Gastrointestinal Endoscopy
Welcome to the Ernest Childers VA Outpatient Endoscopy Clinic. Our doctors, nurses and CRNA’s are committed to providing the highest quality gastrointestinal endoscopy services for Veterans. We offer several resources to help you understand and prepare for your upcoming procedure(s). If you have questions please call our clinic at (918) 252-8000 ext 29042 or 29043, M-F 0700-1530.
How to find the Tulsa Endoscopy Clinic
We are located at 8921 S Mingo Rd, Tulsa, OK 74133. The south parking lot is for patients and visitors. A shuttle service is available to bring you to the main entrance if needed. Once you enter the main entrance turn right. At the elevators turn left, then turn right at the Specialty desk. The Endoscopy reception desk is located to the right of the Specialty desk. We ask that you check-in with your designated driver.
Endoscopic Procedures we provide
Colonoscopy
A colonoscopy is the gold standard procedure for colon cancer screening. This procedure is done by a doctor with the use of a colonoscope (a thin, flexible scope with a camera). It is inserted at the rectum and advanced through the entire colon (large intestine) to look for signs of cancer, pre-cancerous lesions, and polyps. A colonoscopy can also help identify the source of bleeding and treat it, investigate questionable images found on a CT scan or Xray and help you decide on the best treatment plan. If biopsies are taken or polyps removed specimens are sent to the lab for pathology to review. Your doctor will call you with the final report in one week and inform you when to follow up.
You must fast from solid foods at least one day before a colonoscopy, in addition to taking a colon prep. This is a requirement for clearing stool from your colon which allows for a thorough inspection of your colon.
Below are the two types of colon preps frequently used. Click on the one prescribed to you to learn more. Our 24/7 colonoscopy prep instruction line is also available to you by calling
Getting ready with GoLytely (PDF)
Instruction for two-day GoLytely (PDF)
Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy is a long name for an upper GI scope. The abbreviated term is EGD, which stands for esophagus, gastro (stomach), and duodenum (first portion of small intestine). This procedure is performed by the doctor with the use of a an endoscope (a thin, flexible scope with a camera) that allows the provider to inspect and treat problems of your upper GI tract. Some problems can be treated during the procedure, such as bleeding or dilating or stretching a stricture (an abnormal narrowing). Since you will be asleep for this procedure, it is important that your stomach is empty to prevent aspiration.
Please select the link below to read the full instructions. Please follow the instructions exactly as directed and call our endoscopy team if you have any questions
Getting ready for an upper endoscopy (PDF)
Flexible Sigmoidoscopy
A flexible sigmoidoscopy allows the doctor to look only inside your rectum and lower portion of your colon with a colonoscope (a thin, flexible scope). A flexible sigmoidoscopy is a shorter exam, less invasive procedure, and does not allow for full inspection of your colon. This can result in missing a cancerous lesion, mass, polyp, or other abnormality in the unexamined portion of your colon. If an abnormal finding is discovered then a colonoscopy will be needed to examine your entire colon. You will not need to fast the day before and you will not need to drink a full colon prep. You will however, be required to administer an enema before this procedure. This procedure can be done with or without anesthesia. Please click on the instructions below that pertain to your exam.
Getting ready for a sigmoidoscopy if you won't be sedated (PDF)
Getting ready for a sigmoidoscopy if you will be sedated (PDF)
General information for your procedure(s)
Our endoscopy nurse will call you seven (7) days before your scheduled procedure(s) to go over all of the pre-procedure instructions with you.
If you have other appointments scheduled at the clinic on the same day of your procedure, or need prescriptions picked up, please schedule before your procedure since you will be receiving anesthesia.
Please arrive with your driver 15-30 minutes early for your appointment.
You will not be permitted to drive yourself home after your procedure. Driving after you’ve had anesthesia is like driving under the influence of alcohol. You must have a responsible adult accompanying you and they must remain at the clinic throughout the procedure or it will be cancelled.
Women age 55 or younger will need a urine pregnancy test or will need to sign a waiver. Exceptions include a hysterectomy or menopause for 12 months.
We recommend wearing comfortable clothes. Do not wear jewelry. Cellphones and other valuable personal items will not be allowed in the procedure area. Dentures and partials will need to be removed for your procedure. We will provide a denture cup for you.
