Upper Endoscopy (BRAVO) at Piedmont Hospital Instructions

What is an upper endoscopy?

An upper endoscopy is a test performed to evaluate symptoms of persistent upper abdominal pain, bleeding, nausea, vomiting or difficulty swallowing. During the procedure, a doctor examines the lining of your esophagus, stomach and the first part of your small intestine through a thin, flexible tube called an endoscope. If growths or other abnormalities are found during the procedure, the doctor may remove the abnormal tissue for further examination, or biopsy. An upper endoscopy may also be used to treat various conditions of the upper gastrointestinal (GI) tract, such as narrowing, abnormal growths or bleeding.

What is the Bravo pH monitoring system?

The Bravo system is a pH test to help your doctor determine if you have acid reflux. A pH test measures the degree of acidity in your esophagus. The test period usually lasts 48 hours, and measures acidity in two ways:

  • How often stomach acid flows into the lower esophagus
  • Degree of acidity during the test period

Information from the pH test helps your doctor diagnose GERD (gastroesophageal reflux disease) and plan your treatment. Bravo system consists of a capsule, approximately the size of a gel cap that is temporarily attached to the wall of your esophagus. The capsule measures pH levels in your esophagus and transmits this information wirelessly to a portable receiver you wear on your waistband.

Instructions

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PRE-PROCEDURE CHECKLIST

If you have diabetes, ask your regular doctor for diet and medication restrictions. Do not take your oral diabetes medicine on the day of your procedure. If you take metformin, stop taking it the day before your endoscopy. Also, please bring your Insulin and Insulin syringes with you to your procedure; we will check your blood sugar before and after the procedure.

If you take a medication to thin your blood (such as Coumadin, Plavix, Pradaxia or Lovenox) be sure to discuss this with the doctor performing your procedure. You must get your prescribing doctor’s permission if you need to stop these medications.

If you currently are taking other prescription medications, you may continue to take all other medications as instructed by the prescribing physician.

If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.

You MUST arrange for a ride for the day of your exam. If you fail to arrange transportation with a responsible adult, your procedure will need to be cancelled and rescheduled. Your driver must check in with you and stay in our office the entire time that you are there. We cannot start your procedure if you do not have a driver present. In addition to this, you may not take a taxi or ride the bus by yourself. This is for your safety.

If you must cancel or reschedule your appointment, please call 404-355-3200 at least three days prior to your procedure to avoid a late cancellation fee of $150.00.

If you have any special needs, such as a pacemaker, internal defibrillator, latex allergy, need for an interpreter, or if you are allergic to eggs, nuts or soy, please contact our office immediately. Your procedure may need to be rescheduled.

Please be certain to have all of the following items with you:

  • Your completed pink Pre-Anesthesia Evaluation, which was included in your procedure packet.
  • A list of all your current prescription medications and all your over the counter medications.
  • A photo ID.
  • All your up-to-date insurance information, such as your insurance card or required referral forms.

If you currently are taking other prescription medications, you may continue to take all other medications as instructed by the prescribing physician. However, your doctor may want to do this study off of the following medications for 10 days: Aciphex® (rabeprazole), Nexium® (esomeprazole), Prevacid® (lansoprazole), Dexilant® (dexlansoprazole), Prilosec® (omeprazole), Protonix® (pantoprazole) or Zegerid® (omeprazole/ sodium bicarbonate). The following medications may not be taken for two days: Pepcid® (famotidine), Tagamet® (cimetidine), Zantac® (ranitidine), Axid® (nizatidine). Your doctor will let you know prior to the test if you should stop your medications or continue your medications.

DAY OF EXAMINATION

The Piedmont Hospital GI lab is located on the first floor of the 77 building. It is most convenient to park in the North parking deck. Take the elevator to the bridge level (BR). You will need to go to the 77 building registration office to register for your procedure. After getting off at the bridge level you will walk through a glassed-in bridge and go straight. You will pass the 77 building (D) elevator, which will be located on your left. The registration office is located in the next hallway on your left. Once inside, a member of the registration staff will help you complete some additional paperwork, and then escort you to the GI Lab for your procedure. This should take approximately 15 minutes.

STOP AND READ:

  • If you do not follow these instructions your procedure may be delayed or cancelled.
  • Please note that you cannot have any solid foods after midnight the night before your procedure. This includes gum, mints, ice chips and cigarettes.
  • You may have clear liquids up to two and a half hours before your procedure.
  • You may take your medicines with clear liquids.
  • You cannot have anything in your mouth (gum, mint, cough drop, ice chips etc.) two and a half hours before your procedure.

