Endoscopic Procedures

Endoscopy and ERCP

What is an Endoscopy?
Endoscopy is a nonsurgical procedure used to examine a person’s digestive tract. An Endoscope is a long and thin flexible tube with a light and camera attached to it. It is inserted through the mouth (Upper Gastrointestinal Endoscopy) to examine the food-pipe, stomach and upper part of the small intestine. It enables your doctor to view the inner lining of the digestive tract on a color monitor and take pictures.

When is an Endoscopy needed?
Endoscopy is generally done to diagnose and, sometimes, treat conditions that affect the upper part of your digestive system, including the food-pipe, stomach and beginning of the small intestine (duodenum). It is done to investigate digestive symptoms such as nausea, vomiting, abdominal pain, hyperacidity, heartburn, difficulty in swallowing and Gastrointestinal bleeding. During an Endoscopy, Biopsies (small bits of tissue) can be taken from suspected areas of abnormal appearing lining to diagnose inflammation, infection and cancers. Endoscopy is also commonly done to control bleeding from the digestive system, treat narrowing of the food-pipe (known as stricture), and remove polyps and early cancers from the stomach.

Is Endoscopy safe and comfortable?
Generally Endoscopy is a very simple and safe procedure. To make it absolutely comfortable for the patient, it is done under light sedation (medication administered to make you sleep), although it can very well be done without sedation. With modern automatic Endoscope disinfectors, there is no risk of transmission of infection between patients. One may feel a mild soreness of the throat after the procedure and fullness of the belly due to the air that is introduced into the stomach during the procedure.

Why is Endoscopy done for patients with liver disease?
In patients with advanced liver disease, Endoscopy is done to look for prominent blood vessels in the food-pipe and stomach known as varices. These varices may rupture and cause severe and life threatening bleeding. Special rubber bands are applied to these varices to prevent them from bursting and subsequently bleeding. This procedure is known as Endoscopic variceal band ligation [see video].

What preparation is required before the procedure?
You will be given specific instructions to prepare for your Endoscopy by the doctor or the nurse. You will need to be fasting (no food or water) for atleast 8 hours to ensure your stomach is empty for the procedure. If you are on certain blood-thinning medications (such as aspirin, clopidogrel or warfarin), you must inform your doctor since these may need to be stopped for a few days before 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.

How is the procedure done?
During an upper Endoscopy procedure, you’ll be asked to lie down on a table on your back or on your left side. Monitors often will be attached to your body to allow monitoring of your breathing, blood pressure and heart rate. An anesthetic will be sprayed in your mouth to numb your throat. You may receive a sedative medication through a vein in your forearm to help you relax during the Endoscopy. You will be asked to hold a plastic mouth guard to keep your mouth open. Then the Endoscope is inserted in your mouth. Your doctor may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you shouldn’t feel pain. 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 to look for abnormalities in your upper digestive tract. Air is pushed into the food-pipe and stomach so that the folds of your digestive tract are more easily examined. The air can create a feeling of pressure or fullness. Special forceps are used to collect tissue sample or remove a polyp. After the examination is over, the endoscope is slowly retracted through your mouth.