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 NABH Patient Safety & Quality of Care
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What is upper endoscopy ?

Upper endoscopy lets your Doctor examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). Your Doctor will use a thin, flexible tube called an endoscope, which has its own lens and light source, and will view the images on a video monitor. You might hear your Doctor or other medical staff refer to upper endoscopy as upper GI endoscopy, esophagogastroduodenoscopy (EGD) or panendoscopy.

Why is upper endoscopy done ? :

Upper endoscopy helps your Doctor evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty in swallowing. It's the best test for finding the cause of bleeding from the upper gastrointestinal tract. It's also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.

Your Doctor might use upper endoscopy to obtain a biopsy (small tissue samples). A biopsy helps your doctor distinguish between benign and malignant (cancerous) tissues. Remember, biopsies are taken for many reasons, and your Doctor might order one even if he or she does not suspect cancer.

For example, your Doctor might use a biopsy to test for Helicobacter pylori, the bacterium that causes ulcers.

Your Doctor might also use upper endoscopy to perform a cytology test, where he or she will introduce a small brush to collect cells for analysis.

Upper endoscopy is also used for Therapautic work. Your Doctor can pass instruments through the endoscope to directly treat many abnormalities – this will cause you little or no discomfort. For example, your Doctor might stretch (dilate) a narrowed area, remove polyps (usually benign growths) or treat bleeding.

What preparations are required ? :

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination. Your Doctor will tell you when to start fasting as the timing can vary.

Tell your Doctor in advance about any medications you take; you might need to adjust your usual dose for the examination. Discuss any allergies to medications as well as medical conditions, such as heart or lung disease.

Can I take my current medications ? :

Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform your Doctor about medications you're taking, particularly aspirin products or anti platelet agents, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Also, be sure to mention any allergies you have to medications.

What happens during upper endoscopy ? :

Your Doctor might start by spraying your throat with a local anesthetic or by giving you a sedative to help you relax. You'll then lie on your side, and your Doctor will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn't interfere with your breathing. Most patients consider the test only slightly uncomfortable, and many patients fall asleep during the procedure.

What happens after upper endoscopy ? :

You will be monitored until most of the effects of the medication have worn off. Your throat might be a little sore, and you might feel bloated because of the air introduced into your stomach during the test. You will be able to eat after 1 – 2 hrs unless your Doctor instructs you otherwise.

Your Physician will explain the results of the examination to you, although you'll probably have to wait for the results of any biopsies performed.

If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgement and reflexes could be impaired for the rest of the day.

What are the possible complications of upper endoscopy ? :

Although complications can occur, they are rare when Doctors who are specially trained and experienced in this procedure perform the test. Bleeding can occur at a biopsy site or where a polyp was removed, but it's usually minimal and rarely requires follow-up. Perforation (a hole or tear in the gastrointestinal tract lining) may require surgery but this is a very uncommon complication. Some patients might have a reaction to the sedatives or complications from heart or lung disease.

Although complications after upper endoscopy are very uncommon, it's important to recognize early signs of possible complications. Contact your Doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Note that bleeding can occur several days after the procedure.

If you have any concerns about a possible complication, it is always best to contact your Doctor right away.

Important Reminder :

This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your Doctor about your specific condition.

Colonoscopy

Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible fibre optic or video endoscope. The colon begins in the right lower abdomen and looks like a big question mark as it moves up and around the abdomen, ending in the rectum. It is 5 to 6 feet long. The colon has a number of functions including withdrawing water from the liquid stool that enters it so that a formed stool is produced.

Equipment

The flexible colonoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the colon. These colonoscopes now come in two types. The original purely fibre optic instrument has a flexible bundle of glass fibers that collects the lighted image at one end and transfers the image to the eye piece. The newer video endoscopes use a tiny, optically sensitive computer chip at the end. Electronic signals are then transmitted up the scope to a computer which displays the image on a large video screen. An open channel in these scopes allows other instruments to be passed through in order to perform biopsies, remove polyps or inject solutions.

Indications for this examination

There are many types of problems that can occur in the colon. The medical history, physical exam, laboratory tests and x-rays can provide information useful in making a diagnosis. Directly viewing the inside of the colon by colonoscopy is usually the best method.

Colonoscopy is used for :

  • Colon cancer – a serious but highly curable malignancy
  • Polyps- Fleshy tumors which usually are the forerunners of colon cancer
  • Colitis (Ulcerative or Crohn's) – chronic recurrent inflammation of the colon
  • Diverticulosis and Diverticulitis – pockets along the intestinal wall that develop over time and can become infected.
  • Bleeding lesions – bleeding may occur from different points in the colon
  • Abdominal symptoms, such as pain or discomfort, particularly if associated with weight loss or anemia
  • Abnormal barium x-ray study
  • Chronic diarrhea, constipation, or a change in bowel habits
  • Anemia

Preparation

To obtain the full benefits of the exam, the colon must be clean and free of stool. The patient receives instructions on how to do this. It involves drinking a solution which flushes the colon clean or taking laxatives and enemas. Usually the patient drinks only clear liquids and eats no food for the day before the exam. The physician advises the patient regarding the use of regular medications during that time.

The Procedure

Colonoscopy is usually performed on an outpatient basis. The patient is mildly sedated, the endoscope is inserted through the anus and moved gently around the bends of the colon. If a polyp is encountered, a thin wire snare is used to lasso it. Electrocautery (electrical heat) is applied to painlessly remove it. Other tests can be performed during colonscopy , including biopsy to obtain a small tissue specimen for microscopic analysis.

The procedure takes 15 to 30 minutes and is seldom remembered by the sedated patient. A recovery area is available to monitor the vital signs until the patient is fully awake. It is normal to experience mild cramping or abdominal pressure following the procedure. This usually subsides in an hour or so.

Results

After the procedure, the physician explains the findings to the patient and family. If the effects of the sedatives are prolonged, the physician may suggest an appointment on a later date. If a biopsy has been performed or a polyp removed, the results of these are not available for three to seven days.

Benefits

A colonsocopy is performed to identify and/or correct a problem in the colon. The test enables a diagnosis to be made and specific treatment to be given. If a polyp is found during the exam, it can be removed at that time, eliminating the need for a major operation later. If a bleeding site is identified, treatment can be administered to stop the bleeding. Other treatments can be given through the endoscope when necessary.

Alternative Testing

Alternative tests to colonoscopy include a barium enema or other types of x-ray studies that outline the colon and allow a diagnosis to be made. Study of the stools and blood can provide indirect information about a colon condition. These tests, however, do not allow direct viewing of the colon, removal of polyps, or the completion of biopsies.

Side effects and Risks

Bloating and distension typically occur for about an hour after the exam until the air is expelled. Serious risks with colonoscopy, however, are very uncommon. One such risk is excessive bleeding, especially with  the removal of a large polyp. In rare instances, a tear in the lining of the colon can occur. These complications may require hospitalization and, rarely,   surgery. Quite uncommonly a diagnostic error or oversight may occur.

Due to the mild sedation, the patient should not drive or operate machinery following the exam. For this reason, someone should be available to drive the patient home.

Summary

Colonoscopy is an outpatient procedure that is performed with the patient lightly sedated. The procedure provides significant information used to determine which specific treatment will be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications rarely occur from colonoscopy. The physician can answer any questions the patient has.