Know What To Expect While Recovering From Your Procedure

Post-procedure Instructions

Upper Endoscopy
Colonoscopy
Liver Biopsy
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Percutaneous Endoscopic Gastrostomy (PEG) Feeding Tube Placement
Treatment of Barrett's Esophagus

Upper Endoscopy (EGD/Esophagogastroduodenoscopy),
Small Bowel Enteroscopy, Upper Endoscopic Ultrasound (EUS)

SORE THROAT
You may experience a sore throat following the procedure which may last for several hours. Once your swallowing reflex has returned, you will find warm drink

GAS
You may experience some gas pain, since the stomach is inflated with air during the examination, but this discomfort should pass with burping and the passage of several hours. However, if the pain continues or you feel any other discomfort, you should telll your nurse or physician immediately.

NAUSEA
Nausea may be caused by the presence of gas, effects of the medication used or pain. This condition may last several hours but your doctor should be notified if it persists into the following day. Drink only clear liquids (any fluid you can see through), and do not eat solid food until the nausea subsides. Bed rest is recommended. If vomiting should occur notify your physician.

I.V. SITE
Localized irritation of the vein (phlebitis) may occur at the site of medication injection and is not unusual. There may be a red streak going up your arm that is best treated with moist hot packs. If it progresses, call Eugene Gastroenterology as antibiotic therapy may be required to resolve this condition.

FEVER, SEVERE PAIN OR EXCESSIVE BLEEDING SHOULD BE REPORTED
TO YOUR DOCTOR IMMEDIATELY.

Forgetfulness is normal immediately after the procedure and is due to the use of an amnesic drug required for adequate sedation during the colonoscopy. Should you have any questions after your procedure, please call our office and your call will be directed to your physician’s triage nurse. (If this is a toll call, call 1-877-484-4501.)

A pathology report of any biopsied tissue should be received by our office in 14 days. If you have not heard from us within this time frame, please call our office and your call will be directed to your physician’s triage nurse. .

Colonoscopy, Lower Endoscopic Ultrasound (EUS), Flexible Sigmoidoscopy

ABDOMINAL GAS
Directly following your colonoscopy and possibly for several hours thereafter, you may experience abdominal gas or the sensation of being bloated. This is due to the introduction of air into the colon during the procedure in order to facilitate the movement of the colonoscope within the large intestine, and to increase visualization by smoothing out the normally wrinkled bowel wall. You will experience increased flatulence (bowel gas), until your colon returns to its normal state (24 hours). Walking assists your bowel to rid itself of gas. One may experience loose stool or no stool for up to 3 days following the procedure. If you have no bowel movement by the third day, you may take a fiber supplement or milk of magnesia.You may eat when you get home; however, be sure to consume only small portions of food until you rid yourself of the majority of the gas in your colon, as its presence may cause you to feel nauseated. (Eating a full meal stretches the stomach and increases the bloated discomfort.)

BLEEDING
Due to the action of Colyte in the bowel and the frequent elimination which follows, your hemorrhoids may be irritated to the point of bleeding. You may experience continued irritation for the next few days, until your rectal tissue has a chance to recover from the trauma. You may use an over-the-counter preparation such as Preparation-H or Anusol to help ease the soreness. At no time should the present bleeding exceed the pre-procedure amount.

After the removal of polyps, you may notice a small streak of fresh blood on the toilet tissue or in the toilet bowl. This is not a matter for concern as it may indicate only slight trauma to the wall of the bowel during the manipulation and passage of the colonoscope and is readily repaired by your body.

ALWAYS BE SAFE! NOTIFY YOUR PHYSICIAN FOR ANY WORRISOME SYMPTOMS.

FEVER, SEVERE PAIN OR EXCESSIVE BLEEDING SHOULD BE REPORTED TO YOUR DOCTOR IMMEDIATELY.

If you have had polyps removed, please DO NOT take products with aspirin or ibuprofen (Excedrin, Aleve, Motrin, Naprosyn, arthritis medications or Alka-Seltzer) for five days, as this lengthens the time it takes for your blood to coagulate (clot) at the biopsy site(s) and can increase the risk of post-procedure bleeding.

