Endoscopy is a device with a camera at the end, which is approximately one meter long and as thick as a finger. Endoscopy is the examination of the esophagus, duodenum and stomach by entering the mouth with a tube. In particular, patients aged 40 to 45 years and older should be evaluated by endoscopy. Different diagnostic methods can also be used in younger patients. However, if there is a suspicion of bleeding, it should be checked by endoscopy. All endoscopic interventions for diagnosis and treatment are performed by experienced physicians in the Endoscopy Unit of Private Medikar Hospital, which is modernly equipped with videoendoscopy devices. All interventions performed in our unit are performed with sedation (sleep state) or anesthesia (narcosis) if necessary to ensure patient comfort.
All of the following procedures can be performed in our endoscopy unit:
-Upper Gastrointestinal System Endoscopy
-Rectoscopy
- Sigmoidoscopy and colonoscopy
-Diagnosis and treatment of upper (stomach and duodenum) and lower gastrointestinal (colon) bleeding (sclerotherapy, band ligation)
-Diagnosis and treatment of upper and lower gastrointestinal tract strictures (Balloon dilatation, stenting)
-Removal of polyps from the upper and lower gastrointestinal tract (polypectomy)
-Diagnosis and treatment of reflux disease
-24 hour pH monitoring
-Application of esophageal impedance
-Treatment of obesity
-Endoscopic Intragastric balloon application
-Endoscopic feeding tube placement
-Percutaneous endoscopy gastrostomy tube insertion
-Hemorrhoids diagnosis and treatment (Surgery and infrared coagulation)
What is Upper Gastrointestinal (GI) Endoscopy?
Upper GI endoscopy (also known as gastroscopy, EGD or oesophagogastroduedenoscopy) is a procedure that allows evaluation of the lining of the upper parts of the digestive system: the oesophagus (esophagus), stomach and duodenum (the first part of the small intestine). A bendable (bendable) lighted tube the thickness of your little finger is sent through your mouth into your stomach and duodenum.
Why is upper GI endoscopy performed?
Upper GI endoscopy is often used to evaluate symptoms such as persistent upper abdominal pain, nausea, vomiting, difficulty swallowing or chest pain. It is an excellent procedure to find the cause of bleeding from the upper digestive tract. It is also used in the evaluation and follow-up of the esophagus or stomach after surgery. It is more accurate than imaging methods (medicated films, tomography, etc.) in detecting inflammation, ulcers or tumors of the esophagus, stomach and duodenum. Upper endoscopy can detect cancer at an early stage and allows tissue samples (biopsy) to be taken from suspicious areas to distinguish between cancer-related and non-cancerous conditions. Tissue samples are taken using special instruments and sent to the laboratory for examination. A biopsy is taken for many different reasons and does not necessarily mean that cancer is suspected. Various auxiliary instruments can be sent through the endoscope to treat many abnormal conditions with little or no discomfort. Narrowed areas can be widened, polyps removed, swallowed material removed or bleeding in the upper digestive tract treated. Safe and effective control of bleeding reduces both the need for blood transfusions and the need for surgery.
Is a preparation necessary?
Your stomach must be completely empty. You should not have eaten or drunk anything until about 8 hours before the procedure. Your doctor can change your fasting time by evaluating the time of the procedure to be applied to you during the day. Attention should also be paid to the use of medication. It is very important for the safety of the procedure that you inform your doctor about the medications you use, the diseases and surgeries you have undergone and your allergies before the procedure. Aspirin, vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin use should be discussed with your doctor before the endoscopy procedure. It is very important to warn your doctor if you have had to take antibiotics before dental procedures, as you may also need to take antibiotics before gastroscopy. In addition, if you have a serious illness, such as heart or lung disease, that requires special attention during the procedure, you should discuss this with your doctor. During the procedure, you will be sedated (put to sleep with sedatives). Sedatives will affect your judgment and reflexes throughout the day. For this reason, you should ensure that you have someone with you to help you when you return home. You should not drive or operate machinery until the next day. You should not make any important decisions or sign anything.
What Procedures Are Performed During Upper GI Endoscopy?
Unless otherwise stated, a numbing medication will be sprayed into your throat before the procedure begins and medication will be administered through your vein to relax you during the procedure. You will be lying on your side in a comfortable position and the endoscope will be passed slowly through your mouth and into your esophagus, stomach and duodenum. Air will be blown into your stomach during the procedure to get a better view of the lining of the stomach. The procedure usually takes 15-60 minutes. The endoscope itself does not prevent you from breathing. Most patients sleep during the procedure and very few are disturbed by the procedure.
