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.

I usually go no sedation because then I can drive myself home and I like to see what my pouch looks like. Discomfort is minimal-insertion is the most uncomfortable moment, other than that, just a little pressure and a pinch feeling for biopsy.

I just had a scope last Monday and thankfully I had sedation. I've been battling Pouchitis and I have a new pouch which my GI suspected might have strictures; which it did had and he dilated them. I'm happy that I was sedated for the procedures after reading everyone's responses; sounds like it would have been painful without it.

I've had them with and without sedation. Even when I'm sedated, I'm generally aware of what's going on. Unlike some people, I've never been "totally out" for a scope even when I do have sedation, so I always feel things to some degree. The beauty of having no sedation is that you can simply walk out of the hospital after the procedure is completed and go about your day. There's no recovery time and you can drive yourself home.

Without sedation, it's not exactly painful (though if you have active pouchitis or cuffitis you may experience pain), but there is a lot of pressure from the air that is pumped in, and it is certainly uncomfortable. The first thing I always want to do when I'm done is run to the toilet to expel the air. I also felt a bit of a pulling sensation when they did the biopsy, but again, it was all bearable and it's over fairly quickly.

That being said, it should be your choice whether or not to have sedation. Don't let your doctor pressure you. To be honest, I've come to prefer it over time and multiple scopes (I've come to a point where I just don't want to feel things anymore), but I always base my decision on how I'm feeling leading up to the scope, the reason for the scope, and to a lesser extent, what I have planned for the rest of the day. It's not often I get a day off work, so if my scope is early in the morning and I have the rest of the day off, I may opt for no sedation so I have the rest of the afternoon to goof off.

I agree with Spooky. I hurts when you have pouchitis/cuffitis or other problems. The time I didn't use medication I had moderate to severe cuffitis and it was a little painful. IMO we've experienced so much pain from our disease this isn't that bad.

My first scope was done with two Valium. Ha. Didn't do a thing for me. I was so miserable and tore up down there... It was not a pleasant experience but I didn't know. I thought everyone did it this way. I hated going to the GI hated it back then.
The second time was at the same GI... Two more Valium.. as I waited I could hear others getting upper scopes and I could hear gagging coming from closed doors. I went to use the bathroom and the toilet was overflowed from someone else so I went back to my room and sat a minute and looked at the dirty floors and thought for another minute.... I put my clothes on and walked out and never went back to that GI.
No... No regrets either.
I found the best most considerate GI. He is retired now.
But he was the best. Attitude and professional. Straight up no BS with you and I liked that.
After that I had at least 8 more scopes over the years... and now this is with my colon.... And I was pleasantly sedated at each one. Would not do it without it. I sure as heck do not want to watch it on TV!.... Now I even want the mild sedation for my pouch cause usually I am having a problem down there and I have monkey butt as I say. Digital exams are bad enough with monkey butt! And I think all know what I mean when I say that.

Cocktail of fentanyl and versed is the new standard for conscious sedation.  It used to be demerol and versed in the 1990s into the early 2000s, but demerol has fallen into disfavor and been replaced by fentanyl.  However some hospitals like Yale still stock demerol if you absolutely insist on having it splashed into that hypo needle.

 

Most flex sig providers offer 3 choices (1) nothing, (2) conscious sedation, or (3) Propofol, which puts you out cold, although hopefully not forever like Michael Jackson was when he and his Doc overmedicated him.  I choose (2).  What others choose is what they choose.  I recently spoke to a friend of mine who has an MBA from Columbia Business School but was completely ignorant on these matters and didn't even realize he has a choice and can tell his Doctor what can and can't be put into his body.  Hello, it's your body, you should decide what is put into it and why.  He ended up choosing Propofol for his very first colonoscopy at age 51 after I educated him on the subject.

I don't know. At my current hospital workplace, and the hospital where I receive my care, it's Propofol that's the drug of choice, and I totally prefer it.  Rarely have I received the Fentanyl/Versed mix, though it's still used. But there's pushes to get away from benzodiazepines. 

