What is Endoscopy?
An endoscopy is a procedure in which doctors insert a device called an endoscope inside your body to view and take pictures of your internal organs and other structures.
An endoscope is a long, thin, flexible tube that typically has a light and special camera attached at its tip. When it is placed inside your body, the endoscope allows your doctor to see images of your internal organs and other body parts on a computer monitor.
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Many endoscopes are available to detect problems in the digestive system, respiratory system, joints, urinary and reproductive organs, and more. Endoscopy is a safe procedure that can give your healthcare team valuable information about what’s going on inside your body.
How Is Endoscopy Used to Diagnose Diseases?
Endoscopy procedures give your healthcare providers the opportunity to directly visualize different organs and structures in your body. Endoscopy of the digestive tract can be used to:
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Find the cause of unexplained symptoms such as stomach pain, nausea, vomiting, heartburn, chest pain, difficulty swallowing, gastrointestinal bleeding (coffee grounds vomit (blood in vomit) or blood in stool), and weight loss that are indicative of digestive issues.
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Diagnose conditions that can cause diarrhea, inflammation, bleeding, and cancer by obtaining tissue samples (biopsies).
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Treat conditions and perform surgery by passing instruments through the endoscope. For example, doctors can stop internal bleeding, seal wounds, open blockages, remove tissue, remove swallowed objects, clip polyps, or widen a narrowed esophagus.
Types of Endoscopy
There are many different types of endoscopy, but the goal of each is to give your doctor access to examine different parts of your body with a scope.
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Anoscopy- Examines your anus and rectum.
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Arthroscopy- Examines your joints.
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Bronchoscopy – Examines the trachea and lungs via your nostrils.
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Colonoscopy- Examines the entire large intestine.
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Cytoscopy- Examines your bladder via your urethra (the tube that permits pee to flow out of your body).
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Enteroscopy- Examines your small intestine via your mouth or anus.
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Esophagogastroduodenoscopy- Examines your upper GI tract.
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Hysteroscopy- Examines your uterus via the vagina.
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Laparoscopy- Examines your abdominal and reproductive organs.
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Laryngoscopy- Examines your larynx or voice box via your mouth or nostrils.
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Mediastinoscopy- Examines your heart, esophagus, and windpipe.
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Neuroendoscopy- Examines your brain via an incision in your skull
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Proctoscopy- Examines your anus and rectum.
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Sigmoidoscopy- Examines the lower part of your colon and your rectum via the anus.
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Thoracoscopy- Examines your lungs and the area surrounding your lungs via your chest
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Ureteroscopy- Examines the tubes that connect your kidneys to your bladder via your urethra
For the purposes of this article, we will go more in-depth with endoscopy and diagnoses of gastrointestinal diseases such as esophagogastroduodenoscopy and colonoscopy.
Upper GI Endoscopy vs Lower GI Endoscopy
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Upper gastrointestinal endoscopy, also called upper GI endoscopy, upper endoscopy, or esophagogastroduodenoscopy (EGD), is a procedure in which a gastroenterologist inserts an endoscope through your mouth to visualize your upper digestive tract (esophagus, stomach, and duodenum or the upper part of the small intestine).
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Lower gastrointestinal endoscopy, also called lower GI endoscopy, lower endoscopy, or colonoscopy, is a procedure in which a gastroenterologist inserts an endoscope called a colonoscope through your anus to visualize your rectum and colon (large intestine).
A combined upper GI endoscopy and colonoscopy allows your doctors to see the entire length of your digestive tract.
Find out: “The Difference Between a Prostate Exam vs. Colonoscopy”
Common Conditions Diagnosed by Upper GI Endoscopy
Esophageal Conditions
The esophagus is the tube that connects your mouth to your stomach. Your gastroenterologist can do an upper GI endoscopy to diagnose esophageal conditions such as:
GERD, Esophagitis, and Barrett’s Esophagus
Gastroesophageal reflux disease (GERD) occurs due to chronic reflux of stomach acid into the esophagus. An upper GI endoscopy allows your doctor to visualize the inside of your esophagus and stomach.
Although it does not show acid reflux occurring, an upper GI endoscopy can show signs of acid reflux, such as inflammation of the esophagus (esophagitis). In addition, your gastroenterologist can collect a tissue sample (biopsy) to check for complications of GERD, such as Barrett’s esophagus (changes in the lining of the esophagus).
Esophageal Strictures
An esophageal stricture is an abnormal narrowing of the esophagus that can cause trouble swallowing. Your doctor can dilate (stretch) your esophagus during upper endoscopy if they see an esophageal stricture.
Esophageal Varices
Esophageal varices are enlarged veins in the esophagus that develop in people with severe liver diseases. An upper GI endoscopy can be done to look for dilated veins and red streaks in the veins, which indicate a risk of bleeding. Treatment can be done during the upper GI endoscopy – this is called endoscopic band ligation, where the veins are “strangled” by an instrument attached to the endoscope to prevent bleeding.
Stomach and Duodenal Conditions
An esophagogastroduodenoscopy (EGD) or upper endoscopy can be done to diagnose and treat conditions affecting the stomach and duodenum (the initial part of the small intestine). For example:
Peptic Ulcers
A peptic ulcer is an open sore in the lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer). You may seek medical care for peptic ulcers due to symptoms such as abdominal pain, heartburn, and nausea.
An upper endoscopy can detect an ulcer and allow your gastroenterologist to take a tissue biopsy for examination in the lab. This can help to identify if a bacteria called Helicobacter pylori (H. pylori) is the cause of the ulcer. A follow-up endoscopy may be done after treatment to make sure the peptic ulcer has healed.
