Endoscopy/Colonoscopy safety

I'm going to be scheduled soon for endoscopy and colonoscopy due to ongoing issues of functional dyspepsia. I spent last Wednesday in the emergency room. Almost seven hours in the waiting room with brief visits back to get bloodwork, urinalysis, chest xray, CT of the abdomen with contrast, and an EKG. 

ALL tests are normal. (Been through this all exactly-in October -with no resolution of the symptoms.)

So now they want a looky see inside. 

I'm concerned about having these procedures. I've had them before, but not since getting the pacemaker. I called Boston Scientific and they said that if polyps are found, the pacemaker must be managed with a magnet due to electrocautery interference. (I had a polyp removed five years ago.)
 

I'm totally dependent on my device with no discernible escape rhythm. I'm sure I am not the gastroenterologist's first pacemaker patient, but am still concerned about safety. 
 

In reading old posts here on this, others did fine, some developed A fib from the prep-loss of electrolytes. Any comments from anyone who's gone through this while being pacemaker dependent?


15 Comments

Colonoscopy

by Julros - 2023-02-13 17:06:39

I had a colonscopy last year and had the same concerns. I discussed this with my gastroenterologist and he assured me that the type of cautery used would not interfer with my pacer. I had 3 polyps removed. 

Not Exactly

by Old male - 2023-02-13 17:06:49

I have an ICD and had 2 seperate knee replacement procedures about 6 years ago.  They used a magnet to deactivate it for surgery.  Assume they didn't want me bouncing off the table if I got a big zap during surgery.  A tech was there immediately after surgery and made sure it resumed normal operation.  

Hope you get a result

by Penguin - 2023-02-13 17:30:30

Hi Lavender, 

Nothing I hate more than going through tests and then nothing shows up!  I hope you get somewhere with this round of investigations and that your worry about the PM playing up comes to nothing and the procedure is uneventful.

Best Wishes

 

I had both an endoscopy and colonoscopy with my pacemaker during full blown Atrial Fibrillation

by Gemita - 2023-02-13 17:56:32

Hi Lavender, after these procedures you should get some answers, or at least confirmation that all is well and that you only need treatment for the functional side of the problem.  Reading your message I am not at all surprised that you recently had some awful palpitations.  In fact I am surprised that they have actually stopped?

To be honest I feel the preparation for the colonoscopy is far worse than the procedure itself.  In fact I had to be hospitalised for my last colonoscopy prep because I always pass out during this stage and with AF at high heart rates they decided to take me into hospital the night before.  By the time they carried out my last colonoscopy I was in full blown AF due to electrolyte disturbances.  I didn’t think they would be able to do the procedure with such high heart rates.  I am on a lifelong PPI (proton pump inhibitor) for oesophageal dysmotility and stomach emptying problems and together with a low dose beta blocker, both these meds really help calm my palpitations.

I really hope for the very best for you dear Lavender.  I know just how uncomfortable bowel problems can be and how these impact on QoL xx

Grateful for input

by Lavender - 2023-02-13 18:26:22

I'm following along and reading all your input. It's comforting knowing that others got through. The Boston Scientific guy I spoke with said ICDs are a bit more complex when going through this, but all doable. Still, I needed to hear from folks who actually have pacemakers!

Gemita, my life history is full of dramas, as you know. But the palpitations have stopped.  My stomach protests from time to time. It flares up then eases but is never totally quiet 😵‍💫but is manageable. I can take no meds but Tums and GasX-as needed, which isn't often. Had reactions to everything else. (I'm still awaiting my guy's brain tests for the potential aneurysm. All tests are backed up a long time-that's why I was sent right to the ER for my belly. Getting scheduled faster is easier when going that route.) 

I was told that during the pre-colonoscopy prep, I will be drinking gatorade to keep the electrolytes up. They're aware it can cause A fib. 
 

I have had functional dyspepsia for about four (?) years. I take in zero alcohol, caffeine, tomatoes, chocolate and mostly eat high fiber. Functional dyspepsia doesn't show on tests and not much can be done but diet management-and even that isn't always helpful.  It was quiet a long time til last October. 
 

I don't want to refuse getting the endoscopy/colonoscopy in case there's a polyp or maybe adhesions from laparoscopic gallbladder surgery I had in 2019. I guess I just need reassurance that when I go through this, my pacemaker won't be affected.  💗

 

Procedures

by AgentX86 - 2023-02-13 21:49:05

Whenever I see any medical professional for anything, I remind them that I'm dependent on my pacemaker.  I remind anyone who touches me of the same. After that, I trust that they know what they're doing.  If I didn't, I wouldn't be there but people can always forget or miss details. 

Did I say that I remind everyone that I have a pacemaker yet?

