Types of Endoscopy

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fireworks
Regular Member


Date Joined Apr 2012
Total Posts : 178
   Posted 6/20/2012 7:16 AM (GMT -6)   

Gastroscopy

Gastroscopy is an examination of the esophagus (swallowing tube or gullet), stomach and the first part of the small intestine, called duodenum. It is performed by using a thin, flexible fibre-optic instrument, gastroscope that is passed through the mouth and allows the doctor to see the lining of the oesophagus (gullet), stomach and duodenum.

Reasons for Gastroscopy

Gastroscopy is performed for:

  • Persistent or recurrent abdominal pain and discomfort.
  • Prolonged symptoms of indigestion, bloatedness, nausea, vomiting.
  • Severe or frequent heartburn or reflux.
  • Difficulty in swallowing.
  • Vomiting blood, or coffee-ground materials.
  • Passing of black or "tarry" stools.
  • Anaemia, loss of appetite or weight without known reason.
  • Screening for gastric cancer.

The stomach must be completely emptied of food and liquid before the procedure. This involves fasting for at least 6 hours before gastroscopy.

An empty stomach allows the endoscopist to see clearly the lining of the esophagus, stomach and duodenum and reduces the risk of vomiting during the procedure.

If there is food present, gastroscopy has to be postponed. If you are taking any long-term medication, especially blood thinners, warfarin, aspirin or diabetes medication, you should inform the doctor before the procedure.

How is Gastroscopy Performed?

VIEW IMAGEAfter explaining the procedure, the nurse will spray the back of your throat with a local anaesthetic to make it numb. The procedure is painless and is usually done under a light sedation.

A nurse will help you to lie on the left side and the doctor will then gently place the end of the gastroscope into the mouth and may ask you to swallow it, which feels like swallowing a large piece of food.

You may experience mild bloating or belching as the gastroscope will “blow” air into the stomach. This will improve when you pass the gas. Gastroscopy is well tolerated, pain free and does not affect your breathing.

The endoscopist will closely examine the lining of the gullet, stomach and duodenum to identify the cause of the symptoms. If necessary, a biopsy (a small piece of the lining of the stomach) will be taken for further examination, such as testing for bacteria Helicobacter pylori or histology (examining under the microscopy).

The entire procedure will take about 10 minutes.

What Happens After Gastroscopy?

You will be observed until the sedation has worn off, after which the doctor will explain you the result of gastroscopy and you will be discharged home.

Do not drive or operate machinery till the next day, as the sedatives used will impair your reflexes.

Sometimes, a mild sore throat is experienced and it will resolve in a few days. You will be able to eat normally the same day and resume your usual activities the next day.

Is Gastroscopy Safe?

Gastroscopy is a very safe procedure. Minor complications are uncommon and major complications are very rare. Some patients might have reactions to the sedation.

 


fireworks
Regular Member


Date Joined Apr 2012
Total Posts : 178
   Posted 6/20/2012 7:16 AM (GMT -6)   
Colonoscopy

Colonoscopy is the endoscopic examination of the colon (large intestine) with a flexible, fibre-optic instrument, called colonoscope which is passed through the anus.

Colonoscopy is similar to but not the same as sigmoidoscopy. The difference being related to which parts of the colon each can examine. While colonoscopy allows an examination of the entire colon (measuring four to five feet in length), sigmoidoscopy allows doctors to view only the final two feet of the colon.

Colonoscopy allows removal of the polyps as small as one millimetre. Once polyps are removed, they can be studied with the aid of a microscope to determine if they are precancerous or not.

Reasons For Colonoscopy

Colonoscopy is performed for:
•Colon cancer screening.
•Positive FOBT.
•Patients who have polyps.
•Change in bowel habits
•Anaemia, loss of appetite or weight without known reason.
•Blood in the stools.
•Ulcerative colitis and Crohn’s disease.
•Chronic Diarrhoea

Preparation For Colonoscopy

The colon must be free of stool for colonoscopy to be performed properly. This involves bowel cleansing which is done prior to the colonoscopy. You will be given instructions on the bowel cleansing by the doctor and nurse.