For your safety, our procedures require that you do not have anything to eat or drink after midnight on the day of your procedure. This includes all oral tobacco products, mints, chewing gum, hard candy, etc.
Exceptions to the “nothing by mouth after midnight” rule are made for prescription heart and blood pressure medications. These medications may be taken but you must do so at least TWO HOURS BEFORE your procedure, with a few sips of water. Please see your instructions for specific information and follow exactly as directed.
The VA offers Annie text messaging service to help you with the prep instructions. Let the endoscopy staff know if you are interested in receiving instructional text messages from Annie.
Using Annie is voluntary and is designed to support patient self-care.
· Annie messages are automated and are not regularly monitored by the health care team.
· For help with medical concerns, patients should call their health care team directly.
· SMS text messages are not secure. Msg & Data rates may apply. Message frequency varies.
· For problems with Annie, or questions about Annie, text HELP. Text STOP to end participation.
· Collection of a patient's information by Annie is subject to federal law.
· For Terms of Use and Privacy Info visit: mobile.va.gov/annie/terms-privacy
To learn more about Annie text services, click the link below. https://mobile.va.gov/app/annie-veterans
Your care team cannot directly exchange texts messages with you through Annie.
Annie cannot be used:
· To contact your VA health care team directly about specific health concerns.
· To view general medical information or records in My HealtheVet.
· For an emergency or crisis.
Please call 911 or contact the Veterans Crisis Line
If you are a Veteran in crisis or are having thoughts of suicide connect with the Veterans Crisis Line for confidential, caring support 24 hours a day, 365 days a year. Many of our responders are Veterans themselves.
If you take blood thinners
Most blood thinning medications (listed below) need to be stopped several days prior to your procedure to mitigate the risk of bleeding. If you are taking any of the blood thinners listed below, our endoscopy nurse or Anticoagulant Clinic will direct you on when to stop the medication. If you do not receive instructions from our clinic, please reach out to our endoscopy team.
· Warfarin (Coumadin®) · Apixaban (Eliquis®)
· Dabigatran (Pradaxa®) · Edoxaban (Savaysa®)
· Rivaroxaban (Xarelto®) · Dalteparin (Fragmin®)
· Enoxaparin (Lovenox®) · Fondaparinux (Arixtra®)
· Clopidogrel (Plavix®) · Cilostazol (Pletal®)
· Ticagrelor (Brilinta®) · Effient (Prasugrel®)
If you are a Diabetic
You may need to adjust the dose of your insulin or other diabetic medication(s) while taking your colon prep. Diabetic medications are generally not taken the day of your procedure. Please see your instructions for specific information, or call our endoscopy team for assistance.
Weight loss and/or certain diabetic medications
These medications delay gastric emptying and can pose a serious risk of aspiration. Patients scheduled for endoscopic procedures at Ernest Childers VA Outpatient Clinic Tulsa are required to stop these medications at least 7 days prior to your appointment. Your procedure will be rescheduled if these medications are not stopped within the appropriate time frame. Our highest priority is to keep you safe during your procedure. Please let the endoscopy staff know if you are taking any medications listed below and stop them as directed.
· Lirgaglutide (Victoza®) · Tirzepatide (Mounjaro®)
· Dulaglutide (Trulicity®) · Exenatide (Byetta, Byrdureon®)
· Lixisenatide (Adlyxin®) · Pramlinitide (Symlin®)
· Albiglutide (Tanzeum®) · Semaglutide (Ozempic® , Wegovy®, Rybelsus®)
Anesthesia
Our procedures are done with intravenous anesthesia. Your anesthesia provider will meet with you on the day of your procedure and will discuss what to expect.
Monitored Anesthesia Care (MAC) is different from general anesthesia, while you will be asleep throughout the procedure, you will be breathing on your own and will not have a breathing tube. Your oxygen level, heart rate and rhythm, and blood pressure will be continuously monitored throughout the procedure.
You must have a driver that will drive you home. You will not be permitted to leave by yourself after a procedure. Driving after you’ve had anesthesia is like driving under the influence of alcohol. You must have a responsible adult accompanying you and they must remain at the clinic throughout the procedure or it will be cancelled. Again, our highest priority is to keep you safe.
