Endoscopic procedures use flexible fibre-optic tubes, allowing direct vision and usually video imaging. The procedures are done under local anaesthetic and/or sedation, so are usually a day case procedure.
The patient must be fasted at least 6 hours. Local anaesthetic spray is used on the throat and sedation is some-times required. The endoscope is passed through the pharynx, into the oesophagus, stomach and duodenum. Diagnoses which may be made include oesophagitis, oesophageal candidiasis, Barrett’s oesophagus, carcinoma of the oesophagus or gastric carcinoma, and peptic ulcer disease. Mucosal biopsies can be made for histological diagnosis and testing may be done for the presence of H. pylori.
In upper GI bleeding, varices or a bleeding ulcer can be treated, e.g. by sclerotherapy, variceal banding, clips, glue, fibrin sealant (e.g. Beriplast) or laser photocoagulation. Upper GI endoscopy should be repeated 4–6 weeks after an endoscopic diagnosis of gastric ulcer has been made to repeat biopsies to exclude malignancy.
Complications of upper GI endoscopy include perforation (of oesophagus or stomach) and bleeding, but these are uncommon.
The patient has to have bowel preparation, which commences up to 2 days preprocedure with a low-residue diet, then clear fluids. Osmotic laxatives or large volumes of electrolyte solutions are then taken to clear the bowel 12 hours before the procedure (essentially causing watery, frequent diarrhoea).
Sedation and analgesia (usually with pethidine) is required. The instrument is passed via the anus and using air insufflation to view the bowel, passed around as far as the caecum and terminal ileum. In 20% of cases, due to insufficient preparation or patient intolerance, it is not possible to obtain good views as far as the terminal ileum.
Polyps can be biopsied or removed. Biopsies can also be taken in suspected inflammatory bowel disease.
Complications: Bowel preparation may cause dehydration, electrolyte or fluid imbalance particularly in the elderly, or those with cardiac or renal disease. Perforation and peritonitis occur approximately 1 in every 2000 examinations and is more likely if biopsy or polyp removal takes place. Polyp removal also carries a 1 in 200 risk of bleeding. Overall colonoscopy has a mortality of 1:100,000.
This is a generally well-tolerated procedure that requires only a phosphate enema to clear the lower part of the colon, it is inserted to 70 cm. All patients who have a barium enema, e.g. for possible malignancy, should have a sigmoidoscopy, as barium enemas can miss low lesions.
Haemorrhoids are best seen with a proctoscope, which is a shorter, larger diameter tube gently inserted while the patient strains down. It is gently withdrawn whilst the patient continues to strain down. Using a light source haemorrhoids can be directly visualised and can be treated, e.g. with banding or injection of sclerosant.