Understanding Basic Endoscopy!

Understanding Basic Endoscopy!

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By Dr. Tarun Bharadwaj, Gastroenterology

Endoscopy is a common term which includes Gastroscopy and Colonoscopy. “Endoscope” is a flexible tube with light and camera at the end of the tube, by which the doctor can see inside the patient’s body. Upper GI endoscopy is called gastroscopy and helps gastroenterologists to see food pipe (Esophagus), Stomach and duodenum (first part of the small intestine). Lower GI endoscopy is called Colonoscopy and helps gastroenterologists to see large intestine (Colon) and last part of the small intestine (terminal ileum).

1. GASTROSCOPY:

Gastroscopy is additionally called Esophago-gastro-duodenoscopy. The endoscope is a tube that encompasses a little camera and a light source at its tip and gives high-resolution pictures of the higher alimentary canal. The patient lies in the left lateral position and the gastroscope is advanced under direct vision through the mouth of the patient for examination. Pharyngeal anaesthesia is sufficient for most patients but occasionally general anaesthesia is required depending on the patient preferences and procedure complexity. Gastroscopy is a very quick and safe examination and is usually performed on a daycare basis.

 Diagnostic indications of Gastroscopy -

1. Evaluation of Dysphagia(difficulty in swallowing) and Odynophagia(pain during swallowing).

2. Evaluation of non-cardiac chest pain.

3. Evaluation of esophagitis(erosive and non erosive) ,Gastroesophageal reflux disease(GERD) and Barrett’s esophagus.

4. Evaluation of Achalasia cardia.

5. The best test for diagnosing the cause of bleeding.

6. Evaluation of Gastritis and peptic ulcers.

7. Evaluation of Upper GI malignancies(SESCC/EGC/Duodenal malignancies) and taking biopsies.

8. Evaluation of Celiac disease and proximal inflammatory bowel disease.

9. Evaluation of Chronic diarrhea and Anemia.

10. A gastroenterologist is the best doctor to evaluate dyspepsia.

11. Evaluation of Esophageal Varices/PHG/GAVE/GOO/Subepithelial tumors/H.Pylori.

Therapeutic indications of Gastroscopy -

1. Endoscopic variceal band ligation for upper GI bleeding in chronic liver disease patient.

2. Glue injection for fundal varices and argon plasma coagulation for Gastric antral vascular ectasia (GAVE).

3. Hemoclip and/or adrenaline application for peptic ulcer bleeding.

4. Esophageal stricture dilatation of Benign and malignant etiologies  (CRE/SG dilatation).

5. Best done by gastroenterologist without the need for surgery.

6. Placement for Esophageal and Gastroduodenal metallic stents for palliation of advanced GI malignancies.

7. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection(EMR) for earl GI malignancies and Subepithelial tumours(SET).

8. Foreign body removal (Esophageal/Gastric).

9. Intragastric balloon placement for endoscopic management of Obesity.

10. Peroral endoscopic myotomy (POEM) for endoscopic management of Achalasia cardia.

11.  Transluminal Drainage of Peripancreatic fluid collections (pancreatic pseudocysts in acute and chronic pancreatitis)

2. COLONOSCOPY: 

Colonoscopy is an examination of Ileum (Last a part of the small intestine), Cecum, large intestines rectum and anal canal. The colonoscope is a flexible tube that features a little camera at its tip and gives high-resolution pictures of the Lower GI tract. The patient lies in the left lateral position and the endoscope is advanced forwards under direct vision through the large intestine of the patient for examination. Local anaesthesia is comfortable for many patients however sometimes general anaesthesia is needed looking on the patient preferences and procedure complexity.

Diagnostic indications of Colonoscopy -

1. Evaluation of chronic diarrhea and anemia

2. Evaluation of recent onset constipation and weight loss in elderly patients

3. Screening for colorectal carcinoma and Polyps

4. Surveillance after surgery in colorectal cancer

5. Evaluation of ulcerative colitis, Crohn’s disease and tuberculosis.

6. Evaluation of constipation and maroon coloured stools in children/pediatric population

7. Evaluation of rectal varices and Haemorrhoids

8. Evaluation of Ileal and colonic ulcers

9. Evaluation of lower abdominal and ano-rectal pain related to defecation

10. Evaluation of Ileostomy and colostomy prior to surgical reversal and evaluation of pouchitis in Ileal pouch anal anastomosis(IPAA) for ulcerative colitis surgery.

Therapeutic indications of Colonoscopy -

1. Management of lower GI bleeding

2. Stricture dilatation by CRE balloon

3. Polypectomy for small polyps

4. Best done by doctor expert in colonoscopy without the need for surgery

5. Endoscopic colonic decompression in colonic pseudoobstruction

6. Metallic stent placement for the palliation of advanced colon cancer

7. Per rectal Endoscopic myotomy(PREM) for Hirschsprung’s disease

8. Enteral fistula management (Colo-vescical and rectovaginal)