Anesthesia required for a "Flex sig" exam?

Here it is kind of an 'up to you' sort of decision. For people with colons they 'encourage' them to take sedation (it relaxes them and makes it easier on both them and the doctors) but for pouches they don't bother.
Sedation requires a longer outpatient stay. More risk, more time (more money.
Personally when they do my scopes (granted, I've got a k pouch so they enter through an abdominal stoma)I do not get sedated. I am much too curious to watch the screen and see what is going on in there.
It is personal in my opinion. Some people feel like they need it and others don't. Talk to your doctor and discuss how you feel.
Sharon

I always go for sedation as I have pain down there, so it hurts. But some get through it just fine.

For most folks sedation is unnecessary for pouchoscopy. Some folks have particular reasons for preferring or requiring it. I've never considered sedation.

Since we no longer have sigmoid colons, we can't really have a flexible sigmoidoscopy ("flex sig") - the procedure is correctly called "pouchoscopy." The term "flex sig" sometimes still gets used for several reasons: 1) the instrument used is a flexible sigmodoscope (also called a "flex sig"), 2) the staff knows what a flex sig is, but may not know what a pouchoscopy is, and 3) the billing code used is the one for flexible sigmoidoscopy.

Beware an unnecessarily intense prep that might be appropriate for a true flex sig, but simply isn't needed for a pouchoscopy. The pouch can easily be cleaned out with an enema.

If you're able to be sedated then DO IT. There is NO reason to suffer through the pain.

Just have to chime in here because the examination is really quick and quite painless. First a quick feel with her finger and then she inserts the instrument to get a good look. It really takes less than 2 or 3 minutes. I have no prep prior.

That is my experience. Hope it goes as we'll for you as it does for me. Not saying that I like it though

C-jay

It's really a personal decision. There's no right or wrong way to do it, but I've always had mine without sedation. It's not like "screaming out in pain" agony, just really uncomfortable, especially if you have any irritation to begin with. The procedure is so short and manageable. I'm not against sedation at all - had it for my dental implants, etc. - but this is short and you can drive yourself home.

The only time I've had sedation for scopes is for the full colonoscopy. Never had it for a flex sig when I had a colon either. For me, the short duration of manageable discomfort was not worth the extra hours out of my day, or to make someone else take time off to drive me there and back. For an upper endoscopy, there would be sedation too, but I've never had one.

I have been having scopes since I was 15 in 1972, so maybe I just get used to it.

However, if you have strictures or active pouchitis or other reasons you might experience more pain, then it is a different story. Or even if you get too anxious about the procedure it makes sense. Like it was said before, it is a personal choice and should be decided individually. I would recommend trying it without sedation, then you'll know if it is OK for you. Otherwise, how would you know? Medically, it is not necessary.

Jan

Just a pouchoscopy? I can tolerate drug free... However with dilations? DRUGS.

And yes, they will always do an upper GI (EGD) with meds. No one can easily tolerate that scope going down the throat (unless you have zero gag reflex) but a lot of the reason they give you drugs is also so you don't bite down on the expensive endoscope and break its fiber optics.

I've never been sedated for a pouchoscopy. It's no where near as uncomfortable as a sigmoidoscopy and is over before you know it. Also, getting one without sedation doesn't require a driver and day wasted to sedation.

Sue

For me, the only discomfort comes when the doctor inserts air in order to get a better look at the area he is examining. That part of the scoping seems to not even last a minute. I never have sedation anymore. I enjoy watching the procedure on the monitor.

Even brief "procedural" sedation has its own set of risks. Back when I had my colon (stump) I had a flex sig. It seemed to take about 30 seconds and caused absolutely no discomfort at all. I would imagine a pouchoscopy would be even more brief.

No sedation for me, either. It seems unnecessary. For me, the procedure isn't horrible, but the FEAR of pain tends to be more of an issue than the actual brief discomfort of a flex sig.

As to the idea that there is no reason not to have it if offered, I disagree. I recently was given an IV medication following minor surgery (unrelated to j-pouch stuff) and went into acute renal failure from it and spent weeks in the hospital on dialysis. I've never had any kidney issues before, never had any reactions to medication before and I'm not allergic to anything either. Now, almost three months later, my kidney function thankfully has returned to normal but my eyes were opened to the risks that you never think will happen. Not worth it for a flex sig, for me at least, since it wasn't that bad.

I'd suggest bringing an iPod and ear buds, listen to some relaxing or meditative music and it will be over before you know it. Good luck.

I had nothing once when I had cuffitis and it wasn't too bad, he even went up 2 feet past my j-pouch, plus they always take biopsies. I like watching the screen.

The last doctor that gave me one always does them with medication so I didn't argue with him. It depends on how much experience the doctor has doing j-pouch scopes I think.

I like the sedation. It's one of the few times i get a good sleep.

quote:

The last doctor that gave me one always does them with medication so I didn't argue with him. It depends on how much experience the doctor has doing j-pouch scopes I think.

It also depends on how much money your doctor wants to extract from your medical insurance provider. With my old GI, he would bend me over an exam table and be done with it inside ten minutes. No fuss, no muss, pay the $20 co-pay and have a nice day.

Nowadays they want to send you to a clinic, get sedation, do a full bowel prep, get a room, etc. Even if you waive the sedation you still get charged for having the anesthesiologist on hand (in case you fall asleep?). Everyone wants to get paid and what used to be a simple procedure now requires a tremendous amount of time and a bill of a couple of thousand dollars.

If you want to be sedated, wait for the bill to come--that's when you'll need it.

All depends on if you have inflammation or not, at least in my view. I prefer the sedation just because I'm a nervous person at the hospital. If you can tolerate it, why not stay awake, less recovery time. But I like to sleep and not feel/see a thing.

FYI rustyskline,
Both the scopes I'm talking about were done at the Mayo Clinic and the decision not to have conscious sedation was made about 5 minutes before the scope. I have chronic cuffitis so they take biopsies in my entire pouch and look above my j-pouch into my small intestines. In other words it takes longer than 5 minutes but they get me in and out pretty quickly.

WOW, a lot of responses and differing opinions!

Just a bit of perspective on the availability of/recommendation for sedation: In the US it is almost always either regularly done or at least offered. In Canada (KGH, specifically) and the Netherlands, it is almost NEVER routinely done or offered. Even when I was so ulcerated that I was screaming in pain and blacked out (pre-surgery), a full colonoscopy was done with no sedation. Yee haw!

Other than that experience -- which was HELLISH -- I have never had the sedation or even been offered it, and have never felt the need. It's not, you know, a FUN time, but when there is no inflammation it is only uncomfortable, not painful. The air being shot inside can be a bit crampy (think gas cramps), but they always remove it if it is too much.

And I agree with others, I like watching the screen! Hey, we have to get our kicks somewhere.

Gin

Wow I feel like a wimp after reading this. I guess I had a butcher last time or I am just not as tolerant to pain as I thought I was. I had kidney stones and I hear those are one of the most painful things you can go through. My last one he went up to my ileum and that was really painful but not quite like kidney stones,they thought I was going to pass out. So tomorrow I said put me out please. I also have sleep apnea and I guess that changes everything with anesthesia. Oh well. Next time I will try it with light sedation.