my life with gastroparesis: Upper Endoscopy with Botox Injection...

This coming Thursday, I will be having an upper endoscopy(EGD) with Botox which is medically known as an Esophagogastroduodenoscopy. I have had at least six of these procedures in the past and have found them to be beneficial.

Symptoms I experience when it is time for another round of Botox:

I experience pain and soreness in my upper abdominal area which is generally located at the top of my stomach right where my lower ribs are centered. It is especially noticeable when pressure is applied, like when I am nursing my daughter.
Whenever I just begin to eat, I will start experiencing stomach cramping and spasms. Since this has been something that I have dealt with over the years, I try to mentally remind myself what is going on physically with my body. The sudden fullness that I am feeling isn't because my body is no longer hungry, it is because of my pylorus not functioning as it should. The cramping and spasms are a result of that. I try to slow down my eating and chew my food better. It is not always a helpful and productive process. Sometimes I am unable to finish my "GP sized" meal so over time, if this continues, my weight will drop.
It is extremely rare for me to wake up during the night with any type of abdominal pain. (Intestinal pain is a different story.) When I am in need of another round of Botox, I will wake up during the night and experience upper abdominal cramping and spasms.

Results I experience after a round of Botox:

Usually within a few days to a week, I will notice a change in the frequency and intensity of the stomach cramping and spasms. The time frame varies with each procedure. Over time I am able to resume my normal diet and amount of food with no pain.

What is an endoscopy with Botox injections?

An upper endoscopy (EGD) is a procedure that is often performed as an outpatient procedure. It is where an endoscopy of preformed and Botox injections are administered into the pylorus. It is the same idea as a having a pyloroplasty done, just less invasive.

Pyloroplasty: A surgery where the lower part of the stomach (pylorus) is widened to make it easier for the contents of the stomach to pass through into the small intestines.

Botox Endoscopy: It is generally an outpatient procedure where an endoscopy is performed. The Botox is administered into the pylorus (the lower part of the stomach). The Botox helps relax the pyloric muscle so food can empty easier.

Pylorus: The lower part of the stomach which is muscular and thick. If the pylorus is thicker, food has a harder time passing through which could account for stomach cramping and spasms.

Prepping for an EGD with Botox:

At the hospital where I go to have my endoscopies, the general rule is that you are to be NPO (nothing by mouth) after midnight with the exception of the allowed and approved morning medications. With each patient, doctor and hospital, the exceptions will vary. However gastroparesis patients are different with their digestive processes and are often delayed. The hospital where I am going has GP patients be on a clear liquid diet for twenty-four hours prior to the procedure and be NPO (nothing by mouth) after midnight except for the allowed and approved morning medications.

Procedure:

As with any procedure there is the whole waiting process. Once you have been checked in, you will be taken back to a holding bay/room and prepped for the procedure. You will give a brief medical history, check off your medication list and go over any known allergies. After changing into a gown and those fashionable hospital socks, you will have a blood pressure cuff put on, have the leads to a heart monitor and an IV placed. I am always dehydrated and dry so it is always hard for the nurses to find a vein.

There is a nurse who works in the endoscopy unit at the hospital where I go. Her bedside mannerism and nursing skills are amazing. Years ago when I was having one of my endoscopies, as always, my veins were being hard to find. If they found one, it was either too small or it blew. They called her into place my IV (which has happened several times since). As she was walking up, she starts telling me who I am. She knew what type patient that I was, the disease I had and who my doctor was and not because of my chart. She is that good of a nurse. Her skills are amazing! We need more nurses like that today.

The anesthesiologist and doctor who will be performing your endoscopy will come by and access you. When you are finally ready, they will take you back into the procedure room. Where I go, they generally go through the process one more time to make sure that I am who I am. You will lay on your side, get hooked up to the machines (oxygen in your nose along with blood pressure and heart monitors) and have a bite block placed in your mouth which is secured around your head. Once you are ready and everything is placed, the sedation medication is given.

One time, I had had some type of test before my endoscopy. I was in the room, hooked up, prepped and ready. Luckily for me, the sedation hadn't been given. It hit me, I had to go to the bathroom. It was the biggest ordeal and inconvenience to get everything unhook and reattached. The lesson in this story, use the bathroom before your procedure. It never hurts to try.

In the past, I have been given a combination of Fentanyl and Versed. Recently, I have been given Propofol. Personally I seem to wake up easier and quicker with the Propofol. I do not have the lasting drowsiness. Once sedated, the endoscopy scope is inserted through the bite guard by mouth through the esophagus and stomach into the pylorus. The Botox is administered here.

Post Procedure:

It is a quick procedure. Once you are back in the holding bay/room and awake, your doctor will come in and discuss the procedure with you and your designated driver. Afterwards, you will be discharged. As with any sedation, no driving is allowed. It is a day where you can lay around on the couch and watch tv without feeling guilty. Your throat may be a little sore from the scope. I have never had any issues with nausea after sedation. The success of Botox varies with each person. Some patients experience relief immediately while others do not. The effects of Botox usually last around four to six months for me personally.

As always, I am not a doctor. I am just sharing my past experiences with Botox. Each patient is different so the results will be different.