Topic 42: Mini Invasive (Endoscopic) Surgery, Endoscopic Methods of Examination
Endoscopy – Definition and Overview
Endoscopy is a minimally invasive diagnostic procedure that allows direct visualization of internal organs using a small scope, usually inserted through a natural body opening (e.g. mouth, rectum). It allows:
- Direct viewing of mucosal surfaces
- Biopsy sampling of lesions (for histopathology or cytology)
- Minor therapeutic procedures such as:
- Removal of benign tumors (e.g., polyps)
- Hemostasis during GI bleeding
Types of Endoscopy and Their Indications
1. Upper GI Endoscopy
- Esophagoscopy, Gastroscopy, or Esophagogastroduodenoscopy (EGD)
- Examines: Esophagus, stomach, duodenum
- Indications:
- Upper GI bleeding
- Gastric/duodenal ulcers
- Tumors (e.g., gastric adenocarcinoma)
- Dysphagia
2. Lower GI Endoscopy
- Colonoscopy and Rectoscopy
- Examines: Colon and rectum
- Indications:
- Colorectal cancer screening
- Polyp detection/removal (polypectomy)
- Diverticulosis/bleeding
- Inflammatory bowel disease
3. Other Types
- Bronchoscopy – lungs and bronchi
- Cystoscopy – bladder
- Choledochoscopy – bile ducts
- Endoscopic Retrograde Cholangio -Pancreatography (ERCP):
- Used to visualize bile ducts and pancreatic ducts
- Indicated for: bile duct stones, strictures, cysts
- Risk: pancreatitis, cholangitis
Modern Endoscopic Innovations
Video Capsule Endoscopy
- Wireless capsule with a camera is swallowed by the patient
- Sends images of small intestine to an external device
- Useful for: diagnosing obscure GI bleeding, Crohn’s disease
Endoscopic Ultrasound (EUS)
- Combines ultrasound with endoscopy
- Indicated for:
- Cancer staging (esophagus, pancreas, rectum, lung)
- Pancreatic cyst/mass evaluation
- Submucosal lesions, bile duct stones
Virtual Colonoscopy (CT Colonography)
- Non- invasive CT- based method
- Produces 3D images of the colon
- If suspicious lesions found → traditional colonoscopy needed
Contraindications to Endoscopy
Absolute:
- Shock
- Acute myocardial infarction
- Acute GI perforation
- Peritonitis
- Fulminant colitis
Relative:
- Poor cooperation
- Coma (unless intubated)
- Cardiac arrhythmias
- Recent myocardial ischemia
- On anticoagulants (if biopsy planned, stop beforehand)