What to expect after your procedure
You may feel drowsy for few hours afterward. You are restricted from driving, operating machinery, and making legal decisions for 24 hours after anesthesia.
Abdominal discomfort and bloating are rarely a problem but if you do feel bloated walking can help relieve any discomfort.
Some people have throat discomfort after an EGD. Ice chips and drinking liquids may help.
Our endoscopy nurse will call you the next business day. If you had polyps removed or biopsies taken, they are sent to our lab. Results typically take about one week to finalize. Your doctor will call you with the results and tell you when to follow up.
You may notice a small amount of blood with your first bowel movement after your colonoscopy. This usually stops on its own. If you have severe pain, excessive bleeding, or fever report to the nearest emergency room or call 911.
You can resume your usual diet after your procedure unless otherwise directed by your doctor.
It is not unusual to experience some diarrhea for a one or two days after your procedure until the bowel returns to its normal function.
Frequently Asked Questions
Why can’t I just do a stool sample test instead of a colonoscopy
Stool sample tests such as Cologuard® and fecal immunochemical test (FIT) are convenient, non-invasive, and can be cost effective. These tests look for microscopic blood in your stool that may indicate the presence of a cancerous lesion. It is not recommended for persons at high risk for colorectal cancer and there is a small percentage of false-positive results. Any positive result should be followed up with a colonoscopy to evaluate the reason for a positive result. It is important to have a discussion with your healthcare provider when deciding what test is right for you.
Are there any complications or risks associated with having these procedures? These procedures are generally safe. As with any medical procedure,
These procedures are generally safe. As with any medical procedure, there are some risks. Perforation and bleeding are two of the major complications associated with these procedures. Perforation is a tear through the wall of the colon, stomach, or esophagus that may leak fluids into your abdominal cavity or chest cavity. This can be serious and may require surgical intervention but not always. There may also be bleeding at the site of a biopsy or polyp removal. In most cases the bleeding stops without treatment. If needed, the doctor can treat the bleeding with cautery or specialized clips. You should let your healthcare professional know if you have severe pain, fever, or bleeding after your procedure.
Aspirating is another risk and can be life threatening. In simple terms, aspirating is when the contents of your stomach are inhaled into your lungs. Prevention is key. It is important that you follow the instructions exactly as directed and do not have anything by mouth within the restricted time frames of your procedure.
Although complications after colonoscopy, flexible sigmoidoscopy, and EGD are rare, they can be serious and life-threatening. Our highest priority is to keep you safe during your procedure.
What is a polyp?
A polyp is a small clump of cells that forms on the lining of the colon. Most colon polyps are harmless, but over time, some polyps can develop into colon cancer. People age 50 and older are at increased risk of developing polyps.
What are the risk factors of colon cancer?
Persons age 45 or older are at average risk. Persons who are overweight, smoke, consume heavy amounts of alcohol, consume a diet high in fat, live a sedentary life style, have a history of inflammatory bowel disease, and have a personal history or family history of polyps or colon cancer are at higher risk. Veterans and military members exposed to toxic agents such as asbestos, Agent Orange, dioxins, lead, benzene, fumes from burn pits, and fire suppressants are also at a higher risk.
Who should be screened and when?
The American Cancer Society recommends that people with average risk of colorectal cancer start regular screening at age 45. Those with higher risk factors such as family history colon cancer, might need to start screening earlier than age 45. Screening is important because colon cancer is one of the most preventable, treatable, and beatable cancers when detected early.
How long does the procedure take?
The procedure itself usually takes from 20 to 40 minutes, but you should plan on spending 1 ½ to 2 hours total to account the preoperative, intraoperative, and postoperative periods.
What is a “split-prep”?
A split-prep is when you drink ½ gallon of the prep the night before and the remaining ½ gallon the morning of your procedure. Splitting the prep, increases tolerability and compliance. It allows you to extend the amount of time given to drink the large volume of prep and causes less nausea. Several studies have shown the split-prep to be a more effective way of attaining an excellent bowel cleanse.
What is a clear liquid diet?