Bowel cleansing involves taking a laxative preparation (e.g. phospho soda) followed by large quantity of fluid, preferably plain water or whole bowel irrigation using a solution of polyethylene glycol. If the bowel preparation is not completed before the colonoscopy and there is faecal matter in the colon, the procedure cannot be carried on and the colonoscopy has to be postponed.

If you are taking any long-term medication, especially blood thinners, warfarin, aspirin or diabetes medication, you should inform the doctor before the procedure.

How Is Colonoscopy performed?

After explaining the procedure, the nurse will help you to lie on the left side. The procedure is done under a light sedation to help you relax and better tolerate any discomfort.

After giving a sedation, the doctor will insert the colonoscope through the anus up the rectum, colon, and ultimately the terminal ileum, which is the end part of small bowel. During the procedure bowel is occasionally insufflated with air to maximize visibility. This might result in some bloating, cramping or pressure during the procedure, but this is usually well tolerated.

If necessary, tissue samples (biopsies) are taken during the colonoscopy and send for further analysis under the microscopy (histology). If a polyp (small growth of tissue that can develop into a cancer) is found in the colon, it can be removed during the colonoscopy. The entire procedure lasts about 15 to 30 minutes.

What Happens After Colonoscopy?

You will be observed at the Endoscopy Centre until the sedation has worn off, after which the doctor will explain you the result of colonoscopy and you will be discharged home.

Common after-effect from the procedure is a bout of flatulence and minor wind pain caused by air insufflation into the colon during the procedure. This will be relieved after you pass the gas. You will be able to eat normally the same day and resume your usual activities the next day. Do not drive or operate machinery till the next day, as the sedatives used will impair your reflexes.

What Are the Risks?

Colonoscopy is a very safe procedure. Complications are rare, but can occur. These include bleeding (0.1-2%) and bowel perforation (0.1-0.3%) (Ref. ASGE Guidelines). Bleeding can occur up to about two weeks after a colonoscopy especially if patient is taking aspirin or blood thinning medications. Rarely surgical treatment is needed. Some patients might have reactions to the sedation.

It is important to contact your doctor if you experience symptoms of severe abdominal pain, fever or rectal bleeding after colonoscopy.

fireworks
Regular Member


Date Joined Apr 2012
Total Posts : 178
   Posted 6/20/2012 7:17 AM (GMT -6)   

Polypectomy

Polypectomy means removal of polyps during colonoscopy.

What are Colonic Polyps?

Colonic polyps are growths that protrude into the lumen of the bowel. Polyps are usually removed because they can be the source of rectal bleeding or may contain cancer. Although the majority of polyps are benign (non cancerous), some may contain a small area of cancer or may develop cancer if left untouched. Removal of polyps is therefore an important means of prevention of cancer of the large bowel (colon).

What is Polypectomy?

Polypectomy means removal of polyps during colonoscopy. You should feel no pain during polyp removal. Small polyps can be removed by a biopsy forceps, which snips off small pieces of tissue. Larger polyps are usually removed by putting a loop, or snare, around the polyp base and burning through the tissue with electric cautery. Neither of these procedures is painful, and you will usually not be aware that they are being done. Rarely, if a polyp is too large it may require surgery for removal.

VIEW IMAGE

What is the risk of polypectomy?

Polypectomy is very safe, but all procedures entail some risks. The most common complications of polypectomy include bleeding and perforation (creating a hole in the colon). Fortunately, although these are the most common complications of polypectomy, they are still infrequent. Bleeding can usually be controlled during colonoscopy. Surgery is usually required for perforation. Other complications have been described but occur much less frequently.

What is the recommendation post polypectomy?

