Recently I had a gastroscopy and colonoscopy after a positive FIT (Faecal Immunochemical Test) result. I found this thread and decided to offer my experience:

My gastroscopy went well. The minimal sedation cleared my anxiety over a first-time procedure and I was very comfortable throughout. We then moved on to the second procedure.

The colonoscopy did not go well. Once the scope entered the transverse colon the discomfort increased exponentially until it was nothing but torture whenever the scope changed position. The calm state I had entered vanished and the visceral pain was razor sharp – undulled by the analgesia.

Initially I maintained my composure, thinking this was perhaps the worst of it or that the gas&air would work or the analgesia was going to come to my rescue, but soon I ended up trying to adopt a fetal position with the gas&air dropping out of my grasp, forgotten. I understand others in a similar situation might scream and shout or even fight but wanting to be a ‘good patient’ and having invested in the procedure with the prep etc. and perhaps just thinking I was being a wuss, my response was to curl into a ball and silently pray for it to end.

The doctor talked to me occasionally, explaining one or two things as he went. I didn't respond, but appreciated being included. After several minutes, the doctor told me that we didn't have much further to go (to reach the caecum) and that the pain would be less on the way out.  I felt helpless and unable to form coherent thoughts or even remember the nurse who talked to me at the start saying to raise my hand if I needed them to stop. Every part of me was laser focussed on anticipating and bracing for the next stab of pain. I was eager to comply with any request made by the person who, in my mind, was now performing the procedure with a length of barbed wire – what if I upset him or made him angry? I felt terrified and shocked but the sedation made it feel unreal at the same time. I was still in distress during the scope’s return journey – but slowly, each foot of scope that was removed translated into at least a reduction in the breadth of the pain, I held onto this encouraging sign and eventually it was out. The doctor said that it was all over and I thanked him. How British can you get? My prior hernia repair and recovery had been knocked off the top of the leader board for 'Most Pain I've Ever Felt' with a casual indifference.

In the waiting room I felt numb and everything seemed a little unreal. For days after the procedure I would find myself replaying the event over and over in my head and slept terribly.

In the procedure room I recall hearing:

"Put the gas&air back in your mouth"

"Put your head back on the pillow"

"Use the gas&air"

"You have a long colon"

"You have a sensitive bowel"

 

I do not recall hearing things like:

"Are you ok?"

"How bad is the pain?"

“You’re not using the gas&air properly, let’s take a minute to help you with that”

“Do you want to pause?”

"Do you want to stop?"

“Do you want more analgesia?”

“Some people can’t tolerate this procedure, its ok if you want to end it now”

 

So the question is how could it have gone different?

An experienced colonoscopist should be able to quickly recognise signs of a sensitive or hypersensitive bowel and pause the procedure if they feel the selected sedation/analgesia will not offer sufficient relief and only continue at the request of the patient, rather than encourage the patient to grin and bear it. If the procedure is a traumatic event, it is not a successful procedure, even if it reaches completion, particularly when it’s for screening.The literature given by the hospital did not explain much about what pain might be felt. Just that some found it more painful than others. There should have been much more information on the extent of discomfort patients may experience.Use of gas&air requires training and effective support especially for those under sedation and opiates. I was expecting a good correlation between intake and pain reduction. If the patient should be using the gas&air but can’t out of debilitating pain, the procedure should be paused until they can.The NHS generally use midazolam, fentanyl and nitrous oxide (gas&air) for this procedure. It doesn’t need an anaesthetist and nurse anaesthetist and the recovery period is very short. It’s an acceptable procedure for the majority of patients. Many other countries e.g. USA use propofol for a more heavy sedation which does require an anaesthetist but the outcome for the patient is superior – more procedures go to completion and far fewer patients complain of pain. The NHS is short of anaesthetists.A CT colonography is effective at detecting precancerous polyps and is a far less invasive procedure.

Recently I had a gastroscopy and colonoscopy after a positive FIT (Faecal Immunochemical Test) result. I found this thread and decided to offer my experience:

My gastroscopy went well. The minimal sedation cleared my anxiety over a first-time procedure and I was very comfortable throughout. We then moved on to the second procedure.

The colonoscopy did not go well. Once the scope entered the transverse colon the discomfort increased exponentially until it was nothing but torture whenever the scope changed position. The calm state I had entered vanished and the visceral pain was razor sharp – undulled by the analgesia.

Initially I maintained my composure, thinking this was perhaps the worst of it or that the gas&air would work or the analgesia was going to come to my rescue, but soon I ended up trying to adopt a fetal position with the gas&air dropping out of my grasp, forgotten. I understand others in a similar situation might scream and shout or even fight but wanting to be a ‘good patient’ and having invested in the procedure with the prep etc. and perhaps just thinking I was being a wuss, my response was to curl into a ball and silently pray for it to end.

The doctor talked to me occasionally, explaining one or two things as he went. I didn't respond, but appreciated being included. After several minutes, the doctor told me that we didn't have much further to go (to reach the caecum) and that the pain would be less on the way out.  I felt helpless and unable to form coherent thoughts or even remember the nurse who talked to me at the start saying to raise my hand if I needed them to stop. Every part of me was laser focussed on anticipating and bracing for the next stab of pain. I was eager to comply with any request made by the person who, in my mind, was now performing the procedure with a length of barbed wire – what if I upset him or made him angry? I felt terrified and shocked but the sedation made it feel unreal at the same time. I was still in distress during the scope’s return journey – but slowly, each foot of scope that was removed translated into at least a reduction in the breadth of the pain, I held onto this encouraging sign and eventually it was out. The doctor said that it was all over and I thanked him. How British can you get? My prior hernia repair and recovery had been knocked off the top of the leader board for 'Most Pain I've Ever Felt' with a casual indifference.

In the waiting room I felt numb and everything seemed a little unreal. For days after the procedure I would find myself replaying the event over and over in my head and slept terribly.

In the procedure room I recall hearing:

"Put the gas&air back in your mouth"

"Put your head back on the pillow"

"Use the gas&air"

"You have a long colon"

"You have a sensitive bowel"

 

I do not recall hearing things like:

"Are you ok?"

"How bad is the pain?"

“You’re not using the gas&air properly, let’s take a minute to help you with that”

“Do you want to pause?”

"Do you want to stop?"

“Do you want more analgesia?”

“Some people can’t tolerate this procedure, its ok if you want to end it now”

 

So the question is how could it have gone different?

An experienced colonoscopist should be able to quickly recognise signs of a sensitive or hypersensitive bowel and pause the procedure if they feel the selected sedation/analgesia will not offer sufficient relief and only continue at the request of the patient, rather than encourage the patient to grin and bear it. If the procedure is a traumatic event, it is not a successful procedure, even if it reaches completion, particularly when it’s for screening.The literature given by the hospital did not explain much about what pain might be felt. Just that some found it more painful than others. There should have been much more information on the extent of discomfort patients may experience.Use of gas&air requires training and effective support especially for those under sedation and opiates. I was expecting a good correlation between intake and pain reduction. If the patient should be using the gas&air but can’t out of debilitating pain, the procedure should be paused until they can.The NHS generally use midazolam, fentanyl and nitrous oxide (gas&air) for this procedure. It doesn’t need an anaesthetist and nurse anaesthetist and the recovery period is very short. It’s an acceptable procedure for the majority of patients. Many other countries e.g. USA use propofol for a more heavy sedation which does require an anaesthetist but the outcome for the patient is superior – more procedures go to completion and far fewer patients complain of pain. The NHS is short of anaesthetists.A CT colonography is effective at detecting precancerous polyps and is a far less invasive procedure.