Your doctor's office will set-up your procedure appointment, arrange and advance exams and tests, and give you preparation instructions. To ensure we can complete your procedure when scheduled, it is very important that you follow all instructions. If you have any questions concerning these instructions, please call on your physician's office for clarification. Also be sure to notify your doctor of any changes in your health or if you've been exposed to any illnesses.
The day before your procedure, one of our staff will call you to confirm your appointment and give you some reminders for getting ready. We welcome and will be glad to answer any questions you might have about your Center visit and what to expect.
You will need to arrange for a responsible family member or friend to bring you to the Center for your procedure, to drive you home afterward, and to make sure that you have proper attention and care during your recovery.
The Day of Your Procedure:
- If you take medications for high blood pressure, diabetes, or nervous disorders follow your doctor's instructions about these. If you use an inhaler, bring it with you at the Center.
- You must have a responsible adult driver to stay with you at the Center and to drive you home.
- Bathe or shower; if you wash your hair, make sure it's dry.
- Dress in comfortable clothing.
- Remove and leave jewelry and other valuables at home.
- Bring your health insurance card and authorization number with you, a list of your current medications and dosages, a list of any drug or other allergies you have, any other papers and test results your doctors has given you.
Introduction
Upper Endoscopy (also known as gastroscopy, EGD, or esophagogastroduodenoscopy) is a procedure that enables your doctor to examine the lining of the esophagus (swallowing tube), stomach and duodenum (first portion of the small intestine). A flexible, lighted endoscope about the thickness of your little finger is placed through your mouth and into the stomach and duodenum.
Why Do An Upper Endoscopy (EGD)?
Upper endoscopy is performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, difficulty swallowing or heartburn. It is an excellent method for finding the cause of bleeding from the upper gastrointestinal tract. It is more accurate than X-rays for detecting inflammation, ulcers or tumors of the esophagus, stomach and duodenum. Upper endoscopy can detect early cancer and can distinguish between cancerous and non-cancerous conditions by performing biopsies of suspicious areas. These are then sent to the laboratory to be analyzed. A biopsy is taken for many reasons and does not mean that cancer is suspected.
What Preparation Is Required?
The stomach should be completely empty. You should have nothing to eat or drink after midnight prior to the day before the examination. Your doctor will be more specific about the time to begin fasting depending on the time of day that your test is scheduled.
Medication may need to be adjusted or avoided. It is therefore best to inform your doctor of ALL your current medications as well as allergies to medications a few days prior to the examination.
You will be sedated during the procedure. You must have a responsible adult to drive you, stay during the procedure, and to accompany you home. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
Will the procedure hurt?
Your physician or a Certified Nurse Anesthetist (CRNA), under the supervision of an Anesthesiologist, will give you an intravenous medication to make you comfortable and sleeping during the procedure. The physician will put air into your stomach to help visualize the lining and this sometimes causes a cramping or bloated sensation.
What can I expect when I arrive at the endoscopy center?
When you arrive at the endoscopy center, the nurse and/or an Anesthesiologist will ask you questions about your medical history and current medication use. Updating this information will make the procedure safe for you. Please be prepared to review your health history at this time. Bring a list of medications and drug allergies, if necessary. Your blood pressure, pulse rate, and oxygen saturation will be monitored before, during and after the exam. An intravenous (I.V.) needle will be placed in your hand or arm.
What Can Be Expected During The Upper Endoscopy?
You may have your throat sprayed with a local anesthetic before the test begins and given medication through your I.V. to help you relax and sleep during the examination. You will lie on your left side in a comfortable position as the endoscope is gently passed through your mouth and into your esophagus, stomach and duodenum. The endoscope does not interfere with your breathing.
What Happens After Upper Endoscopy?
You will be monitored in the recovery area for about 20-30 minutes until the effects of the sedatives have worn off. In some instances your throat may be a little sore for a day or two. You may feel bloated immediately after the procedure because of the air that is introduced into your stomach during the examination. You will be able to resume your diet and take your routine medication after you leave the endoscopy center, unless otherwise instructed. Your doctor will usually inform you of your test results on the day of the procedure and give recommendations. If biopsy samples were taken allow 1-2 weeks for these results.
The sedation used during your exam impairs judgment, memory, and equilibrium. We cannot perform this procedure unless we know that you will arrive home safely with a responsible adult driver, so please bring a friend or family member with you.
