An endoscopy is a test to look inside the gastrointestinal tract. Potentially, anybody
who has symptoms of a problem inside the stomach or the live bowel or the small bowel may need
an endoscopy. It is the best test to use for diagnosing a number of different symptoms.
These can range from difficulty in swallowing, pain particularly in the chest or the stomach,
problems with bleeding, so anemia or actually vomiting or passing blood, weight loss or
a change in bowel habit such as diarrhea. Any of these may require an investigation
of either the upper GI tract, which would be an endoscopy or gastroscopy or the lower
GI tract which would normally be a colonoscopy or a flexible sigmoidoscopy. As well as for
diagnosing people with symptoms, endoscopy can also be used to provide treatments.
We may want to take biopsies to make a diagnosis of a particular disease or we can remove polyps
or other problems within the GI tract. This is often done after the first endoscopy but
may also be done in the initial procedure. Endoscopy can be carried out by anybody who’s
been properly trained to perform these procedures. Usually, in most cases, this will be a doctor
and they will be trained by a gastroenterologist or a gastroenterological surgeon. Sometimes
these are done by nurses particularly in the National Health Service.
Most people who do these procedures will have been accredited with the joint advisory group
for endoscopy, which is an overarching body which credentials people to perform gastrointestinal
endoscopy. Some people may also be accredited for bowel cancer screening which requires
an additional test and checking of their expertise. There will be some preparation for any endoscopy.
It depends whether the endoscopy is going to be into the stomach or around the large
bowel and through the bottom. There may be a requirement to stop some medicines particularly
things like anticoagulation some days beforehand. There will be a period of fasting particularly
for a gastroscopy which is important because the stomach needs to be empty of fluid to
allow the endoscopist to see things properly. In addition for small valve or colonic procedures
such as a colonoscopy or a sigmoidoscopy, there is the need to take a laxative. This
is to clear the bowel of any debris and stool to again make sure the endoscopist can see
things properly. Most people consider that that is actually
the most difficult part of the test and the endoscopy itself may be easier than the bowel
preparation. It is entirely up to you whether you would
like to have sedation or not. A lot of procedures are done without sedation perhaps with a local
anesthetic spray for gastroscopy or something to relax the bowel for a colonoscopy. If you’re
feeling anxious or worried, then it may be better to have some sedation. We use what
is called conscious sedation so you’re not completely asleep like with the general anesthetic
but you are less aware of what is going on and a bit more relaxed with the procedure.
This can make it much easier. If you are having sedation, it’s important that you
know that you will need someone to take you home after the procedure because sedation
can affect you for up to 12 hours afterwards. You shouldn’t drive or operate heavy machinery
or sign any important documents after that. The choice is whether you want to have sedation
or not, it is something you should talk to your endoscopist about. Some people have these
repeatedly and found it is comfortable to do it without any sedation. But the majority
of people particularly in their first time want something to just make it a little bit
easier for them.
Like with any tests or invasive procedure, there are some small risks in endoscopy. First
of all, there are small risks with any sedation that you can have. These can involve problems
with your heart rate or problems with your breathing, but these are very rare and usually
managed very easily within the department. There are risks of putting the tube either
into the stomach around the bowel. The main risks are causing any bleeding or
damage to the bowel. Both of these are very rare and the endoscopist will take great care
to avoid any problems. If there is bleeding, it is usually a small amount and either easily
controlled at the time of endoscopy or it does not require any further treatment. But
you will be told that in the very, very small chance there is a significant bleed, it may
result in you requiring a blood transfusion. Damage to the bowel or stomach is also extremely
rare, but it can happen. Therefore, when the endoscopist is consenting you for the procedure,
he will mention that it is possible. Again, like with bleeding, usually, this is recognised
at the time of the procedure and can be dealt with during the procedure. Very rarely, it
may be necessary to do further interventions after the procedure and in extremely rare
cases, a surgical operation may be needed to fix the problem. However, this is incredibly
rare and for the vast majority of cases, even when complications do occur, these are managed
very safely and completely, resulting in a normal outcome for the patient.