History of Endoscopy
In the early 1900s, the first attempts to view inside the body with lighted telescopes were made. These initial devices were often fully rigid. In the 1930s, semi-flexible endoscopes called gastroscopes were developed to view inside of the stomach.
Fiber-optic endoscopy was pioneered by South African-born physician Basil Hirschowitz at the University of Michigan in 1957. Widespread use of fiber optic endoscopes began in the 1960s.
A fiber optic cable is simply a bundle of microscopic glass or plastic fibers that literally allows light and images to be transmitted through curved structures.
Fiber optic cables are also replacing metal wires as the backbone of the world’s telecommunications infrastructure. This Internet page may have traveled through a fiber optic cable as a stream of digital data (bursts of light) on its way to your computer.
What is an endoscopy?
Endoscopy is a procedure that lets your doctor look inside your body. It uses an instrument called an endoscope, or scope for short. Scopes have a tiny camera attached to a long, thin tube. It allows surgeons to see problems within your body without making large incisions.
The doctor moves it through a body passageway or opening to see inside an organ. Sometimes scopes are used for surgery, such as for removing polyps from the colon.
An endoscopy is used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.
There are many types of endoscopes. Depending on the site in the body and type of procedure an endoscopy may be performed either by a doctor or a surgeon.
A patient may be fully conscious or anesthetized during the procedure. Most often the term endoscopy is used to refer to an examination of the upper part of the gastrointestinal tract, known as an esophagogastroduodenoscopy. Endoscopy may be used to investigate symptoms in the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing, and gastrointestinal bleeding.
It is also used in diagnosis, most commonly by performing a biopsy to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system.
The procedure may also be used for treatment such as cauterization of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.
Specialty professional organizations that specialize in digestive problems advise that many patients with Barrett’s esophagus are too frequently receiving endoscopies.
Such societies recommend that patients with Barrett’s esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.
Upper endoscopy is a procedure that enables the examiner (usually a gastroenterologist) to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) using a thin, flexible tube called the upper endoscope with a camera on the tip through which the lining of the esophagus, stomach, and duodenum can be viewed using a TV monitor.
An upper endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. A specialist in diseases of the digestive system (gastroenterologist) uses endoscopy to diagnose and, sometimes, treat conditions that affect the esophagus, stomach, and beginning of the small intestine (duodenum).
The medical term for an upper endoscopy is esophagogastroduodenoscopy. You may have an upper endoscopy done in your doctor’s office, an outpatient surgery center or a hospital.
A surgeon inserts an endoscope through a small cut or an opening in the body such as the mouth. An endoscope is a flexible tube with an attached camera that allows your doctor to see. Your doctor can use forceps and scissors on the endoscope to operate or remove tissue for biopsy.
Is Endoscopy Safe?
Overall, endoscopy is very safe; however, the procedure does have a few potential complications, which may include:
- Perforation (tear in the gut wall)
- Reaction to sedation
- Pancreatitis as a result of ERCP
Who Performs Endoscopy?
Your internist or family doctor may perform sigmoidoscopy in their office. However, all of the other endoscopy procedures are usually performed by gastroenterology specialists (gastroenterologists). Other specialists such as gastrointestinal surgeons also can perform many of these procedures.
How Do I Prepare for Endoscopy?
Your doctor will give you complete instructions on how to prepare. Most types of endoscopy require you to stop eating solid foods for up to 12 hours before the procedure. Some types of clear liquids, such as water or juice, might be allowed for up to two hours before the procedure. Your doctor will clarify this with you.
Your doctor may give you laxatives or enemas to use the night before the procedure to clear your system. This is common in procedures involving the gastrointestinal (GI) tract and the anus.
Prior to the endoscopy, your doctor will do a physical examination and go over your complete medical history, including any prior surgeries.
Gut Preparation. Examining the upper digestive tract (upper endoscopy or ERCP) requires nothing more than fasting for 6-8 hours prior to the procedure. To examine the colon, it must be cleared of stool. Therefore, a laxative or group of laxatives is given on the day before the procedure.
Sedation. For most examinations with an endoscope, a sedative is provided. This increases the comfort of the individual undergoing the examination. The sedative, which is administered via an injection into the vein, produces relaxation and light sleep.
There are usually few if any recollections of the procedure. Patients wake up within an hour, but the effects of the medicines are more prolonged, so it is not safe to drive until the next day.
General anesthesia (puts you totally asleep for a period of time) is given in only very special circumstances (in young children, and when very complex procedures are planned).
Be sure to tell your doctor about any medications you’re taking, including over-the-counter drugs and nutritional supplements.
Also, alert your doctor about any allergies you might have. You may need to stop taking certain medications if they might affect bleeding, especially anticoagulant or antiplatelet drugs.
Prior to scheduling the procedure, the patient should inform his or her physician of any medications being taken, any allergies, and all known health problems.
This information will help the doctor determine whether the patient may need antibiotics prior to the procedure, and what potential medications should not be used during the exam because of the patient’s allergies.
The information will provide the individual with scheduling the procedure an opportunity to instruct the patient whether any of the medications should be held or adjusted prior to the endoscopy.
