Endoscopy Download Printable Version [PDF] Endoscopy is a medical procedure wher a doctor puts a tube-like instrument into the

body to look inside. There are many types of endoscopy, each of which is designed for looking at a certain part of the body. Here we provide a brief overview of the most common types of endoscopy, including what they are used for and what to expect when you have them. Click on the topics below to get started. What is endoscopy? Endoscopy (en-dahs-kuh-pee) is a medical procedure that uses tube-like instruments (called endoscopes.) These are put into the body to look inside. This procedure is different from imaging tests, like x-rays and CT scans, which can get pictures of the inside the body without putting instruments into it. There are many different kinds of endoscopes, or "scopes." Some are hollow and allow the doctor to look right into the body. Others use fiber optics -- flexible glass or plastic fibers that transmit light. Still others have small video cameras on the end that put pictures on computer screens. Some endoscopes are stiff, while others are flexible. Endoscopes also vary in length. Each type is specially designed for looking at a certain part of the body. Depending on the area of the body being looked at, the endoscope may be put in through an opening like the mouth, anus, or urethra (the tube that carries urine out of the bladder). In some cases, the endoscope is put in through a small cut (incision) made in the skin. Some types of endoscopes and the areas of the body they are used to view are listed below: Type of endoscope Put into Body part or area(s) looked at Name(s) of procedure trachea (windpipe) and bronchoscope bronchoscopy, bronchi (tubes mouth or nose inside the lungs) flexible bronchoscopy colonoscopy, lower endoscopy cystoscopy, cystoscope urethra bladder cystourethroscopy

colonoscope

anus

colon (large intestine)

esophagogastroduodeno -scope mouth hysteroscope vagina cut(s) in the belly (abdomen)

esophagus (swallowing panendoscopy, tube), stomach, and duodenum upper endoscopy, (first part of small intestine) gastroscopy inside of uterus space inside abdomen and pelvis hysteroscopy laparoscopy,

esophagogastroduodenoscopy (EGD),

laparoscope

peritoneal endoscopy

laryngoscope

Larynx (voice mouth or nose box) cut(s) above mediastinum the breastbone (space between (sternum) the lungs) Rectum and sigmoid colon (lower part of large intestine) space between lungs and chest wall

laryngoscopy

mediastinoscope

mediastinoscopy sigmoidoscopy, flexible sigmoidoscopy, proctosigmoidoscopy thoracoscopy, Pleuroscopy

sigmoidoscope (flexible sigmoidoscope) anus

thoracoscope

cut(s) in the chest

When is endoscopy used? Endoscopes were first developed to look at parts of the body that couldn't be seen any other way. This is still a common reason to use them, but endoscopy now has many other uses too. This section will focus on its role in the prevention, early detection, diagnosis, staging, and treatment of cancer. To prevent and screen for cancer Some types of endoscopes can be used to look for cancer in people who have no symptoms. For example, colonoscopy and sigmoidoscopy are used to screen

for colon and rectal cancer. These procedures can also help prevent cancer because they allow doctors to find and remove polyps (growths) that might become cancer if left alone. To find cancer early Endoscopy can sometimes be used to find cancer early, before it has had a chance to grow or spread. Looking for causes of symptoms When people go to their doctor with certain symptoms, endoscopy can sometimes be used to help find a cause. Examples include:

Laryngoscopy to look at the vocal cords in people with hoarseness Upper endoscopy in people having trouble eating

Colonoscopy in people with anemia (low red blood cell counts) with an unknown cause

Colonoscopy in people with blood in their stool

Looking at problems found on imaging tests Imaging tests such as x-rays and CT scans can sometimes show physical changes within the body. But these tests may only give information about the size, shape, and location of the problem. Doctors can use endoscopy to see more details, like color and surface texture, when trying to find out what's going on. To diagnose and find out the stage (extent) of cancer To get a tissue sample Going one step further, most types of endoscopes have tools on the end that allow the doctor to remove small tissue samples. This is called biopsy (buy-opsee). Samples can be taken from any areas of concern. They are then looked at under a microscope or tested in other ways to know for sure if cancer is present. A biopsy is usually the best way to find out if a growth or change is cancer or something else. Getting a closer look In some cases endoscopes are used to help find out how far a cancer may have spread. Thoracoscopy and laparoscopy can be very useful in finding out whether certain cancers have spread into the chest (thorax) or belly (abdomen). They let the surgeon look into these places without making a large cut (incision) in the skin.

