exams

Endoscopy

Generality

Endoscopy is a medical procedure that allows the visualization of internal organs of the organism, especially those communicating directly or indirectly with the outside (such as the esophagus).

The method involves the use of a rigid or flexible tube, called an endoscope, which records and transmits images to a screen by means of miniaturized cameras; this instrument is inserted directly into the district to be examined, allowing the vision of the interior of the patient's body.

Originally, endoscopy was used only for the esophagus, stomach and colon; now, doctors can use this method to diagnose and treat diseases of the ear, nose, throat, heart, urinary tract, joints and abdomen.

When possible, endoscopes are inserted by natural routes, such as the oral one. Sometimes, instead, it is necessary to create an artificial access through an incision, as in the case of thoracoscopy or laparoscopy.

Endoscopy is widely used in the diagnostic field, but also for the execution of therapeutic interventions or as a support tool during a surgical operation.

What is endoscopy?

Endoscopy is a medical procedure performed with an instrument called an endoscope . The latter is inserted inside the body to detect any anatomical alterations affecting the hollow organs and, sometimes, to guide some types of surgical intervention.

There are different types of endoscopes and the areas of application of the method are varied. Most endoscopes consist of thin tubes and cables (rigid or flexible), equipped with a light source and optical devices at the end, so as to allow the doctor to directly or indirectly view the images on a computer screen.

Endoscopes have different lengths and shapes, and each type of instrument is specially designed for exploring a specific part of the body. For example, an endoscope that helps a doctor examine joints is rigid, while the one used to visualize the inside of the colon is often flexible.

Depending on the area of ​​the body to be displayed, the endoscope can be inserted through the mouth, anus or urethra. Sometimes, however, it is necessary to make a small incision in the skin to access the part to be examined (surgical endoscopy).

Often, an endoscope also has a channel that allows the doctor to insert instruments to collect tissue or perform a therapeutic intervention. Some of these tools are:

  • Biopsy forceps for removal of a tissue sample or suspected tumor formation;
  • Cytological brush for taking samples of cells;
  • Pliers for removing stitches inside the body.
Type of endoscopeAccess routeBody area displayedName of the procedure
arthroscopeSkin incisionsJointsArthroscopy
bronchoscopeMouth or noseTrachea and bronchiBronchoscopy,

flexible bronchoscopy

colonoscopeAnusColon and large intestineColonoscopy,

lower digestive endoscopy

cystoscopeUrethraBladderCystoscopy,

cystourethroscopy

EsofagogastroduodenoscopioMouthEsophagus, stomach and duodenumEsophagogastroduodenoscopy, gastroscopy, upper digestive endoscopy

hysteroscopeVaginaInterior of the uterusHysteroscopy
LaparoscopeIncision in the abdomenAbdominal cavity and pelvisLaparoscopy,

peritoneal endoscopy

LaryngoscopeMouth or noseLarynxlaryngoscopy
mediastinoscopeEngraving above the sternumMediastinum (space between the lungs)Mediastinoscopy
sigmoidoscopeAnusRectum and sigma (lower portion of the large intestine)Sigmoidoscopy,

proctosigmoidoscopy

thoracoscopeIncision in the chestSpace between lungs and chest wallThoracoscopy,

pleuroscopy

When is it used?

Originally, endoscopes were developed to examine parts of the body that could not be evaluated otherwise. Currently, this tool can be used for many other purposes: for example, endoscopy is often used in prevention, early diagnosis, staging and treatment of tumors.

Endoscopy in cancer screening campaigns

Some types of endoscopes are used in the oncology field to diagnose a tumor process at an early stage, in people who do not show symptoms of illness or who belong to groups at high risk of developing neoplasms. Colonoscopy and sigmoidoscopy are applied, for example, to colon and rectal cancer screening.

These procedures can also help prevent the development of neoplastic formation, as they allow the removal of intestinal polyps that could develop in a tumoral sense, if left in place.

In other cases, endoscopy can be used in the early diagnosis of a tumor, before it has had the chance to grow and spread to other body districts.

Endoscopy in the diagnostic pathway

When the patient experiences certain symptoms, endoscopy can be used to identify or confirm the underlying causes .

