ENDOSCOPY: Types, Indications & Complications

 

Introduction

Video endoscopes provide high-definition imaging and accessories can be passed down the endoscope to allow both diagnostic and therapeutic procedures.

Endoscopes with magnifying lenses allow almost microscopic detail to be observed, and imaging modalities, such as confocal endomicroscopy, autofluorescence and ‘narrow-band imaging’, are increasingly used to detect subtle abnormalities not visible by standard ‘white light’ endoscopy.

TYPES

Upper gastrointestinal endoscopy

This is performed under light intravenous benzodiazepine sedation, or using only local anaesthetic throat spray after the patient has fasted for at least 4 hours. With the patient in the left lateral position, the entire esophagus (excluding pharynx), stomach and first two parts of duodenum can be seen.

Indications

• Dyspepsia in patients > 55 years of age or with alarm symptoms
• Atypical chest pain
• Dysphagia
• Vomiting
• Weight loss
• Acute or chronic gastrointestinal bleeding
• Screening for esophageal varices in chronic liver disease
• Abnormal CT scan or barium meal
• Duodenal biopsies in the investigation of malabsorption and confirmation of a diagnosis of coeliac disease prior to commencement of gluten-free diet
• Therapy, including treatment of bleeding lesions, banding/injection of varices, dilatation of strictures, insertion of stents, placement of percutaneous gastrostomies, ablation of Barrett’s esophagus and resection of high-grade dysplastic lesions and early neoplasia in the upper gastrointestinal tract

Contraindications

• Severe shock
• Recent myocardial infarction, unstable angina, cardiac arrhythmia
• Severe respiratory disease
• Atlantoaxial subluxation
• Possible visceral perforation

Complications

• Cardiorespiratory depression due to sedation
• Aspiration pneumonia
• Perforation

 

Endoscopic ultrasound

Endoscopic ultrasound (EUS) combines endoscopy with intraluminal ultrasonography using a high-frequency transducer to produce high-resolution ultrasound images.

Indications

• Helpful in the diagnosis of pancreatic tumours, chronic pancreatitis, pancreatic cysts, cholangiocarcinoma, common bile duct stones, ampullary lesions and submucosal tumours.
• Plays an important role in the staging of certain cancers, e.g. those of oesophagus and pancreas.
• EUS can also be therapeutic, as in drainage of pancreatic fluid collections and coeliac plexus block for pain management.

Complications

• Bleeding
• Infections
• Cardiopulmonary events
• Perforation

 

Capsule endoscopy

Capsule endoscopy uses a capsule containing an imaging device, battery, transmitter and antenna; as it traverses the small intestine, it transmits images to a batterypowered recorder worn on a belt round the patient’s waist. After approximately 8 hours, the capsule is excreted. Images from the capsule are analysed as a video sequence and it is usually possible to localise the segment of small bowel in which lesions are seen. Abnormalities detected usually require enteroscopy for confirmation and therapy

Indications

• Obscure gastrointestinal bleeding
• Small bowel Crohn’s disease
• Assessment of coeliac disease and its complications
• Screening and surveillance in familial polyposis syndromes

Complications

• Capsule retention (< 1%)

 

There are also forms of endoscopy included;

Double balloon enteroscopy, Sigmoidoscopy and colonoscopy, Magnetic resonance cholangiopancreatography, and Endoscopic retrograde cholangiopancreatography.