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Avatar universal

"Double Dip" - endoscopy and colonoscopy at same time?

My GI recommended an upper endoscopy and colonoscopy to take a look at my recurring acid reflux and fairly regular (monthly) rectal bleeding (he suspects hemroidal in nature).  He suggested that they be done in seperate procedures on two different days because, according to him, the preparation for the colonoscopy can make my upper tract appear raw, etc.

I mentioned this to my good friend, a GI resident, and she said that these procedures are routinely done together and didn't think this would be an issue at all - she didn't know why my GI would make that recommendation.

I'm pretty leery about getting put out, so if it's going to happen, I'd prefer it happen once - not twice.  If there is no medical need for me to do this in two seperate procedures, I'd rather get it done all at once.  

So, my question is whether there is any reason why I can't have these procedures done together, i.e., is there any validity to the notion that the preparation for the colonoscopy can skew the results of my endoscopy?

Many thanks!
37 Responses
Avatar universal
I have had both these procedures done, but not at the same time, ever. The preparation procedure to have the colonoscopy done is not pleasant. If you have never done this, it requires you drinking a gallon of fluid designed to 'clean you out' the day before the procedure. You don't eat anything, just drink this 'stuff'', and stay close to a bathroom. I didn't think it did any damage to the upper track or made it raw, however. But, I would go by my GI recommendations.

Avatar universal
Thanks for the response.  Thing is, I already need both, so I'll be doing the prep for the colonoscopy either way (the prep for the endo is simply no food after midnight) - that unpleasantness isn't going to be avoided.  So, if I'm already out for one procedure it makes little sense to me for them not to do the second procedure at the same time.  

From what I've been reading, they are routinely done together - I'm trying to find some medical justification for getting put out twice, instead of once.  Unfortunately the only reason I can think of is that the insurance reimbursement is going to be significantly less if the procedures are combined - I'd hate to think that decisions are being made for me on this basis, which is why I am looking to this group.  My GI friend could think of no reason not to do both at once, so I'm hoping the community here can come up with an answer.

Avatar universal
I just had both procedures done the 24th of last month the doctor told me they usually do the tests seperate he gave me no reason why but i don't like to go 2 times so i asked him to do both at the same time and he did....i got the results back and everything is working as it should so he sent me for a gall bladder test and my test showed that my gall bladder is working but i am having pain when it spasms so now i am scheduled for a nuclear stomach test to see if my stomach is emptying out as it should i wish the best with your tests
Avatar universal
Thanks for recounting your experience.  I've been doing some informal polling around my office, and those who have had the procedures give me stories similar to yours - docs schedule them seperately, but if you ask for them to be done at the same time the GI's usually don't oppose it.  

Would love to hear from a doctor on the issue.  Anyone?
Avatar universal
I had both done at the same time in March with no problem.  My dr. said they are commonly done at the same time.  My only difficulty was the prep for the colonoscopy.  It was difficult to drink the prep solution because I was having trouble with nausea and vomiting at the time.  After the procedures, I woke up feeling fine.  The endoscopy caused minor pinching like sensations for a few day.
203342 tn?1328740807
I had them both done at the same time with no problems at all. I didn't have a sore throat or anything. Like you, I think it makes more sense to get them both done together so that you only have to be sedated, etc. once. I think most doctor's want them done seperately because they get paid more that way.
Avatar universal
Thanks to everyone for their responses.  I am going to raise the issue with my GI and ask to have both procedures go forward at the same time - I don't want to be sedated twice if I don't have to be.

