A look at endoscopy
Posted on 28 August 2012
Meet our expert Dr Carl Streicher is a specialist surgeon at Mediclinic Bloemfontein. After qualifying from the University of the Free State, he completed a year-long laparoscopic surgery fellowship at the University of Surrey and the Royal Surrey County Hospital in Guildford. He’s passionate about laparoscopic surgery and performing endoscopy-assisted interventions to treat problems of the pancreatic and bile ducts. Being a surgeon at a large private hospital means that endoscopies form a large part of his everyday work.
Why would my doctor opt to perform an endoscopy?
An endoscope is a flexible tube with a camera lens and a small light source attached to the front tip that is threaded into your gastro-intestinal tract, from which images are projected back to the doctor so that he can have a look at the inside of your intestines. It is often the easiest, or even the only, way to find the cause of gastro-intestinal problems. An endoscope also contains a channel through which instruments can be passed for performing small procedures such as biopsies or sutures.
What is the difference between a gastroscopy and a colonoscopy?
A gastroscopy is performed to examine the upper part of your gastro-intestinal tract. Your doctor will pass a gastroscope through your mouth, down your oesophagus towards your stomach and then into the first part of the small bowel. A gastroscopy is often used to diagnose the cause of upper-abdominal pain, indigestion, vomiting or heartburn, or to stop acute bleeding in the stomach or early part of the small bowel. During a colonoscopy a colonoscope is passed through the anus into the colon to examine the entire length of your colon. A colonoscopy is most often used to search for the cause of lower-abdominal pain or bleeding, for example an inflamed colon, unusual protrusions along the colon wall (diverticulae) or a tumour.
An endoscopic examination sounds daunting. What should I expect during the procedure?
Endoscopic examinations are nowadays performed routinely using sedation, so you won’t be awake or feel any discomfort during the procedure. A drip is used to deliver the sedation intravenously. A gastroscopy usually takes about 15 minutes, and a colonoscopy about half-an-hour. After a colonoscopy you may feel very bloated, which could cause discomfort. However, once the air in the colon is passed, the pain will settle very quickly.
How should I prepare for a) a gastroscopy and b) a colonoscopy?
For a gastroscopy the stomach needs to be empty, so you won’t be allowed to eat or drink anything for about eight hours before the procedure. For a colonoscopy the colon needs to be clean. You will have to take a special laxative and bowel cleansing preparation the day before the procedure. Although this may be uncomfortable, it is important to follow the instructions for the bowel preparation carefully. If the colon is not adequately clean, it will be very unpleasant to perform the procedure and the visualisation will not be optimal.
How is the scope cleaned between examinations, or are the components disposable?
The endoscope itself is cleaned between procedures in an endoscope-cleaning machine using specifically formulated disinfectants. Instruments that cannot be cleaned properly, for example biopsy forceps, are usually disposable.
Can endoscopy be used for any other examinations or procedures?
Endoscopy has advanced dramatically over the past few years. More and more complex procedures can be performed with and through an endoscope. For example, a duodenoscope can be used to perform procedures along the bile duct or pancreatic duct, rendering potentially serious conventional surgery unnecessary. Endoscopy also often aids in the removal of small growths from the intestines, or are used to stop intestinal bleeding or insert stents to keep narrowed passages open. During surgery, endoscopes can be used to locate a lesion in a hard-to-see place, to assess the outcome of a surgical procedure or examine tissue for bleeding. An endoscope with an ultrasound probe, which allows a view through the wall of the intestines, is a recent development. This scope can also be used for fluid collections or biopsies from areas beyond the intestinal wall, for example lymph nodes. Unfortunately this technology is not yet readily available in South Africa.
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