No, but it is preferred, as your GP may pass on relevant medical information that would be helpful in your care.

Dr. Wei is a Southern Cross Affiliated Provider and part of the NIB first choice network. After a referral is received, our team can take care of the paperwork for you if you are insured with Southern Cross or NIB (We will apply for approval on your behalf and also confirm if you have to pay for anything towards the health care service, depending on your plan type/excess). For other insurance providers, you will need to apply for a preapproval before your treatment to ensure that you will be covered for the treatment.

Endoscopy is the term used to describe the investigation in general terms, and the instrument used is called an endoscope. An endoscopy of the oesophagus (gullet), stomach and duodenum (first part of the small bowel) is called a gastroscopy, and an endoscopy of the colon (large intestines or large bowel) is called colonoscopy. The endoscopes come in different lengths and sizes (short and smaller camera for gastroscopy, longer and larger camera for colonoscopy). All endoscopes consist of a flexible plastic tube which has a camera and light at one end, and wheels to control the movement of the camera on the other end. A video of the lining of the gut is projected onto a video monitor.

A gastroscopy and colonoscopy can cause some discomfort, but they are generally well-tolerated procedures. Sedation and careful technique help make these procedures more comfortable for most patients. During a gastroscopy, patients usually do not experience pain, though some may feel bloated due to air introduced into the stomach. Mild sedatives or anesthetic throat sprays are often used to minimize discomfort and gagging. In a colonoscopy, patients might occasionally feel wind pain or cramping as the endoscope navigates the bends of the bowel, but this discomfort is typically brief. Most patients receive sedation, which helps them feel relaxed and significantly reduces discomfort, leaving many with little memory of the procedure. After the colonoscopy, it's important to release any trapped wind in the bowel to alleviate residual discomfort. Biopsies and removal of polyps in the lining of the bowel are not painful.

A list of medications that should be stopped will be provided in advance, along with bowel preparation instructions: 1. Iron tablets should be discontinued 5-7 days prior to your colonoscopy procedure 2. Blood thinning medications (Antiplatelets and anticoagulants): Please advise the endoscopy unit e.g. Endoscopy Auckland or Greenlane Medical Specialists - see contacts page) if you are on any blood thinning medications other than Aspirin. Generally, - Aspirin can usually be continued - Other medications like warfarin (Marevan), dabigatran (Pradaxa), Ticagrelor, Clopidogrel will likely need to be stopped for a few days prior to gastroscopy or colonoscopy 3. Diabetes medications: Please advise the endoscopy unit e.g. Endoscopy Auckland or Greenlane Medical Specialists - see contacts page) if you are on any diabetes medications. Generally, - Dulaglutide (Trulicity), Liraglutide (Saxenda/Victoza) or Exenatide (Byetta) should be stopped for around one week before the procedure - Empagliflozin (Jardiance), Jardiamet, Dapagliflozin (Forxiga) or Canagliflozin (Invokana) should be stopped 2 days prior to your colonoscopy procedure - Metformin - continued until the day of the procedure. Do not take on the morning of the appointment. - Insulin - You will need less insulin than usual -please discuss this with the endoscopy unit. Closer monitoring would be required and manage a hypo as you would normally. 4. All other medications can be continued as usual (including on the morning of the procedure), but preferably taken at least 4 hours prior to starting oral laxatives or 4 hours after completing bowel preparation to allow for absorption.

In general, most people who undergo endoscopy choose to have sedation. Once the sedation has worn off (approximately after an hour), you are allowed to eat and drink, but small amounts of sedation can remain in the body for up to 12 hours. During this period, you may feel wide awake, but are still under the influence of sedation. Your concentration and coordination may be subtly impaired. For this reason, it is recommended that someone accompany you home and stay for 12 hours. In the 12 hours following sedation, you should avoid: 1. Driving: You will not be allowed to drive yourself home after the procedure, as the sedatives can impair your ability to drive safely. 2. You should avoid riding a bicycle or operate machinery. Arrange for a responsible adult to accompany you to the appointment and drive you home afterward. 3. Decision-Making: Avoid making important decisions or signing legal documents on the day of the procedure, as the sedatives can affect your judgment and cognition. 4. Heavy Lifting or Strenuous Activities: Refrain from heavy lifting or engaging in strenuous activities on the day of the procedure to allow for adequate recovery from sedation. 5. Work: You are advised not to return to work until the day after, especially if your job involves the above. Most people are able to resume normal activities the following day. If a large polyp is removed however, it is advisable not to travel for 2 weeks due to the small risk of bleeding. It is not always possible to tell whether a polyp removal will be necessary prior to the procedure, therefore ideally, it is suggested that you do not book international travel within 2 weeks following colonoscopy.

Endoscopy scopes are thoroughly cleaned after each use through a meticulous process. The process involves wiping down the insertion tube with a special detergent, followed by immersion in a high-level disinfectant solution. Channels within the scope are cleared, and leak tests are performed. Specialized cleaning equipment is utilized, and the decontamination process is highly regulated with strict protocols in place to minimize the risks and ensure patient safety. Despite rigorous cleaning, there’s a small theoretical risk of infection transmission, which is extremely low.

