Combined Endoscopy Center

Combined Endoscopy Center (CEC)

This state-of-the-art hospital-based endoscopy unit was opened in 2015. In the CEC, Gastroenterologists, Surgeons and Pulmonologists perform endoscopic procedures using the latest technology and strictly adhere to all quality and safety guidelines stipulated by all major societies. Our goal is to provide you with the most complete, comfortable and efficient experience as possible.
 

Endoscopic procedures that are performed in the CEC under sedation include: 

• Colonoscopy
• Esophagogastroduodenoscopy (EGD)
• Flexible sigmoidoscopy
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Cholangioscopy
• Endoscopic Ultrasound (EUS)
• Balloon Enteroscopy
• Bronchoscopy
• Endobrochial Ultrasound (EBUS)

Common indications for these procedures include colorectal cancer screening, abdominal pain, gastroesophageal reflux disease, chronic diarrhea or constipation, rectal bleeding, swallowing difficulties, esophageal variceal screening, Barrett’s esophagus screening and surveillance, pancreatic mass, pancreatic cysts, biliary obstruction, lung nodules/masses, and hemoptysis.

Preparing for your Endoscopy Exam

Preparation

To learn more about Upper GI Endoscopy, click this link: https://www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-endoscopy
To learn more about Colonoscopy/Balloon enteroscopy), click this link: https://www.niddk.nih.gov/health-information/diagnostic-tests/colonoscopy

On the day of your procedure:

• Do not eat any food for six hours or drink any liquids for two hours prior to your procedure appointment
• An adult driver must accompany you to the check-in desk at the Endoscopy Center
• Your adult driver must remain at the hospital during the duration of the procedure

Failure to adhere to the above instructions will result in a delay or cancellation of your procedure.

Risks of Endoscopy

Generally, endoscopy is very safe with a very low complication rate. Of all the rare complications it are the risks associated with sedation that are most common including (but not limited to) adverse reaction to sedating medications, hypoxia (e.g. low blood oxygenation), hypotension (e.g. low blood pressure) and aspiration. Because the chance of having a complication from sedation increases with the amount of medications that are given, our goal during sedation is comfort and not putting your to asleep.

Other, even more rare complications of endoscopy include perforation (e.g. creating a hole), bleeding that cannot be controlled during the procedure and introduction of infection. For those who have undergone bariatric surgery in the past, reversal of the surgery is one potential risk of endoscopy. One extremely rare complication unique to colonoscopy is injury to the spleen caused by the colonoscope or pressure applied to abdomen during the procedure. Any of these complication may require further procedures or even surgery or lead to death.

During your clinic visit with a physician or physician assistant involved with setting up your endoscopy you will be counseled on the complication risks associated with your particular planned endosocopic procedure and your questions will be answered.

Types of Sedation Used During Endoscopy

There are three (3) ways patients are sedated for endoscopic examination. The type of sedation you get will depend on the procedure and your medical history.

The most common form of sedation is intravenous conscious sedation (IVCS). For this you will receive a combination of Versed and either Fentanyl or Demerol. In some cases additional medication such as Benadryl or Zofran may be needed to achieve the desired level of sedation. With IVCS you are able to breathe on your own and can be aroused to follow commands.

Some procedures like ERCP or EUS require a deeper state of sedation called monitored anesthesia care (MAC). As the name indicated the medications, usually Propofol, are administered by an anesthesiologist who monitor you during the duration of the procedure. Like IVCS you will breathe on your own but you will generally not be easily aroused during the procedure. Patients who require MAC must be seen in the Anesthesia All patients scheduled for ERCP or EUS and those with certain medical problems will be scheduled for this type of sedation. Your doctor will make the determination at the pre-procedure clinic visit as to whether or not you require this type of sedation. Patients scheduled for anesthesia provided sedation will need to be screened in the anesthesia clinic before your procedure can be performed. Although most cases will be done in the CEC, the anesthesiologist may decide to have your procedure performed in the main operation room if you have significant health problems. You will be alerted at the pre-procedure anesthesia appointment should this be the case.

Some minimally invasive procedures such as flexible sigmoidoscopy and rectal EUS cause minimal discomfort thus sedation is generally not used (thus the risk of sedation can be avoided).