Endoscopy is a procedure in which a flexible fibre-optic tube, called an endoscope, is passed into the gastrointestinal tract (GIT).

The endoscope sends images of the inside of the GIT to a video-screen. During endoscopy, the doctor is able to visually examine the oesophagus (food-pipe), stomach, parts of the small intestine, the colon and rectum. The doctor is also able to perform a biopsy or other minor procedure using fine instruments inserted through the endoscope.

Endoscopic procedures include gastroscopy, sigmoidoscopy and colonoscopy.

For gastroscopy, the instrument used is called a gastroscope. A colonoscope is used for sigmoidoscopy and colonoscopy.

Endoscopy is generally performed for patients with the following complaints:

• Persistent abdominal pain.
• Prolonged symptoms of bloatedness, nausea, vomiting.
• Severe or frequent heartburn.
• Difficulty in swallowing.
• Vomiting blood, or coffee-ground materials.
• Passing of black, or "tarry" stools.
• Loss of appetite/weight without known reason.
• Change in bowel habits.
• Passing of stool with blood.

Are there any risks involved in endoscopy?
Theoretically, there is a minute risk of injury to your gastrointestinal tract during the endoscopic examination. However, this risk is extremely small, less than 1 per 10000, i.e. less than 1 injury in 10000 endoscopies.

How long does the endoscopy take?
Endoscopy itself is quick and most procedures are done in 10 to 20 minutes. However, in the event that the doctor wants to do a biopsy or some other small procedure, the time taken will be prolonged.

You are advised to set aside 2 to 3 hours for your appointment. This is because of the time that will be taken for registration, waiting for your turn, discharge documents and medication. You should not schedule another appointment afterward.

In the event that you are sedated, you will need to return home immediately to rest.

When will I know my endoscopy result?
The endoscopy result is known immediately as the doctor has direct vision during the procedure. Your doctor will discuss your result with you before you leave the Endoscopy Centre.

If a biopsy is done, the sample is sent to the laboratory for analysis. A biopsy result generally takes a few days and as such, you will know this when you next see your doctor.

Do I have to bring someone with me?
You may come alone. However, it is advisable to have a family member or friend, join you later and accompany you home. This is required if you have sedation for your procedure.

Please note that it will not be safe for you to drive a vehicle if you were given sedation. You may ask someone to drive you, or choose to return home in a taxi.

Is sedation necessary?
Sedation is not compulsory. However, it is generally preferred, as it will make you more comfortable, especially for long procedures. Please feel free to discuss sedation with your doctor before your procedure.

If you have sedation, you will sleep after the procedure in the Recovery bay. There will be nurses who can assist you as needed. When you are awake, and feel that you are ready to get up, you can call the nurse for assistance.

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons.

Contraindications

• Recent attack of acute pancreatitis, within the past several weeks.
• Recent myocardial infarction.
• Inadequate surgical back-up
• History of contrast dye anaphylaxis
• Poor health condition for surgery.
• Severe cardiopulmonary disease.

Risks
The major risk of an ERCP is the development of pancreatitis, which can occur in up to 5% of all procedures. This may be self limited and mild, but may require hospitalization, and rarely, may be life-threatening. Patients at additional risk for pancreatitis are younger patients, patients with previous post-ERCP pancreatitis, females, procedures that involve cannulation or injection of the pancreatic duct, and patients with sphincter of Oddi dysfunction.

Gut perforation is a risk of any endoscopic procedure, and is an additional risk if a sphincterotomy is performed. As the second part of the duodenum is anatomically in a retroperitoneal location (that is, behind the peritoneal structures of the abdomen), perforations due to sphincterotomies are also retroperitoneal. Sphincterotomy is also associated with a risk of bleeding.

There is also a risk associated with the contrast dye in patients who are allergic to compounds containing iodine.