Surgical gastroenterology
Gastroscopy
What is a gastroscopy?
Gastroscopy or “upper gastrointestinal endoscopy” is an examination of the inside of the gullet (esophagus), stomach (gastrum) and first part of the small bowel (duodenum). It is performed by using a thin, flexible fibre-optic instrument with a light source and camera at the end that is passed through the mouth. This allows the surgeon / endoscopist to see whether there is any abnormality of or damage to the lining of the esophagus or stomach, and whether there are any ulcers in the stomach or duodenum. The procedure is painless and is usually done under a light sedative as a day-case. Occasionally the procedure can be performed without sedation. When sedation is used, the patient will not be able to drive or operate machinery for the rest of the day.
How is a gastroscopy performed?
Once intravenous access is obtained a trained sedationist or anaesthetist will administer conscious sedation. This is not a full anaesthetic, but the patient will not experience any discomfort or have any recollection of the procudure. The patient lies on their left side. Once sedated a thin tube with a fibre-optic light source and camera at the tip is passed from the anus to the start of the colon (caecum) or the small bowel (ileum) in a controlled manner. The procedure takes 10-20 minutes to complete.
Why is gastroscopy useful?
- The doctor can study the mucous membrane(lining) of the gullet, stomach and duodenum from the top to the bottom.
- It can be used to diagnose irritation, wounds or tumours.
- It can also be used therapeutically in a variety of circumstances (see below).
- Most modern gastroscopes can show the areas in the stomach on a TV screen, so that the mucous membrane(lining) can be studied thoroughly. This can also then be recorded or photographed and used for later comparison.
- Gastroscopy is effective, precise and safe
What are the indications for a gastroscopy?
Diagnosis
Patients are most often given a gastroscopic examination because of their indigestion / heartburn symptoms. The gastroscopy can be useful to confirm the presence of inflammation in the gullet and rule out Barret’s disease. Occasionally, the cause of indigestion is an ulcer and it is now known that many ulcers are due to bacterial infection (Helicobacter pylori) in the stomach. A biopsy (a small piece of the lining of the stomach) may be removed during an endoscopy and examined under the microscope in the laboratory to pinpoint an infection. A very small number of patients with indigestion will turn out to have cancer and, again, the diagnosis can be made accurately by biopsy. Further investigation can then be planned to ensure the most effective treatment.
Other indications include:
Evaluating patients with difficult or painful swallowing (dysphagia and odynophagia).
Investigating the cause of hematemesis (vomiting of blood) or of iron deficiency anaemia.
Investigating the cause of occult blood in a patient’s stool.
Suspicion of cancer or looking for the primary cancer in a case of advanced metastatic (spread to other organs) disease.
Diagnosis of coeliac disease.
Therapy
Gastroscopy has gone from initially being a purely diagnostic procedure to where it has now become an important tool in the treatment of many conditions:
Arresting bleeding from a stomach or duodenal ulcer via adrenaline injection, clipping of vessels, coagulation, etc.
Treatment of esophageal varices by banding or sclerotherapy.
Treatment of early esophageal cancer by endoscopic mucosal resection.
Stenting of advanced tumours of the esophagus or stomach to relieve obstruction and improve nutrition.
Placement of covered stents to seal off esophageal perforations / fistulae or anastomotic leaks.
Placement of feeding (Gastrostomy) tubes through the abdominal wall in patients who cannot swallow (‘PEG’ procedure).
Is gastroscopy safe?
All procedures carry some risk but outpatient diagnostic Gastroscopy is very safe. Minor complications are uncommon and major complications are very rare.
Colonoscopy
What is a colonoscopy?
Colonoscopy is a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.
What are the Colon and Rectum?
The colon and rectum are the two main parts of the large intestine.
The colon and rectum are the two main parts of the large intestine. Most of the large intestine consists of colon, with the rectum only being the most distal (lower most) 12 – 15 cm of the large intestine. The large intestine is also sometimes called the large bowel.
Digestive waste enters the colon from the small intestine as a semi-solid. No further digestion occurs in the large bowel, as waste moves toward the anus, the colon removes moisture and forms stool. The rectum is about 12 – 15 cm long and connects the colon to the anus. The rectum functions as a reservoir before stool leaves the body through the anus. Muscles and nerves in the rectum and anus plays an important part in regulating bowel movements and controlling defecation.
How do you prepare for colonoscopy?
You will be given written instructions about how to prepare for colonoscopy. The process is called a bowel prep. Generally, all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for the day preceding the procedure. Acceptable liquids include:
- Fat-free broth
- Strained or clear (apple / grape) fruit juice
- Water
- Plain coffee
- Plain tea
- Sports drinks, such as Energade
- Gelatin (‘jelly’)
A laxative will be required the night before colonoscopy. A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed as a powder dissolved in water. Patients should inform the surgeon of all medical conditions and any medications, vitamins, or supplements taken regularly, including
- Aspirin
- Arthritis Medications
- Blood Thinners
- Diabetes Medications
- Vitamins That Contain Iron
Driving is not permitted for 24 hours after colonoscopy to allow the sedative time to wear off. Before the appointment, patients should make plans for a ride home.
How is a colonoscopy performed?
Once intravenous access is obtained a trained sedationist or anaesthetist will administer conscious sedation. This is not a full anaesthetic, but the patient will not experience any discomfort or have any recollection of the procudure. The patient lies on their left side. Once sedated a thin tube with a fibre-optic light source and camera at the tip is passed from the anus to the start of the colon (caecum) or the small bowel (ileum) in a controlled manner. The procedure takes 10-20 minutes to complete.
Removal of polyps and biopsy
The endoscopist can remove growths, called polyps, during colonoscopy which will then be tested in a laboratory for signs of cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.
The endoscopist can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows for the tissue to be tested for signs of disease.
The endoscopist removes polyps and takes biopsies using tiny tools passed through the scope. If bleeding occurs, he/she can usually stop it with an electrical probe or special injections passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.
Recovery
Colonoscopy usually takes 20 - 40 minutes. Cramping or bloating may occur during the first hour after the procedure. The sedative takes time to completely wear off. Patients may need to remain at the hospital for 1 to 2 hours after the procedure. Full recovery is expected by the next day. Discharge instructions should be carefully read and followed.
Complications
The most feared complication of colonoscopy is perforation. Fortunately this occurs very infrequently with rates of 1 per 700 to 1 per 1000 cases being deemed acceptable for screening colonoscopies. The perforation rate unfortunately increases 7 fold if a polyp has been removed. Other complications include hemorrhage and transient bacteraemia (blood infection).
Patients who develop any of these rare side effects should contact their doctor immediately:
- Severe abdominal pain
- Fever
- Continued bloody bowel movements
- Dizziness
- Weakness
At what age should routine colonoscopy begin?
Internationally accepted protocols for screening advise that the first colonoscopy should occur at age of 50 for most people, unless there is a family history of colorectal cancer, in which case it should occur 10 years earlier than the age at which the family member was diagnosed with cancer. The interval of subsequent colonoscopies will be determined by the findings of the first procedure.