I would still love to hear from a GI on this, though, if anyone is out there . . .
Not a Dr but I have excellent docs in an excellent hospital.  2 yrs ago (age 64 - not that young ;-)) I had them done together.  Now I am have both again on Tuesday.   Re: sedation - when I needed only an endoscopy I was completely asleep - not twilight.   When I have needed a colonscopy only - that's when it was aware but sedated.
Avatar universal
Hi, I know what you are going through. I have my own recent Gastro issues. I had both ordered for me as well, but they have to be done seperately. It *****, but it's true. Don't worry about being put out though, it's conscious sedation. So you're easily woken up, but you are very sedated. I was nervous about the sedation, but honestly it's just an injection in your iv that slowly makes you sleepy and then next thing I knew I woke up. The worse part about the colonoscopy is obviously the preperation. The endoscopy was a piece of cake except for the nasty numbing spray they spray in the back of your throat. I'm terrified of hospitals, and don't particularly like my doctor, but the procedures really are not bad at all. So I hope this at least helps ease the nervs!
The type of sedation used does vary. I do not respond at all to drugs like Versed that they sometimes use for scoping and other similar procedures, when I had a port put in for chemo, I was awake the whole time (I was shot up with locals so no pain but I was aware of everything they did.) So while that isn't a big issue for colonoscopies, it definitely is a problem with EGD and so they have to use general anesthesia for me. I've had the same issue with the clinic I go to, only being willing to do one procedure at a time, they said I could only do both at the same time if I had it done at the hospital... which means a MUCH higher copay. And they could only get me afternoon appointments so having to go through no food (or the bigger issue, not drinking) for over 12 hours really *****. I even asked why if other people were having theirs done at 8 am, I could still eat or drink for several hours past midnight but that seems to be the cutoff they use for everyone even though it makes no sense medically.
203342 tn?1328740807
They do NOT have to be done seperately. As you see, many of us had both procedures done at the same time. I also know of others who had it done at the same time. I believe doctors that are insisting that they be done seperately are either pressed for time (which really they don't take that long, maybe 20 to 30 minutes for both procedures, depending on whether they have to do biopsies, etc.) or they are wanting more money because I was told that when they turn in each procedure seperately to the insurance companies they get more money than they would turning both in at the same time.
I don't think it's irrational to request both procedures be done at the same time. If he refuses ask why.
Avatar universal
Just chiming in to say I had both done at the same time last year.  Piece of cake, no problems afterward, etc.

Good luck!
Avatar universal
When I went to have my colonoscopy done my Dr decided at that time to also
do the EGD so I am not sure what he is talking about they do it all the time.
They do bill it differently when they are done at the same time.Maybe he gets
a better reimbursement by the insurance.
Avatar universal
Thanks to everyone for sharing their experiences.  Here is how this was resolved for me:

So I called the surgery center Tuesday (it's Thursday when I write this), and the initial response I got was "it depends on what insurance you have, and whether they will cover the procedures together."  Needless to say, this was not an acceptable answer to me - insurance obviously covers both procedures, so what she was really saying to me was, "it depends on how they will reimburse us for it."  Anyway, I was referred back to my GI, told their office what I wanted, and they got back to me this morning saying that it wouldn't be a problem for me to have both done at once because "I'm young" (I'm 31).  Honestly, I don't know what that has to do with anything - you can't tell me it's "better" to be put out twice if you're older - but that was the answer I got.  

