Pouchoscopy While Awake Review!!! FAQ (Frequently Asked Questions!!!!

I have had all my pouchoscopies done while awake. I have a low pain tolerance and I don't find it a big deal at all.

I’ve always had my pouchoscopy awake, over 35yrs worth. Never had an issue, usually went right back to work afterwards. No IV, no big deal.

I've had many decades worth of colonoscopies, and now pouchoscopies (also called an endoscopy) and I've always had them under sedation. No big deal for them to administer it. Insurance is different in Canada and sedation is covered. I know this is an advantage. I tell them in advance of the day and they have a dose ready. My sedation is always administered by the doctor performing the pouchoscopy so it isn't necessary for an anesthesiologist to be booked and paid. I think that is where the higher cost might be. Ask your doctor if he or she can administer.

I'm out for 20 minutes or so for the procedure. Maybe my checkup takes longer because it's also a cancer checkup - my reason for having a pouch. Another 30 - 40 minutes to wake up in the recovery room with the other groggy patients.

No pain, no uncomfortable feeling of pressure from the air they pump into my pouch, or the distressing sense that I'm going to poop while on the table. I don't really want to ask my surgeon any questions or chat with him or his team because I need him to focus entirely on the examination of my pouch. Anything I need to tell him, any concerns or changes I've experienced, I tell him before I go under. He leaves handwritten notes on any findings, and the nurse gives it to me when I wake, along with cookies and juice, water, to rehydrate and help the blood glucose. I book the first appointment of the day so I am done by mid morning and can eat lunch.

I would be too nervous to do this while awake, and they would not get a thorough examination if I were squirming or saying ouch the whole time. So, if you're the least bit anxious or nervous, please don't be afraid to ask for help. It's important to have your pouch checked. There is also a tiny pill called Ativan, by prescription, taken half an hour before the procedure and it doesn't quite knock you out, but relaxes you completely and you can drift. The pill will be less costly than sedation and it wears off very quickly when you wake.

I had my pouchoscopy with sedation in December and was home in a few hours. I got myself home without assistance and ate lunch, starving. Remember, after sedation, do not drive, or operate machinery, or sign any legal documents that day no matter how awake you feel.

Winterberry,

Insurance covers sedation in the USA as well. However patients are often asked to choose between Propofol (the retail cost of which is 20 times more expensive than conscious sedation) and no sedation and they believe they have no other choice. It's completely false to believe this. Conscious sedation is both cheap and covered. However hospitals and busy medical offices push the more expensive propofol for a reason: they can do and bill for more procedures because Propofol reduces recovery times and enables them to push patients out the door. I once confronted a doctor I know who owns a facility that performs numerous endoscopies every day and he laughed and admitted it was true. That's exactly why it's policy. I get conscious sedation and have someone drive, it's cheap and more effective for the patient unless they need to go back to work or drive themselves from the facility.

I don't know what is used in Canada but the standard conscious sedation cocktail used in the USA is fentanyl and versed.  They have and will vary dosages on request. My GI uses a comical scale, "twilight", "medium", and "smoked", or something like that. I go medium rare, or medium twilight. I also one year had 50 mg fentanyl and no versed (versed causes short term amnesia) so that I could recall the procedure. Can you tell me what is the standard cocktail in Canada?

There have been a zillion other threads on this topic and in reading them and in also speaking to patients in real life I find that most people are remarkably uninformed on what their options are, what the insurance coverage and cost issues are, the propofol vs. conscious sedation cost analysis, and how it benefits the provider far more than the patient (especially when they don't tell you the impact of the payouts on your next year's insurance premium, which they don't). The result is that many patients make uninformed choices that are of more benefit to the doctor than it is to them.

I have also had the procedure done with no sedation. I can tolerate it, but don't prefer it. I find that J Pouch and Ileum being pumped full of air is uncomfortable both physically and mentally. I just don't see any need to deal with it when I don't need to. There is no need to have a hero complex on medical procedures.

I am sure my surgeon gives me Propofol. I remember asking at my recent pouchoscopy, just before I went under, and I am almost certain he said Propofol because the image of Micheal Jackson came to mind as I started to drift to sleep.

I'll ask my surgeon and if the answer is something else, I'll post.