Some drugs, such as blood thinners (aspirin, clopidogrel, warfarin) promote bleeding during and post polypectomy. You should follow the instruction of the doctor regarding usage of these medication prior and post polypectomy. In addition, you should follow your doctors instructions about finding out the results of the tissue analysis (histology) of polyps which were removed and when a repeat examination should be performed.


fireworks
Regular Member


Date Joined Apr 2012
Total Posts : 178
   Posted 6/20/2012 7:17 AM (GMT -6)   

Enteroscopy

Enteroscopy is a procedure to examine the small intestine. Using a special endoscope called enteroscope, the lining of the small intestine can be examined visually with the option of taking tissue samples, if necessary. However, the small intestine is 4-6 meters long. There are at least three different ways how to examine the small intestine. The selection of different technique is based on the patient’s condition.

Different Types of Enteroscopy

1. Push Enteroscopy
Push enteroscopy is examination of a short segment of the first part of small bowel called jejunum using a paediatric colonoscope. Due to the length of the small bowel, push enteroscopy is not effective to adequately visualize the entire small intestine. This technique is used for detection and treatment of any lesion or disease localize in the first segment of small intestine, like ulcer, polyp, enlarged vessel called vascular ectasia or angiodysplasia or arterio-venous malformation.

VIEW IMAGE

2. Single-balloon or Double-balloon Enteroscopy
Newer techniques, including single and double-balloon enteroscopy enable to examine the entire small bowel using a special enteroscope. This procedure is done under deep sedation and requires time to complete the entire examination of the small bowel.

3. Capsule Endoscopy
Wireless capsule endoscopy is the non-invasive examination of the entire small bowel. An 11 x 26 mm pill sized video camera is swallowed by the patient and approximately 8 hours of video is transmitted wirelessly to a receiver worn by the patient. The procedure is painless and offers a high accuracy. The limitation of this procedure is the inability to obtain biopsy specimens and provide any endoscopic treatment. Therefore this method is considered a purely diagnostic tool. Another limitation of this technique is the possibility of capsule retention in the small bowel if there is any narrowing or stricture.

How to Prepare for Enteroscopy

Enteroscopy is done on empty stomach, therefore you are asked to not to eat or drink at least 6 hours before the procedure. Before the single and double-balloon enteroscopy , bowel cleansing is required to clear out the content of the small intestine.

If you take a regular medication, inform the doctor before the procedure. Some medications, like blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix), may cause a bleeding. Do NOT stop taking any medication unless told to do so by your doctor.

How Does the Enteroscopy Feel

Just before the enteroscopy you will be given a medicine to help you relax and fall asleep. This is called sedation. With sedation, you should have little, if any, discomfort.

Why Endoscopy is Performed

This test is performed to help diagnose diseases of the small intestines. It may be done if you have:

  • Abnormal x-ray or CT scan results
  • Tumor in the small intestines
  • Unexplained gastrointestinal bleeding
  • Unexplained diarrhea
  • Unexplained iron deficiency anaemia
Risks

The major risks are pain or bleeding when the polyp is removed during enteroscopy. There is also a small risk of perforation (tearing) of the tissue wall during endoscopy. For capsule endoscopy there is a risk of capsule retention if the small intestine is narrowed or if there is a small bowel stricture.

Reactions to the sedation may occur, although they are rare. For this reason your breathing, blood pressure, heart rate, and oxygen level will be monitored during the procedure.


fireworks
Regular Member


Date Joined Apr 2012
Total Posts : 178
   Posted 6/20/2012 7:17 AM (GMT -6)   

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is used to detect and treat conditions of the bile ducts, such as stones, narrowings (strictures), leaks (from trauma and surgery), and cancer. ERCP is performed mostly with a therapeutic intention.

ERCP combines the use of x-rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dye into the bile ducts and pancreatic duct so they can be seen on x- ray.

VIEW IMAGE

Why do I need ERCP?

To find out the cause of blockage of the bile duct:

1. Diseases of the bile ducts

  • Bile duct stones
  • Bile duct tumors
  • Suspected injury to bile ducts

2. Diseases of the pancreas

  • Pancreatic tumors
  • Chronic pancreatitis

3. Treatment of the diseases

  • Endoscopic sphincterotomy (enlargement of the opening of the ampulla)
  • Removal of bile duct stones
  • Insertion of stent(s) (tubes)
  • Dilation (opening) of bile duct narrowing

VIEW IMAGE

Are there any Contraindications?