Do not drive, operate machinery, make critical decisions, drink alcoholic beverages, or do activities that require coordination or balance until the day post-procedure.
You may experience a sore throat for 24 to 48 hours. You may use throat lozenges or gargle with warm salt water to relieve the discomfort.
Because air was put into your stomach during the procedure, you may experience some belching.
What Complications Can Occur?
Gastroscopy and biopsy are very safe when performed by doctors who have had special training and are experienced in these endoscopic procedures. Complications are rare. However, they can occur and include bleeding from the site of a biopsy or polypectomy and a tear (perforation) through the lining of the intestinal wall or complications related to other medical problems that you may already have. Blood transfusions are rarely required. A reaction to the sedatives can occur but is extremely unlikely. Irritation to the vein that medications were given is uncommon, but may cause a tender lump lasting a few weeks. Warm, moist towels will help relieve this discomfort.
Perforation: Passage of the instrument may result in an injury to the gastrointestinal tract wall with possible leakage of gastrointestinal contents into the body cavity. If this occurs, surgery to close the leak and/or drain the region is usually required.
Bleeding: Bleeding, if it occurs, is usually a complication of biopsy, polypectomy or dilation. Management of this complication may consist only of careful observation, or may require cauterization or other methods to stop bleeding during the procedure. Transfusions or surgical intervention is extremely rare.
Medication Phlebitis: Medications used for sedation may irritate the vein in which they are injected. This causes a red, painful swelling of the vein and surrounding tissue. The area could become infected. Discomfort in the area may persist for several days to several weeks.
Conscious Sedation Medication and Pregnancy: There are risks involved with Anesthesia, especially as it relates to a pregnancy. If there is a question that a pregnancy is possible, a urine pregnancy test will be performed prior to the procedure. If you are breast feeding, do not breast feed for 48 hours.
YOU MUST INFORM YOUR PHYSICIAN OF ALL YOUR ALLERGIC TENDENCIES AND MEDICAL PROBLEMS.
Although complications after Upper Endoscopy (EGD) are uncommon, it is important for you to recognize early signs of any possible complication. Go directly to the emergency room and contact your physician if you notice any of the following:
- Chills and/or fever over 101
- Persistent vomiting or vomiting with blood/nasal regurgitation
- Severe abdominal pain, other than gas cramps
- Severe chest pain
- Black, tarry stools
Please be informed that an EGD is never 100% accurate. After the procedure, if you should develop any new or recurrent gastrointestinal signs or symptoms, immediately bring it to the attention of your physician.
What are the alternatives to Gastrointestinal Endoscopy?
Although gastrointestinal endoscopy is an extremely safe and effective means of examining the gastrointestinal tract, it is not 100 percent accurate in diagnosis. Other diagnostic or therapeutic procedures, such as medical treatment, x-ray and surgery are available. Another option is to choose no diagnostic studies and/or treatment. Your physician will be happy to discuss these options with you as well as any other questions about the procedure.
What is a colonoscopy?
An exam using an instrument called a colonoscope. The colonoscope is a thin, lighted flexible tube. This instrument allows the physician to directly view the inside of your colon (large intestine). Photos can be taken to document findings and tissue samples (biopsies) may be taken. This is a way for your physician to evaluate the colon in great detail.
Polyps are small growths originating in the lining of the colon. Most polyps are non-cancerous (benign), but the physician cannot always tell a benign polyp from an adenoma (pre-cancerous) or malignant (cancerous) polyp by its visual appearance. For this reason, all polyps found will be removed and sent to pathology for analysis. You should feel no discomfort during the polyp removal. Removal of colon polyps is important in preventing colorectal cancer.
What preparation is necessary?
Your colon must be clean in order for your physician to get the best view possible. A special diet followed by a laxative preparation is necessary to clear out any waste or solid residue. The instructions must be followed exactly. Any solid material retained in the colon may prolong the procedure or make it necessary to repeat the examination at another time.
Will the procedure hurt?
Your physician or a Certified Nurse Anesthetist (CRNA), under the supervision of an Anesthesiologist, will give you an intravenous medication to make you feel relaxed. Most people fall asleep and do not remember the procedure when they awaken. The physician will put air into your colon to help visualize the lining and this sometimes causes a cramping or bloated sensation. Passing this air during and following the exam will relieve any discomfort.
What can I expect when I arrive at the endoscopy center?
