ENDOSCOPY INFORMATION

What is upper gastrointestinal endoscopy? The endoscope is a highly sensitive video camera on a steerable tube about the diameter of a pencil. The endoscope is gently passed through the mouth, esophagus, stomach, and small intestine to examine their linings. During endoscopy, the physician can not only inspect these organs, but also take tissue samples. Why am I having an endoscopy? People have endoscopy for a variety of reasons. These include evaluating the cause of digestive problems such as heartburn and upper abdominal pain, diagnosing ulcers, and determining the cause of blood loss from the digestive tract. Endoscopy is superior to alternative diagnostic methods such as upper GI series because endoscopy is both more accurate and better tolerated by patients. What happens during the exam? The examination is performed with an anesthesiologist administering deep sedation. Therefore, you will feel nothing, know nothing, and remember nothing. First, we will spray the back of your throat with a local anesthetic. Then, the anesthesiologist will sedate you. Once you are asleep, the doctor will gently pass the instrument through your mouth into your stomach. How long does it take? This is variable from patient to patient, but generally the exam takes 1015 minutes. How will I feel afterward? You will recover full consciousness within a few minutes, but you will feel a little groggy. This passes quickly. Your throat may be a little sore for as long as a few days. Also, you may feel bloated for a few minutes right after the procedure because of air that was introduced into our stomach. When can I eat again? We will give you full written instructions as to how and when to resume eating; generally you can eat about an hour after the exam. Is endoscopy dangerous? The incidence of complications is extremely low, generally less than 1 out of every thousand procedures in most studies. Potential complications can include adverse reaction to the sedative drug, bleeding, perforation of the digestive tract, or aspiration of stomach contests into the lungs. Most complications are mild and require no treatment. However, blood transfusion, hospitalization, or surgery are sometimes necessary. Death is extremely rare. Drs. Baker and Horowitz have performed thousands of endoscopies between them with a superb safety record. Although there can be no guarantees, the doctors will do everything possible to maximize your safety and comfort. What preparation is necessary? For the best possible examination, the stomach must be empty. Therefore, you should have nothing to eat or drink, including water, for at least 6 hours before the procedure. If your examination is scheduled for the morning, please do not eat or drink after midnight the night before. If you are to be examined in the afternoon, you may have a breakfast of apple juice, Jell-O, or coffee or tea without milk or cream. (If your mouth is dry, you may suck on an ice cube up to 2 hours before the examination.) Do I need to take antibiotics before endoscopy? Some people with abnormal heart valves (such as mitral valve prolapse) or with artificial joints must take antibiotics before dental procedures. This is generally not necessary with endoscopy. Should I take my usual medications? You should take no oral medications for 8 hours before the procedure. Coumadin should be stopped 4 days before the exam. Aspirin and other non-

steroidal anti-inflammatories (Advil, Motrin, Voltaren, etc.) should be stopped I week beforehand. There is no need to stop Celebrex or Vioxx. Anti-platelet agents (Plavix, Persantine) should also be stopped 1 week before endoscopy. If you take oral medication for diabetes, skip your morning dose and resume your regular schedule when you get home. If you take insulin, please contact the office for instructions. Important points to remember: 1. You must be fasting for at least 6 hours before the examination. 2. You must stop anticoagulant medications, aspirin, and anti-inflammatories several days before your procedure (see specifics above). Failure to do so raises considerably the risk of bleeding if a biopsy is taken. 3. SOMEONE MUST BE AVAILABLE TO DRIVE YOU HOME AFTERWARD. FOR YOUR SAFETYS SAKE, WE CAN ALLOW NO EXCEPTIONS TO THIS POLICY. YOU SHOULD NOT DRIVE FOR AT LEAST 12 HOURS. 4. If you must cancel your procedure, please do so at least 48 hours prior to your appointment so we can offer your slot to another patient. 5. Most people find that the worst part of the examination is the anticipation. Once it is over, most folks are surprised at how easy it was. 6. Do not hesitate to call the office if you have questions. You can also e-mail questions to Dr. Baker at rbaker~nsima.com and Dr. Horowitz at mhorowitz~nsima. corn.

Note to Medicare patients: Although endoscopy is not a surgical procedure, Medicare classifies it as such. Therefore, when you receive your Explanation of Benefits, you will see your examination listed as surgery.