A clear liquid diet is made up of ONLY liquids that are see-through. Clear liquids are easy to digest and include broth, gelatin, plain tea, black coffee, ice-pops, juices WITHOUT pulp, sodas, water, and sports drinks such as Gatorade. Gatorade comes in many flavors and is an excellent choice because it contains electrolytes such as potassium and sodium. Avoid RED and ORANGE liquids.
Why avoid red and orange liquids?
These colors can persist in the colon and look like blood.
Is there any way that I can make the prep solution taste any better?
You can try:
· hard candy
· rinsing your mouth after each drink
· chilling the prep for a few hours
· drinking it through straw
· lemon flavored rushed ice
· chasing it with Sprite
Do Not mix it with anything other than water.
Patient Education
Barrett's esophagus
Barrett’s esophagus is caused by gastric reflux disease, when stomach acid begins to erode the lining of the esophagus.
There are different degrees based on the severity of cell damage.
Based on your biopsies, you may have a follow-up EGD in one year and then every three to five years thereafter.
Medication and lifestyle changes can ease your signs and symptoms of gastroesophageal reflux disease (GERD). Surgery or endoscopy procedures to correct a hiatal hernia or to tighten the lower esophageal sphincter that controls the flow of stomach acid may be an option.
To learn more about Barrett’s esophagus, click the link below.
https://www.uptodate.com/contents/h-pylori-infection-the-basics?search=h%20pylori&source=search_result&selectedTitle=7%7E150&usage_type=default&display_rank=6
Helicobacter pylori (H. pylori)
H. Pylori is a common bacterial infection found in the stomach. Most people don't realize they have H. pylori infection. H. Pylori can damage the tissue in your stomach and duodenum causing ulcers, lead to gastric cancer, and other gastric related problems.
H. pylori infection can spread by person to person through saliva, stool, contaminated food, or water.
Symptoms include:
· bloody vomit · unintended weight loss
· appetite loss · burping
· dark colored stools · indigestion
· bloating · dull, burning stomach pain hours after eating and at night
· Pain may last minutes to hours, may come and go over several days to weeks
If you are concerned about H. pylori infection or you think you may have a high risk for stomach cancer, talk to your health care provider about having an EGD.
To learn more about H. Pylori, click the link below. https://www.uptodate.com/contents/h-pylori-infection-the-basics?search=h%20pylori&source=search_result&selectedTitle=7%7E150&usage_type=default&display_rank=6
Dysphagia
Dysphagia is the medical term for "difficulty swallowing". Sometimes dysphagia happens if you eat too fast or don't chew your food well enough. Otherwise dysphagia can be a serious medical problem that needs to be treated right away.
The treatment depends on the underlying causes.
If you are experiencing symptoms of dysphagia or have concerns, talk to your health care provider about having an EGD.
To learn more about dysphagia, click the link below.
Diverticulosis
Diverticulosis is a common condition in which small pouch-like pockets form along the lining of your colon. Diverticulosis is often an incidental finding. Most people with diverticulosis have no symptoms and will remain symptom free for the rest of their lives.
Diverticulosis affects males and females equally. The incidence of developing diverticulosis increases with age. Diverticulosis is seen more commonly in developed countries like the United States because of the lack of daily fiber intake.
Most clinicians recommend increasing fiber in your diet to promote digestive health. Adequate daily fiber intake has been linked to health benefits such as reducing the incidence of heart disease, diabetes, and colorectal cancer. It is no longer believed that patients with diverticular disease have to avoid nuts, seeds, and corn because of concern that these foods could cause an episode of diverticulitis.
To learn more about diverticulosis, click the link below.
Colorectal Cancer
Colorectal cancer is cancer that affects the large intestine (also known as the colon) or the rectum. Colorectal cancer can be serious but is treatable if caught early.
Colorectal cancer might not cause any symptoms at first. When it does cause symptoms, it can cause the following:
· abdominal pain
· unexplained weight loss
· Bloody bowel movements
· Feeling weak, tired, or short of breath
· A change in your bowel movements (number, texture, color, or size)
If you are concerned about symptoms or you think you may have a high risk for colon cancer, talk to your health care provider about having a colonoscopy.
To learn more about colorectal cancer, click the link below