What is an endoscopy?
Endoscopy is a general term for a medical procedure that uses an endoscope. An endoscope is a small, tube-like instrument that is inserted into the body through a tiny incision or a body opening. It has a lighted camera that sends pictures of the inside of your body to a video screen. Doctors use endoscopic therapy to diagnose and treat many conditions. Common examples include peptic ulcers, appendicitis, colon polyps, and endometriosis.
Endoscopic procedures are minimally invasive procedures because the endoscope is inserted into the body through a small incision or an opening in the body, such as the mouth or anus. You may have other options to diagnose or treat your condition. Consider getting a second opinion about all of your treatment choices before having an endoscopy.
Types of endoscopy
The types of endoscopy procedures include:
Arthroscopy examines and treats the joints. It involves inserting an endoscope through a small incision near a joint.
Bronchoscopy examines and treats the airways and lungs. It involves inserting an endoscope through the mouth or nose into the windpipe and lungs.
Colonoscopy and sigmoidoscopy examine and treat the large intestine. These procedures involve inserting an endoscope into the large intestine through the anus.
Cystoscopy and ureteroscopy examine and treat the urethra, bladder and ureters of the urinary system. These procedures involve inserting an endoscope through the urethra and into the bladder and possibly the ureters.
Laparoscopy examines and treats the abdomen or pelvis. It involves inserting an endoscope through a small incision in the abdominal or pelvic area.
Upper gastrointestinal endoscopy examines and treats the esophagus, stomach and duodenum, the first section of the small intestine. If only the esophagus is involved, it is called an esophagoscopy. If all of these organs are involved it is called an esophagogastroduodenoscopy (EGD).The procedure is performed by inserting an endoscope through the mouth into the esophagus and possibly the stomach and duodenum.
Why is an endoscopy performed?
Your doctor may recommend endoscopy to diagnose and treat a variety of diseases, disorders and conditions. A common reason to have an endoscopy is to take a tissue biopsy. A biopsy involves removing samples of tissues to examine for disease or malignancy.
Other reasons for endoscopy include:
Abdominal, gynecologic and pelvic organ conditions, such as abdominal pain, hernias, appendicitis, infertility, gallbladder disease, spleen trauma, uterine fibroids, endometriosis, ovarian cysts, ectopic pregnancy, pelvic inflammatory disease, chronic pelvic pain, and abdominal or pelvic tumors or cancer.
Joint and orthopedic conditions, such as acute or chronic joint injuries and pain, joint inflammation, torn cartilage or ligaments, rotator cuff conditions, carpal tunnel syndrome, chronic dislocations, and loose bone or cartilage.
Lower gastrointestinal conditions, such as anemia, lower abdominal pain, colon polyps, colorectal cancer screening, rectal bleeding or bloody stools, and intestinal diseases, such as diverticulosis and diverticulitis (intestinal pockets that can develop over time and become infected).
Lung and airway conditions, such as lung abscess, lung cancer or tumor, coughing up blood, foreign object, fluid or substance in the airway, airway infections, chronic cough, atelectasis (lung collapse), and interstitial lung disease (inflammation of deep lung tissues).
Upper gastrointestinal (GI) conditions, such as upper abdominal pain, vomiting blood, difficulty swallowing, gastric reflux, anemia, tumors, polyps, foreign objects, esophageal varices, esophageal cancer, and peptic ulcers.
Urinary system conditions, such as kidney stones, pelvic pain, enlarged prostate, urethral stricture, abnormal cells in urine, frequent urinary tract infections, and painful, frequent, or bloody urination.
Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on an endoscopy.
Who performs an endoscopy?
Doctors and surgeons who perform endoscopies are specialized in a specific area of medicine and type of endoscopy procedure. They include:
Critical care medicine doctors specialize in the diagnosis and management of life threatening conditions.
Gastroenterologists are internists or pediatricians who specialize in diseases of the digestive system.
General and pediatric surgeons specialize in the surgical care of diseases, injuries and deformities affecting the abdomen, breasts, digestive tract, endocrine system and skin.
Obstetricians-gynecologists (Ob/Gyns) specialize in conditions and diseases of the female reproductive systems.
Orthopedic surgeons specialize in diseases and conditions of the bones and joints.
Pulmonologists are internists or pediatricians who specialize in lung diseases.
Thoracic surgeons specialize in chest surgery.
Urologists and pediatric urologists specialize in diseases of the urinary and reproductive systems.
How is an endoscopy performed?
Your endoscopy will be performed in a doctor’s office, hospital, or outpatient surgical setting. Some types of endoscopy use sedation or nerve block anesthesia. Some procedures are more complex and require general anesthesia and a hospital stay.
