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

[bryan3536]

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!

[valleygirl1436]

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.

Valleygirl1436

[bryan3536]

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.

Thanks.

[pabrown38821]

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

[bryan3536]

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?

[giupset]

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.

[April2]

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.

[bryan3536]

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 . . .

[Joycie_767]

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.

[judeinneverland]

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!

[MJSmink]

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.

[April2]

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.

[Cheri70]

Just chiming in to say I had both done at the same time last year.  Piece of cake, no problems afterward, etc.

Good luck!

[jethro12]

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.

[bryan3536]

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.

[Deb408]

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!

[melnper]

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?

[Gloriarockwell]

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.

[DonAK]

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.  

[Amarro]

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.

[Missy513]

I had a combo done yesterday(Grastro/Colonoscopy) . Today i have cramps in the pit of my stomach. Is this normal.

[lvfrogs]

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.

[shelldrake111]

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

[JerryDK]

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.

[michell221]

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.  

[blonderenagade16]

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.

[bamer]

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.