The ins and outs of endoscopies
Posted on 16 January 2015
Dr Naayil Rajabally, a gastroenterologist at Mediclinic Constantiaberg, answers FAQs on endoscopies, which can be life-saving procedures.
1. When would one need an upper gastrointestinal endoscopy (UGI) check-up?
A UGI is commonly referred to as a gastroscopy and is performed to examine the upper part of your gastro-intestinal tract. Your doctor will pass a gastroscope through your mouth, down your oesophagus towards your stomach and then into the first part of the small bowel. Some of the common reasons for having a gastroscopy include dyspepsia, recurrent heartburn, persistent nausea and vomiting, unexplained weight loss and chronic diarrhoea, to name a few. A UGI is the best way to pick up gastric or duodenal ulcers, detect Helicobacter pylori (H. pylori, a bacterial infection) and Barrett’s oesophagus (a complication of chronic gastro-oesophageal reflux disease).
2. Are there any risk factors that should make certain people be careful about getting the test?
Yes, if there is a history of bowel cancer in a family. This is particularly important in the case of colorectal cancer (where screening is done via colonoscopy) where there is a significant genetic risk in family members. The same applies to gastric cancer, but this is less common. Indeed, screening for gastric cancer is done via gastroscopy.
3. At what age and how often should one get a UGI done?
There is no set age for a gastroscopy. If there are troublesome symptoms present, it is advisable to get a check-up.
4. Should one get a colonoscopy check-up at the same time?
A colonoscopy is an examination of the large intestine. This is the area where polyps develop and some of these have malignant potential. The American and European Gastroenterology Societies have endorsed screening colonoscopy at the age of 50 in people at average risk of developing colorectal cancer. However, if there is a family history of colorectal cancer, the first-degree relatives should have their screening colonoscopy 10 years earlier than the index case. Therefore, if you are close to 50 or if you have a family history of colorectal cancer or even colonic polyps, it would make sense to do both gastroscopy and colonoscopy at the same time.
5. How long does the procedure take – and is it painful?
A gastroscopy is quick and painless. Some patients have a fear of choking when the flexible scope is close to the pharynx, but this subsides quickly when the scope passes beyond that point. An endoscopy is generally performed under conscious sedation or deeper sedation, but an anaesthetist has to be present for the latter.
6. Are there any alternative tests?
As gastroenterologists, we can now visualise any part of the gut including the small bowel, which is about six to eight metres in length, by using a capsule endoscopy. As the name implies, there is a camera in a capsule, which is slightly larger than a conventional antibiotic capsule. The patient swallows this and it travels to the small bowel, taking four to six frames per second. The images are stored in a data recorder and then converted to a movie with specialised software. In this way, if there is a lesion in the small bowel, it can be detected non-invasively and dealt with appropriately.
See the summer issue of Mediclinic Family magazine for more info on taking the test!