Importance of Endoscopy Procedure - Essay Example

ENDOSCOPY Maru Engida Bellingham Technical College Endoscopy permits a physician to look into patient’s body. This procedure helps in the diagnosis of the disease along with its extension and prognosis. Endoscopy is indicated in many gastrointestinal complaints. It has diagnostic and therapeutic value. It has been proved to be the best curative treatment for post surgical bleeding. Endoscopy can be done in outer patient department as well as inner patient department. Procedure times vary depending on the requirements of every patient. There are various types of endoscopies performed by doctors. Patient is back to normal activities within a day’s time after the procedure with usually minimal complications. A lot of new technologies are emerging in the endoscopy field. They are helping physicians to detect cancer like adenomas in very early stages with the good chance of positive recovery. There are many advanced imaging techniques emerging. New methods give better image quality and facilitate faster and accurate diagnosis. Latest high definition endoscopes, self propelled endoscopy technique and infra red laser endoscopy are the key modalities in the current endoscopy world. Endoscopy Introduction Endoscopy is a procedure wherein the doctor looks into the human body with the help of an instrument called “Endoscope”. This endoscope is defined in Merriam-Webster Dictionary as: An illuminated usually fiber- optic flexible or rigid tubular instrument for visualizing the interior of hollow organ or part (such as the bladder or esophagus)for diagnostic or therapeutic purposes that typically has one or more channels to enable passage of instruments such as forceps or scissors (n.p.). Endoscope is attached with the tiny camera to its one end. This camera is either connected to an eyepiece for direct viewing or to a television device for color display. It is inserted in the body passage through mouth, anus or the abdominal wall to view parts of gastrointestinal system from inside. Endoscopy not only helps in diagnosis of many gastrointestinal problems but also helps in treating them (National Institute of Health, 2011). Purpose of endoscopy Endoscopy is advised to diagnose many disease conditions that have affected human digestive system. It is mostly a routine OPD procedure where in upper parts such as esophagus, stomach and duodenum till small intestine or when passed through anus, rectum till the colon of lower of gastrointestinal system is inspected. This procedure helps in taking tissue samples as well as extracting polyp like growths from colon etc (National Institute of Health, 2011). Endoscopy is a therapeutic method that helps in clear viewing of the affected area which is an important step for accurate diagnosis of any disease that eventually reduces further risks of complications. (Mayo Foundation for Medical Education and Research, 2010 &National Institute of Health, 2011). Indications that need Endoscopy Endoscopic procedure is advised to the patients to have a clear concept about the disease state. Endoscope is a portable device and endoscopy can be performed in outer patient department as well as inner patient department. Endoscopy is indicated when the patients complain of any of the following symptoms related to GI tract, Severe heart burn Nausea Severe Vomiting Chest pain Abdominal pain Swallowing difficulty Gastric reflux Severe Anemia Internal bleeding (National Institute of Diabetes and Digestive and Kidney Diseases, 2009). Doctors perform endoscopy in such cases to inspect pathology, to confirm diagnosis and sometimes to receive tissue sample for histopathological examination (National Institute of Diabetes, Digestive and Kidney Diseases, 2009). Endoscopy is also very useful test to diagnose following disease conditions, Inflammations Obstructive pathologies Ulcerative diseases (like gastric or Duodenal) Abnormal growths like tumors and polyps Hernias (National Institute of Diabetes and Digestive and Kidney Diseases, 2009). Endoscopy is more accurate than general x rays in terms of findings and confirming these pathologies. Also, in situation like muscular spasms and ulcerative conditions, doctor may not have clear findings by any other imaging methods (Santacroce & Losacco, 2005). Endoscopy procedure It is either therapeutic or diagnostic procedure where different types