Endoscopy

What is an endoscopy?

Endoscopy is a procedure that employs an instrument called an endoscope to visualize the inside of your body. Depending upon the area to be visualized, and the point of insertion of an endoscope, the endoscopy may be done as –

– Upper Gastrointestinal (GI) endoscopy
– Gastroscopy/Enteroscopy/Colonoscopy/Sigmoidoscopy
– Rhinoscopy
– Otoscopy
– Gyroscope
– Bronchoscopy

Why has my physician ordered endoscopy for me?

Your physician may ask you to undergo an endoscopy if you present with-

– Dysphagia (difficulty in swallowing)
– Hematemesis (blood in the vomit)
– Melaena (blood in the stools)
– Pain abdomen which is persistent in nature.
– Chest pain (when a cardiac or pulmonary origin has been ruled out)
– Persistent diarrhea/nausea and vomiting
– Unexplained weight loss

What are the contra-indications of endoscopy?

Absolute contraindications to endoscopy include shock, acute myocardial infarction, inflammatory conditions of the GI tract (peritonitis, fulminant colitis) and acute perforation. Relative contraindications include an uncooperative patient, coma, and serious cardiac events (including arrhythmias).

What diseases can be diagnosed by endoscopy?

An upper GI endoscopy can be used to diagnose-

– Gastroesophageal reflux disease.
– Dilated veins in the esophagus (esophageal varices).
– Any stricture in the upper GI tract.
– Inflammatory lesions including ulcers.
– Tumors (both benign and cancerous).
– Hiatal hernia( a condition when the upper portion of your stomach protrudes through the muscle separating your abdomen and diaphragm).

Are gastrointestinal disorders common in India?

Changing environmental factors and rapid industrialization have made GI disorders, which were once considered to be typical “Western” diseases, common in Asian nations, mostly in India. Millions of Indians are diagnosed with GERD, peptic ulcers, ulcerative colitis, Crohn’s disease etc every year. The rise of smoking and other forms of tobacco consumption is also held responsible for this surge. Among all the GI disorders common in Asian countries, ulcerative colitis is probably the most widespread.

Are there any risks involved?

Endoscopy is a safe painless procedure. However, a few rare complications that can result are-

Bleeding- This can be a complication of endoscopy when a biopsy is being taken from a lesion or varices are being treated.

A tear in the GI tract- Endoscopy is an invasive procedure. A breach of the mucosa may occur rarely and may lead to hospitalization.

Infection– This can be avoided by using prophylactic antibiotics.

Allergy to drugs used for sedation– Throughout the procedure, continuous monitoring of your vitals are being done. In case of a reaction to any drug, immediate help is at hand.

Respiratory depression– It can be caused by the sedative used. Constant monitoring of the oxygen saturation levels is done to detect and treat it.

Intravenous access is established before the procedure. This may lead to bleeding, bruising and subsequently infection at the puncture site.

Can pregnant females undergo endoscopy?

No radiation is used during endoscopy, except when ERCP (Endoscopic retrograde cholangiopancreatography) is performed. However, sedation, if used, can lead to fetal hypoxia. Sedation can be avoided. An endoscopy if required can be performed in the second trimester of pregnancy.

How should I prepare for an endoscopy?

Inform your physician regarding your medical history including the drugs you are taking. Any drug allergy suffered by you in the past should be detailed out.

– An endoscopy is performed on an empty stomach. Your physician will advise you to fast for 8 hours prior to the procedure.

– If you are taking blood thinners, you will be instructed to stop taking them a few days before the endoscopy.

– Your physician may prescribe antibiotics for you to avoid the risk of infection following endoscopy.

How is an endoscopy performed?

An endoscopy is usually performed on an outpatient basis. A gastroenterologist (a doctor specializing in diseases of the GI tract) performs an endoscopy.

– You will be asked to remove the jewelry and may be asked to remove your clothes. In the latter case, a hospital gown will be provided to you.

– If you are wearing a denture, you will be asked to remove it before you proceed for an endoscopy.

– You will be made to lie down on a table either on your back or your side.

– Monitors will be attached to your body to help your physician keep a check on your vitals including blood pressure, heart rate, and oxygen saturation.

– Intravenous access will be established. You may be administered a sedative before the procedure via this route.

– A local anesthetic may be sprayed at the back of your mouth, numbing that area to help push the endoscope through your oral opening.

– A mouth guard will ensure that you do not bite down on the endoscopic tube.

– Saliva will be suctioned from your mouth periodically as you won’t be able to swallow it on your own.

– An endoscope will be inserted in your mouth. The physician will instruct you to swallow the scope as it moves past your throat.

– The endoscope has a light source and a camera at its end. This helps the gastroenterologist to visualize the inside of your GI tract.

– The tiny camera transmits images to a video monitor. The doctor may make recordings if any abnormality is detected.

– If a biopsy (a small piece of tissue) needs to be taken, your doctor will nip off small samples using surgical tools.

How long does an endoscopy take?

An upper GI endoscopy takes about 15-25 minutes. You may be asked to remain in the recovery unit for an hour or so for the purpose of observation. This also allows the effect of a sedative to wear off.

You may experience sore throat, mild pain abdomen and bloating after the procedure. These effects wear off in a few hours. Do not hesitate to contact your physician if these symptoms persist.

What is the cost of performing endoscopy in India?

A simple upper GI endoscopy used only for diagnostic purposes costs around Rs 1000 in India. The costs are higher if a therapeutic procedure is performed.

What is a therapeutic endoscopy?

Endoscopy plays a vital role in detecting abnormalities of the GI tract. It can also be used to treat diseases of the GI tract such as-

– Endoscopic sclerotherapy of bleeding GI ulcers– In this procedure, hemostatic agents are injected endoscopically in the area of bleeding.

– Endoscopic banding of bleeding esophageal varices– In this technique, rubber bands are placed along the varices to arrest bleeding.

– Dilatation of an esophageal stricture.

– Removal of tumors or polyps.

What are the advantages and limitations of endoscopy?

The overall complication rate of endoscopy is 0.1 to 0.2%. The mortality rate is about 0.03%.

What are specialized endoscopy techniques?

Wireless capsule endoscopy- It is a novel concept as far as endoscopy is concerned. You are made to swallow a capsule, the size of a large pill. This capsule transmits images of your digestive system which are then transmitted to a monitor.

This process has the advantage of detection lesions which may have gone unnoticed during routine endoscopy. This holds true of patients with an occult GI bleed and those having mucosal irregularities.

However, it may sometimes be difficult to swallow the large-sized capsule and to pass it naturally. Moreover, there is a risk of it getting stuck somewhere in the GI tract.