Gastroscopy and Colonoscopy

The ability to directly inspect the inside of the gastrointestinal tract greatly enhances your physician’s ability to diagnose and treat many of the medical and surgical conditions that effect this organ system. The procedures which we utilize to view the GI tract are collectively called endoscopic procedures. Gastroscopy, also known as esophagogastroduodenoscopy, is the examination of the esophagus, the stomach and the first part of the small bowel (duodenum). By using a slightly longer scope we are able to inspect further into the small bowel, known as enteroscopy. To perform these procedures comfortably, a patient is given sedation. At all times his/her breathing and vitals signs are monitored carefully. In this relaxed state, the physician is able to slip a small flexible scope into the patient’s mouth. This scope contains video technology necessary to obtain video images from the end of the scope as it is advanced into the esophagus, the stomach, and the small bowel. Photographs can be saved and shared with the patient. The most common conditions which are identified by gastroscopy include esophagitis (irritation of the esophageal lining) and strictures due to gastroesophageal reflux, hiatal hernias, gastritis (an irritation of the stomach lining) and ulcers involving the stomach and/or small bowel. Diagnostic and therapeutic procedures can be carried out during gastroscopy. Biopsies are frequently taken of the lining of the upper GI tract to look for cellular changes in the linings of these structures, for example, to rule out cancer in a stomach ulcer. Biopsies will also identify the presence of H. pylori, a bacteria which has been linked to upper GI disease. Polyps can be snared and removed if encountered. Strictures in the esophagus, or at the pylorus (the valve separating the stomach from the small bowel), can be dilated with a balloon device allowing for improved swallowing and gastric emptying. Sources of bleeding, such as from large veins, called varices, or from ulcers, can frequently be controlled by endoscopic ligation or cauterization. In a debilitated patient, who is not able to take in adequate nutrition by mouth, a gastric feeding tube can be positioned easily through the abdominal wall utilizing the same endoscopic techniques.

Colonoscopy is the endoscopic procedure that examines the large intestine. Unlike the gastroscopy, however, colonoscopy must be preceded by a colon preparation the day before, in order to clear the colon of stool. There are a number of different preparations which may be prescribed. Like the gastroscopy, colonoscopy is performed under sedation for patient comfort. The actual procedure takes between 20 and 30 minutes to complete. The endoscope is inserted into the rectum and advanced slowly and carefully through the entire length of the colon, examining each segment for evidence of disease. The most common conditions encountered include polyps, diverticulosis (small pouches in the wall of the colon), telangiectasia (small blood vessels), colitis (irritation/inflammation of the lining) and cancer. Perhaps the most important procedure performed during colonoscopy is the removal of polyps, as colon cancer arises in polyps. Removal of polyps dramatically reduces a persons risk of developing colorectal cancer. Because of this benefit alone, colonoscopy is recommended at the age of fifty, and should be repeated every five years. With this screening plan, most polyps will be found and removed before they have the opportunity to become cancerous. Patients may notice changes in their bowel habits (bleeding, diarrhea, constipation, pain) which may warrant colonoscopy. In some of these patients colorectal cancer will be identified. If attention is sought early, then the cancer may be identified and treated early, giving the best opportunity for cure. Other, noncancerous, conditions of the colon can be evaluated very effectively by colonoscopy, enabling the physician make the appropriate recommendations for treatment.

All content copyright 2010, Alan F. Jacks, MD, PA