5 helpful tips to keep you calm during your endoscopy

An endoscopy is a minimally invasive medical procedure when a ‘scope’ (thin, flexible tube with a light and camera on the end) is introduced into the body in order to look at internal organs and structures. This is a fairly common procedure and can be used to investigate symptoms, diagnose certain conditions and even deliver treatments in some cases.

Whilst endoscopy is an everyday procedure for those medical professionals who carry them out, for patients they can sometimes be daunting and stressful. Studies have even shown endoscopy to produce a classical ‘stress response’ with increased release of noradrenaline and cortisol (major ‘stress’ hormones), as well as a significant increase in heart rate. This is a similar physiological pattern seen in the ‘fight or flight’ response. Anxiety during endoscopy is a widely researched area as it often impacts the outcome of the endoscopy, the ease of the procedure itself and whether or not it will need to be repeated; keeping calm and relaxed can make passage of the scope easier and less uncomfortable. This article outlines 5 helpful tips and tricks to help keep calm during your endoscopy!

1. Know yourself and your own coping strategies

For some people, the idea of having a medical procedure is not that much of a worry. However, there are many people for whom this would be a major source of anxiety. The first step in preparing to have something like an endoscopy done is to identify your own anxiety levels. Focused studies of endoscopic procedures show that people who generally have higher levels of anxiety are more likely to experience panic attacks. Identifying your own levels and feelings of anxiety regarding the upcoming procedure is the first step in formulating appropriate coping strategies to reduce stress. Research has also shown that, in addition to identifying the source of stress, those who use specific strategies tailored to their own day-to-day coping mechanisms show maximum benefit during the endoscopy. From a medical perspective, women and patients with other medical problems have been shown to be at the highest risk of developing anxiety during endoscopy,  and that merely identifying these patients who are at a higher risk of stress and anxiety prior to the procedure shows improved patient satisfaction and reduced anxiety during endoscopy.

2. Get to know what is going on

Whether you are feeling particularly anxious or not, it is a good idea to find out as much as you can about the exact procedure that you are going to have in advance of having it done. There are many different types of endoscopy, and patient experience can vary greatly on what is being investigated or treated specifically. Several studies have shown that high levels of patient education/information reduces heart rate and distress during endoscopic procedures, as well as producing positive effects on patient perception, compliance, and procedure-associated anxiety.

The best way to find out all of the relevant information is to speak to your doctor (ideally the one who has referred you or will be performing the endoscopy). Sometimes the consultations can seem a little short, or you may forget to ask some questions, so it can be helpful to write down questions as you think of them, and then take them with you to your consultation for further discussion with an experienced clinician. There is also a lot of good information online. The NHS webpage on endoscopy has a lot of useful information, or visit our specialist pages on endoscopy for more information.

3. Discuss the option of sedation

For the majority of endoscopies, there will be some local anaesthetic to numb the area where the scope is inserted, however, there is often the option of having some sedation in addition to this. The aim of the sedation is to make you feel drowsy and a little more relaxed during the procedure, for those who are particularly anxious or worried. After identifying your own levels of anxiety and finding out about your procedure, the next step is to consider whether you would like some sedation during the endoscopy. This is definitely a conversation that you want to have with the appropriate clinician as it also has some bearing on the ease of the procedure itself. If the doctor performing the endoscopy feels that you may become particularly stressed, they may recommend strongly that you have sedation to make the procedure more comfortable. Research has shown that pre-medication with sedation showed reduced anxiety and blood pressure (a marker of stress and anxiety) during the endoscopy and reduced recovery time afterwards. However, as with any medications, there is a risk of reacting to the sedation and so, slightly increases the risk of medication-associated complications.

4. Listen to music

A study looking at multiple trials, including over 2,000 patients, evaluated both the psychological and physiological effects of playing calming music during endoscopy. The analysis of these studies concluded that music gave a significant overall positive effect, reduced pain scores, reduced patient anxiety and improved patient satisfaction; fairly impressive results for what is considered to be a ‘non-medical’ addition to this intervention! Having music playing during your endoscopy is never going to be compulsory, but if it is something that you feel would help you to relax, then ensure that you mention it to your doctor and the clinical team will be able to arrange it for you.

5. Advice from our experts

One of our top experts at Highgate Private Hospital, Dr Kwok Tang, Consultant Gastroenterologist & Hepatologist, has sub-speciality training in advanced endoscopy and offers his own advice based on his extensive experience:

• The examination is very quick and takes on average 3-5 minutes to complete
• This is not a painful procedure. Most patients are sensitive to the camera passing down the throat, so anaesthetic throat spray and a light sedative injection can make examination much more comfortable
• The endoscope camera is very slim and slippery and will slide pass the throat into the food pipe (oesophagus) easily without any blockage to the airways or choking
• There is no obstruction to breathing during the procedure, and patients breathe normally throughout the examination
• All patients are closely monitored during the procedure including oxygenation, pulse rate, blood pressure, and will receive oxygen supplementation through the nose throughout the examination
• Any tissue samples (biopsies) that are required during the examination are obtained through the camera and are entirely painless
• Patients would be able to eat and drink one hour following the examination

‘Just relax!’ – easier said than done?

Relaxing during an invasive medical procedure is not easy, especially if you are feeling anxious, but following these tips will help you through your procedure. General relaxation techniques such as deep breathing exercises, meditation and mindfulness are also fantastic ways to keep yourself relaxed.

Remember to identify anything that may be making you feel more anxious and to ask your doctor any questions you might have before your procedure so that you are as prepared as you can be.