@Kangaroo posted:

I have had all my pouchoscopies done while awake. I have a low pain tolerance and I don't find it a big deal at all.

Totally agree! I am definitely doing it for now on!

@ytcrockpot posted:

I’ve always had my pouchoscopy awake, over 35yrs worth. Never had an issue, usually went right back to work afterwards. No IV, no big deal.

Wow! That is a long time! So happy to hear that

@Winterberry posted:

I've had many decades worth of colonoscopies, and now pouchoscopies (also called an endoscopy) and I've always had them under sedation. No big deal for them to administer it. Insurance is different in Canada and sedation is covered. I know this is an advantage. I tell them in advance of the day and they have a dose ready. My sedation is always administered by the doctor performing the pouchoscopy so it isn't necessary for an anesthesiologist to be booked and paid. I think that is where the higher cost might be. Ask your doctor if he or she can administer.

I'm out for 20 minutes or so for the procedure. Maybe my checkup takes longer because it's also a cancer checkup - my reason for having a pouch. Another 30 - 40 minutes to wake up in the recovery room with the other groggy patients.

No pain, no uncomfortable feeling of pressure from the air they pump into my pouch, or the distressing sense that I'm going to poop while on the table. I don't really want to ask my surgeon any questions or chat with him or his team because I need him to focus entirely on the examination of my pouch. Anything I need to tell him, any concerns or changes I've experienced, I tell him before I go under. He leaves handwritten notes on any findings, and the nurse gives it to me when I wake, along with cookies and juice, water, to rehydrate and help the blood glucose. I book the first appointment of the day so I am done by mid morning and can eat lunch.

I would be too nervous to do this while awake, and they would not get a thorough examination if I were squirming or saying ouch the whole time. So, if you're the least bit anxious or nervous, please don't be afraid to ask for help. It's important to have your pouch checked. There is also a tiny pill called Ativan, by prescription, taken half an hour before the procedure and it doesn't quite knock you out, but relaxes you completely and you can drift. The pill will be less costly than sedation and it wears off very quickly when you wake.

I had my pouchoscopy with sedation in December and was home in a few hours. I got myself home without assistance and ate lunch, starving. Remember, after sedation, do not drive, or operate machinery, or sign any legal documents that day no matter how awake you feel.

You made excellent points! During the procedure, I never squirmed, I stayed still the whole time. I never said ouch once, There was ZERO pain, I promise. There was pressure at certain times but everything was ZERO Pain. I know it sounds too good to be true, I was skeptical myself before I got it done, but its totally fine. Maybe you should try it once and see how it goes. If you choose not to, that is okay too

**Forgot to say what position I was in**

I was laying on my left side with my right leg bent.

@Winterberry posted:

I am sure my surgeon gives me Propofol. I remember asking at my recent pouchoscopy, just before I went under, and I am almost certain he said Propofol because the image of Micheal Jackson came to mind as I started to drift to sleep.

I'll ask my surgeon and if the answer is something else, I'll post.

If you are Canadian, the same things I said about cost considerations would not apply since the government is insuring you.  When you pay for private insurance premiums it is a whole different ball game.  The retail cost of Propofol in a routine pouchoscopy procedure is $2000 vs. maybe $150-$200 for conscious sedation.  The more that is billed, the more insurance pays, and what they pay determines your next year's premium payment.  The difference in cost is beyond ridiculous to anyone who can do the math, but like I said it benefits medical providers because the swifter recovery times from propofol mean more scopes, more patients and more money for them.  In the USA healthcare is something like 20% of GDP. So if you get scoped at hospitals, or big endoscopy centers, they will try and shove propofol down your throat.  BTW it MUST be administered by an anesthesiologist, whereas conscious sedation need not be.  This is because if you mess around with it, it can kill you, as Michael Jackson found out.  The bottom line is it's so expensive it should never be used in these procedures. It is used to drive profits, and for no other reason.

Dr. Fazio always did them while I was awake.  He was so skilled they never bothered me at all.  Not quite the same with others.  Main benefit to me -- able to ask questions after the procedure and remember responses!

@scallop posted:

Dr. Fazio always did them while I was awake.  He was so skilled they never bothered me at all.  Not quite the same with others.  Main benefit to me -- able to ask questions after the procedure and remember responses!

