An endoscopy involves examining the inside of a person’s body using an endoscope. An endoscope is a medical device consisting of a long, thin, flexible (or rigid) tube which has a light and a video camera. Images of the inside of the patient’s body can be seen on a screen. The whole endoscopy is recorded so that doctors can check it again. Endoscopy is a minimally invasive diagnostic medical procedure. It is used to examine the interior surfaces of an organ or tissue.

The endoscope can also be used for enabling biopsies and retrieving foreign objects.

Endoscopy is a noninvasive alternative to surgery for foreign object removal from the gastrointestinal tract.

When is an endoscopy used?

To confirm a diagnosis

An endoscopy is often used to confirm a diagnosis when other devices, such as an MRI, X-ray, or CT scan are considered inappropriate.

An endoscopy is often carried out to find out the degree of problems a known condition may have caused. The endoscopy, in these cases, may significantly contribute towards the doctor’s decision on the best treatment for the patient.

The following conditions and illnesses are most commonly investigated or diagnosed with an endoscopy:

• Breathing disorders
• Chronic diarrhoea
• Incontinence
• Internal bleeding
• Irritable bowel syndrome
• Stomach ulcers
• Urinary tract infections

Biopsies

Endoscopies are commonly used for the diagnosis of cancer. They are used for biopsies – taking samples of tissue to find out whether it is cancerous. Thanks to an endoscope, biopsies of the intestines or lungs can be done without the need for major surgery. This study explains that colonoscopy is the most effective screening option for colorectal cancer.

Surgery

Some surgical procedures can be carried out with a modified endoscope, such as the removal of the gallbladder, tying and sealing the fallopian tubes, and taking out small tumors and foreign objects from the lungs or digestive system. A study found that the removal through endoscopy of tumors that affect only the superficial layers of the esophagus can avoid complete extirpation of this part of the digestive tract.

What happens during an endoscopy?

The patient may be asked to fast (not eat) or drink for a period before the endoscopy if the instrument is going to go in through the anus. In some cases the patient may be given a laxative. Some patients are given antibiotics to prevent infection.

Patients on blood-thinning medications, such as warfarin, may be asked to stop taking them for a number of days before their endoscopy. There is a risk the blood thinner may cause excessive bleeding during the procedure. It is important the patient only does so if the doctor tells him/her. A study concluded that anti-inflammatory drugs, such as aspirin, do not increase the patient’s risk of bleeding during an endoscopy.

In the UK most endoscopies are done in hospital, or some large GP (general practice) clinics.

The vast majority of endoscopies do not require a general anesthetic. Some patients may receive a local anesthetic. A study found that administering a lidocaine lollipop as a single-agent anesthetic to patients undergoing an upper gastrointestinal endoscopy procedure eliminated the need for sedation in the majority of patients. Patients describe the procedure as possibly ‘uncomfortable’, but hardly ever ‘painful’. This study explains that the use of an evidence-based sedation protocol for endoscopic procedures improves the quality of practice and reduces the incidence of sedation-related adverse events.

Most endoscopes will enter the patient via the:

• Anus
• Throat
• Urethra (urine exits the body through the urethra)
• A small incision made in the skin

In most cases endoscopies will last from 15 to 60 minutes. The patient rarely has to spend the night in hospital. Some patients may notice some blood in their urine after a cystoscopy (bladder examination) or when they pass a stool after a prostate biopsy, for example – this is normal for a few days. Most patients can get up within an hour of their endoscopy. It is advisable that the patient does not drive out of the hospital after an endoscopy.

What are the complications of an endoscopy?

Less than 1% of endoscopies have complications. When they do occur, they may include:

• An infection, possibly somewhere along the path of the endoscope.
• Piercing or tearing of an organ. This may require subsequent surgery
• Bleeding more than normally expected. This may require subsequent surgery.
• An allergy to the anesthetic. Antihistamines may be used to treat this.

The following signs may indicate an infection has developed after the endoscopy:

• Redness
• Swelling
• Fluid or pus discharge
• Pain
• Temperature (fever)

Any patient who experiences these signs after an endoscopy should contact their doctor. A course of antibiotics should clear up the infection.

What Is Polypectomy?

Colonoscopy is a procedure for diagnosing and treating a variety of problems encountered in the colon (also called the large bowel or large intestine). It is performed using an instrument called a colonoscope which is a flexible tube that is about the thickness of a finger. It is inserted via the rectum into the colon and allows the doctor to carefully examine the lining of the bowel.

Abnormalities suspected by x-rays can be confirmed and studied in detail. Abnormalities which are too small to be seen on x-ray may also be identified and colonoscopy is now considered to be a more accurate examination of the large bowel than barium enema x-ray.

If the doctor sees a suspicious area or needs to evaluate an area of inflammation in greater detail, he can pass an instrument through the colonoscope and take a piece of tissue (a biopsy) for examination in the laboratory. Biopsies are taken for many reasons and do not necessarily mean that a cancer is suspected.

Sometimes colonoscopy is undertaken to locate or remove polyps. These are small growths on the lining of the bowel. They are usually benign but occasionally can contain a small area of cancer. Removal of a polyp is called polypectomy. This is achieved by passing a wire loop through the colonoscope and snaring the base of the polyp, which is then severed from its attachment to the bowel wall by means of an electric current. This current cannot be felt and causes no pain.

Early detection and removal of polyps prevents them from becoming malignant, and is therefore an important means of protection from colon cancer, (one of the most common cancers in Australia). The ability to remove polyps with the colonoscope means that the patient can avoid a major operation. After colonoscopic polypectomy the patient is allowed to resume usual activities within a day or two, and can return to a normal diet almost immediately.

Is Any Special Preparation Necessary?

Yes. For a successful colonoscopy, it is essential that the bowel is thoroughly emptied. This will usually mean taking clear liquids as well as a special laxative before the colonoscopy. More specific preparation instructions will be given to you. Occasionally one or more enemas may also be required. This preparation can usually be done at home. Failure to carry out the full preparation may leave solid material in the colon and could prolong the procedure or necessitate a repeat examination at another time.

What Happens During Colonoscopy?

When you arrive for the colonoscopy you will be asked to change clothes and may be given a small enema. The examination may be performed with intravenous sedation or a light anaesthetic and your particular management will be explained to you. If you are being managed with sedation you will probably sleep during most of the procedure but you may be aware of changes in position, inflation of the colon with air (distension) and temporary abdominal discomfort.

Examination of the large bowel lining is made as the instrument is being inserted, and again as it is withdrawn. The examination may take 60 minutes especially if polyps are to be removed.

What Happens After Colonoscopy?

You will be asked to rest for a hour or two until the effects of the sedatives have worn off, and you have passed much of the inflated air. Although most of the effects of the sedative/anaesthetic wear off quickly you should not drive yourself home after your colonoscopy. You should therefore arrange for a friend or relative to accompany you when you leave.

Are There Any Complications From Colonoscopy Or Polypectomy?

Colonoscopy and polypectomy are very safe procedures with a very low risk of complications, although these occur very occasionally.

Localised irritation of the arm vein may occur at the site of injections of the sedatives. A lump may develop and remains for several weeks or even months, it will eventually disappear.

Perforation of the colon rarely occurs during colonoscopy however this can require abdominal surgery to close the defect in the bowel wall. Great care is taken to avoid this complication.