The knowledge that the patient has any major health problems, such as heart or lung diseases, will alert the doctor of the possible need for special attention during the procedure.
Your doctor will give you specific instructions to prepare for your endoscopy.
Food and medications
You will need to stop drinking and eating up to eight hours before your endoscopy to ensure your stomach is empty for the procedure.
Tell your doctor about all the medications and supplements you’re taking before your endoscopy. If you take certain blood-thinning medications, your doctor may recommend that you stop taking them in the days before your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during the endoscopy.
If you have chronic conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you specific instructions regarding your medications.
Most people undergoing an upper endoscopy will receive a sedative to relax them and make them more comfortable during the procedure. You may feel mentally alert, but your memory, reaction times and judgment may be impaired. Plan on allowing 24 hours for the sedative to wear off. Afterward, you may resume your normal activities. Arrange for someone to drive you home after the procedure. You may also need to take the day off from work.
The procedure will depend to some extent on the reason for the endoscopy.
There are three main reasons for carrying out an endoscopy:
- Investigation: If an individual is experiencing vomiting, abdominal pain, breathing disorders, stomach ulcers, difficulty swallowing, or gastrointestinal bleeding, for example, an endoscope can be used to search for a cause.
- Confirmation of diagnosis: Endoscopy can be used to carry out a biopsy to confirm a diagnosis of cancer or other diseases.
- Treatment: an endoscope can be used to treat an illness directly; for instance, endoscopy can be used to cauterize (seal using heat) a bleeding vessel or remove a polyp.
Sometimes, endoscopy will be combined with another procedure such as an ultrasound scan. It can be used to place the ultrasound probe close to organs that can be difficult to image, such as the pancreas.
Modern endoscopes are sometimes fitted with sensitive lights that use narrow-band imaging. This type of imaging uses specific blue and green wavelengths that allow the doctor to spot precancerous conditions more easily.
Endoscopy is typically performed while the patient is conscious, although sometimes the patient will receive local anesthetic (commonly an anesthetic spray to the back of the throat); often, the patient is sedated.
For endoscopy procedures involving entry through the mouth, a mouth guard will be used to protect the teeth and lips as the tube is inserted.
Before the procedure
Before your upper endoscopy procedure, you’ll be asked to lie down on a table on your back or on your side. Monitors may be attached to your body to allow your health care team to keep tabs on your breathing, blood pressure, and heart rate.
At this time, you may receive a sedative medication. This medication, given through a vein in your forearm, helps you relax during the endoscopy.
Your doctor may also spray an anesthetic in your mouth, which will numb your throat in preparation for the insertion of the long, flexible tube (endoscope). You may be asked to wear a plastic mouth guard to hold your mouth open.
During the procedure
Your doctor will then insert the endoscope into your mouth. He or she may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you generally shouldn’t feel pain.
You can’t talk after the endoscope passes down your throat, though you can make noises. The endoscope doesn’t interfere with your breathing.
As your doctor passes the endoscope down your esophagus:
- A tiny camera at the tip transmits images to a video monitor in the exam room. Your doctor watches this monitor look for abnormalities in your upper digestive tract. If abnormalities are found in your digestive tract, your doctor may record images for later examination.
- Gentle air pressure may be fed into your esophagus to inflate your digestive tract. This allows the endoscope to move freely. And it allows your doctor to more easily examine the folds of your digestive tract. You may feel pressure or fullness from the added air.
- Your doctor will pass special surgical tools through the endoscope to collect a tissue sample or remove a polyp. Your doctor watches the video monitor to guide the tools.
When your doctor has finished the exam, the endoscope is slowly retracted through your mouth. An endoscopy typically takes 15 to 30 minutes, depending on your situation.
After the procedure
You’ll be taken to a recovery area to sit or lie quietly after your endoscopy. You may stay for an hour or so. This allows your health care team to monitor you as the sedative begins to wear off.
Once you’re at home, you may experience some mildly uncomfortable signs and symptoms after endoscopy, such as:
- Bloating and gas
- Sore throat
These signs and symptoms will improve with time. If you’re concerned or quite uncomfortable, call your doctor.
Take it easy for the rest of the day after your endoscopy. After receiving a sedative, you may feel alert, but your reaction times are affected and judgment is impaired.
What are the types of endoscopy?
Endoscopies fall into categories, based on the area of the body that they investigate. The American Cancer Society (ACS) lists the following types of endoscopies:
- thoracoscopy, also known as a pleuroscopy
- upper gastrointestinal endoscopy, also known as an esophagogastroduodenoscopy
What are the latest techniques in endoscopy technology?
Like most technologies, endoscopy is constantly advancing. Newer generations of endoscopes use high-definition imaging to create images in incredible detail. Innovative techniques also combine endoscopy with imaging technology or surgical procedures.
Here are some examples of the latest endoscopy technologies.
A revolutionary procedure known as a capsule endoscopy may be used when other tests aren’t conclusive. During a capsule endoscopy, you swallow a small pill with a tiny camera inside. The capsule passes through your digestive tract, without any discomfort to you, and creates thousands of images of the intestines as it moves through.
Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP combines X-rays with upper GI endoscopy to diagnose or treat problems with the bile and pancreatic ducts.
Chromoendoscopy is a technique that uses a specialized stain or dye on the lining of the intestine during an endoscopy procedure. The dye helps the doctor better visualize if there’s anything abnormal on the intestinal lining.
Endoscopic ultrasound (EUS)
EUS uses ultrasound in conjunction with an endoscopy. This allows doctors to see organs and other structures that aren’t usually visible during a regular endoscopy. A thin needle can then be inserted into the organ or structure to retrieve some tissue for viewing under a microscope. This procedure is called fine-needle aspiration.
Endoscopic mucosal resection (EMR)
EMR is a technique used to help doctors remove cancerous tissue in the digestive tract. In EMR, a needle is passed through the endoscope to inject a liquid underneath the abnormal tissue. This helps separate the cancerous tissue from the other layers so it can be more easily removed.
Narrowband imaging (NBI)
NBI uses a special filter to help create more contrast between vessels and the mucosa. The mucosa is the inner lining of the digestive tract.
Wireless capsule endoscopy
You swallow a small capsule with a camera and light in it. The capsule sends images of the inside of your body to a computer for a doctor to look at.
The capsule is the size of a large tablet and leaves your body naturally when you go to the toilet.
It’s often used if you have any internal bleeding and there’s no obvious cause.
There are some complications associated with wireless capsule endoscopy. It can be difficult to swallow the capsule and to pass it naturally. The capsule can also get caught in the narrow areas of your bowel, causing a blockage.
The Risks of Endoscopy
Endoscopy is a safe procedure and when performed by a physician with specialized training in these procedures, the complications are extremely rare.
The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding. Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids.
Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterization. Seldom does surgery become necessary?
Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems.
Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently.
A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.
They may include localized irritation of the vein where the medication was administered, reaction to the medication or sedatives used, complications from pre-existing heart, lung, or liver disease, bleeding may occur at the site of a biopsy or removal of a polyp (which if it occurs is almost always minor and rarely requires transfusions or surgery).
Major complications such as perforation (punching a hole through the esophagus, stomach, or duodenum) are rare but usually require surgical repair.
Every medical procedure has some risks. Endoscopies are generally pretty safe, but there is always a risk of:
- adverse reaction to sedation
- puncturing the organ
- over-sedation, although sedation is not always necessary
- feeling bloated for a short time after the procedure
- mild cramping
- a numb throat for a few hours due to the use of local anesthetic
- infection of the area of investigation: this most commonly occurs when additional procedures are carried out at the same time. The infections are normally minor and treatable with a course of antibiotics
- persistent pain in the area of the endoscopy
- perforation or tear of the lining of the stomach or esophagus occurs in 1 in every 2,500-11,000 cases
- internal bleeding, usually minor and sometimes treatable by endoscopic cauterization
- complications related to preexisting conditions
When to seek medical help
See a GP if you notice any signs of infection.
Signs of infection include:
- redness, pain or swelling near where the endoscope was put in
- a discharge of fluid or pus near where the endoscope was put in
- a very high temperature, or feeling hot or shivery
Other signs of a possible complication after having an endoscopy include:
- black or very dark-colored poo
- shortness of breath
- very bad tummy pain, or tummy pain that does not go away or keeps coming back
- vomiting blood
- chest pain
- difficulty swallowing
See a GP or visit your nearest A&E immediately if you notice any of these signs or symptoms.
What happens after an endoscopy?
Most endoscopies are outpatient procedures. This means you can go home the same day.
Your doctor will close incision wounds with stitches and properly bandage them immediately after the procedure. Your doctor will give you instructions on how to care for this wound on your own.
Afterward, you’ll likely have to wait for one to two hours in the hospital for the effects of the sedation to wear off. A friend or family member will drive you home. Once you’re home, you should plan to spend the remainder of the day resting.
Some procedures may leave you slightly uncomfortable. It may require some time to feel well enough to go about your daily business. For example, following an upper GI endoscopy, you may have a sore throat and need to eat soft foods for a couple of days.
You may have blood in your urine after a cystoscopy to examine your bladder. This should pass within 24 hours, but you should contact your doctor if it persists.
If your doctor suspects a cancerous growth, they’ll perform a biopsy during your endoscopy. The results will take a few days. Your doctor will discuss the results with you after they get them back from the laboratory.
Results of my endoscopy?
When you receive the results of your endoscopy will depend on your situation. If, for instance, your doctor performed the endoscopy to look for an ulcer, you may learn the findings right after your procedure.
Under most circumstances, the examining physician will inform the patient of the test results or the probable findings prior to discharge from the recovery area.
The results of biopsies or cytology usually take 72-96 hours and the doctor may only give the patient a presumptive diagnosis pending the definitive one, after the microscopic examination of the biopsies.
If he or she collected a tissue sample (biopsy), you may need to wait a few days to get results from the testing laboratory. Ask your doctor when you can expect the results of your endoscopy.