100% agree

And we can drive home

@scallop posted:

Main benefit to me -- able to ask questions after the procedure and remember responses!

Good doctors (like mine) set up a separate appointment to go over the scope results a couple weeks later, after the biopsy results come back. Since the questions and the answers are going to be the same at that time, and there will be new questions about the biopsy results which can't be asked during the procedure, this should not be a major consideration in deciding to have the procedure without sedation.  I also find it's easier to view photos on a TV monitor in my doctor's office than it is in a procedure room.  He puts them on the TV monitor, I have a much better view of them, and we can discuss them without either of us having distractions.  This does not need to happen at the time of the procedure, it can happen at any time that is convenient for the patient.

Hi, CTBarrister. I will ask my surgeon what he used to sedate me. I am almost certain he said Propofol. Perhaps sedation procedures are different in Canada?  My surgeon administers the drug into my IV.  I know there wasn't an anesthesiologist present because I would have been introduced to him/her. He always introduces his team, resident, nurse, aide, etc., since it would be considered rude to peer inside someone's bum without formal introductions!  Then they briefly discuss me while I'm in the room, my name, birthdate, procedure, and then I'm asked to sign something -- just to make sure someone else didn't volunteer to take the scoping for me, and for liability.

Before Covid lockdown, we always set a followup in the office to review my scope and CT scan results. Now I get results by email to save a trip to the hospital.

Definitely Propofol here in CT has to be administered by an anesthesiologist (and in NY).  I have never seen it administered by a nurse or other doctor in either State.  Usually they have a staff anesthesiologist at hospitals, or large endoscopy centers, or bigger doctor's offices, who are available to do it.

Canada is different than the USA on a lot of things, like what a prescription is required for.  There are lots of medicines that are prescription only in the USA that are over the counter in Canada.  One time I was in Montreal and I was really sick. I went to a pharmacy called Jean Coutu or something like that and was able to get a cough medicine which had codeine or something in it, which I did have to fill out some special papers for, but did not need a prescription.  That would not have happened in the USA.

I did have propofol a few times, always by an anesthesiologist.  I have no problems with it other than the obscene expense of it at retail to the patient.  The benefit of Propofol is you are out cold and when you come to you are 100% and not groggy like you are with conscious sedation.  It's because of that swift recovery that they can kick your ass out quickly, and then bring in the next person for their scope. Using propofol probably results in 25% more patients seen and procedures performed every day, meaning many more profits.  They are all about moving the bodies in and out.

CT, your cost analysis seems incomplete. Making an endoscopy center able to see more patients per hour makes it more efficient in many ways, since lots of the costs (staff, overhead, etc.) accrue by the hour. While you can certainly argue that they make more money for being efficient, that’s far from a completely bad thing. Wacky drug pricing and reimbursement skews this, of course, but there’s much more to it than the price of propofol. In any case I’ve never bothered with sedation for a pouchoscopy, so I (happily!) get out there quicker than the propofol recipients.

Scott the efficiency is not the bad thing.  The $2000 bill to your insurance company for the retail cost is the bad thing. That means an unnecessary payout by your insurer, and higher premiums next year when it's all added up.  I was simply pointing out why the facilities use propofol.  It increases efficiency and profits- but at the expense of the patient and his or her wallet.  It is MUCH cheaper to choose conscious sedation, which keeps insurance costs down. It's on the order of 1/10th to 1/15th the cost.

I go to the Cleveland Clinic and I've never even been asked if I wanted to be sedated.  I don't even think she used Lidocane.  It was uncomfortable, for sure, but really it wasn't bad.  I liked that she could tell me what she was seeing live and I could look at the screen, too, to see what she was talking about.  I don't think I'd ever be sedated for it after doing it 3 times with no real problems.  

Why does USA not have free healthcare for all as it's such a wealthy country.Its been very sad to see people struggling to afford ostomy bags or wearing them for 11 days and cleaning them out.

USA more like a 3rd world country with 80 year olds running it.your maternity leave and holidays need extending as well.

New Zealand

Free healthcare for all New Zealand residents.including all ostomy appliances.

52 weeks payed maternity leave.

20 days a year holiday pay not including public holidays.

40year old Prime Minister.

