The Different Types of Endoscopy Procedures

An endoscopy is a medical procedure used to view the internal organs in a non-surgical way. These are often called "minimally invasive" procedures since they are less invasive ways to visualize organs than via surgery. Before we had endoscopic procedures, surgery was generally necessary to get the same results as we now get from endoscopy. These procedures can also be done without the general anesthesia often necessary for surgery, and therefore carry less risk.

doctor holding an endoscope
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With endoscopy, an endoscope is usually inserted down through the mouth, up through the rectum, or through a small incision made in the skin when evaluating the inside of joints, the chest, or the abdomen. An endoscope is a flexible tube with a lighted camera attached. The camera returns a picture so that internal body structures can be visualized on a monitor.

An endoscopy is usually done when visualization of internal organs is necessary to make a diagnosis, an endoscopy allows the diagnosis to be made with less risk than surgery. Endoscopy may also be used to gain access to internal organs for treatment.

Complications

Possible complications of endoscopy include bleeding, a tear in the wall of the cavity being entered, and reactions to sedation medications.

Anesthesia

Endoscopy is most often performed under sedation from IV medications. Patients often sleep during the procedure, but the sleep is quite light, and most people awaken shortly after the procedure is done. This type of sedation has sometimes been called "twilight sleep." With some procedures, general anesthesia may also be given.

Preparation

Preparing for an endoscopy most often requires fasting (not eating) for six to eight hours prior to the procedure. For endoscopy of the colon (colonoscopy), a laxative to clean the bowels will also be used.

Types of Endoscopy

There are many types of endoscopy procedures, including:

Arthroscopy

Arthroscopy is a procedure in which a tiny incision is made in the skin and a scope is inserted into a joint. Arthroscopy can be used to diagnose and treat joint conditions, ranging from diagnosing different types of arthritis to repairing rotator cuff tears. The procedure cannot be used on all joints, and we don't as yet have a way to perform all surgeries, such as joint replacement surgery, using this method.

Bronchoscopy

In a bronchoscopy, a tube is inserted through the mouth and passed down through the trachea into the bronchial tubes (the large airways of the lungs). Bronchoscopy can be used to visualize tumors and do biopsies. By adding ultrasound, it can also be used to biopsy lung tumors that are near but not within the airways (endobronchial ultrasound). It may be used for treatment as well, to stop bleeding from a tumor, or to dilate the airway if a tumor is causing narrowing.

Colonoscopy

You may be familiar with colonoscopy from colon cancer screening. In a colonoscopy, a tube is inserted through the rectum and threaded up through the colon. It can be used in this way to diagnose colon cancers or to remove polyps which may have the ability to turn into cancer. As such, colonoscopies have reduced the risk of death from colon cancer both by early detection, finding cancers when they are small and have not spread, and through primary prevention, removing polyps that could become cancerous.

Colposcopy

A colposcopy is inserted through the vaginal opening in order to better visualize the cervix. It is most often done due to an abnormal Pap smear to look for evidence of cervical dysplasia or cervical cancer.

Cystoscopy

A cystoscopy allows a doctor to visualize the inside of your bladder to diagnose conditions ranging from interstitial cystitis to bladder cancer. In this procedure, a narrow tube is inserted through the urethra (the tube going from the bladder to the outside of the body) and into the bladder. The instrument has a special tool at the end which allows doctors to take a biopsy of any suspicious-appearing areas.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

In an ERCP, a tube is inserted down through the mouth and stomach and into the bile and pancreatic ducts which lead into the small intestine from the liver and pancreas. This method can be used to retrieve gallstones that have lodged in these ducts, as well as to visualize the ducts (such as with the rare bile duct cancers) as well as visualize the pancreatic duct to evaluate the anatomy for chronic pancreatitis or other pancreatic lesions.

EGD (Esophogealgastroduodenoscopy)

In an EGD, a doctor inserts a narrow tube in through the mouth and down sequentially through the esophagus, the stomach, and into the duodenum (the first part of the small intestine). EGD has been very effective in diagnosing conditions which were once hard to diagnose, including problems with the esophagus such as Barrett's esophagus (when the lining of the esophagus changes to stomach lining due to chronic inflammation as a result of acid reflux), ulcers in the stomach and duodenum, inflammation, cancers, gastroesophageal reflux disease, and even celiac disease.

Laparoscopy

In a laparoscopy, small incisions are made in the belly button and over the abdomen allowing a scope to be introduced into the peritoneal cavity (the area housing the abdominal organs). It can be done both for diagnosis and as a method of treating everything from infertility to removing an appendix.

Laryngoscopy

A laryngoscopy is a procedure in which a tube is inserted through the mouth in order to visualize the larynx (the voice box). This method can detect abnormalities in the voice box ranging from polyps to laryngeal cancer.

Mediastinoscopy

A mediastinoscopy is a procedure in which a scope is inserted through the chest wall into the space between the lungs (the mediastinum). It may be used to diagnose conditions such as lymphomas and sarcoidosis (a disease characterized by tiny collections of inflammatory cells, [granulomas], leading to the enlargement of lymph nodes), but is most often done as a part of staging lung cancer, to look for lymph nodes in the mediastinum to which cancer may have spread.

Proctoscopy

A proctoscopy is a scope that can be inserted through the anus to evaluate the rectum (the last 6 to 8 inches of the colon or large intestine). It is done most often to evaluate rectal bleeding.

Thoracoscopy

A thoracoscopy is a procedure in which small incisions are made in the chest wall to gain access to the lungs. In addition to being used to do lung biopsies, this procedure is now often used to remove lung cancers. This procedure is referred to as VATS or video-assisted thoracoscopic surgery. A VATS procedure can be done in much less time with a significantly fewer short term and long term side effects of surgery. Not all surgeons, however, are trained in this procedure, and not all lung cancers can be reached by this technique.

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