Areas of Expertise
Advanced Endoscopic Procedures
Endoscopy is a method that allows the inside of the body to be viewed directly with a thin, flexible camera. This page gives a general overview of the main endoscopic procedures of the digestive system. The information is general; your physician’s instructions should guide the procedure and preparation that suit you.
01
Upper gastrointestinal endoscopy (gastroscopy)
It is a procedure that examines the inside of the esophagus, stomach and duodenum with a camera.
Gastroscopy is performed by passing a thin, flexible tube with a camera at its tip through the mouth. The inner surface of the esophagus, stomach and duodenum is viewed directly. It is used to investigate the cause of symptoms and to detect inflammation, ulcers and other changes. If needed, small tissue samples (biopsies) can be taken, and some bleeding sites or foreign bodies can be managed during the same procedure.
When is it performed?
- Long-standing or recurrent heartburn and difficulty swallowing
- Upper abdominal pain or indigestion without a clear cause
- Signs of digestive tract bleeding, such as vomiting blood or black stool
- Anemia or unintentional weight loss without a known cause
- When a known condition of the stomach or esophagus needs follow-up
- When a tissue sample is needed to investigate conditions such as celiac disease
Preparation
- You are usually asked not to eat or drink for several hours beforehand.
- Follow the fasting instructions given by your physician and the center.
- Tell your physician in advance about all medicines, including blood thinners.
- Only your physician decides whether any medicine should be stopped.
- Share any allergies and conditions such as heart or lung disease.
- If sedation is planned, bring an escort and do not drive that day.
How is it performed?
The procedure is usually done lying on the left side. The throat may be numbed with a spray, and sedation is given when appropriate. The endoscope is swallowed and advanced slowly while the images are watched. It generally takes a short time, though this varies with the findings. A brief period of observation follows.
Risks and aftercare
- Serious complications are rare; bleeding and perforation are among them.
- Breathing or heart rhythm problems related to sedation can rarely occur.
- A mild sore throat and bloating may follow and usually pass quickly.
- Follow your physician’s instructions on when to start eating and drinking.
- After sedation, do not drive that day and postpone important decisions.
- Seek care at once for severe abdominal or chest pain, fever, vomiting or black stool.
02
Colonoscopy and polyp removal
It is a procedure that aims to examine the entire large bowel with a camera and, if needed, allows polyps to be removed.
Colonoscopy is the viewing of the inner surface of the large bowel with a thin, flexible endoscope passed through the anus. It is used to investigate bowel symptoms and for colorectal cancer screening. If growths called polyps are found, they can be removed in the same session by polypectomy, and tissue samples can be taken.
When is it performed?
- Rectal bleeding or blood seen in the stool
- A long-lasting, unexplained change in bowel habits
- Anemia without a known cause, or chronic diarrhea
- Colorectal cancer screening or follow-up because of family history
- Follow-up of previously found polyps or bowel diseases
- Examination of bowel changes seen on imaging tests
Preparation
- Bowel cleansing is the key to a good examination; follow the given plan completely.
- A diet change may be requested in the days before; follow your physician’s instructions.
- Your physician or the center will tell you which product to use and when.
- Consult your physician in advance about blood thinners, diabetes and other medicines.
- If sedation is planned, an escort is needed; do not drive on the day of the procedure.
- Let your physician know beforehand if you have constipation, heart or kidney disease.
How is it performed?
The procedure is usually done lying on the left side, and sedation is often given. As the endoscope advances, air or carbon dioxide opens the bowel. If a polyp is seen, it is removed with special instruments and sent for pathology. The duration varies with the findings and is generally short to moderate.
Risks and aftercare
- Bleeding and perforation of the bowel wall are rare but serious complications.
- Polyp removal slightly increases the bleeding risk, which can occur days later.
- Bloating and a feeling of gas may follow and usually pass quickly.
- If polyps were removed, follow your physician’s instructions on activity and medicines.
- After sedation, do not drive that day and postpone important decisions.
- Seek care at once for severe abdominal pain, fever, marked bleeding or vomiting.
03
Rectosigmoidoscopy
It is a more limited endoscopic procedure that examines the last part of the large bowel, the rectum and sigmoid colon.
Rectosigmoidoscopy is the viewing of the last part of the large bowel, the rectum and sigmoid colon, with a thin, flexible endoscope passed through the anus. It examines a shorter segment than colonoscopy. It may be used to evaluate rectal bleeding, diarrhea or inflammatory bowel disease. A biopsy can be taken if needed, and the results contribute to diagnosis. If the whole bowel needs to be examined, the physician may recommend colonoscopy.
When is it performed?
- Fresh blood from the rectum or blood seen in the stool
- Long-lasting diarrhea or a change in bowel pattern
- Evaluation or follow-up of inflammatory bowel disease activity
- Investigating the cause of symptoms in the anal area and lower bowel
- Examination and sampling of a rectal polyp or other finding
Preparation
- Preparation usually involves a more limited bowel cleansing than colonoscopy.