PREPARATION

To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

  • Stop eating solid foods at midnight.
  • Clear liquids are okay to drink (examples: water, Gatorade, clear broth, black coffee and apple juice).
  • Do not drink red liquids or alcoholic beverages.
  • You may have nothing by mouth (no water, gum, mints, ice cubes, etc.) at least 4 hours before your exam.
  • You may take your usual medications (exceptions noted above) with up to 4 oz. of water at least 4 hours prior to your procedure. Be sure to wear comfortable clothes and shoes that will remain on your feet (preferably tennis shoes) to your procedure. Please do NOT wear flip flops, sandals, or backless shoes.
  • Please remove ALL jewelry including earrings, rings, bracelets, anklets, necklaces, and watches prior to the procedure, and be sure to leave any and all valuables at home.
  • Plan to spend up to two hours at the endoscopy center the day of your procedure. The exam itself takes about 10-15 minutes to complete.

Before the exam:

  • You will change into a gown and robe.
  • Your medical history will be reviewed with a nurse and an anesthesiologist.
  • You will be given a consent form to sign.
  • A nurse will insert an intravenous (IV) line into your hand or arm.
  • Pre-menopausal women will be asked to give a urine sample for a pregnancy test.

During the exam:

  • Medicine will be given through the IV line to sedate you.
  • Your heart rate and oxygen levels will be monitored. If your blood pressure is low, you may be given fluids through the IV line.
  • The doctor will insert a flexible, hollow tube – called an endoscope – into your mouth and will advance it slowly through the esophagus, stomach and duodenum (the first part of your small intestine).
  • If abnormal tissue is found, the doctor may remove it through the endoscope for closer examination, or biopsy. Tissue removal is painless.
  • The doctor will pass the Bravo capsule into the esophagus. After the capsule is in place, suction is applied. This draws a small amount of tissue into the capsule to allow for the attachment.

What happens after the exam?

  • The doctor will talk with you about the initial results of your exam.
  • The doctor will prepare a full report for the physician who referred you for the upper endoscopy.
  • You may feel bloated after the procedure. This is normal.
  • Your throat may feel sore for a short time.
  • Medication given during the exam will prohibit you from driving for the rest of the day.
  • Following the exam, you may resume your normal diet. Avoid alcohol until the next day.
  • You may resume your regular activities the day after the procedure.
  • A nurse will provide you with complete discharge instructions before you leave the endoscopy center. Be sure to ask the nurse for specific instructions if you take blood thinners such as aspirin, Coumadin or Plavix.
  • Any tissue samples removed during the exam will be sent to a lab for evaluation. It may take 5-7 working days for you to be notified of the results.

As soon as the capsule is attached, it begins measuring the pH levels in your esophagus. The capsule transmits these measurements wirelessly to a small receiver you wear on your waistband or belt. As long as the capsule and receiver are within 3 feet of each other, the system will measure and record your pH levels. This means you can place the receiver nearby when bathing or sleeping without interrupting the test.

The receiver is about the size of a standard pager, and has three symptom buttons. You will be instructed to press the appropriate button during the study when you experience heartburn, regurgitation, or chest pain. The Bravo Receiver is designed to prevent you from turning it off during the test period.

You will also be asked to record periods of eating and sleeping in a diary throughout the test. You can go about your daily routine without any restrictions.

Some people say they have a vague sensation that “something” is in their esophagus. Others say they feel the capsule when they eat or when food passes the capsule. Chewing food carefully and drinking liquids may minimize this sensation.

Please note: The capsule contains a tiny magnet, and you should not undergo an MRI study within 30 days of using the Bravo system.

When the pH study is complete, you will return the receiver and diary to your doctor’s office. The information stored in the receiver will be uploaded to a computer. Your doctor will analyze your results to determine if you have acid reflux and plan the best treatment for your heartburn symptoms.

The disposable capsule will spontaneously detach and pass through your digestive system a few days after the test period. Only a small area of esophageal tissue is affected by the capsule. Please do not take any over the counter antacids during the study period, such as Tums®, Rolaids®, Maalox®, Mylanta®, Gaviscon or Carafate® (sucralfate).

What are the possible complications of Bravo?

If you have a bleeding tendency, narrowing of the esophagus, severe irritation of the esophagus, varices, obstructions, a pacemaker, or an implantable cardiac defibrillator, you should not undergo a Bravo pH test. Additionally, because the capsule contains a small magnet, you should not have an MRI study within 30 days of undergoing the Bravo pH test.

Rare complications from using the Bravo pH Monitoring System include the following events: The capsule could detach from the esophagus before the test is complete, tears in the lining of the esophagus, causing bleeding and requiring possible medical intervention, and perforation.