of small equipments are made to pass through an endoscope reaching distant places and opening of upper and lower GI tract without much discomfort to the patient. And without any invasive procedure doctor can remove small polyps or any other swallowed object from the tract. Steps of Upper GI Endoscopy Procedure are as follows Patient is asked to lie down on left side with a mouthpiece placed in the mouth Patient is put on sedation. A sterilized and lubricated endoscope is passed through the mouthpiece into the esophagus, then the stomach and further down under video guidance. Meanwhile any saliva collected in the mouth is suctioned. Doctor examines target areas and performs desired actions e.g. inspection, foreign body or polyp removal or biopsy sample taken, etc. In the case of lower GI endoscopy, patient is asked to lie down on left side with hips flexed against abdominal wall. Endoscope is passed through anal opening heading towards rectum till colon. Doctor performs the required inspection and surgical procedure. (Santacroce & Losacco, 2005). After procedure Patient is given rest till he comes out of sedation and then sent home. He is advised rest and light meal. Alcohol and driving is prohibited for one or two days. Patient is asked to consult doctor immediately if any complications such as pain, uneasiness, and reflux symptoms, bowel difficulties, etc. occur (Santacroce & Losacco, 2005). Different types of endoscopy Various types of endoscopic procedures are performed by the specialist nowadays. For example, Colonoscopy – This procedure is recommended to visualize lower part of GI system to rule out colorectal cancer. It is aimed to view colon for any polyp or other abnormal growth. The thin flexible scope with a tiny camera is passed through the anus up into the colon. During the screening if any polyps are found, they will be mostly removed then and there. Early detection of any kind of growths improves the prognosis of the disease state (American Society for Gastrointestinal Endoscopy, 2010). Easophagogastroduodenoscopy or upper endoscopy – Similar to Colonoscopy, EGD is performed to screen the upper GI tract which consists of esophagus, stomach and duodenum. This is mainly indicated in the cases of reflux, swallowing difficulties, gastric or duodenal ulcers etc. Thin, flexible probe with camera is passed gently through the mouth downwards to screen the lining mucosa and to scrape the tissue for biopsy (American Society for Gastrointestinal Endoscopy, 2010). Endoscopic ultrasound – This technique is same as simple Endoscopy however the endoscope will have tiny transducers which emits sound waves that help in accessing condition of the wall of GI system and surrounding structures like gall bladder, bile duct and pancreas etc. Very useful in biopsy cases and very safe method enabling endoscopist to determine the staging of the various gastrointestinal cancers with most accuracy (American Society for Gastrointestinal Endoscopy, 2010). Video capsule endoscopy – This is designed mainly to visualize small regions of GI system where normal endoscopes cannot reach e.g. small intestines. It is small a capsule size thing with a tiny camera. Patient swallows it and it runs through the entire GI tract recording pictures. This helps further in early diagnosis of bowel diseases especially conditions like Crohn’s Disease, bleeding in small intestine, tumors etc. (American Society for Gastrointestinal Endoscopy, 2010). Endoscopic Retrograde Cholangiopancreatography – Endoscopic Retrograde Cholangiopancreatography is performed to see into bile and pancreatic ducts to detect any blockage due to stones or strictures. Once the endoscope reaches Duodenum, catheter is passed through to inject contrast dye into biliary ducts and pancreatic ducts. After that, x-ray is taken which gives a fair idea about the blockage. In case of stone or tumors, they can be removed or another stent (either metal or plastic) is fitted in the duct to broaden the pathway for drainage (American Society for Gastrointestinal Endoscopy, 2010). Sigmoidoscopy – This is performed to examine the lining of rectum and colon in case of polyps, fissures or bleeding. (American Society for Gastrointestinal Endoscopy, 2010). Percutaneous Endoscopic Gastrostomy – Mainly advised in patients who have been restricted to eat or drink or have swallowing difficulty. A small tube is