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G I Endocsopy
Critical Care
General Medicine
Diabetology & Endocrinology

G I Endocsopy

Endoscopic Procedures

Endoscopy: Procedures using an endoscope to diagnose or treat a condition. There are several types of endoscopy. Those using natural body openings include esophogealgastroduodenoscopy (EGD)-often called upper endoscopy, gastroscopy, enteroscopy, endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), colonoscopy, and sigmoidoscopy. Those using small incisions include percutaneous endoscopic gastrostomy (PEG). Endoscopies are usually performed under sedation to assure maximal patient comfort.

Sigmoidoscopy: An examination of the inside of the rectum and sigmoid colon using an endoscope-a thin, lighted flexible tube (sigmoidoscope) inserted through the anus. Also called flexible sigmoidoscopy and proctosigmoidoscopy

Colonoscopy: An examination of the inside of the colon, including the rectum, sigmoid colon, descending colon, transverse colon, ascending colon, and cecum (where the small bowel attaches to the large bowel) using an endoscope-a thin, lighted flexible tube inserted through the anus.

Endoscopic retrograde cholangiopancreatography (ERCP): A technique used to study and treat problems of the ducts involving the liver, pancreas, and gallbladder. This procedure utilizes a special endoscope with a side-mounted camera can facilitate passage of a catheter into the bile and pancreatic ducts.

Enteroscopy: A procedure that allows the visualization of more of the small bowel than is possible with EGD, through the use of a long conventional endoscope, a wireless camera mounted in a swallowed capsule, or a double-balloon endoscope (inserted in the mouth).

Endoscopic Ultrasound (EUS): An examination with a special endoscope fitted with a small ultrasound device on the end, used to look inside the layers of the wall of the GI tract and visualize the surrounding organs including the pancreas, liver and gallbladder. The scope is inserted in the mouth or anus in the same manner as a conventional endoscope.

Percutaneous Endoscopic Gastrostomy (PEG): A procedure through which a flexible feeding tube is placed with the assistance of an endoscope through a small incision in the abdominal wall into the stomach. This procedure is performed in cases where oral ingestion of nourishment or medication is impossible.

Upper Endoscopy

Upper endoscopy allows the doctor to examine the lining of the upper part of the gastrointestinal (GI) tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). In upper endoscopy, the physician uses a thin, flexible tube called an endoscope. The endoscope has a lens and light source, which projects images on a video monitor. This procedure is also referred to as upper GI endoscopy, or esophagogastroduodenoscopy (EGD). Upper endoscopy is often done under sedation to assure maximal patient comfort.

Upper endoscopy helps the doctor evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is the best test for finding the cause of bleeding from the upper GI tract and is also more accurate than X-rays for detecting inflammation, ulcers, and tumors of the esophagus, stomach, and duodenum.

A physician may also use upper endoscopy to obtain small tissue samples (biopsies). A biopsy helps distinguish between benign and malignant (cancerous) tissues. Biopsies are taken for many reasons, and a doctor might order a biopsy even if cancer is not suspected. For example, a biopsy can be taken to test for Helicobacter pylori, bacteria that can cause ulcers.

Upper endoscopy can also be used to perform a cytology (cell) test, in which a small brush is passed through the channel of the endoscope to collect cells for analysis. Other instruments can be passed through the endoscope to directly treat many abnormalities with little or no discomfort. For example, the doctor may stretch a narrow area (a stricture), detect Barrett's esophagus (a possibly precancerous alteration in the esophageal lining), detect and biopsy gastrointestinal cancers, remove polyps (usually benign growths) treat bleeding (with standard cautery or the newer argon plasma coagulation method), and detect and treat symptoms of gastroesophageal reflux disease (GERD).


Sigmoidoscopy, or "flexible sigmoidoscopy," lets a physician examine the lining of the rectum and a portion of the colon (large intestine) by inserting a flexible tube about the thickness of your finger into the anus and slowly advancing it into the rectum and lower part of the colon. This procedure evaluates only the lower third of the colon. Sigmoidoscopy is often done without any sedation, although sedation can be used if necessary.

Various miniaturized tools can be inserted through the scope to help the doctor obtain samples (biopsies) of the colon and to perform maneuvers to diagnose or treat conditions.

Flexible sigmoidoscopy can detect and sometimes treat polyps, rectal bleeding, fissures, strictures, fistulas, and foreign bodies, colorectal cancer, and benign and malignant lesions.

Flexible sigmoidoscopy is not a substitute for total colonoscopy when it is indicated. The finding of a new, abnormally growing polyp during sigmoidoscopy, for example, is an indication for a colonoscopy to search for additional polyps or cancer. Sigmoidoscopy should not be used for polypectomy unless the entire colon is adequately prepared. This procedure should also not be used with cases of diverticulitis, and peritonitis.


Colonoscopy is a common, safe test to examine the lining of the large bowel. During a colonoscopy, doctors who are trained in this procedure (endoscopists) can also see part of the small intestine (small bowel) and the end of the GI tract (the rectum). This procedure is often done under sedation to assure maximal patient comfort.