- Your physician or the center will specify the type and timing; follow the instructions.
- Whether fasting is needed depends on the procedure plan and the sedation decision.
- Consult your physician in advance about blood thinners and other medicines.
- If sedation is planned, bring an escort and do not drive that day.
How is it performed?
The procedure is usually done lying on the left side. The endoscope is advanced gently through the anus, with a little air to open the bowel. The rectum and sigmoid colon are examined, and a biopsy is taken if needed. The physician decides whether sedation is necessary. It generally takes a short time.
Risks and aftercare
- Mild abdominal pain, bloating and a feeling of gas may occur and usually pass quickly.
- A small amount of blood in the stool may be seen after a biopsy.
- Bleeding and perforation of the bowel wall are rare but serious complications.
- If sedation was given, do not drive on the same day.
- Seek care at once for severe abdominal pain, fever or marked bleeding.
04
Endoscopic ultrasound (EUS)
It is the detailed imaging of the digestive tract wall and nearby organs with an endoscope that carries an ultrasound at its tip.
Endoscopic ultrasound uses a thin endoscope with a small ultrasound probe at its tip. The endoscope is advanced through the digestive tract, so the wall layers of the esophagus, stomach and bowel, as well as the pancreas, bile ducts and nearby lymph nodes, are viewed closely. When needed, a fine needle can be used to take a sample. The procedure contributes to diagnosis and treatment planning.
When is it performed?
- Examination of masses or bulges in the stomach or bowel wall
- Evaluation of cysts or masses found in the pancreas
- Investigation of suspected bile duct stones and bile duct narrowing
- Assessment of wall layers in tumors of the esophagus, stomach and rectum
- Examination of lymph nodes, with fine-needle sampling if needed
- Looking for the cause of recurrent pancreatitis of unknown origin
Preparation
- The procedure is usually done with sedation; follow your physician’s fasting instructions.
- Additional bowel preparation may be requested depending on the area examined.
- Tell your physician in advance about all medicines, including blood thinners.
- Follow only your physician’s decision on stopping or continuing any medicine.
- Bring your previous imaging results and reports on the day of the procedure.
- Bring an escort; do not drive on the same day after sedation.
How is it performed?
The procedure is done under sedation, in a way similar to gastroscopy. The endoscope carrying the ultrasound probe is advanced through the mouth for the upper digestive tract and pancreas, and through the anus for the rectum. If needed, a fine needle passed through the endoscope takes a sample from the target area. The duration varies with the area and intervention.
Risks and aftercare
- Complications are rare, but bleeding, infection and perforation can occur.
- Pancreatitis can rarely develop after sampling of the pancreas.
- Mild throat discomfort and bloating may occur and usually pass quickly.
- Follow your physician’s instructions on resuming eating, drinking and medicines.
- Seek care at once for severe abdominal pain, fever, vomiting or black stool.
- Do not drive on the same day after sedation.
05
ERCP: endoscopic retrograde cholangiopancreatography
It is an endoscopic procedure used mainly to treat problems of the bile ducts and the pancreatic duct, such as blockages and stones.
In ERCP, the endoscope is advanced through the mouth to the duodenum. A contrast agent is introduced at the opening of the bile duct and pancreatic duct, and X-ray images are taken. ERCP is mainly a treatment procedure; for diagnosis, less invasive methods such as MRCP or EUS are usually used first. Bile duct stones can be removed, narrowings can be widened, and small tubes called stents can be placed when needed. It is usually planned when earlier tests have shown a problem.
When is it performed?
- Suspected bile duct stones, or removal of stones already identified
- A narrowing in the bile duct or the pancreatic duct
- Jaundice and dark urine caused by bile duct blockage
- Treatment of bile duct infection (cholangitis) or bile leakage
- When a stent is needed to open a blocked bile duct
Preparation
- Fasting is required beforehand; your physician or the center will specify how long.
- Tell your physician in advance about all medicines, including blood thinners.
- Only your physician decides whether any medicine is stopped or continued.
- Report any allergies, especially to contrast agents.
- Sedation or anesthesia is used; bring an escort and do not drive that day.
- Because X-rays are used, tell your physician beforehand if pregnancy is possible.
How is it performed?
The procedure is done under sedation or anesthesia, usually lying on the left side or face down. The endoscope reaches the duodenum, the bile duct is entered with a thin tube, and contrast is given under X-ray guidance. If needed, stones are removed or a stent is placed. The duration varies with the intervention.
Risks and aftercare
- Pancreatitis is the best-known complication after ERCP and presents with abdominal pain.
- Bleeding, perforation and bile duct infection can also occur, though rarely.
- These risks differ from person to person; your physician will explain them beforehand.
- Observation may be needed afterwards; follow the instructions on eating, drinking and medicines.
- Seek care at once for severe abdominal pain, vomiting, fever, shivering or black stool.
- If a stent was placed, attend follow-up visits for its replacement or removal.