I am not unsympathetic to the issues docs face in getting reimbursed from insurance companies - I'm an attorney and actually do work for them in that area - but it absolutely drives me nuts to think I was about to undergo two seperate procedures, on two different days, getting anesthesia twice, and effectively missing 3 days of work (two surgery days and the colonoscopy prep day), because of a reimbursement issue, not a medical consideration.
Avatar universal
I may be a little late in getting back to you, but I just has both procedures done yesterday and I have no problems. The worse is the prep.  I'm 41 and made it through!
Avatar universal
Please tell me the endoscope down the throat is not bad. I am going to have it done very soon and I am terrified. I have been having nasuea and gagging and near vomiting for the last 4 weeks, all day, every day. The only relief I have is when I sleep. I have had abdominal xrays, a gall bladder ultrasound and a gall bladder hide-a-scan, as well as blood work. Everything came back normal. I have now had to take a leave of absence from work and am in bed almost all day, every day. I have taken Reglan and Phenergan for the nasuea and neither has helped. I am gagging so much that I sometimes have shaking episodes (the kind you get when you have a fever and get the chills). I have now been given Zofran for the nasuea and Xanax for anxiety because of the "shakes". I was in the hospital for a few hours yesterday. Mostly they just hydrated me with a couple of bags through an I.V. because I haven't been able to eat or drink. I have to go to the GI on Tuesday to schedule the endoscopy and am terrified. I am told that you are not completely asleep and that, even though you don't eat for several hours before, you can still vomit. I am gagging so much right now that I don't know if I can handle having a tube down my throat. Please explain how the procedure was for you. I am assuming you are not completely asleep because they said they have you swallow to help move the tube down. Can you tell me exactly how they did it to you?
Avatar universal
If you do the endoscopy and colonoscopy together and something goes wrong after you are discharged than you complicate the emergency surgery.  My husband had both done and started vomiting blood at home.  He had to have energency surgery, but because he had had both proceedures done that morning the surgen had to predict where he was bleeding from.  The result was an insision from his chest to his groin.
Avatar universal
By suggesting that the procedures be done on different days, the GI's may be looking out for the patients pocketbooks.  I had both done on the sme day and since my insurance company applied the "multiple same day procedures" guidelines, the GI billed me for the part that insurance did not pay.  In my case $593.00.  Check with your insurance company prior to scheduling both on the same day to see if they will pay in full or you will have to pay the difference.  My insurance company required that I get prior approval to have both done on the same day, but made no mention of their lesser payment to the doctor and my monetary involvement.  
Avatar universal
I had both done at the same time and didn't have any problems.  In fact, my doctor didn't even offer the option of having them separately and I was happy to get both over and done with at the same time.
Avatar universal
I had a combo done yesterday(Grastro/Colonoscopy) . Today i have cramps in the pit of my stomach. Is this normal.
329994 tn?1301666848
To Missy513,
I think that the cramps are probably fairly normal. You have had two invasive procedures. If they worsen or the pain is really bad (scale of 1-10, and they are 7 or above) I would call the doctor. If you are still concerned, call the doctor's office anyway. They are there for you!! So get the answers you want. Hope the results come back ok.
Avatar universal
I am going through this right now. I just got denied for the FACILITY my doctor resides out of. The insurance company wanted me to go to the hospital to have it done because it is cheaper. I was 3 hours away from starting the Magnesium Citrate drink(the girl at the doc's office called me at 3pm and I was due to start the first round at 6pm!)to tell me if I went ahead with the scheduled procedure as is? It was gonna be $1800 instead of $600. My doctor also scheduled me to have them done separately and everyone I have talked to from age 17(my niece)age 21(my nephew) up to my mother age 75 and many many many other people ALL had it done at the same time. The reason they want to do it separate is because they get paid more. The problem is I get CHARGED more! Two anesthesiologists,..two rounds of anesthesia! I am an otherwise healthy individual age 42!

I talked this over with my insurance company this morning and they agreed that it needs looking into. Since the facility wasn't covered,..they did not ask for my "specialist" co-pay which is normally $35 up front and they said I would have to have the money upon arrival of the day of the procedure which was supposed to be Friday! Today was supposed to be round two and my liquid diet day as well as the Movi Pack drinks.

3 HOURS before I started I found this out because ETHICALLY they HAVE to inform me of my charges. On the day of my rectal exam and consult? The office girl was too backed up to check me out and go over this so she sent an assistant out to go over my pre-op instructions and said NOTHING about the insurance coverage. That the insurance comapny denied the FACILITY(surgical Center) should have already been determined before even scheduling the procedure!

It inconvenienced me,.my co-workers who jumped through hoops to cover me for the days off I would need for the prep and procedure as well as the family members who changed their schedules to drive me to and from the procedure since I wasn't allowed to drive.