@Disneynut posted:

I go to the Cleveland Clinic and I've never even been asked if I wanted to be sedated.  I don't even think she used Lidocane.  It was uncomfortable, for sure, but really it wasn't bad.  I liked that she could tell me what she was seeing live and I could look at the screen, too, to see what she was talking about.  I don't think I'd ever be sedated for it after doing it 3 times with no real problems.  

Wow! COOL!!! The doctor put Lidocaine cream in my butt so I did not even feel the scope at all. Thank-you for mentioning that you did fine without Lidocaine, Now I know its not bad without Lidocaine

The Lidocaine was free for me so I definitely did not complain

@Former Member posted:

Why does USA not have free healthcare for all as it's such a wealthy country.Its been very sad to see people struggling to afford ostomy bags or wearing them for 11 days and cleaning them out.

USA more like a 3rd world country with 80 year olds running it.your maternity leave and holidays need extending as well.

New Zealand

Free healthcare for all New Zealand residents.including all ostomy appliances.

52 weeks payed maternity leave.

20 days a year holiday pay not including public holidays.

40year old Prime Minister.

Hopefully some day we will have free healthcare, I know that would be great! We do have great emergency healthcare though.

USA has the right to bare arms but not the right to an ostomy bag.A society is judged on its care of its weakest citizens,

@CTBarrister posted:

Good doctors (like mine) set up a separate appointment to go over the scope results a couple weeks later, after the biopsy results come back. Since the questions and the answers are going to be the same at that time, and there will be new questions about the biopsy results which can't be asked during the procedure, this should not be a major consideration in deciding to have the procedure without sedation.  I also find it's easier to view photos on a TV monitor in my doctor's office than it is in a procedure room.  He puts them on the TV monitor, I have a much better view of them, and we can discuss them without either of us having distractions.  This does not need to happen at the time of the procedure, it can happen at any time that is convenient for the patient.

why do your results take so long? I get results from scope and biopsy reports usually by the next day..

@CTBarrister posted:

Winterberry,

Insurance covers sedation in the USA as well. However patients are often asked to choose between Propofol (the retail cost of which is 20 times more expensive than conscious sedation) and no sedation and they believe they have no other choice. It's completely false to believe this. Conscious sedation is both cheap and covered. However hospitals and busy medical offices push the more expensive propofol for a reason: they can do and bill for more procedures because Propofol reduces recovery times and enables them to push patients out the door. I once confronted a doctor I know who owns a facility that performs numerous endoscopies every day and he laughed and admitted it was true. That's exactly why it's policy. I get conscious sedation and have someone drive, it's cheap and more effective for the patient unless they need to go back to work or drive themselves from the facility.

I don't know what is used in Canada but the standard conscious sedation cocktail used in the USA is fentanyl and versed.  They have and will vary dosages on request. My GI uses a comical scale, "twilight", "medium", and "smoked", or something like that. I go medium rare, or medium twilight. I also one year had 50 mg fentanyl and no versed (versed causes short term amnesia) so that I could recall the procedure. Can you tell me what is the standard cocktail in Canada?

There have been a zillion other threads on this topic and in reading them and in also speaking to patients in real life I find that most people are remarkably uninformed on what their options are, what the insurance coverage and cost issues are, the propofol vs. conscious sedation cost analysis, and how it benefits the provider far more than the patient (especially when they don't tell you the impact of the payouts on your next year's insurance premium, which they don't). The result is that many patients make uninformed choices that are of more benefit to the doctor than it is to them.

I have also had the procedure done with no sedation. I can tolerate it, but don't prefer it. I find that J Pouch and Ileum being pumped full of air is uncomfortable both physically and mentally. I just don't see any need to deal with it when I don't need to. There is no need to have a hero complex on medical procedures.

Wow!!! I don't have a pouch yet but had a flex. sig yesterday and had a horrible experience. They forced me to use "MAC" anaesthesia (it's propofol), which I had a terrible reaction to last November. They knew of this reaction and my GI told me they could not give me twilight sedation or else they would need to make me wait in the hospital for 4 hours before letting me leave, despite me having a driver waiting there! They lied to me because i've had twilight done 7 other times with different doctors and never once had to wait very long at all. I called and asked their endoscopy center about this today and she told me, no, you only have to wait 1 hour with twilight/conscious sedation. So I am waiting for a call back from their office manager, because both my GI AND the anaesthesiologist nurse both came in separately and told me the same reason why I HAD to do MAC and not twilight. The MAC makes me extremely depressed and suicidal after it wears off for the rest of the night, I was sobbing uncontrollably and had zero appetite. Same exact thing happened in November. Now I'm wondering if they just wanted more money!!!