To get better pictures Some types of endoscopy can help get better, more detailed imaging tests. This can be especially helpful when trying to find the stage (extent) of cancer within the body. Endoscopic ultrasound (EUS): Ultrasound is an imaging test in which a wand (called a transducer) is moved over the skin. The transducer sends sound waves into the body. The waves bounce back in a pattern that a computer can use to make a picture. Endoscopic ultrasound (EUS) is a procedure in which a small transducer on the tip of an endoscope is put into the mouth or rectum. By putting the transducer on the tip of the endoscope, it can get closer to an organ or tumor to take more detailed pictures. EUS is used to get information about problems in the digestive tract and nearby organs. EUS can be used to see how deep a tumor may have grown into the rectum or esophagus, or into a nearby organ like the pancreas. It can also help show whether lymph nodes are swollen, which means they may have cancer in them. EUS is proving useful in staging some lung, digestive tract (esophagus, stomach, pancreas, etc.), and other cancers. EUS can also help a doctor guide a needle into a lymph node or other area of concern to do a biopsy. Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a complex procedure that helps doctors diagnose problems in the pancreas, gall bladder, or liver. In this procedure, an endoscope is passed down the throat, through the stomach, and into the first part of the small intestine. The doctor then guides a very small tube at the end of the endoscope into the common bile duct, which connects the intestine with the pancreas. A small amount of dye (contrast material) is pushed in, and x-rays are taken. This dye helps outline the bile ducts and pancreatic duct. The x-rays can show whether ducts are narrowed or blocked, which might be caused by a gallstone or a cancer. The doctor doing this test can also put a small brush through the tube to take some cells for biopsy. To treat cancer Destroying cancer cells Endoscopes can be used to remove or destroy small cancers. Small instruments passed through an endoscope can be used to cut out small growths. Some forms of endoscopy allow doctors to use tools like a cautery or laser through the tip of the endoscope to burn or vaporize growths. Surgery to take out cancer Over the last decade or so, a many types of endoscopic tools have been developed to let doctors perform minimally invasive surgery. This type of surgery is sometimes called "keyhole" surgery. When it is used for the belly (abdomen), it is called laparoscopic surgery. Instead of making one long surgical cut (incision), several small cuts are made in the skin -- usually in the chest or abdomen. Long, thin instruments are then put through the cuts or "holes" to reach the inside of the

body. A video endoscope (thoracoscope or laparoscope) is put through one of the holes so that the surgeon can see inside during the operation. This type of surgery is sometimes used to treat small cancers of the lung (this is called video-assisted thoracoscopic surgery, or VATS). It can also be used for colon (called laparoscopic colectomy), prostate (called laparoscopic radical prostatectomy), and some other organs, but not all doctors agree on whether keyhole surgery is better than regular surgery. There are benefits to keyhole surgery. There is generally less blood loss during the operation. Patients often recover faster and with less pain because the cuts are much smaller than in regular surgery. Some forms of keyhole surgery use robotic arms, which a surgeon controls from a console. This better magnifies the area so more precise work can be done with tiny, delicate surgical instruments. Keyhole surgery also has some drawbacks. It takes longer for doctors to learn. It usually involves more time in the operating room and more drugs to keep the patient asleep (more time under anesthesia). It also takes away the surgeon's ability to feel organs for problems that they may not be able to see. Most studies done so far have not found keyhole surgery to be any less effective than regular "open" surgery, at least in the short term. But as of yet there are no studies to show that the long-term outcomes are the same. If you are thinking about some type of minimally invasive or keyhole surgery, it is important to understand the known benefits and risks. It is also important to find out what is not yet known about the procedure. If you decide on keyhole surgery, be sure your doctor has a lot of experience and is skilled with the technique. What is the procedure like? There are many different types of endoscopy procedures, and the experience of having an endoscopy can vary a lot from one type to the next. The table below shows some of the key facts of the more common forms of endoscopy. It does not include minimally invasive surgeries. Special preparation Usually done in (usually starting an operating Usual type of About how the night before) room? anesthesia* long it takes local and sedation or general 30 min to 2 hours