The endoscopy technique varies depending on the procedure, your symptoms or diagnosis, and other factors. Endoscopies are performed by inserting the endoscope through a small incision or through an opening in the body, such as the mouth. Types of endoscopy include:
Arthroscopy involves inserting an endoscope through a small incision near a joint. It is performed by an orthopedic surgeon. It uses a general, spinal, or local anesthetic, depending on the type of procedure.
Bronchoscopy involves inserting an endoscope through the mouth or nose into the windpipe and lungs. It is done by a pulmonologist, a specialist in lung diseases, or a thoracic surgeon (chest surgeon). The procedure is often performed using sedation, and a local anesthetic will be given to relax the throat. In some cases, generally anesthesia may be necessary.
Colonoscopy and sigmoidoscopy involves inserting an endoscope into the large intestine through the anus. They are generally performed by a gastroenterologist, a specialist in diseases of the digestive system. A sedative is often used to reduce anxiety and discomfort.
Cystoscopy and ureteroscopy involve inserting an endoscope through the urethra and into the bladder and possibly the ureters. These procedures are generally completed by a urologist, a specialist in diseases of the urinary and reproductive systems. A local anesthetic is used to numb the urethra.
Laparoscopy involves inserting an endoscope through a small incision in the abdominal or pelvic area. It 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 endoscopy involves 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. A local anesthetic may be used to numb the throat.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may have discomfort with some procedures. Your doctor will treat your pain or discomfort. Tell your care team if you are uncomfortable in any way.
You will have one or more of the following medications to keep you comfortable during endoscopy:
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Pain medication is given intravenously (through an IV) or orally.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
Sedation is usually given through an IV. It makes you drowsy and relaxed. In some cases, deeper sedation may be used, called conscious sedation. It makes you more relaxed. Patients who have conscious sedation are usually unaware of the procedure and may not remember it.
Topical anesthesia is applied to the surface of the skin or mucosa. Examples include gargling or spraying the throat with an anesthetic to help numb it and reduce the gag reflex.
What are the risks and potential complications of an endoscopy?
As with all surgeries, endoscopy involves risks and the possible complications. Complications are uncommon but may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of endoscopy
Complications of endoscopy include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Perforation or tear of the local tissue
Potential complications of specific endoscopy procedures
Potential complications are related to the type of endoscopy:
Arthroscopy can result in blood clots, severe swelling of the joint, and nerve or blood vessel damage.
Bronchoscopy can result in sore throat, hoarseness, fever, pneumonia, and pneumothorax (collapsed lung).
Colonoscopy and sigmoidoscopy can result in nausea, vomiting, rectal discomfort, bloating, puncture of the large intestine, bleeding, and dehydration due to taking enemas and laxatives before the procedure.
Cystoscopy and ureteroscopy can result in bloody urine and urinary tract infection.
Laparoscopy can result in blood vessel or organ damage, which may require further surgical repair.
Upper gastrointestinal endoscopy can result in puncture of the upper gastrointestinal tract, difficulty swallowing, bleeding, and sore throat.
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during your recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my endoscopy?
You are an important member of your own healthcare team. The steps you take before your surgery can improve your comfort and outcome and help obtain the most accurate test results.
You can prepare for an endoscopy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following preoperative instructions, such as not eating or drinking before a procedure, or taking a laxative or enema as directed
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), certain vitamins, diabetes medications, and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Having an endoscopy can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before endoscopy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need an endoscopy? Are there any other options for diagnosing or treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain?
When will I get the results of my test or tissue biopsy?
When should I follow up with you?
When and how should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my endoscopy?
Knowing what to expect after an endoscopy can help you get back to your everyday life as soon as possible.
How will I feel after the endoscopy?
What you experience after endoscopy will vary depending on the procedure, your health history, and other factors.
You will have discomfort or pain after some procedures. Be assured that modern pain control methods are very effective. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
You might feel drowsy for about 24 hours if you had narcotic pain medications, a sedative, or general anesthesia. You may also have some nausea. Tell your doctor or care team if you are nauseated so it can be treated.
You may have some numbness for a short period after endoscopic therapy with regional or local anesthesia (nerve block). Tell your doctor or care team if you feel numbness longer than expected for your particular procedure.
When can I go home?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will go home the same day as an outpatient procedure. You will be drowsy and cannot drive for 24 hours. You will need a ride home, and someone should stay with you for the first day.
A hospital stay may be required after extensive procedures, such as some types of arthroscopy, bronchoscopy, and laparoscopy.
When should I call my doctor?
It is important to keep your follow-up appointments after an endoscopic therapy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding, including bloody or black stools, rectal bleeding, or vomiting blood
Bloody urine or difficulty urinating, especially if it increases after you get home or does not go away as expected
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Cough that does not go away
Fever. You should not have a fever after a minor endoscopic procedure, but a low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after a major laparoscopic surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Sore throat or hoarseness that lasts longer than expected
Unexpected drainage, pus, redness or swelling of your incision