Endoscopy

Endoscopy is a procedure that uses a scope to enter the body, to take pictures or video, to help make diagnoses, screen for diseases, and potentially treat a condition if it is present.

Endoscopy definition

Endoscopy is a procedure that uses a scope to enter the body, to take pictures or video, to help make diagnoses, screen for diseases, and potentially treat a condition if it is present.

The endoscope is a thin tube that contains a fiberoptic light and camera to allow the physician to directly see inside the body. The tube may also have other channels that allow the physician to perform a variety of functions including suction, irrigation, biopsy (obtaining a tissue sample for analysis) and cautery (using electricity to burn tissue, for example, to stop bleeding).

The diameter and length of the endoscope depends upon what part of the body is being evaluated. A sinus endoscope may be only inches long, where a colonoscope’s length is measured in feet.

What is the purpose of endoscopy?

Endoscopy is used to help diagnose and treat a variety of illnesses and injuries. Most organ systems in the body may benefit from an endoscopic procedure. These can include orthopedics, ear nose and throat, gastrointestinal tract, gynecology, and the chest and abdomen.

Physicians rely on endoscopy to help diagnose and treat a variety of illnesses and injuries. There is benefit of being able to look directly inside the body. Compared with imaging like X-ray, CT or MRI scans, endoscopy may also allow the physician to take a biopsy or even treat the diagnosed condition.

Examples of endoscopy include the following:

• Gastroenterologists may evaluate the whole of the gastrointestinal (GI) tract:
  • Upper GI endoscopy: esophagus, stomach and duodenum (the first part of the small bowl)
  • Enteroscopy: most of the small bowel, including the duodenum, jejunum, and the ileum
  • Colonoscopy: the whole of the colon
• Arthroscopy: orthopedic surgeons can evaluate joints such as hips, knees, ankles, shoulders, elbows, and wrists.
• Endoscopic sinus surgery: otolaryngologists (ENT) can look inside the sinuses of the face
• Cystoscopy: urologists can look inside the bladder
• Hysteroscopy: gynecologists can see inside the uterus
• Bronchoscopy: pulmonary specialists can evaluate the bronchial tubes of the lung
• Some endoscopies are more invasive and require an incision be made to insert the endoscope into the abdomen (laparoscopy), or chest (thoracoscopy).

The rest of this article will discuss upper GI endoscopy.

Upper GI endoscopy may be used to diagnose and treat a variety of conditions that affect the esophagus, stomach and duodenum (the first part of the small intestine).

Plain X-rays including a barium swallow or upper GI series, can outline the shape and contours of the esophagus, stomach, and duodenum. The endoscopy can look directly at the lining of these structures, and in some conditions like a food impaction of the esophagus or a bleeding ulcer, can offer treatment at the same time. Using the endoscope, the gastroenterologist may be able to obtain biopsies, small pieces of tissue that can be analyzed under a microscope by a pathologist, to diagnosis conditions like celiac disease or cancers.

The value of the endoscope exam is in the ability of the gastroenterologist to directly view the esophagus, stomach and duodenum, looking at the inner lining of the organs, determining whether the motility is normal (the motion of the organs as they fill and empty), and any abnormal tissues or masses that may be present.

Some diseases that may be detected include the following:

• GERD (gastroesophageal reflux disease) or acid reflux
• Barrett’s esophagus
• Swallowing disorders, including achalasia
• Esophageal strictures, including Schatzki’s ring
• Esophageal varices
• Hiatal hernia
• Gastroparesis
• Peptic ulcer disease
• Tumors and masses
• Celiac disease

Endoscopy also has a role in diagnosing and treating gallstones that are lodged in the common bile duct, which can cause liver and pancreas inflammation.

Prior to a planned procedure, the patient will be evaluated by the gastroenterologist to discuss any medical problems, including medications and allergies that might affect the procedure. This history and physical examination may also be done by the primary care provider as part of the referral process to the specialist who will do the procedure.

For an elective endoscopy procedure, the patient will have nothing to eat or drink for 6-12 hours beforehand. This accomplishes two objectives. First, the stomach and duodenum should be empty, so that the gastroenterologist will have a clear view of the lining of the organs. Second, should sedation be required, there is less risk of vomiting and aspirating the contents of a full stomach into the lungs.

It is important to discuss all medications with the gastroenterologist and their staff, especially anticoagulation (blood thinning) medications, to minimize complication risks.

There will be at least two to three people in the procedure room for an endoscopy. The gastroenterologist will be responsible for placing the tube in the proper position, and watching the tissues of the esophagus, stomach and duodenum while threading the tube from the mouth into the upper GI tract. Assistants will help with some of the technical aspects, including instilling air or water in the tube and suctioning to help the camera with visualization. The assistants also help with threading different instruments through the tube to help with biopsies or cauterization to stop bleeding. They will also be present to help monitor the patient and their vital signs, and help with sedation should that be needed.

Do they put you to sleep for endoscopy?

Patients may be sedated for an endoscopy. How much or how little sedation provided depends upon the clinical situation, the stability of the patient, and the anxiety that patient may have. Often, the gastroenterologist and the patient discuss sedation options before the procedure begins. Depending upon how the procedure progresses, the amount of sedation provided may be increased or decreased.

Is endoscopy painful?

Endoscopy should not be painful, but after the procedure the patient may have some discomfort in their throat from the tube. There may also be some jaw tightness as the mouth has to be kept wide open for the duration of the procedure to prevent biting down on the tube.

If air is used to distend the stomach or duodenum to help with visualization, the patient may feel bloated afterwards.

Recovery from endoscopy is based on how long it takes to recover from sedation, but usually it takes less than an hour or two to wake up fully.

Is it normal to have throat, stomach, or back pain after endoscopy?

Patients undergoing endoscopy may have a sore throat that gets better relatively quickly. Abdominal distention may occur due to air being used to distend the stomach and duodenum.

Back pain is not common.

Can you drive home after endoscopy?

Patients are asked to have a driver accompany them for the procedure. Driving after an endoscopy is not recommended.

As with any procedure, there are some risks including infection and bleeding.

Dental injuries may occur.

The complications from sedation include oversedation and decreased breathing effort, which can be treated with medication to reverse. Some patients, especially the elderly, may develop heart rate disturbances and transient low blood pressure. The complication risk may be as low as 1 in 1,000.

There is the unlikely possibility of perforation of the esophagus, stomach, or duodenum. The risk is very low between 1 in 2,500 and 1 in 11,000 cases.

While not truly a risk, an adverse event of an endoscopy is that the gastroenterologist misses or does not see an abnormality like a tumor.

Depending upon the condition, the gastroenterologist should be able to give the patient and family the results immediately. However, if biopsies are taken it may take up to a week to receive the pathology report.