. This discomfort should pass with burping and with the passage of time.
Nausea may be caused by the presence of gas, effects of medication for sedation, or pain, and may last several hours. Should nausea persist into the next day or is you have significant vomiting, please contact us.
Localized irritation of the vein (phlebitis) may occur at the IV site. If you notice a red streak progressing from the IV site upward, antibiotics may be needed; contact us.
Forgetfulness is normal immediately after the procedure. This is due to the use of a sedative that causes temporary amnesia. If you have questions about your procedure that have not been addressed in your discharge papers, contact us.
If you experience fever, severe pain, difficulty breathing, signs of bleeding, or any other significant concerns, contact your physician immediately by calling 541-868-9500.
Since ablation is the controlled destruction of tissue, there are risks involved. The most common risks are pain, bleeding, side effects of medications given for the procedure, and infection (mostly at the IV site). Less common but more serious complications include stricture formation (narrowing of the esophagus), perforation (causing a hole in the esophagus), and aspiration (having liquid get into the airway). Strictures cause difficulty swallowing (food getting “hung up” in the chest area) and may not be apparent for weeks or months after the ablation. Perforations lead to severe chest pain and difficulty breathing. For information about RFA using instruments manufactured by Barrx, visit this website.
Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.
