Endoscopy

I perform endoscopy in every hospital I attend and in some stand-alone endoscopy centres. Each centre has slightly different fee structures so please clarify this with reception staff at my rooms or at the endoscopy centre in question.

UPPER ENDOSCOPY:

Gastroscopy / oesophagogastroscopy

This procedure is for evaluation of the oesophagus, stomach and duodenum.

Diseases such as peptic ulcer disease, gastro-oesophageal reflux disease[GORD], Barretts oesophagus are evaluated with this test. Investigation of abdominal pain, anaemia, nausea and vomiting is with this test often.

The preparation of this test requires a fasting period only. Certain anticoagulants and diabetic medications should be ceased prior to this test so please check with booking staff or myself.

This is a very safe and generally rapid procedure. The commonest problem I have seen is aspiration of some fluid irritating the voice box and sometimes causing spasm of the voice box making it difficult to breath.

This is why we always do this test with a doctor trained in anaesthetics who manages the airway.

LOWER ENDOSCOPY:

Colonoscopy

This procedure is for evaluation of symptoms and diseases of the colon. Altered bowel habit, rectal bleeding and unexplained abdominal pain are common indications. Follow up colonoscopy is often done if you have a history of polyps in the bowel, a history of bowel cancer in the past, or a family history of bowel cancer.

The preparation is more involved than gastroscopy. The colon needs to be cleansed with a bowel preparation prior to the procedure. If the bowel preparation is unsatisfactory then the procedure is generally unsatisfactory and must be repeated.

The preparation must be taken in advance of the procedure. Once the preparation is started, NO SOLID FOOD must be eaten UNTIL AFTER THE PROCEDURE.

Once the preparation is begun, as well as the preparation, you are allowed, MODERATE AMOUNTS OF CLEAR FLUIDS until you fast for your procedure.

Again certain diabetic tablets and anti-coagulants must be ceased prior to your procedure, so please check with the booking staff or myself. You will be given detailed instructions on your bowel preparation as part of the booking process.

Colonoscopy has 2 main risks associated with it. Bleeding can occur after a polyp has been removed. Immediate or primary heamorrhage is uncommon and can usually be controlled with diathermy[electrocautery] or clipping at the time.

Bleeding is more likely to occur in a delayed fashion at about 5 days after polyp removal. If you experience moderate or large volume bleeding at this time you must immediately go to a large hospital emergency centre for treatment. Treatment is often resuscitation only treatment, where once you are stabilized, no further bleeding occurs. Very rarely re-colonoscope and clipping or even surgery can be required to stop the bleeding. This complication can occur at a rate of approximately 1:500 if there is a polyp taken.

The other complication is colon perforation. This thankfully rare but very serious. If you experience significant pain after colonoscopy then this complication needs to be ruled out.

You must let medical staff know if you have any pain when you wake up after the procedure. If after assessment there is a possibility that a bowel puncture has occurred treatment with antibiotics and investigation with X-Rays and scanning will often take place. If your condition worsens/fails to improve/or you deteriorate in your nursing observations, urgent surgery is required to close the puncture. This could be done simply but in some cases a stoma-bag is placed is part of your surgery.

The risk of this complication is varied in the literature but most experienced endoscopists will see this only 1:3000.