An endoscopy, commonly referred to as “a scope” is a non-surgical procedure that is used to examine an internal organ or tissue (for instance in the digestive tract) in detail to determine if there are any problems and may be used to carry out procedures or minor surgery without having to make large incisions. Specialised instruments are used during the procedure to view and operate on the internal organs and vessels of the body.
An endoscope is a thin flexible tube with a camera and a light attached to it. It is inserted through a small opening in the body such as the mouth, and in some instances a small cut (incision).
There are many types of endoscopy procedures which are generally categorised by the area of the body needed for examination. A specialist will generally use an endoscope procedure to view high definition images (or video) of the body on a colour TV monitor (or screen) as a way to help determine a cause of problematic symptoms, as well as make a diagnosis for treatment. Some endoscopes are passed into the mouth and throat (upper endoscopy), while others can be passed into the colon (large intestine) and through the rectum (sigmoidoscopy or colonoscopy) to examine other areas too.
Endoscopic retrograde cholangiopancreaticography (ERCP) is another form of endoscope procedure which allows for images to be taken of the gallbladder, pancreas and other related structures. An endoscope ultrasound (EUS) combines an upper endoscopy procedure and ultrasound examination to retrieve information and images of specific areas of the digestive tract.
A specialist can also use tongs (forceps) and scissors on the endoscope if they need to remove tissue for biopsy (examination and evaluation). From there he or she will use their findings to diagnose and treat conditions that affect the oesophagus, stomach and small intestine (duodenum).
Many endoscopes use technology called narrow band imaging, which makes use of a special light to also help better detect various ‘difficult-to-see’ conditions. This has been very helpful in detecting precancerous conditions, such as Barrett’s oesophagus.
An upper endoscopy may be performed at an outpatient surgery centre (clinic) or a hospital.
Uses and types
Why would an endoscopy be recommended?
Your doctor or specialist may strongly suspect an infection of a specific area of your body or may wish to examine one or more of your organs in order to see the extent of damage to determine a diagnosis and treatment plan. Before he or she will recommend an endoscopy, he or she will review your symptoms, perform a physical examination and possibly order some blood tests to gain an understanding of the possible causes. In some instances, a blood test may help to determine the cause of a set of symptoms without a need for an endoscopy.
If a cause is not clear, an endoscopy will be recommended. Without making a large incision, an endoscopy procedure allows your doctor to see exactly what the endoscope sees once inside the body, on screen. An endoscope essentially becomes the eyes of your specialist.
If your specialist deems it necessary, an endoscopic biopsy will be performed (a small sample of tissue taken) and sent to a laboratory for testing. Diseases and conditions that may be tested include anaemia, bleeding, inflammation, diarrhoea or cancers of the digestive system. Testing will assess whether there is an infection, the nature of any damage to a specific portion of the body or whether the sample is cancerous.
Symptoms which your doctor may want to look at more closely via an endoscope include:
- Stomach pain
- Nausea and vomiting
- Peptic ulcers
- Difficulties with swallowing (due to a blockage or structural obstruction in the oesophagus)
- Digestive tract bleeding / gastrointestinal bleeding
- Chronic constipation (blocked bowel passages), diarrhoea and other bowel habit changes
- Growths, polyps and tumours in the small intestine or uterus
- GERD (gastroesophageal reflux disease or acid reflux)
- Hiatal hernia
- Pain in a specific area, especially the joints and in females, the pelvis
- Persistent joint swelling or stiffness
- Damaged cartilage
- Presence of excess fluid
- Carpal tunnel syndrome
- A persistent or unexplained cough
- Blood in coughed up mucus (sputum)
- Abnormal chest X-ray
- Potential lung infection (such as tuberculosis)
- Growths within the wall of the intestine (possible colorectal cancer or colon cancer)
- Bloody diarrhoea
- Unexplained weight loss or malnutrition
- Blood in the urine
- Pain during urination
- Bladder or urethal tumours and bladder stones
- A high white blood cell count
- Intestinal damage from radiation treatment
- An abnormal X-ray results
- Abnormal vaginal bleeding
- Retained placenta
- An abdominal mass or tumour
- Fluid in the abdominal cavity
- Liver disease
- Hoarseness, throat pain and bad breath
- Persistent ear ache
- A mass or growth in the throat
- Lung and lymphatic cancers (lymphoma or Hodgkin’s disease)
It is possible for an endoscopy procedure to be used to treat a particular digestive tract concern. For instance, an endoscope may pick up internal bleeding from an ulcer. Devices and tools can be passed through the endoscope to stop the bleeding (burn a bleeding vessel) during the procedure.
If a polyp is detected in the colon, it can also be removed through the scope and thus prevent colon cancer from developing. If gallstones have passed outside the gallbladder and into the bile duct, these can also be removed (on occasion).
Sometimes an ultrasound can be performed at the same time if another kind of specialised image of the inside of the body may be useful for diagnosis. An ultrasound probe is attached to the endoscope allowing your doctor to have another view of the wall of the oesophagus or stomach. An ultrasound is particularly useful for hard-to-reach organs, such as the pancreas.