Type of endoscopy

bronchoscopy

fasting+

no

laryngoscopy upper endoscopy

fasting+ fasting+

no no

15 min to 1 local or generalhour local and 15 to 30 min

sedation liquid diet, laxative/enema liquid diet, colonoscopy cystoscopy mediastinoscopy thoracoscopy laxative/enema fasting+ fasting+ fasting+ no sometimes yes yes mild sedation 30 to 60 min local or general15 to 30 min general general 1 to 2 hours 2 to 3 hours 20 min to 1 hour no usually none 15 to 30 min

flexible sigmoidoscopy

laparoscopy

fasting+

yes

general

+ Fasting means not eating for a certain amount of time before the procedure *Anesthesia is the use of drugs to make you sleepy and not feel anything during a procedure. Local means the area the scope is passed through is numbed and you are awake Sedation means you are awake, but drugs are used to make you sleepy and relaxed. General means drugs are used to put you into a deep sleep. It's important to keep in mind that there may be more than one way to do some procedures. For example, bronchoscopy and laryngoscopy can be done with either a flexible or rigid scope. Local anesthesia (numbing the area) is generally used for flexible scopes, while rigid scopes often require general anesthesia (where you are given drugs to put you into a deep sleep). Each person's experience may also vary depending on the person's health and what needs to be done (such as whether biopsy samples are going to be taken). If you are going to have an endoscopy, your health care team will explain to you what will be done and what to expect before, during, and after the test. They will also tell you what you need to do to prepare for the procedure. The preparation may mean that you must fast (not eat anything) for a certain amount of time, follow a liquid diet for a certain amount of time, or use laxatives or enemas. Newer types of endoscopy

In recent years, researchers have developed other ways of using an instrument to look inside the body. These methods are often referred to as newer forms of endoscopy, but they don't involve putting tubes into the body. Capsule endoscopy Doctors can reach much of the digestive tract using upper endoscopy or colonoscopy. But most of the 20 feet or so of small intestine can't be seen this way. Cancers in this area are rare, but tumors and other problems such as ulcers can develop here. One way to look at this area is to use capsule endoscopy. To do this, a person swallows a capsule (about the size of a large vitamin pill) that contains a light source and a tiny camera. Like any other pill, the capsule goes through the stomach and into the small intestine. It travels through the small intestine (usually over the course of about 8 hours) and takes thousands of pictures. These pictures are sent to a device worn around the person's waist, while he or she goes on with normal daily activities. The pictures can then be downloaded onto a computer, where the doctor can look at them as a video. The capsule passes out of the body during a normal bowel movement and is flushed away. This technique may help find the source of bleeding, pain, or other symptoms that may be coming from the small intestine. But it's not useful for looking at the colon or other parts of the body. Because it costs a lot, you will need to find out if your insurance company will cover it. Virtual endoscopy Technically, virtual endoscopy is an imaging test rather than endoscopy. It uses a special CT scan to look at the inside surfaces of organs such as the lungs (virtual bronchoscopy) or colon (virtual colonoscopy, also called CT colonography). Patients have the procedure just as they would any other CT scan -- they lie still on a table while a large ring (the CT scanner) passes over the part of the body being imaged. Unlike normal CT scans, which make pictures in 2 dimensions, virtual endoscopy uses a computer to combine many images to create a 3-dimensional (3-D) picture. Doctors can even use the images to create a black and white "flythrough" view on the screen, which looks a lot like it would if they were doing an actual endoscopy. Virtual endoscopy has some advantages over standard endoscopy -- nothing is put into the body and no drugs are needed for the test. It also allows the doctor to change the angle or magnify the image, which can help with diagnosis. But there are some disadvantages, too. Virtual endoscopy does show good detail, but it's not quite as good at showing fine detail as standard endoscopy. (For example, it can't show color differences.) It also exposes the patient to some radiation -- about the same amount as a standard CT. And because nothing is

put into the body, the doctor can't take biopsy samples or remove growths. This means that if something abnormal is found, the patient may still need a standard endoscopy. Virtual endoscopy is still a fairly new procedure, and doctors aren't yet sure how best to use it. It will likely be used more in the future as the technology continues to improve.