For example:

  • Laryngoscopy: in people with chronic hoarseness, it allows visualizing possible alterations of the larynx and vocal cords;
  • Upper digestive endoscopy: clarifies the causes of symptoms of the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding;
  • Colonoscopy: can clarify an anemia condition (reduced number of red blood cells) of unknown cause or ascertain the reason for the presence of blood in the faeces.

Deepen the picture found in the imaging tests

Imaging tests, such as radiographs and computed tomography, can show physical changes within the body. Endoscopy can support these findings by providing more information about the size, shape and location of the alteration.

Some endoscopies also integrate the echographic approach to the classic or radiographic endoscopic approach:

  • Endoscopic ultrasound (EUS - Endoscopic UltraSonography) is a diagnostic procedure performed above all in the gastroenterological field, which allows the endoscopic study of the upper digestive tract (esophagus, stomach and duodenum), and which provides better access routes for the ultrasound study of organs proximal, such as the pancreas and biliary tract.

    Ecoendoscopy can provide important information, such as the depth and extent of lesions, which are not obtainable by conventional endoscopy. In addition to normal endoscopic and ultrasound diagnostic functions, it is often possible to perform biopsy samples of histological findings.

  • Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that uses the combination of endoscopy and radiology to diagnose problems affecting bile ducts, pancreas, gall bladder or liver. During the procedure, the doctor introduces the endoscope by mouth to the papilla where the outlet of the bile and pancreatic ducts is located; a small amount of contrast medium (dye) is then injected into the bile duct and / or pancreatic duct, through a small catheter (or sphincterotome) passed through the endoscope. Subsequently, radiographs are made to highlight whether the ducts being examined are of reduced size or blocked. The doctor can also perform a biopsy sample.

To get a fabric sample

Some endoscopes allow cell and tissue samples to be extracted from suspicious areas by brushing or biopsy forceps . These samples will then be subjected to microscopic examination by the pathological anatomy specialist.

Verify the spread of a disease

In some cases, endoscopy is used to find out how far a tumor has spread ( staging ).

Thoracoscopy and laparoscopy can be very useful, for example, to check if a tumor has spread to the chest or abdomen.

Removal of cancer cells

The procedure can be used to extract, destroy or reduce small tumor masses that can be reached by endoscopy. Doctors can use instruments such as scalpels, diathermic handles for electroresection or lasers .

Minimally invasive surgery

Many types of endoscopic instruments have been developed to allow doctors to perform minimally invasive surgeries .

In the case of the abdomen, laparoscopic surgery involves performing several small cuts or holes on the chest or abdomen, to reach the inside of the body with long and thin surgical instruments ; this avoids the practice of a single large incision.

The benefits of minimally invasive surgery are different: in general, intra-operative blood loss is lower than in open-air procedures and, often, patients can recover faster and with less pain, because the cuts are small size. On the other hand, more time is needed in the operating room to carry out the operation and the surgeon must have a lot of experience with the technique.

Endoscopic therapeutic procedures can be used for the treatment of small tumors of the prostate, the cauterization of a bleeding vessel by thermal coagulation or laser photocoagulation, the dilatation of membranes or stenoses, the reduction of volvulus or invaginations, the excision of an intestinal polyp or the removal of a foreign body.

How do you do it?

The different endoscopic procedures may differ from one another by the type of endoscope used, the procedure and the site of the body to be examined. Endoscopy can be performed by a doctor or a surgeon; the patient may be fully conscious or anesthetized.

The following table highlights the characteristics of some of the most common forms of endoscopy.