Gastroscopy and colonoscopy remain the most accurate way of assessing diseases of the gut wall. The miss rate of significant pathology, such as cancer or precancerous lesions during endoscopy is generally low but not zero. Several factors can influence the miss rate, such as the cleanliness of the bowel wall and the type or size of lesion. There are various strategies used to further minimize the risk of missing a significant abnormality. Despite efforts to minimize the miss rate, there remains a small possibility of undetected pathology. Patients should be aware of this possibility and understand the importance of regular follow-up examinations, especially if symptoms persist or new symptoms develop.

The preparation process differs: For a sigmoidoscopy, you may be required to use an enema or take laxatives to empty only the lower part of your colon, typically the rectum and sigmoid colon. This preparation is less extensive than the oral preparation required for colonoscopy and may not require as strict dietary restrictions. Colonoscopy requires more extensive bowel preparation and is a longer procedure (about 30 minutes). Both procedures utilize a flexible tube with a camera, however, flexible sigmoidoscopy focuses on examining the lower part of the colon, including the sigmoid colon and rectum, while colonoscopy provides a thorough examination of the entire colon, from the rectum to the cecum. This allows for the detection and removal of polyps or abnormalities throughout the entire colon. Overall, a colonoscopy offers a more comprehensive view of the colon, making it a preferred option for screening and diagnostic purposes when a thorough evaluation is needed. In specific cases where we do not need to examine the whole colon, flexible sigmoidoscopy may be adequate.

When it comes to sedation options for gastroscopy and colonoscopy, the two main types of sedation employed are: conscious sedation (using medications like midazolam and fentanyl) and deep sedation or anaesthesia (typically with propofol). 1. Conscious Sedation (Midazolam and Fentanyl): With this sedation, during gastroscopy or colonoscopy, you'll feel deeply relaxed and may be drowsy but conscious. Most patients experience minimal discomfort and can respond to instructions, although you will not necessarily be "asleep". The aim of "conscious sedation" is to reduce anxiety, reduce awareness and reduce potential discomfort caused by air being pumped into the bowel. It is not a general anaesthetic. Pros: Keeps you conscious but deeply relaxed, reducing anxiety. Minimal recovery time. Can be administered by the gastroenterologist without the need for an anaesthesiologist. Lower risk of sedation related complications compared to deep sedation or anaesthesia. Cons: May not provide complete pain relief, and you may still feel some discomfort or pressure during the procedure. Some patients may experience drowsiness, temporary memory loss, or nausea. Requires careful monitoring of vital signs during the procedure. 2. Deep Sedation (Propofol) or General Anaesthesia: You will be in a deeply relaxed state or unconscious throughout the procedure. An anaesthesiologist will monitor you closely for safety. Pros: Induces a state of deep relaxation or sleep, ensuring you feel no discomfort during the procedure. Propofol has a rapid onset and recovery, allowing for a fast return to normal activities. Provides complete pain relief and a comfortable experience for most patients. Administered and monitored by an anaesthesiologist or trained provider, ensuring safety. Cons: Requires additional monitoring from anaesthetic staff to ensure this is safely administered Both options work well and provide satisfactory outcomes. If you have strong preferences or want to discuss more, we can help determine the most suitable sedation approach for your individual needs. In that case, the choice of sedation depends on factors such as your medical history, preferences, and the complexity of the procedure. There is also the option of no sedation, which has the advantages of a fast recovery and resumption of normal activities. This is ideal for those who wishes to return to normal activities or work on the same day after the procedure.

Modern endoscope uses fibre-optic technology that can bend whilst still maintaining the ability to transmit light signals across its length. This signal is then converted into an image that is projected onto a screen as a highly detailed pictures of the digestive tract.

No, they are all enclosed in a black plastic tube.

Yes. The endoscopes have a channel that allows tools to pass through and allow precise sampling/biopsies. Biopsies and even removal of polyps are completely painless, because the mucosa (lining) of the stomach and intestines is insensitive to pain.

Yes. Occasionally, we often investigate the upper and lower digestive tract with Gastroscopy and Colonoscopy in one session. An example of this would be in the setting of unexplained iron deficiency anaemia. This allows us to undergo the required tests all together under the same sedation. Usually, a gastroscopy is completed first before all endoscopic equipment is switched out for the second (colonoscopy) procedure.

Yes, in most cases, your GP may have already assessed the indication for gastroscopy or colonoscopy and passed on this information with the referral. A procedure may be all that is needed. Sometimes a clinic appointment is recommended to determine the nature of your symptoms and what sort of further investigations are required (which may or may not involve endoscopy).

We can generally tell if there is anything significant at the time of the procedure. A complete report of your procedure along with images will be provided to you on the same day of the procedure. This report will also be sent to your GP. Biopsies taken (including from polyps removed) will take up to two weeks to return from the laboratory. A separate report once the biopsy results return will be sent to your GP. In some cases, a follow up clinic appointment will be arranged to discuss these results with you.