The digestive endoscopy activity, in Somesan Clinic, is performed by Dr. GRAD SIMONA, Dr. GRAD OVIDIU and Dr. IONESCU RADU.
Superior endoscopy (gastroscopy)
Superior endoscopy or gastroscopy is a medical procedure that allows the specialist doctor (gastroenterologist) to examine the esophagus, stomach and duodenum, with the help of a narrow and flexible tube, that has attached to one of its ends a video camera.
Superior endoscopy used more and more, instead of radiology (based on X-ray), because it offers the possibility to discover some more subtle abnormalities like ulcer and tumors, and also the possibility to tap some tissue sample (biopsy) or a cellular sample (cytology). These samples have a very important role in defining the nature of the found abnormality.
Sometimes, this investigation is called fibrogastroduodenoscopy, which means:
-"fibro" shows the fact that for the examination a special probe is used, that consists of "optic fibers", that transmits video images of the investigated organs;
-"gastro" shows the fact that examining the stomach is included;
"duodeno" shows the fact the the examination of the initial part of the bowel (duodenum) is included;
"scopy" shows the fact that, using a probe, the doctor visualizes the interior walls of the investigated organs.
In some sources you can see the term of fibroesophagogastroduodenoscopy, that means, that aside from the stomach and duodenum, during examination, the medic examines the walls of the esophagus.
The term of superior digestive endoscopy is related to the fact that during the procedure, the examination of the superior part or the digestive tube takes place.
Depending on the specific objectives of the examination, and depending on the investigated organ with a maximum of attention, superior digestive endoscopy can be called gastroscopy (it especially studies the stomach) or duodenoscopy (it especially studies the duodenum).
Why is the test performed?
In general superior endoscopy is recommended for the tracing of some esophagus, stomach and duodenum affections, and also for establishing the causes of some symptoms like superior abdominal pain, nausea and vomit, difficulties in deglutition or intestinal bleedings provoked by anemia.
Also, during the investigation, the doctor has the possibility to perform certain manipulations inside the superior digestive tract: for example extraction of foreign bodies from the stomach (coins, buttons etc.), cauterization of blood vessels that bleed, extraction of a gastric polyp etc.
Many people have a negative attitude towards the gastroscopy and get indisposed when the doctor prescribes this kind of test. This reaction from their part is normal because the gastroscopy can be unpleasant. Anyway, in case you need to decide if you accept the endoscopy or not, you must consider the fact that only this investigation can offer answers foe questions regarding the possible causes of some diseases, and only based on the results of this test the doctor can prescribe a correct treatment.
Preparing the patient
For the results of the superior endoscopy to be as conclusive as they can, it's necessary that the stomach is empty, and for this thing to happen the patient doesn't have to eat and drink anything for at least 6 hours before the test. Also, it's recommended to inform your doctor regarding any type of treatment that you are taking, and if you are allergic to a certain type of medicines or pharmaceutical products. Also, the persons who suffer from severe disease like heart or lung diseases will necessitate special care during the test.
How is the test performed?
The gastroscopy is performed only in special cabinets, equipped with all the necessary facilities (fiberscope+monitor). The investigation procedure starts with placing the patient on the bed, lied down on his left side. After that the doctor introduces through his nose or mouth a tube, similar to a cable or a elastic bar. First of all, the probe goes through the throat, into the esophagus, in the stomach and from the stomach in the duodenum. After closing the examination, the doctor quickly extracts the probe outside the organism. Usually, all the procedure lasts less than 10-15 minutes.
The procedure followed by superior endoscopy does not include a physic or psychic discomfort sensation. Before introducing the endoscope, the doctor will use an anesthetic spray for the throat area and amygdalae. For the prevention of pain, you doctor will dispose the intravenous administration of some sedatives and pain killers. During the entire test you need to lie down on your left side, while the doctor introduces the endoscope to analyze the esophagus, stomach and duodenum. This procedure does not involve risks or pain and doesn't block the respiration. After the test, the patient will be observed closely until the effect of the pain killers and the anesthesia disappears. Considering that superior endoscopy implies sedating the patient, he should be accompanied by a family member, that will take the patient home.
In most of the cases, to reduce the discomfort at minimum, doctors use special medicines for local anesthesia of the nose and pharynx (for example lidocaine) or medicines for light anesthesia, that induce a sleeping sensation for a short period and eliminates all unpleasant feelings and memories of what happened during the investigation.
