Upper endoscopy: preparation and monitoring
Fasting is the whole preparation: nothing by mouth for six to eight hours, clear fluids sometimes allowed up to two hours before according to the local protocol. The purpose is an empty stomach, both to see and to avoid aspiration. Remove dentures before the procedure and note it. Ask about loose teeth. The throat is anaesthetized with a topical spray. Nothing by mouth until the gag reflex has returned, which is verified before offering anything to drink, not assumed after a fixed number of minutes. This is the single most common source of aspiration after this examination. After: a sore throat and belching are expected. What is not expected and must be reported immediately is chest or abdominal pain that increases, difficulty swallowing that worsens, subcutaneous crepitus in the neck, fever, or vomiting blood. These point to perforation or bleeding. If a biopsy was taken or a lesion was treated, the bleeding risk is higher and the surveillance is prolonged accordingly. Sedation carries the same restrictions as for a colonoscopy.