Endoscopy - An Overview

What Is Endoscopy?

An endoscopy is a non-surgical procedure done to look into the organs inside the human body with an instrument called an endoscope. It is a long, thin, flexible tube with a light and camera at one end. The images are seen through a television screen. Sometimes, modified endoscopes are used for surgeries. The patient may be fully conscious or anesthetized during the procedure.

What Is An Endoscope?

Endoscopes were first used in the 18th century. They include-

1. A long tube that is rigid or flexible.

2. A light delivery system to illuminate the organ under examination. The light source is generally outside the body, directed through an optical fiber system.

3. A lens system.

4. An eyepiece. Modern endoscopes have videoscopes instead of an eyepiece.

5. An additional channel to allow entry of medical such as

• Flexible Forceps - they are used to take tissue samples.

• Biopsy Forceps - They are used to remove a suspicious tissue sample.

• Cytology Brushes - They take cell samples.

• Suture Removal Forceps - to remove the stitches inside the body.

Advances In Endoscopy

New techniques are emerging to make endoscopy more comfortable for people. It includes-

1. Virtual Endoscopy- This procedure includes virtual bronchoscopy (to look inside the lungs) and virtual colonoscopy (to look inside the colon) where the doctor does not insert an endoscope. Instead, these tests involve computed tomography technology to produce images.

2. Capsule Endoscopy- The patient swallows a small, vitamin-sized capsule with a camera taking pictures inside the digestive tract. It transmits the images to a device attached to a wearable belt. Then, it passes through the digestive tract within 24 to 48 hours. This procedure is mainly used to image the small intestine, a region that is difficult to image by standard methods.

What Are the Types of Endoscopy?

Different types of endoscopy are available, and various body parts are investigated in each kind. The following body parts are viewed:

• Esophagogastroduodenoscopy - Esophagus, stomach, and duodenum.

• Enteroscopy - Small intestine.

• Colonoscopy or sigmoidoscopy - Large intestine or colon.

• Magnification endoscopy.

• Rectoscopy - Rectum.

• Anoscopy - Anus.

• Rhinoscopy - The nose.

• Laryngoscopy - The upper respiratory tract.

• Bronchoscopy - The lower respiratory tract.

• Otoscopy - The ear.

• Cystoscopy - The urinary tract.

• Gynoscopy - The female reproductive system.

• Colposcopy - The cervix.

• Hysteroscopy - The uterus.

• Falloposcopy - The fallopian tubes.

A small incision is made in the body cavities that are usually closed like

• Laparoscopy - The abdominal cavity.

• Arthroscopy - The interior of a joint.

• Thoracoscopy and Mediastinoscopy - Organs of the chest.

When Is an Endoscopy Used?

Endoscopy can be used in three circumstances-

• Investigation.

• Confirmation of a diagnosis.

• Treatment.

Endoscopy may be used for investigation purposes to diagnose a particular disease and when the symptoms are confusing. Sometimes, a cutting tool can be attached to the end of the endoscope, and they are used in performing a biopsy and treatment procedures such as cauterization of a bleeding vessel, widening a narrow esophagus, removing a polyp, or a foreign object, keyhole surgery in laparoscopy, etc. They are used in the following cases such as,

• During pregnancy - The amnion (amnioscopy).

• Plastic surgery.

• Panendoscopy (or triple endoscopy)- This procedure is a combination of laryngoscopy, esophagoscopy, and bronchoscopy.

• Orthopedic surgery.

• Endodontic surgery - Maxillary sinus surgery, apicoectomy.

• Endoscopic endonasal surgery.

• Endoscopic spinal surgery.

What Are the Risks Involved in Endoscopy?

The main risks involved in endoscopy are infection, over-sedation, injury to the lining mucosa, and bleeding. The chances depend on the site of the procedure and the body’s condition. For example, dark-colored stools, vomiting, and difficulty swallowing can happen after a colonoscopy. A hysteroscopy carries the risk of uterine perforation, uterine bleeding, or cervical trauma. Minor perforations may heal with antibiotics and intravenous fluids. Otherwise, they may require surgery. Bleeding during a biopsy or polyp removal may stop on its own or can be corrected with cauterization. They are rare during gastroscopy. The risk is higher in people with the condition that causes narrowing of the digestive tract, like a tumor.

Other rare complications include chest pain, fever, persistent pain in the endoscopy area, redness, and swelling at the incision site. The patient may also feel bloated or have mild cramping for a short period after the procedure.

How to Get Prepared for Endoscopy?

The healthcare team will give detailed instructions on preparing before an appointment. The patient may require to stop eating solid foods for up to 12 hours before the procedure. Medications can be taken 4 hours before examination with little sips of water. It is advisable to talk to the health care provider about specific instructions about taking iron supplements, Aspirin, or Pepto Bismol, NSAIDs, blood thinners, weight loss medication, and diabetic medications prior to the procedure. Some types of liquid foods may be allowed for up to two hours before the procedure. The doctor may suggest a laxative or enema the night before the procedure to clear the digestive system and the anus. It is important to tell the doctor about any previous surgeries or medications the patient may be taking. Also, alert the doctor if suffering from any allergies.

Why Do I Need Sedation for My Endoscopy?

An endoscopic procedure is usually painless, and most people only have mild discomforts like indigestion or sore throat. The patients are generally awake and are given a local anesthetic to numb the specific area of the body, which can be in the form of spray or tablets. Sometimes, they are also given a sedative to make them less aware of things around them. Sedation is used to minimize anxiety and discomfort and improve patient satisfaction and tolerability. Sedation is defined as a drug-induced state of reduced excitement or anxiety, but can still follow simple instructions while asleep. Some patients might require deeper sedation also. Propofol is the most commonly used medication, and at very high doses, it can achieve general anesthesia, like in surgeries. In such cases, close monitoring is required. The medical team regularly checks heart rate, breathing rate, blood pressure, and oxygen for any issues. In case of any adverse reactions, necessary medicines can be given to reverse sedation. The patient is kept under a short observation period and discharged.

What Happens After Endoscopy?

This procedure usually takes 15 minutes to 45 minutes, depending on the organ involved. The doctor will close the incision wounds with stitches, and the biopsy results may take a few days. If the patient had a sedative, he would probably need to rest for about one to two hours after having an endoscopy. Otherwise, the patient can usually go home the same day and not have to stay in the hospital overnight. There can be slight discomfort like sore throat after an upper GI endoscopy or blood in the urine after a cystoscopy. This should be cleared within 24 hours and must be discussed with a doctor if it persists.

Conclusion

An endoscopy is a quick and safe procedure. Today, the related risks involved are less with modern technology, and it delivers detailed images. It is easy and fast to carry out and has proven to be useful in many areas of medicine. This procedure can help the doctor to visually examine an organ without the need for a large incision and open up the organ, which may later need to be sutured.