Liver Biopsy

You have just recently undergone a liver biopsy, and in order to keep you safe and healthy we would like you to follow these instructions:

If you were given any medications during your liver biopsy to reduce pain or anxiety you many not drive for a 24-hour period. This is a legal restriction that must be observed. Any narcotics or anti-anxiety medications reduce your reflexes.
You may remove the bandage which covers the liver biopsy site. You do not have to replace it. You may shower or bathe as you desire.
You may have some bruising at the biopsy site. This is to be expected. You may also have some mild discomfort at the biopsy site or deeper within this region. It may feel like you have been punched in your right side.
Upon taking a deep breath you may feel some discomfort in the biopsy area. This is normal for the first 24-48 hours, as long as that discomfort does not exceed what you can comfortably tolerate.
You should not lift any object heavier than 20 pounds for the next three days.
You should not engage in excessive physical activity (jogging, contact sports, etc.) for the next three days. Light exercise such as walking is permissible.
Please do not use any aspirin or pain medications in the class of “non-steroidal anti-inflammatory drugs” (i.e. ibuprofen, Advil, Motrin, Naprosyn, etc.). These products tend to act as blood thinners and we do not want to increase your risk of bleeding from the procedure. If you are taking Coumadin/Warfarin, you will be instructed when to resume this medication.
You may resume your normal regular diet after the procedure.
If you have fever, moderate/severe pain, difficulty breathing, please notify our office immediately at 541 868-9500 (toll free 877 484-4501). We have a doctor on call 24 hours a day. If for some reason you are unable to contact us, you will need to go to the emergency room (or call 911) to be evaluated for these symptoms as a complication of the procedure may have occurred.
Liver biopsy results take approximately 1 week to get back to our office. We will call you at the end of that time with the results. If you do not hear from us by 7 working days please feel free to contact our office.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Having recently undergone an endoscopic retrograde cholangiopancreatography (ERCP) there are certain symptoms which could potentially appear. In our experience, it is best that you do not eat any solid foods for the next 12-18 hours. You should remain on clear liquids (anything you can see through), for at least the next 12 hours. Patients who attempt to eat solid foods or drink rich beverages (i.e., milkshakes), have more of a tendency to develop nausea and vomiting.

Because there is a possibility of developing pancreatitis (inflammation of the pancreas) and/or cholangitis (infection of the bile duct), due to the use of dye which illuminates the ducts coming from the pancreas and the common bile duct, we ask you to report any of the following:

Fever;
Sweats and chills;
Severe nausea and/or vomiting;
Moderate-to-severe abdominal pain (this is graded on a 1-10 scale, with 10 being the worst pain you personally have ever experienced);
Vomiting blood or passing bright red or black, tarry, foul-smelling stool.

Pancreatitis does not occur frequently. However, when it does occur, it usually requires hospitalization and IV pain medications. You did receive antibiotics prior to your ERCP, but occasionally cholangitis can still occur. Other rare complications can include bowel perforation, with signs and symptoms of severe abdominal pain with or without fevers, and, intestinal bleeding presenting as the passage of black, tarry stools with or without dizziness, shortness of breath, or chest pain. You should notify us immediately if you develop any of these symptoms. We have a doctor on call 24-hours a day, who may be reached by dialing 541 868-9500 (toll free 877 484-4501). Our answering service will relay the message to the doctor and the doctor will get back to you immediately. If your symptoms are severe, it would be advisable to go directly to an emergency room.

Percutaneous Endoscopic Gastrostomy (PEG) Feeding Tube Placement (PEG)

CARE OF YOUR PEG

You may begin to use the PEG feeding tube 3 hours after placement. You will be instructed on how to administer the tube feedings.
PEG site may be cleaned with Betadine swabs daily for 7 days. If the skin is irritated by the Betadine, you may use a mixture of 1:1 hydrogen peroxide and sterile water. After one week, the site may be cleaned with soap and water on a daily basis.
For the first week, cover the PEG site with a sterile gauze and medical tape each time you clean the site. Even after a week some drainage from the site can occur and, therefore, most patients prefer to continue to cover the site with gauze (changing the gauze as necessary). If there is no drainage, no gauze covering is required after one week.
You may shower/bathe 3 days after PEG placement. Make sure the end of the tube is firmly clamped.
If there is swelling at the PEG site, you may need to loosen the flanges (plastic wings holding the tube against the skin), by gently sliding the flange away from the body.
The tube site may ooze pinkish/red drainage for the first several days. This is expected. You may use cotton dressings to absorb the fluid. If the discharge changes color (yellow, green or brown), or has a foul odor, notify your doctor immediately.
If there is excessive pain (requires more medication than is provided, or is extreme in nature), a fever (temperature above 100 degrees F), nausea or vomiting, call your physician immediately.
It is extremely important that you remember to flush the tube with a 1:4 mixture of vinegar and tap water (10 to 20 ml) after every use, to prevent fungus buildup and clogging. Once per week you may use a carbonated drink such as 7-Up or Pepsi to "bubble away" any debris which may stick to the inside of the tube.
You may coil the tube and tape it against your abdomen in whatever manner is comfortable. The PEG tube should not interfere with your normal activities and when clamped and not in use it can be hidden discreetly beneath your normal clothes.
If you have questions, please ask the healthcare provider who is supplying your PEG feeding formula.