inserted through the abdominal hole with the help of an endoscope to inject food directly into stomach for nourishment (American Society for Gastrointestinal Endoscopy, 2010). New Advancement in the field of endoscopy Gastrointestinal Endoscopy is coming up with a lot of improved versions. Many new techniques have been emerging worldwide along with refinement in its current optical features to add up its diagnostic value helping every step for better results. This is getting furthermore useful in the early detection of neoplasia. Advanced functional and molecular imaging techniques are able to provide new diagnostic tools, helping physicians to define prognosis and to plan the outcome of further therapy plan. (Kiesslich, Goetz, Hoffman & Galle, 2011). Here is the summery of some new advancement in imaging technologies emerging in the field of gastrointestinal endoscopy, 1. High resolution and magnifying endoscopy -This is much better than the old style, showing distinctly clear images helping to locate even smallest adenomas (Kiesslich, Goetz, Hoffman & Galle, 2011). 2. Conventional and Digital or virtual Chromo endoscopy- It is a method to apply different stains with the dyes in the conventional style and in the latest virtual style with different lights. Dyes are placed on the surface of the mucosa. Different stains help to differentiate mucosal lesions and altered vessel architecture reporting early signs of neoplasia (Kiesslich et al., 2011). 3. Light scattering spectroscopy-It is a type of reflectance spectroscopy. Dense portions of tissue structures like nucleus scatters illuminated light to different degrees. This study helps to locate early neoplastic changes in the tissue morphology (Kiesslich et al., 2011). 4. Optical coherence tomography- It is a new technique offers in vivo imaging of intact mucosal layer during the procedure. This process is far better than conventional cytology. (Kiesslich et al., 2011). 5. Confocal laser endomicroscopy- This technology provides microscopic images from sub cellular portion. So, the imaging that was done earlier in the laboratory can now be done at the bedside during ongoing endoscopy (Kiesslich et al., 2011). Detection of the lesion has become simpler due to improved imaging technique providing better view of the mucosal lining. Chromoendoscopy and spectroscopy have helped physician to characterize the lesion and analyze it in details whereas new histopathological techniques such as Confocal Laser Endomicroscopy helps physician to confirm the diagnosis during the procedure itself. (Kiesslich et al., 2011). Importance of endoscopy Thus, the information obtained through endoscopic procedures is more accurate and reliable than many other imaging tests such as radiographic test (x-ray) or ultrasound. Recent studies have shown endoscopy biopsy to be very useful in diagnosing and treating affection of GI system due to opportunistic infections commonly seen in AIDS patients. This lesion will have typical look under endoscopy which further guides for the biopsy (Mel Wilcox, n.d). In patients with lymphoma, surgical endoscopic techniques have been accessed to have more efficacies in obtaining adequate tissue substance for histopathology examination (Gossot, de Kerviler, Brice, Mariette, Meignin, Cazals-Hatem, Frija & Celerier, 2003). In the ‘World Journal on Gastrointestinal Endoscopy’ published in September 2011, it is mentioned that Esophageal Adeno carcinoma which is widely reported in the western countries, arises mainly from Barrett’s esophagus. Frequent endoscopic surveillance programme and latest technologies such as “resection technique and ablation therapy” (Ortiz Fernandez Sordo, Parra Blanco, Garcia Verona, Rodriguez Pelaez & Madrigal Hoyos, 2011) can detect and treat the neoplasm at its early stage .It also provides improvised therapeutic approach for total eradication of whole Barrett’s segment reducing further development of metastasis (Ortiz et al., 2011). Latest technologies in endoscopy Recent studies have come up with various technologies in the endoscopic world. Here is the summery of few. Self propelled endoscopy- It is a wireless technology wherein a small capsule is swallowed or inserted through anus. This capsule is less than half an inch in diameter and 2inches in length. This capsule swims into digestive tract so has been nicknamed as ‘Mermaid’. Capsule movements are