Endoscopy: Diagnostic & Therapeutic Procedures
Colonoscopy
Screening Colonoscopy
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Upper GI Endoscopy
ERCP
Colonoscopy
A camera attached to a flexible tube with a viewing lens is used to take video pictures.
Colonoscopy provides an inside view of the entire colon.
Colonoscopy is used to view the inside of your lower digestive tract (colon and rectum). It can help screen for colon cancer and can also help find the source of abdominal pain, bleeding, and changes in bowel habits. The test is usually done in the hospital on an outpatient basis. During the exam, the doctor can remove a small tissue sample (a biopsy) for testing. Small growths, such as polyps, may also be removed during colonoscopy.
Getting Ready
- Be sure to tell your doctor about any medications you take. Also tell your doctor about any health conditions you may have.
- Discuss the risks of the test with your doctor. These include bleeding and bowel puncture.
- Your rectum and colon must be empty for the test. So be sure to follow the diet and bowel prep instructions exactly. If you don’t, the test may need to be rescheduled.
- Ask your doctor whether you need to have a friend or family member prepared to drive you home after the test.
During the Test
- You are given sedating (relaxing) medication through an IV line. You may be drowsy or completely asleep.
- The procedure takes 30 minutes or longer.
- The doctor performs a digital rectal exam to check for anal and rectal problems. The rectum is lubricated and the scope inserted.
- If you are awake, you may have a feeling similar to needing to have a bowel movement. You may also feel pressure as air is pumped into the colon. It’s okay to pass gas during the procedure.
After the Test
- You may discuss the results with your doctor right away or at a future visit.
- Try to pass all the gas right after the test to help prevent bloating and cramping.
- After the test, you can go back to your normal eating and other activities.
Who Should Get a Colonoscopy?
The American Cancer Society recommends colonoscopy at age 50 and then every 5–10 years. However if a polyp is found and depending on the histology, the colonoscopy may need to be repeated within 1 or 2 years.
For patients who have survived colon cancer, we usually recommend colonoscopy every 3-5 years. For patients with a significant family history, colonoscopies need to be done much earlier.
Families who have FAP (which means thousands of polyps in the colon, often diagnosed in teenage years) you start colonoscopies at age 12 and then every year. For families who have HNPCC (which means you have a genetic predisposition for colon cancer which may be associated with ovarian, endometrial and gastric cancer and has no polyps) we start 10 years younger than the youngest family member diagnosed with colon cancer.
For example, if your uncle was diagnosed with colon cancer at age 45, family members should be screened at age 35. Please check with your physician if your family may have a genetic predisposition. In HNPCC families, colonoscopies need to be done every year.
Risks and Possible Complications Include:
- Bleeding
- A puncture or tear in the colon
- Risks of anesthesia
Upper GI Endoscopy
During endoscopy, a long, flexible tube is used to view the inside of your lower GI tract.
Upper GI endoscopy allows your doctor to look directly into the beginning of your gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (the first part of the small intestine) make up the upper GI tract.
Before the Exam
Follow these and any other instructions you are given before your endoscopy. If you don’t follow the doctor’s instructions carefully, the test may need to be cancelled or done over.
- Do not eat or drink anything after midnight the night before your exam. If your exam is in the afternoon, drink only clear liquids in the morning, and do not eat or drink anything for 6 hours before the exam.
- Bring your x-rays and any other test results you have.
- Because you will be sedated, arrange for an adult to drive you home after the exam.
- Tell your healthcare provider before the exam if you are taking any medications or have any medical problems.
The Procedure
- You lie on the endoscopy table.
- Your throat may be numbed with a spray or gargle. You are given sedating (relaxing) medication through an intravenous (IV) line.
- You swallow the endoscope. This is thinner than most pieces of food that you swallow. It will not affect your breathing. The medication helps keep you from gagging.
- Air is inserted to expand your GI tract. It can make you burp.
- The endoscope carries images of your upper GI tract to a video screen. If you are awake, you may be able to look at the images.
- After the procedure is done, you rest for a time. An adult must drive you home.
Call your doctor if you have:
- Black or tarry stools; blood in your stool.
- Fever.
- Persistent pain in your abdomen.
Risks and Complications
- Infection or bleeding from the incision site
- Infection or swelling in the abdomen, or leakage of bowel material
- Bowel ileus (slowness of bowel muscles) or bowel blockage
- Problems from anesthesia
ERCP
The endoscope moves from the mouth, through the upper digestive tract, to the common bile duct opening.
A balloon at the tip of a catheter opens above the stone. The stone is pulled out of the duct and leaves your body through stool.
ERCP stands for endoscopic retrograde cholangiopancreatography. This procedure is used to view the common bile duct to help locate and treat blockages in the duct. It may also be used to locate pancreas problems.
Preparing for ERCP
- Talk to your doctor about any health problems or allergies you have, and medications you take.
- Ask your doctor about the risks of ERCP. These include pancreatitis, infection, bleeding, and bowel perforation.
- You may be asked to take antibiotics ahead of time.
- Avoid blood-thinning medications for 1 week before ERCP.
- Do not eat or drink for 12 hours before ERCP.
- Have someone ready to take you home.
The Procedure
ERCP takes 30–90 minutes. You may be given medication through an IV to help you relax. Your throat is numbed. A thin tube (endoscope) is placed into your throat. The endoscope lets the doctor see the common bile duct on a video screen. A cut may be made where the common bile duct opens to the duodenum to make it easier to remove stones. As blockages are located and removed, x-rays are taken. Contrast dye is injected through a catheter to make the duct show up better on the x-rays.