Endoscopic Therapy

Endoscopic therapy is performed in a doctor’s office, hospital, or outpatient surgical setting by a medical or surgical team led by your doctor. Doctors and surgeons who perform endoscopies are often specialized in a particular area and are proficient in a specific type of endoscopic therapy procedure.

Some types of endoscopic therapy are performed using sedation or nerve block anesthesia. In some cases, such as with some laparoscopic treatments, the procedure is more complex and may require general anesthesia and a stay in the hospital for a few days. The technique used to perform your endoscopic therapy will vary depending on the specific procedure, your symptoms or diagnosis, and other factors. Endoscopic therapies are performed either by inserting the endoscope through a small incision or through an opening in the body, such as the mouth:

• Arthroscopy involves inserting an endoscope through a small incision near a joint and is generally performed by an orthopedic surgeon. An orthopedic surgeon is specialized in diseases and conditions of the bones and joints. It is performed using a general, spinal, or a local anesthetic, depending on the type of procedure.
• Bronchoscopy is performed by inserting an endoscope through the mouth or nose into the windpipe and lungs. It is generally done by a pulmonologist, a specialist in lung diseases, or a thoracic surgeon (chest surgeon). Depending on the specific treatment, the procedure may be performed using general anesthesia or sedation, and a local anesthetic will be given to relax the throat.
• Colonoscopy and sigmoidoscopy involve inserting an endoscope into the large intestine through the anus and are generally performed by a gastroenterologist, a specialist in diseases of the digestive system. A sedative is often used to minimize anxiety and discomfort.
• Cystoscopy and ureteroscopy involves inserting an endoscope through the urethra and into the bladder and possibly the ureters. These procedures are generally performed by a urologist, a specialist in diseases of the urinary and reproductive systems. A local anesthetic is used to numb the urethra.
• Endoscopic retrograde cholangiopancreotography (ERCP) involves inserting an endoscope through the mouth into the esophagus, stomach and duodenum. A sedative is often used to minimize anxiety and discomfort, and a local anesthetic may be used to numb the throat.
• Laparoscopy involves inserting an endoscope through a small incision in the abdominal or pelvic area and is generally performed by an abdominal surgeon, general surgeon, or an obstetrician-gynecologist, a specialist in diseases of the female reproductive system. General anesthesia or sometimes spinal anesthesia is used so that you will not feel pain during the procedure.
• Upper gastrointestinal endoscopic therapy is done by inserting an endoscope through the mouth into the esophagus, stomach, and possibly the duodenum, the first section of the small intestine. It is generally performed by a gastroenterologist. A sedative is often used to minimize anxiety and discomfort, and a local anesthetic may be used to numb the throat.

Will I feel pain?

Your comfort and relaxation is very important to both you and your care team. In some procedures, you may feel brief discomfort.You should expect that sufficient care will be taken so that you stay as comfortable as possible. If you are uncomfortable in any way, tell a member of your healthcare team.

To reduce or eliminate anxiety, pain and discomfort, your endoscopic therapy may be performed using a variety of techniques:

• Pain medication is given intravenously (through an IV) or orally.
• Topical anesthesia is applied to the surface of the skin or mucosa, such as gargling or spraying the throat with an anesthetic to help numb it and reduce the gag reflex.
• Sedation, which is often delivered through an IV, to make you drowsy and relaxed. In some cases, deeper sedation may be used, called conscious sedation, in which you are more relaxed and unaware of the procedure and may not remember it.
• Regional or local anesthesia (also known as a nerve block) is injected around the nerves in the spine (epidural or spinal block) or the peripheral nerves that transmit pain signals from the surgical area. This temporarily eliminates all pain while the endoscopic procedure is performed. During regional or local anesthesia, you will be awake during the procedure.
• General anesthesia is generally a combination of IV medications and gases that are used to put you in a special type of sleep so you are unaware of the procedure and do not feel any pain. In some cases, you may also receive a peripheral nerve block infusion in addition to general anesthesia. This type of anesthesia involves a continuous drip of a liquid anesthetic, which flows through a tiny tube inserted near your surgical site to control your pain during and/or after your treatment procedure.