Endoscopy

Endoscopy

Upper GI Endoscopy (Gastroscopy) and Colonoscopy

Upper GI Endoscopy (Gastroscopy)

dr-coolen-gastroscopy

Upper GI endoscopy or commonly what is called a gastroscopy is a procedure that is performed in order to visually examine the upper part of the gastrointestinal tract which includes the oesophagus (the gullet), the stomach and the duodenum. The examination is performed under sedation where a fibre optic camera is passed via the mouth to inspect the inner lining, the mucosa of the oesophagus, stomach and duodenum. The test is usually done in order to look for ulcers, cancers, bleeding sites and other forms of tumours and inflammatory problems that could effect the upper part of the gastrointestinal tract.

Indications

The procedure is indicatedin the following situatioin

  1. When a patient is complaining of upper abdominal pain for no other obvious reason
  2. bleeding from the upper gastrointestinal tract that manifest as either vomiting of blood or coffee ground vomiting or passing dark tarry bstools also called malena.
  3. Constant symptoms like nausea and vomiting for no explained reason.
  4. Suspicion of duodenal ulcer
  5. Suspicion od stomach cancer
  6. Patients with heart burn who is suffering from gastro-oesophageal reflux (GORD)
  7.  Difficulty in swallowing
  8. Hiatus hernia
  9. Cancer of the Oesophagus
  10. Stricture of the oesophagus
  11. Dilated veins at the lower part of the oesophagusAll these things can be looked at directly and can be found out as mentioned earlier. Your Doctor will have a direct look and will be able to diagnose ulcers, site of bleeding, tumours and also it is useful for the oesophagus to see if there are any areas of changes as a result of reflux. The acid reflux from the stomach into the oesophagus might damage the inner lining because of the oesophagus and that can lead to what is called Barrett’s oesophagus which is precancerous. Photographs are likely to be obtained  for any abnormality to document the findings, theses are kept in your medical file.Your Surgeon should be able to see that usually clearly and take some biopsies to confirm the diagnosis. Also with the upper GI endoscopy or the gastroscopy your Doctor is sometimes able to treat the condition. If there is a polyp it will be removed, biopsies will be taken from inflamed tissue and tumour tissue and if there are bleeding spots they can be dealt with either by clipping with a metal clip of injected with adrenaline or cauterised with an Argon beam laser.

 

 

You need to prepare for the procedure only by fasting, no other preparation is needed. Your surgeon will warn you about the risk factors associated with this problem. Bleeding is the main concern particularly when a biopsy is removed or from a lesion  and sent for histopathology examination , or any other tissue piece dealt with such as a polyp. Bleeding is usually transient and self limiting but occasionally it might need a further procedure or scans or blood transfusion. Another complication that is feared is endoscopy might lead to a tear in the gastrointestinal tract. The risk of that is very small and it has been reported as about only 1 in 10,000 of diagnostic gastroscopies. The risk will increase of course for perforation if your Doctor is dilating part of your gastrointestinal tract, particularly the oesophagus. This is a particularly feared complication because a hole in the oesophagus can lead to a significant infection and might need further intervention which can include surgery. However, this is rare and only happens if you have an inflamed oesophagus that caused narrowing and needed to be dilated, usually with a balloon that is inserted at the time of the procedure. You need to ensure that after you go home you look for warning signs that something is not right such as chest pain, fever, shortness of breath, dark stools, difficulty to swallow, abdominal pain and vomiting.

When you are having this procedure you will need to be fasting; the procedure will happen under light anesthesia and is very well tolerated. Usually you won’t remember much of the event due to the effect of the sedation medications. If there is a major pathology found, usually your Doctor will speak to you on the day, otherwise they might take some biopsies and usually meet you back for a follow-up in their rooms to discuss the findings and the plan of the treatment after that.

Colonoscopy

Image result for colonoscopy

Colonoscopy is a camera test where the surgeon inserts a camera into the large bowel in order to examine the inner lining (the mucosa) of the large bowel. With doing the procedure the patient is usually sedated and a camera is inserted and visualisation of the inner lining of the colon will happen. Your surgeon might be able to take some biopsies from lesions. If there are polyps they can be removed. If they find cancer they will take samples of that for examination under microscope. They will also take some biopsies if there are areas of inflammation in the colon. If there are pockets in the colon, your surgeon will take pictures and document that.

Indications:

  1. Bleeding per rectum
  2. Altered bowel habit
  3. Screening  if you are above the age of 50
  4. Family history of cancer
  5. Familial adenomatous polyposis
  6. Known history of polyps
  7. Previous history of cancer
  8. Inflammatory bowel disease
  9. Weight loss for unknown reason
  10. Positive bowel scan (fecal occult blood)

 

During the bowel preparation you need to make sure you are well hydrated and stay on liquid diet the day prior to the procedure. The thing that you need to be aware of is to ensure that when you go to the toilet your bowels are clear. Sometimes despite taking all of the preparation with all the care that you take your bowels could still have faecal material that will need to be cleared. You need to tell the nurses on arrival to the hospital as in that situation you may need to have an enema to help clear the residual faecal matter in the bowel.

Blood thinning medications:

These medications are frequently used by patients who had a prosthetic heart valve, previous thromboembolic disease (blood clot in the main vessels), atrial fibrillation, cardiac disease, previous clot in the lungs. If you are any any blood thiner you need to discuss that with your surgeon, because you may be required to stop the medications and do some blood tests.

During the procedure you will have deep sedation and your Doctor will examine the colon all the way up to the junction between the small and the large bowel. The procedure may take anywhere between 25 minutes to one hour. It depends on the difficulty of the examination. All the findings will be documented and pictures will be taken and your surgeon will discuss the results with you if there is something serious such as cancer , usually on the day. Otherwise you will return to the Doctors rooms in about two weeks time and the results will be discussed and a plan for further treatment will be discussed.

An important benefit of colonoscopy is the early detection of cancer also the fact that in patients above the age of 50 there will be 25% chance of finding a polyp, which is a wart like growth from the bowel inner lining that can progress to cancer, your surgeon will remove the polyps and that works as a cancer prevention strategy. Your5 surgeon will use electric current to remove the polyp to reduce the risk of bleeding, there is a small risk of bleeding after polyp removal, which is usually self limiting but can be significant at certain times.

Occasionally the procedure is not successful, a particular group of patients may have that problem, usually women who had previous pelvic surgery and people who are overweight. If that happens we have a rescue  option by getting the patient to have a CT colonography, which is a CAT scan with specific protocol to examine the colon for cancers and polyps.

After you wake from the procedure the nurses will monitor you and ensure you are pain free. Usually you will be given something to eat and if you are pain free and well you will be discharged home. You need to get a relative or friend to drive you home as you won’t be able to drive for 24 hours due to the anaesthesia. You need to watch for the following symptoms of complications such as bleeding from the bowel or also if you have excessive pain then you would need to present to the emergency department or see your local GP for examination and further tests.

Complications of Colonoscopy:
1. Perforation of the colon is the most serious complication because it will likely need an open operation to fix the problem. The estimated risk of that is one in a 1000.

2. Bleeding: excessive bleeding is not a common complication but may happen after a polyp removal or a biopsy.

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