Endoscopies are categorised by the area of the body needed for examination. Types of scopes include:
- Arthroscopy: This scope is inserted through a small incision near a bothersome joint in the body.
- Bronchoscopy: This scope is inserted into the nose or mouth to examine the lungs.
- Colonoscopy: A scope is inserted through the anus to examine the rectum and colon.
- Cystoscopy: A scope needed to examine the bladder will be inserted through the urethra (the hole through which we urinate).
- Enteroscopy: A scope inserted through the mouth or anus may be used to examine the upper to distal part of the small intestine.
- Hysteroscopy: This scope will be inserted through the vagina to examine the inside of a woman’s uterus.
- Laparoscopy: A small incision will be made close to an abdominal or pelvic area giving trouble allowing for a scope to be inserted.
- Laryngoscopy: A scope inserted through the mouth or nostril will be used to examine the larynx or voice box.
- Mediastinoscopy: The area between the lungs is called the ‘mediastinum’. A scope will be inserted through a small incision above the breastbone to examine the area.
- Upper gastrointestinal (GI) endoscopy (also known as a Gastroscopy): A scope is inserted through the mouth and into the oesophagus to examine the upper intestinal tract including the oesophagus, stomach, and first part of the small intestine known as the duodenum.
- Ureteroscopy: A cope is inserted through the urethra to examine the ureter (the duct through which urine passes from the kidney to the bladder).
Preparing for an endoscopy
For any and every scope, it is important to take certain precautions or prepare ahead so that the procedure goes smoothly. The nature of the necessary scope will predetermine what may be required in terms of preparation. Your doctor will give you specific instructions to ensure your comfort, safety and best possible outcome of the procedure.
If you are having an endoscope inserted through the anus, your doctor may give you a laxative or enema to use the day before a procedure to assist with clearing out your system (rid the body of any stool or faeces).
Some general preparation tips include:
- A discussion of medical conditions or problems: If you have any known medical conditions such as heart disease, cancer or pregnancy, this will help your doctor to foresee any specific precautions they may need to take ahead of the procedure. You should discuss your entire medical history, including prior surgeries with your doctor as well.
- Medications and allergies: If you have any known sensitivities, intolerances or allergies to both prescription or over-the-counter medications (as well as supplements), you should mention this to your doctor ahead of the procedure. Certain medications can interfere with the sedative (or anaesthetic) you will be given to relax during the procedure and even the results (for example, some medications coat the bowel making it difficult to view during a Gastroscopy). Some medications which can cause interference include insulin and anti-inflammatory drugs. It is important not to stop or change your medication schedule until you have discussed it with your doctor. He or she will advise the best course of action once they’ve taken everything into account.
- A discussion about potential risks: Any procedure has risk of potential complications. Complications during a scope procedure can include aspiration (when food or liquids get into the lungs), an adverse reaction due to an allergy or the sedative used, minor bleeding (especially if a growth or polyp is removed or if a biopsy is performed) or tearing in the area being examined (this can be life-threatening and will require immediate medical attention).
- Arrange for safe transport: Any narcotic or sedative administered (usually via injection in a vein) to help you relax (and place you in a light sleep state) during the procedure will impair your ability to drive and make you feel drowsy. Normally, you will wake up within an hour of the procedure and will have little to no recollection of it at all. It will be strongly recommended that you pre-arrange for someone to pick you up following your procedure and safely drive you home.
- Fasting: Your doctor may request that you don’t eat or drink anything for a period of time before your procedure. This can range from as little as 6 to 8 hours, and up to 24 hours the night before. Fasting can include the chewing of gum and sucking of mints (not just meals and small snacks). Clear liquids (water, broth, sodas and apple juice) after midnight (the night before) and up to 6 hours ahead of an afternoon procedure is sometimes allowed. Your doctor may specify that you avoid drinking anything that is red or orange before your procedure.
- Dress comfortably: Complications during your procedure are rare and may not occur, but the experience can still cause some level of discomfort. It is advisable to wear comfortable clothes and avoid wearing any jewellery. Glasses and dentures will be removed before any procedure as well.
- Consent forms and necessary paperwork: As with any procedure, you will be required to fill out consent forms and other paperwork ahead of time. Some of this may be done before the day of your procedure. It is important to complete and submit all forms of paperwork necessary for your doctor to go ahead with the scope procedure.
- Recovery: Scopes do have minor effects on a person post-procedure, so it is important to plan for a little time to rest and recuperate. You may experience mild discomfort in the area the scope was inserted (such as the mouth and throat) and effects (drowsiness) of the sedative / medication used to relax you while it wears off. Post procedure you may experience some abdominal bloating, cramping, gas (or flatulence) due to air being used to inflate certain areas and/or a sore throat. These symptoms will be mild and improve with a little time. You may begin to feel alert soon after the procedure, but reaction times (reflexes) may be impaired and delays in judgement may occur for some time.
What happens during the procedure?
The procedure will vary depending on the type of scope your doctor will be performing and the nature of what needs to be examined.