 

Propofol is is metabolized and out of your system in minutes after it's turned off. No hung-over feeling with it, too. 

 

We also use a med called Precedex often, too, though less with conscious sedation and more for short term (24-48 hours) in the ICU. 

I think we need to distinguish between scopes at hospitals and scopes at a GI's office.  Propofol (a) has to be administered by an anesthesiologist, and (b) is 15 times more expensive than conscious sedation.  The profitability of administering Propofol has led to scams and I have personal experience with one.  The scam is perpetrated by the anestheologist who insinuates himself or herself into a business relationship with a GI who does scopes all day. They sell the GI on Propofol being better but the TRUTH is it's not better, it's more money for the anesthesiologist than if the Doc gives the conscious sedation to his own patients (yes, and you don't have the grogginess).

 

The problem is people soon realize that $1500 vs. $100 is a lot of money when the insurance carrier isn't covering it.  They then squawk about the needlessness of this and the scam is shut down.  I was part of seeing one get shut down.  It was all sales pitch and at the end of the day people were needlessly getting Propofol, complaining about bills, when Doc has to choose between angry patients and firing the anesthesiologist guess who wins?

 

Hospitals are in business to make money and to pay you and the anethesiologists they need to keep them busy and Propofoling people is one way to do that, like I said, it is 15X as much which is huge.  And I am not sure why insurance carriers don't squawk because at the end of day someone has to pay the bill for 15x more expensive.

 

I am pretty sure at Yale that conscious sedation is the standard based on what I witnessed being put in the recovery room there BEFORE the procedure due to my Doc being late.  I had always assumed it was due to costs although the other side of it is that it is easier to communicate with a patient who is not groggy.  In any event I am stuck on the cost and I think Propofol is a needless waste of money for a flex sig and the only reason it's being done is to keep anesthesiologists busy and paid.

 

If anyone is wondering why Healthcare is headed towards being 33% of the GNP of the USA, there you have it.  It's the easiest business in which to sell people things they don't need. You are selling to sick people, and they want to believe that what you tell them they need IS what they need, even if it isn't.

 

I've had 2 different kinds of scopes.  I didn't realize there was a "straight scope" one and a flex sig one.  Jan enlightened me then explaining that my surgeon had done the straight scope as he probably doesn't have the training to do a flex sig.  He had me come a year after take down and without any prep he had me literally pull down my pants, lean over an examination table and it was raised up so he could stand up, insert it, have a look around and was done. It left like a broomstick or baseball bat was shoved into me.  I actually visualized a scene from "Deliverance" then.  He did have some air of sorts to inflate it so he could examine me.  I will NEVER have this type again.  I had cuffitis then and found out when I went to my GI for a flex sig that I had c.diff as well.  So IMO only do one without sedation if you aren't having problems or the doctor that is performing it does them without sedation. One of the without medication flex sigs was enough for me.  I am becoming a weeny in my disabled days.  Last year I had 18 little cavities as my gums receded, because of all of the medications I take.  No longer a tough girl I requested and gladly paid for nitric gas, think that is what it's called, for the 3 times I had 6 cavities filled at once.  I also took a xanex and some times a xanex during the marathon drilling events.

I just had 2 "little" cavities at my gum-line filled yesterday, it's the first time I've had a cavity in probably 20 years. The dentist said it was from all of my medications.   Stupid UC and Medications. 

 

If a medical professional offers me pain-relief for a procedure I'm taking it.

@ks1905, my dentist has me on a prescribed toothpaste that is 7% fluoride vs the normal of 1.7%. I'm brushing twice a day along with flossing and using my Waterpik a few times a week. I also am getting my teeth cleaned more than 2 times a year.  I hate UC, and everything else.  Mine were mostly at my gum line too and didn't occur until several years after my take down.

 

I've have conscious medication, like CTBarrister, and never been offered Propofol for any of my colonoscopies or pouch scopes, at clinics or hospitals. I think that would be overkill and I'm a pain weenie.