When you arrive at the endoscopy center, you will be asked to change into a gown. The nurse and/or an Anesthesiologist will ask you questions about your medical history and current medication use. Updating this information will make the procedure safe for you. Please be prepared to review your health history at this time. Bring a list of medications and drug allergies, if necessary. Your blood pressure, pulse rate, and oxygen saturation will be monitored before, during and after the exam. An intravenous (I.V.) needle will be placed in your hand or arm.
What can I expect during the colonoscopy?
The nurse will help you get comfortable on a stretcher. After blood pressure and heart rate monitors are applied you will lie on your left side. Your physician or Certified Nurse Anesthetist (CRNA) will give you an intravenous injection of medication. After you become relaxed, the physician will insert the tip of the scope into your rectum and advance it forward into the colon. The procedure usually takes 20-45 minutes. When your exam is finished you will be taken to the recovery room for observation.
The sedation used during your exam impairs judgment, memory, and equilibrium. We cannot perform this procedure unless we know that you will arrive home safely, so you must have a responsible adult with you who is able to drive you to and from the Center and stay with you during the procedure.
Do not drive, operate machinery, make critical decisions, drink alcoholic beverages, or do activities that require coordination or balance the day of your procedure.
Because air was put into your colon during the procedure, you may experience cramping, bloating and expelling large amounts of air from your rectum. This is normal for the first 24 hours.
You may not have a bowel movement for 1-3 days because of the colonoscopy prep. This is normal.
Except for these restrictions, you may resume your normal diet unless directed otherwise by your physician. Your physician may give you additional instructions at the time of discharge.
What are the possible complications of colonoscopy?
Please be informed that a colonoscopy is never 100% accurate. The accuracy varies with the quality of the prep and the size of the polyp. After the procedure, if you develop any new or recurrent gastrointestinal signs or symptoms, immediately bring it to the attention of your physician.
When performed by a knowledgeable and competent physician, a colonoscopy is a very low risk procedure. Very rarely, bleeding or perforation (tearing of the lining of the colon) may occur. Other risks include a reaction to medication, irritation at the site of the injection, or complications related to other medical problems that you may already have.
Perforation: Passage of the instrument may result in an injury to the gastrointestinal tract wall with possible leakage of gastrointestinal contents into the body cavity. If this occurs, surgery to close the leak and/or drain the region is usually required.
Bleeding: Bleeding, if it occurs, is usually a complication of biopsy, polypectomy or dilation. Management of this complication may consist only of careful observation, or may require transfusions or possibly a surgical operation.
Medication Phlebitis: Medications used for sedation may irritate the vein in which they are injected. This causes a red, painful swelling of the vein and surrounding tissue. This usually resolves quickly and warm compresses to the affected area can be used to relieve any discomfort.
Conscious Sedation Medication and Pregnancy: There are risks involved with anesthesia, especially as it relates to a pregnancy. If there is a question that a pregnancy is possible, a urine pregnancy test will be performed prior to the procedure. If you are breast feeding, do not breast feed for 24 hours.
Other Risks: Include drug reactions and complications from other diseases you may already have. Instrument failure and death are extremely rare but remain remote possibilities.
YOU MUST INFORM YOUR PHYSICIAN OF ALL YOUR ALLERGIC TENDENCIES AND MEDICAL PROBLEMS.
Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Go directly to the emergency room and contact your physician if you notice any of the following:
- Chills and/or fever over 101
- Persistent vomiting
- Severe abdominal pain, other than gas cramps
- Severe chest pain
- Black, tarry stools
- Any bleeding exceeding ¼ cup
Other Questions
If you have any questions please contact your physician and your doctor will be happy to answer any questions that you may have.
What Is Flexible Sigmoidoscopy?
Flexible sigmoidoscopy is a procedure that enables your physician to examine the lining of the rectum and sigmoid colon (lower bowel). A soft, flexible tube about the thickness of the index finger is gently inserted into the anus (rectal opening) and advanced or moved into the rectum and the lower part of the colon.
What Preparation Is Required?
The rectum and lower colon must be completely emptied of stool (feces) for the procedure to be performed. Your doctor or his/her staff will give you instructions regarding the cleansing routine to be used. If the area to be examined is not totally clear, the doctor will not be able to perform an effective examination. Be sure to follow your doctor's preparation instructions.