Gastroscopy in an induced sleep is used especially in the case of children or difficult patients that couldn't bare this procedure otherwise. Without anesthesia the gastroscopy isn't painful, but can be unpleasant. The unpleasant sensations appear especially when the probe goes through the throat and esophagus (gag reflex and suffocation sensation). In most of the cases, the doctor will establish a casual diagnosis and discuss with the patient after finishing the endoscopy. If taking off a tissue sample is imposed (biopsy) or a cellular sample (cytology), the results will be available in 72-96 hours. Introducing the endoscope into the organism doesn't imply a major discomfort sensation. Occasionally, after finishing the endoscopy, the patient may feel a light pain in the throat and a amygdalae, and sometimes even the sensation of swelling in these areas, due to the air used during the procedure. These symptoms will disappear in a few hours.
Risks
Superior endoscopy does not imply major risks and neither the risk of breathing blockage during the introduction of the endoscope for the examination of the esophagus, stomach and duodenum. If you suffer from severe affections of the heart and lungs, it is indicated that your doctor is informed about his thing, so he could give you special care during the test.
Severe complications after the gastroscopy are very rare, but are not completely out of the question. The most dangerous complications could be bleeding, esophagus perforation, stomach or duodenum perforation and infection.
Death during the procedure is very rare (1/100000 investigations) and usually in the cases of patients with severe cardiovascular diseases.
There are records of very rare irritations of the vein where the intravenous treatment was administrated, allergic reactions to the administrated medicines or sedatives, or complications in the cases of patients diagnosed with severe heart, lungs or liver diseases. Also rare are the cases or hemorrhage during the extirpation of a polyp or the performance of a biopsy. If this thing happens a surgical intervention will be necessary.
Rezults
Normally, the doctor can discuss with you and form a temporary diagnosis immediately after the exam. If the take of of a tissue sample (biopsy) or cellular sample (cytology) is needed, the results will be available after 72-96 hours. In the moment the results become available, your doctor will establish a meeting to inform you of everything and if to establish an adequate treatment.
What could the test affect?
It is indicated that before the superior endoscopy to establish a meeting with your doctor, so that he can explain to you exactly what are the steps that you need to follow so that the results are conclusive. It is also very important that your doctor is informed regarding any treatment that you are taking, and any diseases or severe affections that you are suffering. Due to the fact that the endoscope's structure allows attaching some medical accessories, this form of examination allows treating some additional medical conditions, like strictures, removing some benign excrescence (polyp), accidentally swollen objects, or treating superior gastro intestinal hemorrhages.
COLONOSCOPY
The colonoscopy is an investigation that allows the doctor to observe the interior of the large intestine (rectum and colon) with the help of a flexible instrument that has a little camera called colonoscope. This investigation is of great help in discovering polyps, ulcerate areas, tumors and inflamed or hemorrhagic areas. During the colonoscopy you can take biopsies from the colon and the rectum, or tumors can be removed. It can also be used in a screening for identifying and removing tumors with cancer potential or malign tumors from the colon and rectum (colorectal cancer).
The colonoscope is a slim, flexible instrument, with a lenght between 121.9 cm and 182.9 cm. A small camera is attached to the colonoscope, this can take photos and video recordings inside the large intestine. In some cases optic fiber can be used to examine the entire large intestine, but also the examine just a small portion of the small intestine. Another test, called sigmoidoscopy can only show the rectum and the last inferior third of the colon.
Before the investigation, a preparation of the colon is necessary. This preparing could last a day or two, depending on the doctor's requests. In some cases just a preparation from the previous night is enough. For many patients this preparation is much more difficult than the investigation. In the day of the preparation, the patient must stay at home because he will use the toilet many times. Preparing for the colonoscopy will make the patient to have many ejections, until the diarrhea appears, because the digestive tube must be empty for the visualization to be better. Preparing for a colonoscopy can be annoying and the patient could feel hunger. Before drinking the special solution that is necessary for the preparation, it would be ok to have a fruit juice near you because that solution is very salty.
The purpose of colonoscopy
The colonoscopy is necessary when:
· there are problems or certain affections of the anus, rectum and large intestine. This examination is necessary when the patients presents with symptoms like inexplicable bleeding of the rectum, chronic diarrhea or constipation, hidden or visible bleeding in ejection, pain in the inferior abdomen
· the evaluation of abnormal results of barium examination is wanted
· a screening for colorectal cancer or colon polyps is performed. Most of the experts recommend the screening for persons that lack risk factors for colorectal cancer starting with the age of 50. The tests for determining hidden bleedings together with sigmoidoscopy are recommended, but colonoscopy and double contrast barium exam can be used. If the tests for finding hidden bleedings or the double contrast barium test are abnormal, a colonoscopy or sigmoidoscopy are recommended
· it is recommended that the persons who have increased risk of developing colon cancer to start doing these exams starting with the age of 40.
