Endoscopy: Overview

Endoscopy is a non-surgical procedure that involves the insertion of a long, thin, flexible tube attached with a light and camera for observation of internal organs and tissues to detect any abnormalities in the body. It is a quick and easy procedure that provides detailed images and is proven to be useful in different areas of medicine. Your doctor may perform endoscopy for investigation of different parts of the gastrointestinal tract (GIT) in the body which include: the upper gastrointestinal tract, Small intestine, and lower gastrointestinal tract, etc.

Types of endoscopy

Endoscopy broadly classified into either diagnostic or therapeutic

Diagnostic endoscopy

• Upper gastrointestinal endoscopy: The scope is inserted through the mouth for examination of the oesophagus and upper intestinal tract.
• Enteroscopy: The scope is inserted through the mouth or anus to examine the small intestine.
• Colonoscopy: The scope is inserted through the anus to examine the colon.
• Sigmoidoscopy: The scope is inserted into the anus to examine the rectum and lower part of the large intestine (sigmoid colon).
• Esophageal manometry: It is a test to assess the pressures and pattern of muscle contractions of the esophageal body and sphincters.
• 24 hour Esophageal pH metry: It measures the amount and severity of acid reflux in the esophagus over 24 hrs.

Therapeutic and newer endoscopic technologies

• Endoscopic ultrasound (EUS): An ultrasound probe attached to tip of an endoscope to visualize organs adjacent to intestinal lumen and through which, tissue samples also can be obtained.
• Endoscopic retrograde cholangiopancreatography (ERCP): It includes a combination of upper gastrointestinal tract endoscopy with X-rays for diagnosis and treatment of bile and pancreatic ductal diseases such as stones, strictures, cancers, etc.
• Capsule endoscopy: It involves swallowing of a capsule embedded with a tiny camera which passes through your gastrointestinal tracts and creates images without causing discomfort.
• Spy-Cholangioscopy: It involves passing a tiny camera into the bile duct or pancreatic duct through a working channel of an endoscope to identify and treat stones, cancers, strictures, etc.
• POEM (Peroral Endoscopic Myotomy): It is an endoscopic equivalent of surgical myotomy (division of lower oesophageal sphincter) to treat a rare clinical condition called Achalasia Cardia.
• EMR (Endoscopic submucosal resection)/ ESD (Endoscopic Submucosal Dissection): It is a newer technique to remove superficial cancers involving upper or lower gastrointestinal tract without surgical removal of an organ.
• Narrow band imaging (NBI): It helps in better differentiation of inner lining of the digestive tract (mucosa) and surrounding blood vessels.
• Chromoendoscopy: It involves usage of a special dye on the intestine lining during endoscopy for better visualisation of intestinal lining abnormalities

Preparation for Endoscopy

Before the procedure

• Your doctor will take a thorough medical history including information about your present medications and any previous procedures followed by a physical examination.
• Prior to most endoscopic procedures, patients are advised to fast for about 8 hours, although this may vary with different types of endoscopies.
• Your doctor may prescribe laxatives the night before your procedure to clear out the gastrointestinal tract and anus.

During the procedure

• The majority of endoscopies are outpatient procedures. You may be consciously sedated with a local anaesthetic or general anesthesia may be administered depending on the type of endoscopy.
• For endoscopic procedures which require insertion of the tube through the mouth, a mouth guard is used for protection of the teeth and lips.
• Your doctor inserts the endoscopic tube through openings such as the mouth and the anus or through small incisions depending on the body part being examined.
• Once images are created, the endoscope is removed. The procedure may be completed in few minutes to a few hours depending on the type of procedure.

After the procedure

Recovery time may vary with the type of endoscopy performed. Once your procedure is completed, you will be required to remain in the hospital for about 1-2 hours until the sedative effect is worn off. Patients are advised to avoid working or driving on the day of the procedure due to the sedative effects. You may feel mild discomfort following some endoscopic procedures. Following gastrointestinal endoscopies, you may experience soreness in your throat and bloating, however, these symptoms are normal and generally subside within 24 hours.

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