Dr Ganesh Ramalingam: Is an endoscopy as uncomfortable as they claim?

Endoscopic examinations are famously known for their dreadful discomfort. But if you’re feeling anxious about your upcoming procedure, or are fearfully considering one, fret not. Chances are, the idea you have in your head is much more terrifying than the actual procedure.

In this article, we’ll talk about the procedure and risks of an endoscopy, and what you can do to make your endoscopy experience as comfortable as possible. 

What is an endoscopy?

An endoscopy is a procedure wherein organs inside your body are examined using an endoscope. While an endoscopy is not usually painful, many individuals tend to experience anxiety or mild discomfort. 

There are various types of endoscopies (eg. colonoscopy, upper endoscopy, gastroscopy) and procedure times vary from 15 to 45 minutes.

Read to find out the difference between a colonoscopy, endoscopy and gastroscopy. 

Most people go through the procedure awake. I know how mentally uncomfortable an endoscopy might be for some people, which is why a local anaesthetic (spray or lozenge) or sedatives are often employed to keep patients calm.

Depending on the part of your body being looked at, an endoscope may be put down your throat, bottom, or urethra. An endoscopy can be used to:

  • Help perform certain types of surgery.
  • Remove a small tissue sample (biopsy).
  • Help with laparoscopic (keyhole) surgery and arthroscopy.
  • Investigate unusual symptoms like dysphagia or recurring tummy pain.
  • Diagnose conditions such as cancer (endoscopies in Singapore have an overall accuracy rate of up to 93% when it comes to gastric cancer).

Read: Is a blood test better than an endoscopy at detecting gastric cancer? 

Interestingly, studies by the National University of Singapore1 have found that the most common endoscopy diagnoses in Singapore from 2014-2019 were gastritis and duodenitis, while diagnoses for cancer were comparatively rare (23.8% per 1,000 endoscopies).

This is atypical to other developed countries like the US, where gastric cancer is one of the top five most commonly endoscopy-diagnosed conditions. In my experience, endoscopic esophagitis is much less common in Singaporean patients.

What are the risks of an endoscopy?

An endoscopy is a low-risk procedure. However, there are rare cases in which individuals develop an infection. Such infections may require treatment with antibiotics.

Other rarer complications such as perforation of an organ or bleeding might also occur. Such patients might need surgery following their endoscopy. Signs of complications include:

  • Redness, pain or swelling, or
  • Discharge or pus near the insertion site of the endoscope
  • A high temperature, feeling hot or shivery
  • Black or abnormally dark poo
  • Shortness of breath or chest pains
  • Bad or recurring tummy pain
  • Vomiting blood
  • Difficulty swallowing

Please pay an urgent visit to your trusted gastroenterologist or the A&E if you experience any of these symptoms after an endoscopy.

How to mentally prepare for an endoscopy in Singapore

Rejecting foreign bodies is a natural human reflex. While some feel next to nothing about an endoscopy, other patients might have anxiety, or a vomiting reflex that is so strong it makes the procedure terribly traumatic. 

This is why it’s important to have a doctor who takes the time to explain the procedure, answer your questions, and allay unnecessary fears about your endoscopy.

In fact, studies2 have shown that when doctors and patients work together to aptly prepare patients for their procedure, this results in a drop in hospital duration and use of sedative agents, faster recovery, and a remarkable drop in fear and anxiety before and after surgery.

While waiting, it might help to take your mind off the procedure. You might want to download a Netflix series on your phone, read a novel, or find some other distraction to keep you occupied, especially as you’ll be unable to eat. I try to stock up as many magazines/reading materials as possible at my clinic – I certainly hope that has helped my anxious patients! 

Having something else to ruminate about during your procedure can also help alleviate your anxiety and fear. You might want to try thinking of the multiplication tables, visualising yourself in your favourite place, or recount lyrics to your favourite songs.

Of course, it goes without saying that choosing the right clinic is paramount when it comes to staying calm and collected during your endoscopy. 

It can be a good idea to arrange a private endoscopy to shorten your waiting time. The right private clinic will also help you to relax and stay calm by offering not just a comfortable environment, but the highest quality of care and expertise possible.

How to physically prepare for an endoscopy in Singapore

  • Do not eat at least 6 hours before your procedure
  • Check with your doctor if you can continue to take your medications as per norma

For example, if a patient has diabetes, they might need to adjust the time of their prescription. Patients taking medicines such as aspirin or clopidogrel will also need to talk about their risk of thrombosis with their doctor and take the cautionary measures necessary.

  • Prepare your bowels

You will need to drink special liquids to cleanse your colon. It is therefore key that you allow yourself some comfort and ease the night before your procedure, as you might find yourself visiting the toilet more than usual.

  • Check if your insurance provider covers endoscopies 

The Straits Times reported in August 2020 that some insurers are no longer allowing claims for diagnostic endoscopies. So before seeing your doctor, check with your insurer about the costs that will be covered. If you’re prepared financially, you’ll have fewer things to worry about on the day of your procedure. 

Should you have a sedative?

Another option that might help you to relax during your endoscopy is to be sedated. Although you’ll still be awake for the procedure, the medication will help you to feel calmer and less aware of your discomfort. It can even make your recollection of the procedure less clear.

Sedation is usually low-risk and safe, but it can sometimes cause side effects such as:

  • Feeling or being sick
  • A bruise or burning sensation on the injection site
  • Low blood pressure (hypotension)
  • Breathing difficulties

You should always thoroughly discuss your decision with your doctor. The decision to use sedatives depends on factors such as your health, the purpose of your endoscopy, and whether it will make you feel calmer.

What to do after an endoscopy

If you had a sedative, you’ll probably need to rest for about 1-2hours after having your endoscopy. A friend or relative will also need to escort you home after your procedure. If you did not have a sedative, you should be discharged pretty soon after your endoscopy.

A particular food regimen may be prescribed by your doctor afterward, but otherwise, it’s safe to start with a simple diet of healthy and easily digestible foods.

Do you have any questions? Feel free to drop me a line or schedule an appointment


  1. https://sph.nus.edu.sg/wp-content/uploads/2021/02/SSHSPH-Endoscopy-analysis-Highlights.pdf
  2. Behrouzian, F., Sadrizadeh, N., Nematpour, S., Seyedian, S. S., Nassiryan, M., & Zadeh, A. (2017). The Effect of Psychological Preparation on the Level of Anxiety before Upper Gastrointestinal Endoscopy. Journal of clinical and diagnostic research : JCDR, 11(7), VC01–VC04. https://doi.org/10.7860/JCDR/2017/24876.10270 

This article was written and medically reviewed by Dr. Ganesh Ramalingam, M.D.