Most of your medications can be continued as usual. However, drugs such as aspirin, non-steroidal anti-inflammatories, and blood thinners are examples of medications whose use should be discussed with your doctor prior to the examination.
What Can Be Expected During The Procedure?
The procedure is usually well tolerated and rarely causes discomfort. The inside of the colon has few nerve endings; therefore, it is unusual to feel the scope moving within the body. Air is injected to distend or widen the passage. This may cause a feeling of pressure, bloating or cramping during the procedure. You will lie on your side while the colonoscope is advanced through the rectum and lower colon. The lining of the intestine is examined carefully and biopsies can be taken if necessary. The procedure usually lasts for five to fifteen minutes. You can discuss anesthesia options with your doctor. Some patients choose to not have Anesthesia for this procedure.
What Happens After Sigmoidoscopy?
Your doctor will explain the results to you and discuss any findings. You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of gas. You should be able to eat and resume normal activities after leaving the doctor's office if there was no anesthesia given. If anesthesia was used you will not be able to drive or operate machinery so you will need a responsible adult with you to take you home.
Are There Complications Of Sigmoidoscopy?
Flexible sigmoidoscopy and biopsy are safe when performed by physicians with appropriate training and experience in endoscopic procedures. Complications are rare, however, they can occur. They include bleeding from the site of a biopsy or a perforation, which is a tear through the lining of the bowel wall. It is important to contact your doctor if you notice symptoms of severe abdominal pain, abdominal distension, nausea, fever, chills, or rectal bleeding more than 1/4 cup. Bleeding can occur up to several days after a biopsy.
Other Questions
If you have any questions please contact your physician and your doctor will be happy to answer any questions that you may have.
We’re pleased that you are considering care recommended by your physician at the Center. Health services involve a partnership among patients, families, and health care providers. Each member of the partnership has certain rights and responsibilities, and the Center encourages respect for each individual’s personal preferences and values. When you are well informed, participate in treatment decisions, and communicate with your health professionals, you will maximize the effectiveness of your care.
Your acceptance of your doctor’s referral for treatment at the Center is voluntary. You have the right to obtain these recommended services from any facility of your choice. Every patient has the right to be treated as an individual with their rights respected. This facility and medical staff have adopted the following patient’s rights:
- To be treated with respect, dignity and consideration in a safe setting, without regard to age, race, color, religion, nationality, gender, sexual orientation, disability or source of payment.
- To be provided appropriate privacy and security of self and belongings during the delivery of patient care services.
- To receive information from their physician about his/her illness, course of treatment and prospects for recovery in terms that the patient can understand.
- To receive information about any proposed treatment or procedures as he/she may need in order to give informed consent prior to the start of any procedure or treatment.
- When it is medically inadvisable to give such information to a patient, the information is provided to a patient representative, surrogate or a legally authorized person.
- To make decisions regarding the health care that is recommended by the physician. Accordingly, the patient may accept or refuse any recommended medical treatment. If treatment is refused, the patient has the right to be told what effect this may
have on their health, and the reason shall be reported to the physician and documented in the medical record.
- Participate in and make informed decisions about your care and pain management, including being able to request or refuse treatment and to leave the facility even against the advice of his/her physician.
- To be free of mental and physical abuse, free from exploitation, and free from use of restraints. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel.
- Full consideration of privacy concerning his/her medical care program. Case discussion, consultation, examination and treatment are confidential and shall be conducted discretely.
- Confidential treatment of all communications and records pertaining to his/her care and stay in the facility. The patient’s written permission shall be obtained before his/her medical records can be made available to anyone not directly concerned
with their care. The facility has established policies to govern access and duplication of patient records.
- Reasonable continuity of care and to know in advance the time and location of appointment, as well as the physician providing the care.
- To be informed by his/her physician or a delegate of the physician of the continuing health care requirement following discharge from the facility.
- To know the identity and professional status of individuals providing services to them, and to know the name of the physician who is primarily responsible for coordination of his/her care.
- To know which facility rules and policies apply to his/her conduct while a patient.
- To have all patient’s rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient. All personnel shall observe and respect these patient’s rights.
- To be informed of any research or experimental treatment or drugs and to refuse participation without compromise to the patient’s usual care. The patient’s written consent for participation in research shall be obtained and retained in his/her patient
record.
- To examine and receive an explanation of his/her bill regardless of source of payment.
- To appropriate assessment and management of pain.
- The right to change providers if other qualified providers are available.