ANd due to them wanting to re-schedule it,.it interrferred with my son having his wisdom teeth out which I was gonna have to pay $700 to have done anyway and yet they were like "Oh no problem,.we can do the procedures on August 3rd and August 10th so just show up then k?" and i was like "Uh NO! I can't pay you guys for one procedure on the 3rd(my part is 10% of the total cost) and then 3 days later pay my son's oral surgeon $700 and then 3 days later on the 10th pay you guys ANOTHER 10% for TWO procedures that SHOULD be combined into one ANYWAY!You people have inconvenienced me beyond what is reasonable and ethical so I am going to another doctor!"

Oh and I forgot to add that my original consult was already changed ONCE by this doctor and I was asked to come in a 1/2 hour earlier than I was scheduled and had to have someone cover for me at work because of it! Yet when I DID get there a 1/2 hour early? They STILL did not have time to go over the costs with me and sent out an assistant who didn't KNOW that Blue Cross wouldn't pay for their facility anyway!

It has been a NIGHTMARE!

I will update with what happens as I have already contacted my insurance company,my referring regular doc and given my boss the heads up too. I bought a nice card for my co-workers who came through and were willing to fill in for me and took back the days they were gonna work for me and told them to take the days off like they originally had when I asked them to switch. As a result? I lost one of my days off,.amd completely stressed out and leery of the whole ethics thing with this doctor and refuse to let him TOUCH me now!

Guess it's kind of like,..Buyer Beware huh?LOL

Avatar universal
Today is September 8, 2009.  Because of some chronic abdominal discomfort during the last two months I had both a colonoscopy and endoscopy on the same day, the morning of September 4.  Because of the sedation I have no memory of the procedures.  I awoke and seemed OK.  For the rest of that day I felt OK, no pain anywhere -- but I suspect that was because the demerol was still masking some pain.  The next day the middle of my upper abdomen (above the belly button and below the sternum) was almost constantly sore. The pain also seemed like a cramping or a pinching -- it is hard to put in words what the pain was.  I knew the doctor had taken some tissue for biopsy, so I tried to assuage myself by thinking that the pain was probably from where the tissue was taken and tried to accept the pain, but it kind of depressed me too.  The next day, Saturday, there was some improvement. On Sunday, I was just a little better.  On Monday about the same as Sunday.  Today is Tuesday and my abdomen still does not feel normal, and at random times that "cramping" or "pinching" feeling will come for a few seconds and the diminish or go away -- for awhile. I called the office where the procedure was done to tell them about my condition, and they said the doctor would call me back in the afternoon -- but he did not.  I will try again tomorrow. I am not happy about the soreness after the endoscopy, especially since I was feeling completely normal for the five days prior to the colonoscopy and endoscopy -- so I thought I was finally getting better.  But now I am have this soreness that is different than the other times during my chronic abdominal discomfort. But, since others here have said they had abdominal soreness for days after their procedure, maybe what I am experiencing is not alarming.
611999 tn?1298761891
I have had both done and experienced pain and soreness in my abdomen for about a week both times with my colonoscopy.  The first few days were the worst but I still had that cramping pinching for a while.

I also had one endoscopy with no pain and another endoscopy with a sore painfull throat for about 1 week.  
Avatar universal
I had both procedures done several days ago.   I am so sick now.  I am bloated beyond belief..........belching............sick..........feel light headed........can't eat...............tired...........don't know what to do.   will call dr on monday..................i have had this done before and it went well.  I am wondering if it is the stuff they gave me to knock me out.   I feel like I have been poisoned.
Avatar universal
Thats not good I would sugests you go into the ER and not wait another day, they could have tore something inside while doing your procedure. you need to get checked out right away, just think of it like this its better to be safe then dead (sorry)  I have these done regularly due to me having FAP and no that is not normal. Because I have them so offten this is one thing they tell me that I need to come in ASAP if I have half the symtoms you do.
Avatar universal
I had the "double dip" colonoscopy and Endoscopy today and I have to say, it was super easy and fast. By far the hardest part of the whole thing was downing the laxative last night. Took hours and yeah, you do have be close to the throne.  But keep thinking--"I need to clean out the pipes so they can really see what's going on."

