Endoscopy

 

 

Gastroscopy

A gastroscopy, also known as an endoscopy is a procedure performed by a doctor, a well-trained subspecialist who uses the endoscope to diagnose and, in some cases, treat problems of the upper digestive system.

The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end.

By adjusting the various controls on the endoscope, the doctor can safely guide the instrument to carefully examine the inside lining of the upper digestive system.

Diagnostic Indications for Endoscopy

  • Difficulty in Swallowing
  • Persistent isolated nausea or vomiting. In the event of isolated nausea or vomiting persisting for more than 2 days, investigation of the upper gastrointestinal tract is justified after any non-gastrointestinal origin and acute intestinal occlusion have been eliminated
  • Diagnostic Indications for Endoscopy. Upper gastrointestinal endoscopy is recommended in
    • In subjects aged over 45 years and/or if there are any warning signs or symptom’s such as anaemia, difficulty swallowing, weight loss or any other warning signs and symptoms
    • In subjects aged under 45 years with no warning signs or symptoms, upper gastrointestinal endoscopy is recommended in the following situations
      • Positive diagnostic test for Helicobacter pylori
      • When symptomatic treatment has failed or recurrence occurs at the end of treatment
    • Chronic anaemia and/or iron deficiency anaemia. Upper gastrointestinal endoscopy is recommended in iron-deficiency anaemia and/or iron deficiency, after any non-gastrointestinal origin has been eliminated
    • Acute gastrointestinal bleeding originating in the upper gastrointestinal tract. Upper gastrointestinal endoscopy is recommended as first choice in acute digestive bleeding which is assumed to originate in the upper gastrointestinal tract (hematemesis or melena)
    • Gastro Oesophageal reflux (GORD). Upper gastrointestinal endoscopy is recommended if there are symptoms of gastro oesophageal reflux combined with warning signs (weight loss, dysphagia, bleeding, anaemia), or if the patient is aged over 50 years, or if there is a recurrence on withdrawal of treatment or resistance to medical treatment

 

Colonoscopy

The term “colonoscopy” means looking inside the colon. It is a procedure performed by a subspecialist endoscopist. (Surgeon or gastroenterologist)

Colonoscopy is a procedure used to view large intestine (colon and rectum) using an instrument called colonoscope (a flexible tube with a small camera and lens attached). The procedure can detect inflamed tissue, ulcers, and abnormal growths. It is used to diagnose early signs of colorectal cancer, bowel disorders, abdominal pain, muscle spasms, inflamed tissue, ulcers, anal bleeding, and non-dietary weight loss.

Indications for colonoscopy are:

  • Rectal bleeding
  • Iron deficiency anaemia
  • Abdominal pain and alteration in bowel habit
  • The presence of colorectal cancer risk factors
  • Clarification of barium enema findings
  • Positive Faecal occult test
  • Indication for repeat colonoscopy
  • Patients with previous bowel polyps or cancer
  • Surveillance of inflammatory bowel disease
  • Patients with a family history of bowel cancer or polyps in first degree relatives

Procedure

The procedure is done under general anaesthesia. The colonoscope is inserted into the rectum, which gently moves up through the colon until it reaches the cecum (junction of small and large intestine). Colonoscopy provides an instant diagnosis of many conditions of the colon and is more sensitive than X-ray.

The colonoscope is then withdrawn very slowly as the camera shows pictures of the colon and rectum onto a large screen. Polyps or growths can also be removed by colonoscopy, which can be sent later for detection of cancer.

Instructions for colonoscopy

Your physician may provide you written instructions and also will be communicate verbally on how to get prepared for the colonoscopy procedure. The process is called bowel prep.

Gastrointestinal (GI) tract should be devoid of solid food; a strict liquid diet should be followed for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Liquids that can be taken before surgery include fruit juices, plain coffee, tea, and water

Certain medications such as aspirin, ibuprofen, naproxen or other blood thinning medications, iron-containing preparation should be stopped before the test. Iron medications produce a dark black stool, and this makes the view inside the bowel less clear.

A laxative or an enema may be required the night before a colonoscopy. Laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water.

Other features of colonoscopy:

  • Colonoscopy is more precise than an X-ray. This procedure also allows other instruments to be passed through the colonoscope. These may be used, for example, to painlessly remove a suspicious-looking growth (polyp) or to take a biopsy-a small piece for further analysis. In this way, colonoscopy may help to avoid surgery or to better define what type of surgery may need to be done.
  • Colonoscopy is a safe and effective way to evaluate problems such as blood loss, pain, and changes in bowel habits such as chronic diarrhoea or abnormalities that may have first been detected by other tests. Colonoscopy can also identify and treat active bleeding from the bowel.
  • Colonoscopy is also an important way to check for colon cancer and to treat colon polyps – abnormal growths on the inside lining of the intestine. Polyps vary in size and shape and, while most are not cancerous, some may turn into cancer. However, it is not possible to tell just by looking at a polyp if it is malignant or potentially malignant. This is why colonoscopy is often used to remove polyps, a technique called a polypectomy.