Depending on the risk level, the screening could include testing for finding hidden bleedings, sigmoidoscopy, double contrast barium exam or colonoscopy. In the cases of persons with an increased risk for colon cancer, the doctor can advise you about the most useful exam for every case.
Colonoscopy can also be performed in the next situations:
· in case of patients that were operated of colon or rectal cancer the screening can reveal if there are some recurrence
· monitoring the growth of the polyps that can not be completely removed
· monitoring the treatment in the case of intestinal inflammatory diseases
· extracting foreign bodies
· evaluating the causes of chronic diarrhea
Preparing the colonoscopy
Before the colonoscopy you must talk to the doctor about:
· a possible treatment like insulin treatment or other medicines used in arthritis. You must talk to your doctor if you are allowed to take these medicines in the day of the colonoscopy
· possible medicine allergies, including to anesthetics
· problems in blood coagulation or anticoagulant treatment or non steroid anti inflammatory medicines like aspirin
· a history of cardiac diseases or problems of such nature. If the patient is on antibiotics before dental interventions he must ask the doctor if in this case too it's necessary to take the treatment
· the performance of a radiology exam with contrast substance less than four days ago
· the possibility of a pregnancy
It is possible that it is indicated for the patient to stop the treatment with aspirin or iron with 7-14 days before the examination. If the patient must follow a treatment with anticoagulants on a regular bases, he must talk to the doctor first.
Before the examination the colon must be prepared. The possibility for the doctor to see clearly inside the colon depends in a great measure that this is clean. The next information are necessary for a better preparation of the colon. The doctor will discuss with he patient and will give him indications depending on health condition, age and some chronic treatment:
· before the colonoscopy, with a day or two the patient must not eat solid food, and he must drink only clear liquids like water, tea, coffee, fruit juices. The patient must not eat or drink red food and juices. There are some solutions that are very helpful with preparing the colon, but this must be discussed with the doctor
· the doctor will prescribe a laxative that the patient will take the night before the intervention. Sometimes the laxative is a powder that must be mixed with water; this solution will be drank by the patient for 2 hours. The solution could have a salty taste and could give nausea. Every time the patient swallows a bit of that solution he can drink water after, so he gets rid of that taste.
· it is recommended that the patient stays home in the night before the examination, because he will need to go to the bathroom often
· the patient must drink many liquids to avoid dehydration and for a better preparation of the colon
· solid food must not be eaten after administrating the laxative
· hydration must be avoided with 6-8 hours before the colonoscopy
· the doctor could recommend an enema for a better preparation of the colon
· the patients must be accompanied by another person because he will be sedated before the intervention
Utility of the colonoscopy
The colonoscopy is an investigation that allows the doctor to observe inside the colon with he help of a thin and flexible tube that has a camera at the end. If during examination a biopsy will be performed, the test will be sent to a morpho pathological analysis:
· the tissue samples will be examined in a morphopathology laboratory in search of possible affections of the digestive tube
· other samples will be analized to certify if there is an infection
· The doctor can discuss with the patients about the partial conclusions of this examination immediately after the exam. The other results are ready in a few days. Certain tests, for infections, can last for a few weeks.
Normal:
· The digestive tract mucosa is smooth, pink, with numerous villosity. There are no tumors, bleedings of the mucosa or areas of inflammation.
Pathological:
· One of the most frequent discoveries in the colonoscopy is the presence of hemorrhoids (the most frequent bleeding cause in the stool), polyps, tumors, ulcerate areas, or inflammation. A red mucosa, edematous (colitis) can be associated with an intestinal inflammatory disease.
· Different types of polyps
· Colon cancer
What affects this investigation
The factors that could intervene in the test's results are:
· another barium examination with a week before the colonoscopy. The presence of barium in the colon/rectum can block the obtaining of images
· the presence of faeces, anterior surgical interventions on the colon or a colon with many bends could create major discomfort during the intervention
· treatments with iron supplements can make the stool darker and can also make the cleansing of the colon harder. The iron pills must be avoided a few days before the procedure
· red liquids and gelatinous can modify the color of the secretions and can be mistaken for blood
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