Lol AgentX86

by Lavender - 2023-02-13 22:05:14

AgentX86- yep I am uber cautious and don't let anyone touch me without telling them that I'm 100% dependent on my device. The nurse at the gastro office told me today that they "just turn it off for the procedure ". I said, "no! Wait! They can't turn mine off. I will die. I have no detectable escape rhythm."  
 

She then told me to call my cardiologist to ask permission. I called the cardiologist and the office said that this is not how it's done. They said the gastroenterologist has to ask in writing for cardiology approval and advice on how to proceed. SO I called the nurse at gastro back and relayed that. 

I don't know if I will be having these tests next week or when but they better get their plan straight. I also emailed my trusted pcp today to keep him in the loop. 
 

Honestly!  I'm sure the nurse isn't the one who schedules the procedure and does intake info but I'm so tired of getting conflicting information. It's what triggers distrust. You can be sure I will be on everyone's case to make sure they know what I require. 

Cardiac clearance

by AgentX86 - 2023-02-13 22:36:20

That's exactly what should happen automatically.  Any procedure needs a cardiac "clearance letter" with instructions from the cardiologist to the surgeon.

When I had the surgeries on my wrist, both times I needed not only cardiac clearance but nerological clearance. My neurologist's instructions included that if I needed general anesthesia that I had to be held for observation overnight.  Since it was an outpatient orthopedic surgery center a GA wasn't an option.

Nurses s

by PacedNRunning - 2023-02-13 22:37:20

most of the front office people are not nurses. They will often say they are a nurse when they are not. They are usually medical assistants or secretaries. Some of the knowledge isn't there. So they don't say the right thing. Which can be confusing and like hey! What is right? So I understand. ICD's can be turned off with a magnet. It's what the use when using the device to remove Polyps. Magnet near a pacemaker put it in safe mode. Safe mode is 100% pacing in both leads. I have a boston Sci and that rate is 100bpm. It's is the pacemaker does not confuse the noise from the cautery with your own heart. It keeps us safe. So when she said turn it off, she probably hears that for ICD's. Pacemaker knowledge in the medical world is basic if you don't deal with them all the time. I didn't even know all it can do.
 

I'm surprised you have no escape rhythm. That's rare unless you've had AV node ablation. They should check for 30 seconds before confirming you have no escape beats. Our hearts have more than one electrical system. We have the main ones and back up ones. The back up ones are our escape rhythm. When they check they provide back up pacing. Your Heart won't just pause for 30 seconds. It will allow you to go as low as 30bpm all while checking. So it either paces or your own heart takes over. It takes a good 20 seconds for my espape beats to wake up. So if they checked mine 20 seconds or less, they would say I have no escape beats. Maybe you are sensitive when they check so they don't check as long?  Some get dizzy or lightheaded? I just feel a wobbly wheel in my heart but no other symptoms. They say it's because I'm a runner I can tolerate the wobbly wheel. 
 

After all that🤗 I've had both with pacemakers and I pace 100%  of the time in the ventricles and 30% in my atria. They don't mess with your device unless they need to remove polyps. Otherwise it will be left alone. So while they use the cautery they quickly place a magnet over your device. It will pace you 100bpm( each manufacturer is different on what the rate is but I have boston too so I know it's 100bpm). Once they are done they remove the magnet and the device goes back to previous function. They do this with all surgeries that can interfere with the device. MRI is the same. They place it in MRI mode, it paces 100% in both leads and returned to normal after the MRI is done. 
 

I'm sure you'll be fine. They do these all the time. Ask to talk to a nurse next time if you can. They shouldn't scare you like that. 

Thank you PacedNRunning

by Lavender - 2023-02-13 22:57:23

My gastroenterologist has everyone triaged through the nurses not receptionist. You can't even make an appointment without talking to a nurse first. But these nurses are not the ones who schedule or do intake for surgery questions. So this one did alarm me. Lol

The info you provided is very helpful and informative! The Boston Scientific tech I spoke with on the phone told me it's a common misconception that the magnet shuts off the pacemaker. He said it's not shut off. He wouldn't tell me anything more about it but said I must give the clinic their number for orders on proceeding.  
 

I am so grateful for your posting. As for escape rhythm: when tested by pacemaker techs I nearly faint. They tell me they can't find an escape rhythm. I asked my cardiologist and she said that I have none. I never had an ablation but was told my AV node doesn't function at all. My heart had a 33 second pause before my pacemaker insertion. My boyfriend inadvertently did a precordial thump on me which restarted my heart. 
 

Also pre-pacemaker-during anesthesia for gallbladder surgery, my heart paused so long they were about to jump start me. I ended up in  ICU. 
 