Hiatal Hernia
Hiatal hernia is a condition in which the upper part of the stomach bulges through the diaphragm (the muscle that separates the abdominal and chest cavity). A hiatal hernia can be diagnosed with an upper GI endoscopy and other procedures such as barium swallow (X-ray) and esophageal manometry.
Gastritis
Gastritis is an inflammation of the inner lining of the stomach. It can occur due to H. pylori infection, overuse of painkillers (nonsteroidal anti-inflammatory drugs) such as ibuprofen and naproxen, excessive alcohol use, cancer treatments, and autoimmune diseases, among other causes. An upper endoscopy can be done to look for signs of inflammation and obtain a biopsy to detect H. pylori.
Celiac Disease
Celiac disease is a genetic condition that causes chronic digestive problems. When people with celiac disease eat gluten (a protein found in grains such as wheat and barley), their body has an abnormal immune reaction, causing damage to the lining of the small intestine and preventing the absorption of nutrients. An upper endoscopy procedure can be done to diagnose celiac disease by obtaining a biopsy (tissue sample) for examination in the lab.
Other Conditions Detected by Upper Endoscopy Procedures
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Infections of the upper GI tract.
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Gastrointestinal bleeding in the upper GI tract.
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Benign (non-cancerous) and malignant (cancerous) tumors.
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Damage caused by swallowing caustic (harmful) substances, such as chemicals.
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Crohn’s disease of the upper GI tract.
What Diseases Can Be Detected by a Lower GI Endoscopy?
Some of the conditions that can be detected with a colonoscopy include:
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Chronic colitis (inflammation of the colon or large intestine). For example, inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.
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Diverticulosis (formation of abnormal pouches called diverticula in the bowel wall) and diverticulitis (inflammation of the diverticula).
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Large bowel obstruction (a blockage in the large intestine).
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Ulcers and perforations in the colon.
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Ischemic colitis (damage to the bowel due to reduced blood flow to the large intestine).
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Colorectal polyps (growths inside the colon or rectum).
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Colorectal cancer.
Procedure Details
Preparation for an upper endoscopy involves:
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Fasting (stopping solid foods 8 hours before and liquids 4 hours before the procedure) so that your stomach is empty during the procedure.
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Stopping certain blood thinning medications for a few days before your upper GI endoscopy (these drugs can increase the risk of bleeding).
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Additional instructions may be given depending on your medical history.
Preparation for a colonoscopy involves:
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Following a special diet (no solid food, only clear liquids, avoid red or orange liquids) the day before the procedure.
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Taking a prescription laxative called a bowel prep the night before the colonoscopy.
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Specific instructions for stopping or adjusting the doses of medications, such as blood thinners.
Read next: “What Foods Can You Eat 2 Days Before A Colonoscopy?”
What to Expect During Upper Endoscopy Procedure
You will lie on your back and have monitors attached to measure your blood pressure, heart rate, and breathing rate. The gastroenterology team will give you medicines through a vein in your arm to help you relax. These drugs cause moderate sedation, and you will remain awake during the procedure. Your doctor may give you a mouth guard to hold your mouth open. They will spray a local anesthetic in your throat to numb it so you don’t feel pain when the endoscope (thin tube) is placed. You may feel pressure in your throat, and you won’t be able to speak during the procedure. But you can breathe normally while the endoscope is in place.
The procedure usually takes 10-30 minutes long as the doctor examines the lining of your upper GI tract.
What to Expect During Colonoscopy Procedure
A colonoscopy can be done using general anesthesia with the placement of a breathing tube, where you are asleep throughout the procedure. However, most endoscopies are done using monitored anesthesia care (sedation and pain medication) where you remain awake. You will lay on a table with your knees drawn up to your chest. Your healthcare team will insert the colonoscope through your rectum and examine the entire length of your colon. They may pump air or carbon dioxide into your colon for better visualization of the bowel wall.
Post-Endoscopy Care
Side effects after an upper endoscopy procedure can include bloating, gas, stomach cramps, and sore throat. Side effects after a colonoscopy may include stomach cramping, an urge to have a bowel movement, and other symptoms. These symptoms are temporary and usually improve over time.
If you receive a sedative during your procedure, you will need someone to drive you home. It’s also a good idea to take it easy for the rest of the day to recover because you may feel tired and not mentally alert for the next 24 hours.
FAQ: Endoscopy and Disease Detection
What Are The Most Common Things Found In Endoscopy?
Some of the most common things found on upper endoscopy are gastroesophageal reflux disease (GERD), peptic ulcers, gastritis, and hiatal hernia. Some of the most common things found on colonoscopy (lower GI endoscopy) are inflammatory bowel disease, colorectal polyps, and colon cancer.
Can An Endoscopy Detect All Stomach Problems?
An endoscopy can detect many stomach problems, but some conditions, including stomach cancer, can be missed. The results of endoscopy are not perfect and depend on the skill of the provider and other factors. Studies show that about 11% of upper gastrointestinal cancers (esophageal cancer or stomach cancer) are missed on upper endoscopy, and up to 6% of colorectal polyps or cancers are missed on colonoscopy.
Can Endoscopy Detect Liver Problems?
An endoscopy does not directly detect liver problems, but it can show signs of liver disease, for example, esophageal varices.
In addition, your healthcare provider can do a procedure such as endoscopic ultrasound (EUS), which combines endoscopy and ultrasound. It is done using an endoscope with an ultrasound device at the tip. This device produces sound waves to create detailed images of gastrointestinal tract organs such as the gallbladder, liver, and pancreas. A needle can be attached to the endoscope to remove fluid, obtain a biopsy, or deliver medicine.
A procedure called endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and X-ray. It can diagnose and treat problems of digestive system organs such as the liver, gallbladder, bile ducts, and pancreas.
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