Will the tube need to be replaced?
Several PEG tubes are available and your doctor will decide on the best type and size for you. Most are designed to last 6-12 months before they deteriorate. Thus, if the tube wears out and PEG feeding needs to be continued the tube can be easily replaced. If, however, your swallowing condition improves and PEG feeding is no longer required the PEG tube can be easily removed as an outpatient. This is done in our office without the need for sedative/pain medications. The PEG feeding tube, however, needs to remain in place for at least one month prior to attempting removal.

Possible problems with PEG feeding and tubes
Most people have no problems coping with PEG feeding or with their tubes if they follow the advice from the hospital. Most of the problems that arise can be dealt with quickly by you or a relative or by contacting your doctor or nurse. Below is a list of some possible problems and how to prevent or overcome them. If you are unsure about any problem do not be afraid to ask for help.

Diarrhea, bloating, constipation, reflux
If you have not been able to eat normally for some time it may take a while for the bowel to get used to the feeds. Your dietitian will advise you on the correct type of feed and rate of feeding. If you have constipation you may be advised to have a high fiber feed. If you suffer with reflux or vomiting after feeds it may help to sit up or change position during feeding. You should inform you nurse or doctor if you develop abdominal symptoms at any time.

Skin infection
It is important that the skin around the PEG is cared for well. It should be kept clean and, after washing, bathing etc., should be dried carefully. Ensure that the area under the disc is also carefully dried. If the skin becomes red, swollen or sore you should contact your doctor or nurse.

Tube blockage
You will be given clear instructions on the tube feeding and medicines that can be given through the PEG tube. Only specially approved tube feedings should be used and medicines should be given in the form of liquids. The tube should be flushed with 30-50ml of water before and after each feeding or medication. If this is not done, the tube feeding or medicines can solidify in the tube and may cause blockage. You will be taught what to do if your tube blocks but if these measures fail you should contact your nurse or doctor as soon as possible.

If the tube splits or the hub breaks
Stop using the tube and clamp it shut close to the retention disc to prevent leakage. Contact your nurse or doctor as soon as possible. It may be possible to repair the tube otherwise they will arrange for a replacement to be inserted.

If the tube falls out
You will need to contact your nurse or doctor immediately. The exit hole can close in a short period of time. In order to avoid another endoscopic placement of the PEG feeding tube, the exit hole needs to stay open. Cover the exit hole with a dressing to absorb any leakage and get in touch with the nurse or doctor immediately. If this occurs after hours when the office is closed you will need to go to the emergency room so that the feeding tube may be replaced before the exit hole closes. If the exit hole closes/heals, the PEG feeding tube placement may need to be repeated endoscopically.

Treatment of Barrett's Esophagus

You may experience a sore throat following the procedure which may last for several hours. You may find warms drinks very soothing. You may also take Tylenol for the minor discomfort. If your pain becomes severe, please notify your physician.
After ablation of Barrett’s esophagus, it is common to experience significant chest pain which may last for a number of days. Sometimes the pain is severe enough that even drinking water may be very uncomfortable. Your physician has provided prescriptions for your use for pain and control of stomach acid. Please use these as directed by your physician. The chest pain should gradually resolve over the next few days. If your pain is not responding to pain medications, lasts longer than 5 days, or is becoming worse instead of better, please do not hesitate to contact your physician.
You should consume only liquids for the first 24 hours after the ablation procedure. Liquids, such as Carnation Instant Breakfast, Ensure, Boost, and Slim Fast are encouraged due to the balanced nutrition. It is recommended that you consume only soft foods for the first few days after your procedure, and then advance to a regular diet as your pain subsides. Avoid highly acidic foods, such as citrus, carbonated beverages, and spicy items which may make the pain worse.
You may experience some gas pain since the stomach is inflated with air during the examination. This discomfort should pass with burping and with the passage of time.
Nausea may be caused by the presence of gas, effects of medication used for sedation, or pain. This may last for several hours; should this persist into the next day, your doctor should be notified. If you have significant vomiting, please call your physician.
Localized irritation of the vein (phlebitis) may occur at the IV site. If you notice a red streak progressing from the IV site upward, call your physician; antibiotics may be needed.
Forgetfulness is normal immediately after the procedure. This is due to the use of a sedative which causes temporary amnesia. If you have any questions about your procedure which have not been addressed in your discharge papers, please call.
FEVER, SEVERE PAIN, DIFFICULTY BREATHING, SIGNS OF BLEEDING, OR ANY OTHER SIGNIFICANT CONCERNS SHOULD BE REPORTED TO YOUR PHYSICIAN IMMEDIATELY. PLEASE CALL EUGENE GASTROENTEROLOGY AT (541) 868-9500 AT ANY TIME. During business hours, ask to speak with your physician’s triage nurse; after hours, please ask the operator to call the on-call physician.

Note: the information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.