Thank you again for taking time to reassure me. I know that I am not their first rodeo. I'm more confident and comfortable knowing what's up. I know that some people do better knowing nothing and going in blindly trusting. Not me. Once I understand what's planned, then I am more relaxed. Thanks for relaxing me. You're a blessing!

Yes!!!! I’m the same way

by PacedNRunning - 2023-02-14 00:45:00

If I know and understand I'm less anxious than if I know nothing. I found knowing helps so much. Glad I could help with some additional information.

Procedures With Pacemaker- My Experience

by Marybird - 2023-02-14 16:32:27

Basically, I just let the providers know about my pacemaker, ( as well as informing them I also take Eliquis) and let them decide what they need to worry about with these issues. I figure, especially since we're located in an area where there are a lot of senior citizens, they have a lot of experience dealing with people who have implanted cardiac devices,(not just older, but younger too) and will carry out whatever is needed. This goes for cardiac clearance as well.  I've found this indeed to be the case. I don't have an implanted defibrillator, just a pacemaker,  perhaps more provisions need to be taken with ICDs, but I've not found any issues at all with an EGD and colonoscopy ( to find a GI bleeding source,) and a colon resection surgery last year.

The surgeon who did the colonoscopy said there were no issues at all with the pacemaker, and instructed me to keep taking the Eliquis up till the day of the colonoscopy. He said he wanted me NOT to stop taking the Eliquis to ensure a better chance they would find the source of the bleeding. And they would have had to obtain cardiac clearance for my stopping the Eliquis. They did instruct me to postpone taking the morning dose of Eliquis on the morning of the colonoscopy ( it was done early) until after it was done. I don't believe I had any polyps removed during this colonoscopy, but there was a biopsy done of the mass they found, and the surgeon "tattooed" the mass so it could be located more easily during the upcoming surgery. Don't know if these steps included some electrocautery, but they weren't worried about interference with the pacemaker, due, as I understand it, to the GI sites being greater than 6 inches away from the pacemaker.

I informed everybody that looked to be remotely involved with my colon surgery about the pacemaker ( pre-op nurses, surgeon, OR staff, anesthesiologist), just so they would know about it. It was also in my hospital records. They duly noted this information, but no one seemed anything other than noncommital about it. I specifically asked the anethesiologist about any provisions for the pacemaker when I met him in the pre-op suite, and he explained that there were no anticipated issues with it ( even with the electrocautery or whatever they use for partial colon removal) due to the distance of the operative site being greater than 6 inches ( it was at least a foot, maybe more) from the pacemaker. I figured they knew what they were doing, so I didn't worry any more. I guess they were right, I didn't have any issues with my pacemaker, and it seemed to be ticking along just fine afterwards.

The surgeon instructed me to stop taking the Eliquis three days before the surgery, and his office had to get cardiac clearance for that. The surgeon's office faxed a form requesting the ok signed by the cardiologist to the cardiac office within a day or two after they set up the surgery date, and the cardiology office returned it within a week after that. They informed me that they would send this form, suggested I call the cardiac office to give them a heads up in case they wanted to see me before they gave the clearance. So I was off the Eliquis for three days before and two days after the surgery.

I'm not pacemaker dependent, but my daughter, whose intrinsic rate is an AV escape rhythm between 30 and 40 BPM that kicks in around 30 seconds after they turn off her pacemaker, has had a couple endoscopies with that pacemaker. Thank goodness, no problems with that.

Thank you Marybird!

by Lavender - 2023-02-14 18:50:12

Wow you've been through a lot! I read your post with great interest. Read it twice to make sure I understood it all. Thank you for sharing this. I've had three endoscopy/and two colonoscopy procedures over the years. Never bothered me except for the prep. This time it will be a new gastroenterologist. All medical offices are so busy! It's harder to have anyone spend time explaining and even harder being heard when you have concerns. 

I was pleased to get an email reply from my pcp's nurse today. It made me know they're paying attention:

Hello,

Thank you for keeping us in the loop. I pulled your ER report and the labs you had performed. It is def a great idea to follow up with Dr. (Gastroenterologist name)and (cardiologist name).

I don't expect any issues getting you cleared from a cardiac standpoint for the required tests (Tons of patients have pacemakers and undergo these procedures). But still follow up with Dr.

(Cardiologist name). I reviewed the tests performed in the ER. Let us know if you need anything. Everything will be ok

Have a Great Day, (name)RN

been there done that

by dwelch - 2023-02-15 15:02:09

been there done that and they used the magnet.  remember the magnet puts the pacer in a fixed rate mode it doesnt turn the pacer off.  

Thanks dwelch

by Lavender - 2023-02-15 21:37:39

Good to know that you've experienced it and all was ok. I'm still awaiting scheduling after a week! Guess things are backed up. No pun intended. 

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