You will be positioned on a table, often on your back or on your side, in such a way that is most comfortable for you and your doctor to perform the procedure. Monitors will be attached to your body, allowing your doctor and his or her health care team to safely assess your breathing, blood pressure and heart rate throughout the procedure.
A sedative or anaesthetic will be administered through a vein (typically in the forearm) by an anaesthetist and will quickly help you relax (fall into a light sleep). An anaesthetic may even be sprayed into your mouth to numb the throat if the scope is to be inserted through the mouth and throat. Your doctor may also use a plastic mouth guard to hold your mouth open during the procedure.
Once a scope is inserted, the tiny camera at the end of the flexible tube transmits high definition images to a video monitor (screen) in the examination room. Your doctor will then begin looking for any abnormalities. He or she can also record images (take photographs) for later examination if necessary.
If having an upper endoscope procedure, your doctor may feed a gentle air pressure into your oesophagus to inflate the digestive tract. This allows the endoscope to move more freely and make for easier examination of the folds in the digestive tract.
If samples are deemed necessary to be taken for biopsy or treatment is required during the procedure, surgical tools can be passed through the endoscope. Your doctor will watch the monitor closely while guiding the tools to either remove a tissue sample or polyp, or stop any bleeding.
Once the examination is complete (usually between 15 and 30 minutes long), your doctor will slowly retract the endoscope and prepare you for the recovery area. The health care team will monitor you while the sedative begins to wear off as you lie quietly in the recovery room.
It rarely happens, but complications can occur. In all discussions leading up to your procedure, your doctor will do their utmost to foresee potential risk factors based on your current condition and take necessary precautions to avoid complications (as best they can).
Some risk factors include:
- Bleeding: This can occur during a biopsy or during the treatment of a detected problems in any type scope procedure. It can happen that blood vessels are accidently punctured during a scope procedure causing haemorrhage.
- Infection: The risk of an infection due to the scope procedure is low, but can increase when additional procedures are performed. Infections that do occur are generally minor and can be easily treated with antibiotics. You may even be given preventative antibiotics before a procedure if your doctor feels you are at higher risk of developing an infection during the scope.
- Tearing: Sometimes a tear in the oesophagus or another part of the upper digestive tract can occur. A tear can also occur in the rectal wall or colon, and in the wall of the small intestine. If this happens, it may be required that you are hospitalised for treatment. In some cases, surgery may be needed to repair the damage.
- Nerve damage and blood clots
- Knee stiffness, injury or damage to ligaments, the cartilage, meniscus, nerves or blood vessels of the knee
- A low blood oxygen level during a bronchoscopy
- Pneumothorax: A collapsed lung can occur due to increased pressure on the lung as air escapes into the lining.
- Allergic reactions to medications and sedatives (anaesthetic): Symptoms can include difficulty breathing, excessive sweating, low blood pressure, slow heartbeat, or spasm of the larynx.
Signs and symptoms that will alert your doctor to a possible complication having occurred post procedure include fever, chest pain, shortness of breath, difficulties with swallowing, severe or persistent abdominal pain, vomiting (especially if there is a presence of blood or it resembles coffee grounds), persistent pain in the area of scope insertion, redness and swelling at the site of an incision, and bloody, black or very dark coloured stool (faeces).
If you notice any of these changes in your body, it is strongly advised that you see your doctor as quickly as possible.
Results and patient follow-up
Most endoscopes are outpatient procedures (requiring no overnight hospital stays). Any incision wounds will be closed with stitches and properly bandaged immediately after the examination has been completed. Once you are awake post procedure, your doctor will give you care instructions for the wound.
Much of the endoscopy findings may be discussed with you post procedure, once you are awake and alert. Results of the examination will depend on what the doctor could determine as a cause of a bothersome symptom. Some instances may mean that a course of treatment or medication can be prescribed and sent home with you. In other instances, where sample testing was required, you will need to wait to receive results.
If a biopsy sample has been taken, your doctor will advise you and give you some indication as to when you may expect results to be completed by a laboratory. This often takes a few days. Once any results are ready, they will be sent to your doctor or specialist and he or she will arrange a consultation (follow-up) to discuss these with you (if necessary).
Is an endoscopy safe?
In general, any type of endoscopy is considered a safe procedure. There are potential risks for complications, as is the case with any medical procedure. Your doctor, however, can often foresee any potential for complications once a thorough assessment is done ahead of the procedure. Many potential complications can be significantly reduced or foreseeably avoided altogether.
Some potential complications can include tears in the gut wall, an adverse reaction to the sedative given, an infection, bleeding or even pancreatitis (as a result of Endoscopic retrograde cholangiopancreaticography or ERCP).
Who can perform an endoscopy?
An internist (doctor or internal medicine who specialises in the diagnosis and non-surgical treatment of medical conditions) or general practitioner (family doctor or GP) may perform an endoscopy in their office.
Generally, endoscopy procedures are performed by gastroenterology specialists (gastroenterologists and gastrointestinal surgeons), orthopaedic surgeons, pulmonologists, thoracic surgeons, gynaecologist, and ENTs (ear, nose and throat specialist).