What you need to know about endoscopy

Endoscopy is the insertion of a long, thin tube directly through the body for thorough examination of an internal organ or tissue. This can also be used for other functions such as diagnosis and minor surgery.

Endoscopes are minimally invasive and can be inserted into body openings like the mouth or anus.

Instead, for example in the knee or abdomen, they can be placed through small incisions. Surgery is called keyhole surgery, performed by a small incision and aided by special instruments such as the endoscope.

Since modern endoscopy poses relatively few risks, offers accurate images and is easy to conduct, it has proven extremely useful in many medicine fields. Today tens of millions of endoscopies are performed annually.

We will clarify some of the forms of endoscopy in this article, why and how they are done, the general protocol and any possible risks.

Fast facts on endoscopy

Below are a few key points on endoscopy. The main article includes more descriptions and supporting material.

  • Endoscopies are quick and relatively safe procedures.
  • The first endoscope was designed in 1806.
  • The main reasons for endoscopy are investigation, confirmation, and treatment.
  • Endoscopy can be used to remove tumors or polyps from the digestive tract.

Types

Endoscopy can be useful in a wide array of medical situations.
Endoscopy can be useful in a wide array of medical situations.

Endoscopy is useful for the study of many processes within the human body; these include:

  • Gastrointestinal tract: esophagus, stomach, and duodenum (esophagogastroduodenoscopy), small intestine (enteroscopy), large intestine/colon (colonoscopy, sigmoidoscopy), bile duct, rectum (rectoscopy), and anus (anoscopy).
  • Respiratory tract: Nose (rhinoscopy), lower respiratory tract (bronchoscopy).
  • Ear: Otoscopy
  • Urinary tract: Cystoscopy
  • Female reproductive tract (gynoscopy): Cervix (colposcopy), uterus (hysteroscopy), fallopian tubes (falloposcopy).
  • Through a small incision: Abdominal or pelvic cavity (laparoscopy), interior of a joint (arthroscopy), organs of the chest (thoracoscopy and mediastinoscopy).

What is a capsule endoscopy?

Capsule endoscopy was developed in the mid-1990s, with a wireless camera involved. The camera is small enough to fit into a capsule (approximately the size of a vitamin tablet) and therefore can be swallowed.

When the capsule passes through the digestive tract, thousands of photographs are taken which are transmitted to a computer connected to a wearable belt.

Capsule endoscopy is used to view the small intestine, a area which uses standard endoscopy to be difficult to picture. It is also very effective to analyze the small intestinal mucosa and to diagnose the disease of Crohn. The capsule normally passes within 24-48 hours through the digestive system.

This is a fairly new technique and in 2001 FDA approval was issued for use in the US. To date, more than 500,000 capsule endoscopy procedures have been performed and almost 1,000 papers covering its clinical use have been published.

Preparation

Female doctor and her patient
Advice will be provided by a doctor on how to prepare for an endoscopy, as different procedures will have different requirements.

The procedure does not require a hospital overnight stay, and usually only takes about 1 hour to complete. The doctor should send advice on how to plan for the operation.

The patient needs to run for around 12 hours for certain forms of endoscopy but this varies depending on the procedure.

The laxatives may be taken the night before for procedures inspecting the gut to clear the system.

Before endoscopy a doctor must conduct an exam. Mention should be made of all existing medications (including supplements) and any prior procedures.

Procedure

In some degree the treatment will depend on the reason for the endoscopy.

There are three key reasons to get an endoscopy done:

  • Investigation: If an individual is experiencing vomiting, abdominal pain, breathing disorders, stomach ulcers, difficulty swallowing, or gastrointestinal bleeding, for example an endoscope can be used to search for a cause.
  • Confirmation of a diagnosis: Endoscopy can be used to carry out a biopsy to confirm a diagnosis of cancer or other diseases.
  • Treatment: an endoscope can be used to treat an illness directly; for instance, endoscopy can be used to cauterize (seal using heat) a bleeding vessel or remove a polyp.

Endoscopy will sometimes be combined with another procedure, such as an ultrasonic scan. This can be used to position the ultrasound probe near organs, such as the pancreas, which can be difficult to image.

Traditional endoscopes also come with sensitive lighting using narrow band imagery. This form of imaging uses different wavelengths of blue and green that make it easier for the doctor to detect precancerous conditions.

Usually, an endoscopy is done when the patient is conscious, but occasionally the patient requires local anesthetic (usually an anesthetic spray at the back of the throat); the patient is also sedated.

A mouth guard will be used for endoscopy procedures involving entry through the mouth as the tube is inserted to secure the teeth and lips.

Endoscope use in surgery

Endoscopes used in surgery help minimize bleeding and recovery times.
Endoscopes used in surgery help minimize bleeding and recovery times.

Endoscopy has improved in recent years, allowing some types of surgery to be done using a modified endoscope; this makes the operation less invasive.

Procedures such as gallbladder removal, sealing and tying of Falopian tubes and removal of small tumors from the digestive system or lungs are now commonplace.

A laparoscope is a modified endoscope (also known as laparoscopic surgery) used in keyhole surgery.

Laparoscopic surgery involves only a slight incision and can be used for appendectomies (removal of the appendix), hysterectomies (removal of the uterus), and prostatectomies (removal of prostate tissue).

Patients lose less blood during and after surgery using this technique, and can heal much quicker compared to traditional surgical procedures.

Risks and side effects

Endoscopy is a fairly safe technique but it entails certain risks. Risks are dependent on the environment being investigated.

Risks of endoscopy may include:

  • over-sedation, although sedation is not always necessary
  • feeling bloated for a short time after the procedure
  • mild cramping
  • a numb throat for a few hours due to the use of local anesthetic
  • infection of the area of investigation: this most commonly occurs when additional procedures are carried out at the same time. The infections are normally minor and treatable with a course of antibiotics
  • persistent pain in the area of the endoscopy
  • perforation or tear of the lining of the stomach or esophagus occurs in 1 in every 2,500-11,000 cases
  • internal bleeding, usually minor and sometimes treatable by endoscopic cauterization
  • complications related to preexisting conditions

Any of the following symptoms should be reported to a doctor:

  • dark colored stool
  • shortness of breath
  • severe and persistent abdominal pain
  • chest pain
  • vomiting blood

Recovery

Recovery depends on the form of proceedings. In an upper endoscopy, which is used to allow a doctor to view the upper gastrointestinal tract, the patient may be examined for some time after the operation, typically around an hour, when any sedative medication is fading away.

Normally the person does not operate or drive for the rest of the day, due to the sedative effect of the drug used to alleviate the pain.

There may be a certain sorrow. Bloating and a sore throat can occur with this form of endoscopy but these typically resolve quickly.

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