Endoscopy

What is an endoscopy?

An endoscopy is where the doctor uses an instrument called an endoscope to look at the oesophagus food pipe), stomach and the small bowel. This is common if bleeding, inflammation, ulceration or other abnormalities of the small bowel are suspected.

An endoscope is a long, thin, flexible tube with a small camera and light attached which allows the doctor to see the pictures of the inside of your gut on a video screen. The scope bends, so that the doctor can move it around the curves of your gut. The scope also blows air and this expands the folds of tissues so that the doctor can see the linings better. As a result, you might feel some pressure, bloating or cramping during the procedure.

This instrument can also be used to remove or burn polyps or to take tissue biopsies. Before the procedure, the doctor may spray your throat with a numbing agent that will help prevent gagging. Most patients have some sedation, but this can be one without sedation if you prefer.

You will then lie on your left side, and the doctor will pass the endoscope into your mouth and down to your small intestine. Your doctor will examine the lining again as the endoscope is taken out.
The endoscope does not cause problems with your breathing.

Sometimes the endoscope is inserted into the small bowel via the rectum. Bowel preparation is required for this.

If the doctor sees anything unusual or wants to look at the bowel with a microscope they may need to take a biopsy (small pieces of tissue) for testing. Polyps and tumors can sometimes be removed this may. You will not feel the biopsy.

You should plan on two to three hours for waiting, preparation and recovery. The procedure itself usually takes anywhere from 10 to 15 minutes.

This procedure may or may not require a sedation anesthetic.

Will there be any discomfort? Is any anaesthetic needed?

The procedure can be uncomfortable and to make the procedure more comfortable a sedative injection or a light anesthetic will be given. Before the procedure begins, the doctor will put a drip into a vein in your hand or forearm. This is where the sedation or anaesthetic is injected.

What is sedation?

Sedation is the use of drugs that give you a ‘sleep-like’ feeling. It makes you feel very relaxed during a procedure that may be otherwise unpleasant or painful. You may remember some or little about what has occurred during the procedure. Anaesthesia is generally very safe but every anaesthetic has a risk of side-affects and complications. Whilst these are usually temporary, some of them may cause long-term problems.

The risk to you will depend on:

• personal factors, such as whether you smoke or are overweight.
• whether you have any other illness such as asthma, diabetes, heart disease, kidney disease, high blood pressure or other serious medical conditions.

What are the risks of this specific procedure?

There are risks and complications with this procedure.
They include but are not limited to the following.

Common risks and complications include:

• Nausea and vomiting.
• Faintness or dizziness, especially when you start to move around.
• Headache.
• Pain, redness or bruising at the sedation injection site (usually in the hand or arm).
• Muscle aches and pains.
• Allergy to medications given at time of the procedure.

Uncommon risks and complications include:

• About 1 person in 100 will experience bleeding from the oesophagus (food pipe), stomach or small bowel where a lesion or polyp was removed. This is usually minor and can usually be stopped through the endoscope. Rarely, surgery is needed to stop bleeding.
• Heart and lung problems such as heart attack or vomit in the lungs causing pneumonia.
• Emergency treatment may be necessary.
• ‘Dead arm’ type feeling in any nerve, due to positioning with the procedure – usually temporary.
• Missed polyps or growths.
• Your procedure may not be able to be finished due to technical problems.
• An existing medical condition that you have getting worse.

Rare risks and complications include:

• About 1 person in 1,000 will accidentally get a tear or hole (perforation) through the wall of the put. It can cause a leak of gut contents into the abdomen. Further surgery may be needed to repair the hole perforation).
• Pancreatitis or inflammation of the pancreas.
• Bacteraemia (infection in the blood). This will need antibiotics.
• Anaphylaxis (severe allergy) to medication given at the time of procedure.
• Death as a result of complications to this procedure is rare.

What are you responsibilities before having this procedure?

You are less at risk of problems if you do the following:

• Bring all your prescribed drugs, those drugs you buy over the counter, herbal remedies and supplements and show your doctor what you are taking. Tell your doctor about any allergies or side effects that you may have.
• Do not drink any alcohol and stop recreational drugs 24 hours before the procedure. If you have a drug habit, please tell your doctor.
• If you take Warfarin, Persantin, Clopidogrel (Plavix or Iscover), Asasantin or any other drug that is used to thin your blood ask your doctor if you should stop taking it before the procedure as it may affect your blood clotting. Do not stop taking them without asking your doctor.

Tell your doctor if you have:

• had heart valve replacement surgery.
• received previous advice about taking antibiotics before a dental treatment or a surgical procedure.

Preparation for the procedure

Your stomach must be empty for the procedure to be safe and thorough, so you will not be able to eat or drink anything for at least six hours before the procedure.
A bowel preparation will be needed if it is performed via the back passage (anus).

What if the doctor finds something wrong?

Your doctor may take a biopsy (a very small piece of the stomach lining) to be examined at Pathology.
Biopsies are used to identify many conditions even if cancer is not thought to be the problem.

What are polyps and why are they removed?

Polyps are fleshy growths in the bowel lining, and they can be as small as a tiny dot or up to several centimeters in size.
They are not usually cancer but can grow into cancer over time. Taking polyps out is an important way of preventing bowel cancer.
The doctor usually removes a polyp along the endoscope by using a wire loop. An electric current is sometimes also used. This is not painful.

What if I don’t have the procedure?

Your symptoms may become worse and the doctor will
not be able to give you the correct treatment without knowing the cause of your problems.

Are there other tests I can have instead?

X-rays and scans can be used to look at the small bowel. They are not as accurate and treatment cannot be performed.
Your doctor will discuss with you other ways of managing your condition.

What can I expect after the enteroscopy?

You will remain in the recovery area for about 2 hours until the effect of the sedation wears off.
Your doctor will tell you when you can eat and drink.
Most times this is straight after the procedure.
Your throat may feel sore and you might have some cramping pain or bloating because of the air entering the stomach during the procedure.
You will be told what was found during the examination or you may need to come back to discuss the results, and to find out the results of any biopsies that may have been taken.

What are the safety issues?

• Sedation will affect your judgment for about 24 hours.
• For your own safety and in some cases legally;
• Do NOT drive any type of car, bike or other vehicle. You must be taken home by a responsible adult person.
• Do NOT operate machinery including cooking implements.
• Do NOT make important decisions or sign a legal document.
• Do NOT drink alcohol, take other mind-altering substances, or smoke. They may react with the sedation drugs.
• Have an adult with you on the first night after your surgery.

Notify the hospital Emergency Department straightaway if you have:

• severe ongoing abdominal pain.
• trouble swallowing.
• a fever.
• sharp chest or throat pain.
• have redness, tenderness or swelling for more than 48hours where you had the injection for sedation (either in the hand or arm).