- If you will need a translator, please let us know in advance and one will be provided for you. If you have someone who can translate confidential, medical and financial information for you, please make arrangement to have them accompany you on the
day of your procedure.
Rights and Respect for Property and Person:
The patient has the right to:
- Exercise his/her rights without subjected to discrimination/reprisal.
- Voice grievance regarding treatment or care that is (or fails to be) furnished.
- Receive information on treatment and care.
- Make informed decisions regarding treatment and care.
- Security of self and property during delivery of care services.
- Confidentiality of personal medical information.
Privacy and Safety:
The patient has the right to:
- Personal privacy.
- Receive care in a safe setting.
- Be free from all forms of abuse or harassment.
Have your compliments, concerns, complaints or grievances addressed. Sharing your concern and/or complaint will not compromise your access to care, treatment and services. Your concerns will be reviewed and you will be given a response to your concerns. You may initiate the complaint process and discuss your concerns with your physician or the Center’s Compliance Officer, Elizabeth Prior. You may report the complaint to:
Elizabeth Prior, R.N.
Rochester Endoscopy & Surgery Center
1349 Rochester Road; Suite 150
Rochester Hills, MI 48307
(248) 844-3800
Additionally, satisfaction concerns of Medicare patients may be directed to the Office of the Medicare Beneficiary Ombudsman, whose role is to help Medicare patients understand their Medicare options and apply their Medicare rights and protections.
You also may express a complaint to State officials by toll-free telephone, FAX, mail, or by email:
Department of Licensing and Regulatory Affairs
Bureau of Community Health Systems
PO Box 30664
611 W. Ottawa
Lansing, MI 48909
Telephone: (800) 882-6006
Facsimile: (517) 241-0093
https://www.michigan.gov/bhcs
Advance Directives;
You have the right to information on the Center’s policy regarding Advance Directives.
The Policy of this Facility Regarding Advance Directives:
Advance Directives will not be honored within the center. In the case of a life-threatening event, emergency medical procedures will be implemented. Every attempt will be made to stabilize and to transfer you to a hospital where the decision to continue or terminate emergency measures can be made by the physician and family. The State of Michigan has an Advance Directives Guide available to you upon request. The forms may be downloaded at http://www.michigan.gov
If you have Advance Directives, you may bring them with you. In the unlikely event of transfer to a hospital, they may be honored at that time.
Patient’s Responsibilities:
- Provide the facility with current and accurate identification and health insurance information.
- Accept personal financial responsibility for any charges not covered by your insurance.
- Provide the facility with complete and accurate information to the best of your ability about your health and medications, including over-the-counter products, and any allergies or sensitivities.
- Follow the treatment plan prescribed by your provider.
- Provide a responsible adult to transport you home from the facility and remain with you for 24 hours, if required by your provider.
- Be respectful of all the health care professionals and staff, as well as other patients.
The Center was established to meet the special needs of patients with gastrointestinal complaints or diseases. It is an “Ambulatory Surgery Center” specially designed for the practice of Gastroenterology. The physicians providing services at our facility are Board-Certified in Gastroenterology and our clinical staff are trained professionals experienced in caring for our patients. The mission of the Center is to provide quality care in a specialized outpatient setting.
Each patient will have our utmost careful and personalized attention. By law, we are required to notify you that some of the physicians performing procedures here have a direct financial interest/ownership in this center. In order to ensure that our patients understand their financial responsibility and our payment policies, we ask that you take a minute to read the following and discuss any questions you may have with our billing representative.
The fee that we charge for our services is intended to cover the cost of operating this facility including equipment, staff, rent, supplies, etc. You will also receive a separate bill from the physician’s office for their professional services, anesthesiologist for anesthesia services, and possibly the laboratory for any pathology services. The facility, anesthesia services, laboratory and physicians’ professional office are all separate legal entities providing separate and distinct services.
As a courtesy to our patients, insurance claims will be submitted on the patient’s behalf to the insurance company specified during the registration process as long as we have the complete name and address of the insurance company, the subscriber’s name, social security number and birth date, and the group number and any other required pre-authorization for the procedure.
All co-payments and deductibles will be billed by the Billing Department as required by the contract between the patient, the insurer and our center. Some insurers require pre-certification, preauthorization or a written referral.
If you are having financial difficulty or have any questions, please contact our Billing Office to discuss your account at (248) 844-4888.