My entire scope was pointless anyway. I just finished a round of prednisone so all it showed was mild inflammation and instead of realizing this was from the pred, my doctor tells me I have to stay on Stelara and change my mesalamine from Delzicol to Lialda. I haven't been able to get off steroids for years and he thinks a mesalamine switch is now the answer?!

Sorry to hijack this thread. Thank you all for the pouchoscopy information.

@Sara14 posted:

Wow!!! I don't have a pouch yet but had a flex. sig yesterday and had a horrible experience. They forced me to use "MAC" anaesthesia (it's propofol), which I had a terrible reaction to last November. They knew of this reaction and my GI told me they could not give me twilight sedation or else they would need to make me wait in the hospital for 4 hours before letting me leave, despite me having a driver waiting there! They lied to me because i've had twilight done 7 other times with different doctors and never once had to wait very long at all. I called and asked their endoscopy center about this today and she told me, no, you only have to wait 1 hour with twilight/conscious sedation. So I am waiting for a call back from their office manager, because both my GI AND the anaesthesiologist nurse both came in separately and told me the same reason why I HAD to do MAC and not twilight. The MAC makes me extremely depressed and suicidal after it wears off for the rest of the night, I was sobbing uncontrollably and had zero appetite. Same exact thing happened in November. Now I'm wondering if they just wanted more money!!!

My entire scope was pointless anyway. I just finished a round of prednisone so all it showed was mild inflammation and instead of realizing this was from the pred, my doctor tells me I have to stay on Stelara and change my mesalamine from Delzicol to Lialda. I haven't been able to get off steroids for years and he thinks a mesalamine switch is now the answer?!

Sorry to hijack this thread. Thank you all for the pouchoscopy information.

Your welcome Sarah, you did not hijack anything. I learn a lot from you post as much as you want

First time sedated with propofol (sp?) last month. All previous scopes I was awake and were very painful. Will always have sedation in the future. I think it depends on the person and the doctor performing the procedure,

Super happy it is an option to me now.

@Accept It posted:

First time sedated with propofol (sp?) last month. All previous scopes I was awake and were very painful. Will always have sedation in the future. I think it depends on the person and the doctor performing the procedure,

Super happy it is an option to me now.

What made you switch dear?

I moved from Michigan to Florida.  New doctor didn't even ask, just scheduled with anesthesia as an outpatient.  My Michigan doctor did it in the office same day as my consult. Horrible!!

Back when I had a colon I did a few flex sigs awake. Pretty easy and painless.

way back in the early 2000’s I hated the fentanyl/versed combo. Made me loopy for 24 hours.

propofil then came out and I never looked backed.

for my August  pouchoscopy I am being sedated. No debate in my mind. For the 10 minutes I will be under, I will wake up feeling refreshed. Unless there is a contraindication, my position is:

Why should I be uncomfortable at all?

CT Barrister, I'm in Canada. I although an anesthesiologist was  involved for an 'examination under anesthetic',  conscious sedation for pouchoscopies. I have had both conscious sedation and no medication although I did have the iv in the arm in case I ran into big pain. Fortunately I didn't need it.

I am having the surgeon do my scope in the office at the end of the year due to costs of being put under by the GI at Cleveland Clinic. Its like a fourth of the cost of having it done under sedation. Only problem is he doesn't take photos to view later. I wanted to have them sent to my GI but oh well.

@Pouchomarx posted:

I am having the surgeon do my scope in the office at the end of the year due to costs of being put under by the GI at Cleveland Clinic. Its like a fourth of the cost of having it done under sedation. Only problem is he doesn't take photos to view later. I wanted to have them sent to my GI but oh well.

Are you having it awake?

@Former Member posted:

Are you having it awake?

yes, in surgeons office

@Pouchomarx posted:

yes, in surgeons office

PERFECT! I love how we can drive home afterwards

Your lucky getting it done in offices is much better than the hospital or surgery center, for sure, that is if there is no emergency of course.