controlled by remote. It works on magnetic propulsion mechanism. It can be directed wherever it is needed by its gear system. It has extensive battery life for better performance (Nova, 2011). Infrared based endoscopy- This endoscope is equipped with an infra red laser and a tiny mirror this is capable of taking pictures up to 2 mm beneath the tissue surface. Unlike conventional endoscopes which focus only on the surface area, this latest endoscopy technique will take you deep down to detect very early stages of cancer and will also be helpful during the cancer surgery as this will demonstrate the extent of the cancer tissue (Chu, 2009). High definition endoscopes- These high definition endoscopes with the help of wide screen sensor offer great imaging of the tissues. It also provides the physician better clarity and visibility during surgical procedures (HD endoscopy, n.d). More and more healthcare equipment manufacturing companies have been collaborating successfully with digital imaging equipment manufacturers to develop cutting edge optical technology and narrow band imaging techniques which is helping to have better views of tissue morphology as well as in detecting and extracting early stage tumors during the surgical procedures. For example, digital imaging industry leader Olympus Corporation’s acquisition of Spirus Medical, Inc, which will use synergies between both technologies for development of next generation endoscopy technology (Olympus Global, 2011). Conclusion Endoscopies are improving day by day with newer technologies coming up. Optical features are getting more refined and creating wonders in early cancer detection minimizing many unnecessary surgical events. With further inventions in functional and biological technology, endoscopy technique will serve the mankind in a much better manner. References American Society for Gastrointestinal Endoscopy. (2010). Endoscopic procedure. Retrieved on November 27, 2011 from http://www.asge.org/press/press.aspx?id=548 Chu, J. (2009, December 03). New endoscopes see what lies beneath. Retrieved on Nov 14, 2011 from http://www.technologyreview.com/biomedicine/24052 Gossot, D. D., de Kerviler, E., Brice, P., Mariette, X., Meignin, V., Cazals-Hatem, D., Frija, J., & Celerier, M. (2003). Surgical endoscopic techniques in the diagnosis and follow up of patients with lymphoma. British Journal of Surgery, 85(8), 1107-1110.doi: 10.1046/j.1365-2168.1998.00774.x HD Endoscopy. (n.d.). Retrieved on Nov 28, 2011,from http://www.hd-endoscopy.com/ Kiesslich, R., Goetz, M., Hoffman, A., & Galle, P. R. (2011). New imaging techniques and opportunities in endoscopy. Nature Reviews Gastroenterology and Hepatology, 8, 547-553, doi: 10.1038/nrgastro.2011.152 Mayo Foundation for Medical Education and Research. (2010, July 01). Endoscopy. Retrieved on Nov 12, 2011 from http://www.mayoclinic.com/health/endoscopy/MY00138/METHOD=print Mel Wilcox, C. (n.d.). Endoscopy in Aids: A Pattern approach to diagnosis. Visible Human Journal of Endoscopy, 4(1). Retrieved on Nov 13, 2011 from http://www.vhjoe.org/Volume4Issue1/4-1-5New.htm Merriam-Webster. (n.d.). Endoscope. Retrieved on Nov 27, 2011 from http://www.merriam-webster.com/medlineplus/endoscopy National Institute of Health. (2011, November 01). Endoscopy. Retrieved on Nov 13, 2011, from http://www.nlm.nih.gov/medlineplus/endoscopy.html National Institute of Diabetes and Digestive and Kidney diseases. (2009, May).Upper GI Endoscopy. Retrieved on Nov 14, 2011, from http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy Nova, C. (2011, June 21). Japan develops Self-propelled capsule endoscope. Retrieved on Nov 27, 2011, from http://www.tgdaily.com/hardware-brief/56756-japan-develops-self-propelled-capsule-endoscope Olympus Global. (2011).Our promise. Retrieved on Nov 14, 2011, from http://www.olympus-global.com/en/corc/ir/factbook/medical/2011/pdf/factbook01.pdf Ortiz-Fernandez- Sordo, J., Parra- Blanco, A., Garcia- Verona , A., Rodriguez-Pelaez, M., Madrigal- Hoyos, E., Waxman, I., & Rodrigo, L. (2011). Endoscopic resection techniques and ablative therapies for Barretts neoplasia. World Journal of Gastrointestinal Endoscopy, 3(9), 171-182. doi: 10.4253/wjge.v3.i9.171 Santacroce, L., & Losacco, T. (2005, October 27). Gastrointestinal endoscopy. Retrieved on Nov 27, 2011 from http://www.emedicinehealth.com/gastrointestinal_endoscopy/article_em.htm Read More