 

Interventional Endoscopy

Endoscopy

Endoscopy is a diagnostic procedure used to diagnose diseases of the digestive tract. A long flexible optic fiber with a camera and a light source at the tip is inserted through the mouth. This transmits images to a television monitor which helps the doctor view the digestive tract from inside. During endoscopy, if surgical tools are introduced through the endoscope for taking tissue samples or to treat certain disease of the biliary and pancreatic ducts, the procedure is called interventional endoscopy.

The interventional endoscopy procedures are broadly classified into:

Endoscopic ultrasound

Endoscopic ultrasound utilizes endoscope and high frequency sound waves to diagnose the abnormalities in digestive tract. In this procedure echoendoscope a special device that has an ultrasound probe on the tip is used to obtain the images of internal organs of the digestive tract. It is used to take biopsy of the tumours, cysts or lymph nodes through a small needle in the endoscope (fine needle aspiration) and to give injection into the nerves of the celiac plexus using imaging, when narcotics cannot provide relief from intense pain in pancreatic cancer or chronic pancreatitis.

Endoscopic Retrograde Cholangio-Pancreatography

In endoscopic retrograde cholangio-pancreatography (ERCP) once the endoscope reaches the papilla, the place where the pancreas and bile ducts meet, a thin tube will be inserted through the endoscope and a dye is injected into the ducts. X-ray images are taken to diagnose any problem related to the ducts. In the case where a problem is detected the doctor may give treatment at the same time. It can be used for

  • Stone removal
  • Manometry and Sphincterotomy: A sphincter is a cylindrical muscle functioning similar to a one way valve regulating the flow of bile and digestive juices from the bile and pancreatic duct into the small intestine. It sometimes becomes hard and becomes narrow. This causes the backup of digestive juices and a strong upper abdominal pain. The pressure is measured at the sphincter using manometry while doing ERCP. If the doctor finds that the pressure is high, the sphincter is enlarged using electrically heated wire in ERCP.
  • Biopsy
  • Balloon dilatation: Due to cancer, gallstones, inflammation or scar tissue, narrowing of the pancreatic or bile duct ducts may occur. A balloon is inflated inside the narrow portion of these ducts to open them through ERCP.
  • Stenting: A small plastic or metal tube is left inside the pancreatic or bile duct through ERCP to open up the narrow area in them.

 

Oesophageal Dilatation

Oesophageal stricture is narrowing or tightening of the oesophagus, (a tube that carries foods and liquids from the mouth to the stomach) which leads to pain and difficulty in swallowing, vomiting, and loss of weight. Some of the factors that can cause narrowing include congenital defects, radiation therapy, sclerotherapy, oesophageal surgery, stomach narrowing, and scar tissue formation. Stricture is relieved by dilatation technique.

Oesophageal dilatation: It is a procedure to widen or clear the blockage in the oesophagus. It relieves difficulty in swallowing. It is done under local anaesthesia. Patient should not take food for 4 to 6 hours before the procedure.

This treatment uses dilators along with an endoscope (a narrow tube with a tiny light and camera at the end). It is inserted through the mouth into the oesophagus. Dilators are passed to the blocked site. The endoscope enables viewing of the inside of oesophagus, and dilators pass down the oesophagus to increase the size.

Various types of dilators are available for use in oesophageal dilatation.

Simple Dilators (Bougies): These are a series of flexible dilators. One or more of these bougies are passed down through the oesophagus which helps in opening the oesophagus.

Guided wire bougie: During endoscopy a flexible wire is passed across the stricture. The wire is left in place and endoscope is removed. A small tube that is wider at one end is passed down the oesophagus through the stricture. The wire is removed at the end of the procedure. Guided wire bougies are used to treat all kinds of strictures.

Balloon dilators: Deflated balloon is passed through the endoscope across the stricture. The deflated balloon is then inflated which breaks the stricture. It is used to treat achalasia, a rare swallowing disorder of the lower sphincter muscle of the oesophagus. A larger balloon type dilator is inserted into the lower oesophagus through an endoscope. The muscle fibres are stretched and broken. This procedure helps in easy passage of food into the stomach.

Some of the complications of oesophageal dilatation procedures include perforation, bleeding, and infection. Perforation causes a hole in the lining of oesophagus which is surgically repaired.

Percutaneous Endoscopic Gastrotomy

Percutaneous endoscopic gastrostomy (PEG) is a surgical method of passing a tube into the stomach to supply food, liquids, and medicines directly into the stomach without performing an open operation. It is performed when patients have difficulty in swallowing or are unable to take food through the mouth.

Polypectomy

It is the surgical removal of a polyp. Polyps are non-cancerous, abnormal growths of the tissue along the lining of the gastrointestinal wall. Gastrointestinal polyps can be removed endoscopically through colonoscopy or surgically if the polyp is too large. During colonoscopy, the polyps are identified and cut using forceps. Larger polyps are removed by passing a wire snare, tightening the snare around the polyp base and then burning with electric cautery.

ERCP

Endoscopic Retrograde Cholangiopancreatography (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas.

ERCP is used primarily to diagnose and treat conditions of the bile ducts including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.

Procedure

ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X rays.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Complications

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

Points of Interest

  • ERCP takes 30 minutes to 2 hours
  • You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort
  • After the procedure, you will need to stay at the hospital for at least 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave.
  • If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight

 

 

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