Q. We hear so much about the endoscope these days. What is it, and what does examination entail?
A. The endoscopes suddenly swirled across the medical horizon in the late 1960s, and during the 1970s became the most widely used form of investigation by the gastro-enterologists, the doctors who specialise in disorders of the G.I. system. Indeed, they have revolutionised diagnosis and treatment.
The principle is very simple. The endoscope is a long, flexible solid tube made of fibreoptical material. This is pliable and can turn and twist and be bent into many different positions and directions. At the far end there is a light. At the near end, there is an eye piece.
The doctor places the tube down the patient’s throat, into his stomach and duodenum, or lower bowel if desired. The light illuminates the area. When viewing through the eye piece, the doctor can see by direct vision, the inside part of the organs under examination. The image is perfectly clear, despite the number of turns and twists the tube makes.
Q. Therefore, diagnosis is perfectly clear to the doctor?
A. Precisely. He can see if there is an ulcer on the walls of the stomach or duodenum. He can gain a good idea if there are other disease processes present also. What is more, if there is a lesion that is suspect, small instruments located on the side of the endoscope may remove small sections. This is called a biopsy, and is invaluable for an ulcer, specially of the stomach, which in fact may be an early stomach cancer. These are later examinated by the pathology experts and an exact diagnosis made. The amount of information that is yielded may be phenomenal.
Q. Is the procedure painful, and is it given under anaesthetic?
A. The process is not painful. It may be a little bit uncomfortable, and a general anaesthetic is not given. Usually food is restricted for the twelve hour period immediately preceding the examination. When you arrive, you may be given a fluid to gargle and swallow. This is aimed at partially anaesthetising the back part of the throat to make the examination less irritating. You may be given a mild sedative or tranquilliser to settle the nerves, and make you feel a bit lightheaded and sleepy. But you usually are not rendered unconscious. Later, you may have only a hazy recollection of what took place. However, about 40 minutes later, you will feel okay, with no ill effects. The throat may be a little bit uncomfortable.
Q. Does it take long?
A. In all, the examination itself takes about 20 minutes. The endoscope is about as thick as a pencil, and you will ‘swallow’ this. The end in your stomach has a light, and a wiping system a bit like a windscreen wiper in the car, which keeps the tip clear so the doctor can see clearly. The flexible fibres carry the picture around bends and corners to the viewing piece at the doctor’s end.
After the test, when you ‘come to’, you may feel a bit drowsy, but generally within 40-60 minutes you are back to normal. If a working person, you usually only require a day off duty. Ideally do not plan to drive your car for the remainder of the day — just to be doubly sure of safety.
Q. Is this test safe during pregnancy?
A. Unlike x-ray examinations, there are no risks to the foetus during an endoscopic examination. However, if you are breastfeeding, or taking medication, it is wise to tell the examining doctor about this.
Q. What happens after this examination?
A. As with the results of the x-ray, these are relayed back to the referring physician, and the patient will then be placed under the appropriate therapy.
However, unlike the x-rays, which are taken by a radiologist, a doctor who spends all of his time in taking and interpreting x-rays, the gastro-enterologist who performs the endoscopy is a specialist in the field of the G.I. system. Therefore, he will often commence treatment once he has made the diagnosis. This may be instituted at once, for the patient is still with him, and after the diagnosis is confirmed, it is often convenient to proceed with therapy.
Q. Is it necessary or desirable to have other tests carried out?
A. Before the advent of the endoscope, various other tests were available, for checking acid levels, but these are now rarely used, and then only for specific conditions. The endoscope has revolutionised diagnosis of ulcers, as well as other bowel disorders. Now it forms a vital part of the doctor’s investigations, and an increasing number of these tests are being performed — usually to the patient’s benefit.
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