Type of endoscopy

Exam preparation (usually starting the previous evening)Is it usually performed in an operating room?Type of anesthesiaHow long does it take (estimate)
ArthroscopyFasting*YupLocal anesthesia and sedation30 to 45 minutes
BronchoscopyFastingNoLocal and sedation or general anesthesiaFrom 30 minutes to 2 hours
Lower digestive enteroscopyFasting, liquid diet and laxative / enema, if anal entry is usedNoSedation or general anesthesia45 to 90 minutes
laryngoscopyFastingNoLocal or general15 minutes-1 hour
Upper digestive endoscopyFastingNoLocal and sedation15 to 30 minutes
Flexible sigmoidoscopyLiquid diet and laxatives / enemaNoUsually, none15 to 30 minutes
ColonoscopyLiquid diet and laxatives / enemaNoMild sedation30 to 60 minutes
CystoscopyFastingSometimesLocal or general15 to 30 minutes
MediastinoscopyFastingYupGeneralFrom 1 to 2 hours
ThoracoscopyFastingYupGeneral2 to 3 hours
LaparoscopyFastingYupGeneral20 minutes-1 hour

Endoscopy generally requires intravenous sedation or local or general anesthesia. Usually, routine preparation includes abstaining for 6-8 hours from solid foods and for 4 hours from liquids before the procedure.

In any case, it should be remembered that some procedures could be performed in various ways: for example, bronchoscopy and laryngoscopy may involve the use of a flexible and rigid endoscope.

Colonoscopy requires preventive colon cleansing; for this purpose different protocols can be used, but all generally include a semi-liquid or liquid diet for 24-48 hours and the use of laxative preparations, with or without enema. For further information:

  • Preparation for Colonoscopy
  • Diet for Colonoscopy

After endoscopy

At the end of the exam, the patient is monitored by a qualified person for a few hours, until the effects of the anesthetic administered disappear; at that point he will be able to leave the structure where the examination was carried out, accompanied by a family member or an assistant. It is inadvisable to drive vehicles, due to the negative effect that anesthesia can have on attention levels. Full recovery will take place from the day following the exam.

If the endoscopy practiced was of an operative type (eg, polypectomy), the post-operative monitoring period is on average longer, up to 24 hours-48 hours. The greater the recovery time at home.

In the hours following endoscopy, mild and fleeting discomfort may remain (eg burning in the throat after a laryngoscopy or a feeling of distension in the abdomen due to the air blown during colonoscopy).

Risks and contraindications

Endoscopic procedures are safe and only rarely can there be complications such as infections, bleeding and organ perforation .

Bleeding may occur at the site of a biopsy or intestinal polyp removal procedure. However, blood loss is generally minor and tends to resolve spontaneously; otherwise it can be obtained by cauterization and only rarely is surgery necessary.

Although the perforation of an organ generally requires surgical management, some cases can be treated by administering antibiotics and intravenous fluids.

Other risks include allergic reactions and complications related to concurrent patient health problems .

Absolute contraindications to endoscopy include:

  • Acute myocardial infarction;
  • Peritonitis;
  • Acute perforation;
  • Fulminant colitis.

Furthermore, endoscopy is not indicated in cases of poor patient collaboration, coma (unless the patient is intubated), cardiac arrhythmias or recent myocardial ischemia.

Patients in anticoagulant treatment or in chronic therapy with NSAIDs can undergo a diagnostic endoscopy with confidence. However, if there is a likelihood of having to perform a biopsy or photocoagulation, these drugs must be suspended for a certain period before the procedure.

New types of endoscopy

In recent years, other ways of looking at the inside of the body have been developed. These methods are often referred to as "new forms of endoscopy" and include:

Virtual endoscopy

Virtual endoscopy is a non-invasive diagnostic technique, which provides three-dimensional and two-dimensional images of the internal surfaces of organs, such as the lungs (virtual bronchoscopy) or the colon (virtual colonoscopy), in real time and without the introduction of any endoscopic probe . The method uses a special computerized tomography that simulates a traditional endoscopy.

Capsular endoscopy

Capsular endoscopy is a non-invasive diagnostic test recently introduced in the medical field, which allows the study of the intestine by means of a video capsule of the size slightly larger than a medical tablet.

The endoscopic capsule contains a light source and a small camera; during the procedure, this capsule is swallowed by the patient and, like any other pill, passes through the stomach and reaches the intestine, capturing thousands of images otherwise difficult to obtain. These are sent to a device and, after about 8 hours, can be downloaded to the computer and examined by the doctor. Capsular endoscopy is particularly useful in patients with occult gastrointestinal bleeding.