During a colonoscopy, the endoscopist uses a flexible tube, about the width of your index finger, fitted with a miniature camera and light source. This device is connected to a video monitor that the doctor watches while performing the test. Various miniaturized tools can be inserted through the scope to help the doctor obtain samples (biopsies) of the colon and to perform maneuvers to diagnose or treat conditions.

Colonoscopy can detect and sometimes treat polyps, rectal bleeding, fissures, strictures, fistulas, foreign bodies, Crohn's Disease, and colorectal cancer.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized technique used to study and treat problems of the liver, pancreas, and, on occasion, the gallbladder. ERCP is performed under sedation.

To reach the small passageways, known as ducts, that connect these organs, an endoscope is passed through the mouth, beyond the stomach and into the small intestine (duodenum). A thin tube is then inserted through the endoscope into the common bile duct and pancreatic duct connecting the liver and pancreas to the intestine. A contrast material (dye) is injected through the tube and flows into the liver and pancreas, outlining those ducts as X-rays are taken. The X-rays can show narrowing or blockages in the ducts that may be due to a cancer, gallstones, or other abnormalities. During the test, a small brush or biopsy forceps can be put through the endoscope to remove cells for study under a microscope.

ERCP can be used to diagnose biliary colic, jaundice, elevated liver enzymes, cholangitis (inflammation of a bile duct), pancreatitis (inflammation of the pancreas), and bile-duct (biliary) obstruction due to gallstones (choledocholithiasis) and cancer. ERCP can be used to treat gallstones, malignant and benign biliary strictures, cholangitis, pancreatic cancer and pancreatitis.


Enteroscopy includes several types of procedures that allow a physician to look further into the small bowel (which is up to 25 feet long) than other methods mentioned here. A physician may use a longer conventional endoscope, a double-balloon endoscope, or a wireless capsule endoscope. Enteroscopy is primarily used to find the source of intestinal bleeding, but can also be used to find lesions, and determine causes for nutritional malabsorption.

An extended version of the conventional endoscope (called a "push endoscope") may be employed to study the upper part-about 40 inches-of the small intestine. Another, similar but longer instrument actually makes use of the normal digestive contractions of the small intestine to move the instrument further-up to 150 inches-into the small bowel. This procedure takes more time than the "push" method, and still may not be able to see the entire small intestine.

Capsule endoscopy uses a swallowable capsule containing tiny video cameras. The capsule, about the size of a large vitamin pill, contains a light source, batteries, a radio transmitter, and an antenna. The capsule transmits the images to a recording device worn around the patient's waist. When complete, the recording is downloaded to a computer which displays it on a screen. The capsule is disposable and usually takes eight hours to move through the digestive system, after which it is passed harmlessly in a bowel movement. Capsule endoscopy does not require sedation and is painless. Capsule endoscopy can be used to diagnose hidden GI bleeding, Crohn's disease, celiac disease, and other malabsorption problems, tumors (benign and malignant), vascular malformations, medication injury, and to a lesser extent, esophageal disease. Currently, capsule endoscopy cannot be used to biopsy or treat any conditions.

Double-balloon enteroscopy uses a basic endoscope for viewing the inside of the entire small colon, but that endoscope travels inside another tube which is pulled along the inside of the colon by alternately inflating and deflating two small balloons against the inside of the intestinal wall. This allows the scope to travel further, give stable images, perform biopsies, remove polyps, and perform other therapies. This procedure is done under sedation to assure patient comfort.

Endoscopic Ultrasound (EUS)

A flexible endoscope which has a small ultrasound device built into to end can be used to see the lining of the esophagus, stomach, small bowel, or colon. The ultrasound component produces sound waves that create visual images of the digestive tract which extend beyond the inner surface lining. Endoscopic ultrasound examinations (also called endoluminal endosonography) may be performed through the mouth or through the anus. EUS is performed under sedation.

EUS provides more detailed pictures of the digestive tract anatomy EUS can be used to evaluate an abnormality below the surface such as a growth that was detected at a prior endoscopy or by X-ray. EUS, because of its ability to examine through the layers of the surface of the GI tract, provides a detailed picture of the growth, which can help the doctor determine its nature and decide on the best treatment.

EUS can also be used to diagnose diseases of the pancreas, bile duct, and gallbladder when other tests are inconclusive, and EUS can be used to determine stage of cancers. Tissue samples can be obtained and certain therapies (such as the removal of certain cysts or aspiration of lymph nodes) can be performed with EUS guidance.

Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous endoscopic gastrostomy, or PEG, is a procedure through which an endoscope assists the placement of a flexible feeding tube through the abdominal wall and into the stomach. The PEG procedure is for patients who have difficulty swallowing, problems with their appetite or an inability to take enough nutrition through the mouth. It allows nutrition, fluids, and/or medications to be put directly into the stomach, bypassing the mouth and esophagus.

In this procedure, the endoscopist uses a lighted, flexible tube called an endoscope to guide the creation of a small opening through the skin of the abdomen and directly into the stomach. This allows the doctor to place and secure a feeding tube into the stomach. Patients generally receive a mild sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure or the next day.

A PEG does not prevent a patient from eating or drinking, but depending on the medical condition and situation, the doctor might decide to limit or completely avoid eating or drinking.

PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. The doctor can remove or replace a tube without sedatives or anesthesia, although he or she might opt to use sedation and endoscopy in some cases. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.

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