Here's how it went. Checked in at 10:30. Vitals all checked, questions, then into the gown. My blood pressure was high, and I'm sure it was because I was a bit stressed and would soon find out--I should not have been--at all.

I was wheeled into the where the doctor was. There was calm music playing. The nurse put in the IV to get it all set up. She was nice and I told her, "yeah get that stuff going." She said, "the good stuff is on the way." It was cute.

Then the Doctor asked me a few questions. Make sure you tell him all your symptoms. He's not just a tech, but a doctor. He was super nice and calming. He said he does the "double dip" all the time.

Then they put an oxygen thing in your nose, which feels great. Cool air going into your nose.  a light spray of stuff that taste a bit like bad cough syrup into your mouth to numb your tongue and back of your throat. At this time the "good stuff" that puts you into LA LA land starts. And I gotta tell you, it's amazing. You just go, "whooooooooaaa".

And that my friends is about that last thing you really remember. They go to work and your just don't really know it. I do remember trying to talk during the endoscopy. And the doctor saying, "don't talk." But that was it.

Then you literally wake up and he's going over what he found. Which in my case was a bit of redness and Hiatus Hernia--I have reflux. But my colon was clear of all polyps. Wheeeew. What a relief.  

The whole idea her is people--we need to do these tests to stop things like colon cancer or esophageal cancer before they start.

Bottom line, if you are having both of these done and have apprehension or anxiety, forget about it. Just know it's going to be a piece of cake and will be over really before you know it began. Go through the steps, try to relax and even make jokes to keep yourself calm. There is ZERO to worry about with this procedure.

Good Luck!

1387175 tn?1326404597
Wow The colonoscopy Prep Was Nasty 64 Oz Of Gatorade Mix With Miralax Drink Every 15-30  Minutes Till It All Gone Then Drink Some Sodium Crap With 7 Up A Lot Laxatives
Avatar universal
I just recently had both done in the same day about 3 weeks ago. My GI doctor recomended it that way for the specific reason that I would not have to come back for a second procedure. He said that he prefers to do it that way he said it is easier on the patient and also on the patients pocket book. He said that since you are already there and are under  anesthesia it only makes sense to do them together. He also said that doing them together saves a lot of money for the patient. They charge so much for the room and the anesthesia so he said it is best to do it all in one visit rather than having the patient pay out twice. I was not looking forward to having it done at all. It was not bad at all they put me out and I dont remember a thing. I am also very glad that I had this done because they found 3 pre-cancerous sist. I was told that if they would not of caught it now that within a year it would have turned into full blown cancer. I had to go in a week later to have them all removed. I am so thankful that I had it done. Hope it all turns out great for you!!!
4777100 tn?1359039774
I have my Upper GI endoscopy and Colonoscopy together tomorrow morning. My doctor wanted them both done at once, since they imply its safer to sedate you one time instead of having to put you under twice. They never mentioned about my upper GI would be raw. I go to the best Colon Rectal surgeon in Los Angeles. I hope your went well!
Avatar universal
I was registered to have the endoscopy and colonoscopy on the same day. I live in nottingham , England. Despite being very early for my appointment, just a few minutes later I was sent straight through to a nurse to go over the risks / complications / if i wanted sedtive & for me to sign my consent form. 5 minutes later I was lied on the bed greeting the doctors / nurses who would be performing the procedure. The doctor / nurses instantly put me at ease, introducing themselves with a smile and the doctor even told me some funny stories which really calmed me down. A brief discussion of the order of the procedure so I knew what was going to be happening, then I was given the sedative and told very nicely by a nurse who stayed right by my side the whole time that I could squeeze her hand as hard as I wanted. They performed the endoscopy first, then turned the bed and I was given more sedative before they performed the colonoscopy. While being quite out of it at this point, I still remember the nurse holding my hand and asking me if I was okay throughout, though I was mostly mesmerised watching the screen!
The staff in the recovery room were equally as nice, and there was no pressure for me to rush 'coming around' from sedation. Lots of checks to see if I was feeling okay, while not being pushy at all.