1. Absolute contraindication:

  • The patient that is not able to cooperate.

2. Relative contraindications

  • Recent heart attack.
  • History of allergy to dye (contrast).
  • Frail and unfit for surgery.
  • Severe heart and lung disease.

VIEW IMAGE

Procedure

The procedure is done under the sedation which will make you comfortable during the procedure. A flexible camera (endoscope) is inserted through the mouth, passed the stomach into duodenum until it reaches the ampulla of Vater. A plastic catheter or cannula is inserted through the ampulla, and dye is injected into the bile ducts, and/or, pancreatic duct. X-ray is used to look for stones, blockages, or other lesions.

When needed, the opening of the ampulla can be enlarged with an electrified wire (sphincterotome) and access into the bile duct obtained so that stones may be removed or other therapy performed.

Stones from the bile ducts are removed with a basket or balloon. Other procedures during ERCP include insertion of a plastic stent to assist in the drainage of bile. The pancreatic duct can also be accessed and stents inserted.

Preparation

Stomach and duodenum must be empty for the procedure to be accurate and safe. You should not eat or drink after midnight, before the procedure, or for 6 to 8 hours beforehand, depending on the time of the procedure. Your doctor need to know whether you have any allergies, especially to iodine, which is in the dye and whether you are taking any blood thinners, warfarin, clopidogrel and aspirin.

Risks

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), which can occur in up to 7%* of all procedures.

Gut perforation (0.1-0.3%*) is a risk of any endoscopic procedure, and is an additional risk if a sphincterotomy is performed. Sphincterotomy is also associated with a risk of bleeding (0.8-2%*). *ASGE Guidelines

Other risks may be related to sedation and contrast dye, but these are rare.


fireworks
Regular Member


Date Joined Apr 2012
Total Posts : 178
   Posted 6/20/2012 7:18 AM (GMT -6)   

What is a Urea Breath Test?

VIEW IMAGEUrea breath test is a simple test analyzing patient’s breath to detect bacteria Helicobacter Pylori. It is a non-invasive non-radioactive test which is used for follow-up of Helicobacter Pylori eradication after therapy.

What is Helicobacter Pylori?

Helicobacter Pylori is a spiral-shaped bacteria that lives in various parts of the stomach and duodenum (the first part of the small intestine). It causes an inflammation of the stomach lining and is linked to the development of duodenal and stomach ulcers. It increases the risk of gastric cancer 2-6 times. However, 80% of individuals infected with this bacteria are asymptomatic.

VIEW IMAGE

How Common is Helicobacter Pylori Infection?

Helicobacter pylori infection is one of the most common infections in the world. Fifty percent of the world’s population is estimated to be infected with this bacteria. It is more prevalent with developing countries. The precise mode of transmission remains unknown, but the oral-oral and fecal-oral routes are the most probable. The infection is usually acquired in childhood before age of five and transmission between adult is consider rare.

What is the Principle of Urea Breath Test?

VIEW IMAGEHelicobacter pylori produces an enzyme urease. When Helicobacter pylori is present in the stomach, the enzyme urease, produced by Helicobacter pylori, will convert 13C urea ingested in the test drink into ammonia and carbon dioxide. Carbon dioxide is exhaled though the lungs and collected in the chamber bags.

How is Urea Breath Test Performed?

There is no special preparation required before the Urea Breath Test. The patient drinks the orange drink with 13C urea and blows the breath into the chamber bags at respective intervals. The patient could drink plain water during the test but not any carbonated drinks. Bags with collected gas are sent to the laboratory for analysis.

How Safe is Urea Breath Test?

13C-Urea Breath Test is widely recognized as the easy, safe and most reliable non-invasive diagnostic test. The test is using 13C which is a stable, non-radioactive isotope. about 1.1% of our body contains naturally occurring 13C. A normal daily food intake of an adult will contain about 3g of 13C.

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