All in all- a very good experience. Upon my arrival I was a mess of nerves, but when dealing with such lovely staff I felt so much more at ease. Very professional and genuinely nice team.
Avatar universal
If we get them done separately, the surgical center bills twice (usage fees), the anesthesiologist bills twice, the anesthesia itself is doubled, there is a second fee for the nurse anesthetist, and other attending personnel that are not included in the center's basic fees.  Considering our co-pay, separate procedures are much more costly - in our case.
Avatar universal
You get put out for both endoscopy and/or colonoscopy.  No need to worry about gagging.  
Avatar universal
I had both done at the same time and my Mom said they should allow this to happen...she thinks they only do them separately to get more money out of us.

The worst was by far was the bowel prep...I felt like I had the stomach flu and it was absolutely terrible. Then again my stomach is sensitive in general so this wasn't going to be easy on me.

Got sedated for my xxxscopy's as I call it and I don't remember a thing, nor did I feel a thing. I only remember getting oxygen tubes in my nose, the mouth block between my teeth that was tightened around my head, and told to lay on my left side and cross one foot over the other.

Once they told me to have a nice nap I was out like a light and woke up in recovery. I was fairly alert but definitely loopy...I told the nurse that was the best thing I'd ever had done (what??) and she said I needed a vacation LOL. But seriously in the grand scheme of things the procedure was painless and no one should be scared about it beforehand like I was!

The anesthesia wore off about an hour or so later and I was eating pretty normally again that night. :) still a little bloated I guess from the air they pumped into my stomach but that's okay. :) Hopefully I won't have to get one of these for another 20 years I'm 30 years old now and have been suffering from chronic nausea and cramping for the past 5 years. :(
Hi Im curious what was your diagnosis? What did you have? Because Ive been feeling the same and also did you get better?
Avatar universal
Right now it is 5:15am,and I have being wake since 1:30am.  
Today at 14:00 o'clock I'm going to have  both,endoscopy,and colonoscopy .
I'm little nervous,,and hungry,but other wise I'm ok!
  I enjoyed reading all the comments.
Good luck to all that going to have the same!
10869581 tn?1413426119
Thank you, best comment and information about procedure I have yet to read.  Totally put me at ease and my intuition that all will go well and must be done and I am in good hands and it will be in and out, and intuitive feelings of ease about the whole thing were heightened.  Thanks for making me feel so much better about this.  Been putting if off for four years, but now very sick for one year, lost 70 pounds, can't eat or drink and dire situation.  Hope they find out what is wrong and can fix it and it is not serious.  Thanks for your comments.
Avatar universal
Thank you for saying this. I've had several colonoscopies but will have it again on Julyh 31st with the endoscopy. The latter concerned me with gagging but my gastro promised me I won't know anything.It seems from reading other posts, the endoscopy is done first. Some seem they're knocked out for the endoscopy, others say they're in Lala Land.
Avatar universal
I am a Board Certified Anesthesiologist.  I can not think of any medically necessary reason why both procedures should not be performed at the same time.  A vast majority of my Gastroenterology colleagues confirm that unfortunately it is the 'bottom line' that motivates most practitioners to perform an endoscopy and a colonoscopy on separate days, thus generating up to twice the revenues.  However, this means that the uninformed patient must take two days 'off work', and be subjected to twice the anesthetic risk, which in every patient is significant and in many patients critical.
Avatar universal
I'm getting both done at same time day after tomorrow
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