What happens after the procedure?
You will be monitored in the endoscopy unit for 1-2 hours after the sedatives have worn off. You may feel a little pain in your throat for 1-2 days. You may feel gas and bloating in your abdomen after the procedure due to the air given to your stomach for better evaluation during the procedure. After you leave the endoscopy unit, you can eat and take your medication unless you have been advised otherwise. If your doctor has not taken a biopsy during the procedure, he/she will inform you on the day of the procedure. If a biopsy was taken, the results may take more than a few days. If you cannot remember the results of your procedure or the doctor's recommendations after the procedure, you can contact your doctor later to find out what to do.
What Complications May Occur?
Gastroscopy and biopsy performed by teams trained and specialized in endoscopy are very safe. However, complications may occur, although rare. These include bleeding from the biopsy or polypectomy site and perforation of the digestive tract wall. Blood transfusions are rarely necessary due to bleeding. Reactions to the drugs used during the procedure may develop. Damage to the blood vessels where the drugs are administered is very rare, but can cause tenderness that lasts for several weeks. Warm, moist towels can reduce this discomfort. It is important for you to recognize the early signs of these possible complications and you should contact your surgeon if you have symptoms such as difficulty swallowing, chest pain, severe abdominal pain, fever, chills, rectal bleeding more than half a glass.
What is Lower Gastrointestinal Endoscopy - Colonoscopy?
Colonoscopy is a procedure that allows your doctor to evaluate the surface of the large intestine. A soft, bendable tube about the thickness of an index finger is gently inserted through the anus (anus) and advanced through the large intestine (rectum and colon) to evaluate the intestinal wall.
Why is lower gastrointestinal tract endoscopy - colonoscopy performed?
Colonoscopy is usually performed to evaluate changes in bowel habits, bleeding and unexplained abdominal pain, to remove and control polyps in patients known to have polyps (formations growing on the wall of the large intestine) or who have previously had polyps removed, to control before or after some surgical procedures, to evaluate changes in the surface of the large intestine in diseases known as inflammatory diseases, as part of a screening program in patients with suspected polyps or tumors in large intestine radiographs and other imaging methods, or with a family history of polyps or colon cancer.
Is a preparation necessary?
For the procedure to be performed and for a complete evaluation, the stool in the large intestine must be completely cleaned. For this purpose, it is recommended to consume clear (pulp-free) food a few days before the procedure (3-4 days) and not to take foods with pulp. In addition, special cleansing solutions or laxatives to clean the bowel and enemas before the procedure will be recommended. Your doctor or the endoscopy nurse will give you instructions on how to use these medicines or solutions. It is especially recommended to follow the instructions carefully. If the preparation is not good enough, the procedure may be unsafe and may need to be rescheduled. As you will be dehydrated during this period, it is recommended that you drink plenty of water. If you are unable to complete the preparation, it is important that you contact your doctor and the unit that gave you the appointment. You can continue with many of the medicines you are taking. You should tell your doctor about your medications such as aspirin, blood thinners, non-steroidal anti-inflammatories, vitamin E and insulin before the procedure, just like any other medication you are taking. Some of these medications may need to be stopped or changed at least one week before the procedure. If you need to take antibiotics before dental procedures, it is imperative that you warn your doctor as you may also need to take antibiotics before the colonoscopy. During the procedure you will probably be severely sedated (put to sleep with sedatives). The sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate any machinery until the following day. You should therefore have someone with you to help you on your way home. You should not make any important decisions or sign anything.
What Procedures Are Performed During Colonoscopy?
The procedure is usually well tolerated, but discomfort such as pressure, flatulence, bloating, cramps or pain may be felt at various times during the procedure due to air or manipulations to get a better image. Your doctor will give you intravenous medication to relax you and you will be better able to tolerate (complete) the procedure without any discomfort. You will usually lie on your side or on your back while the colonoscope travels through the large intestine. However, you may be asked to change position with the help of staff if necessary. The surface of the colon will be carefully examined as the device is inserted and withdrawn. The procedure is usually finished in 30 to 60 minutes. Rarely, the entire surface of the large intestine cannot be visualized and your doctor may recommend a barium colon radiograph.
What to do if an abnormality is seen during the procedure?
If your doctor sees an area that requires more detailed evaluation, he or she may take a biopsy and send it to the laboratory for analysis. This is done by inserting a special instrument through the colonoscope to take a small sample from the surface of the large intestine. Polyps are usually removed. Most polyps are benign (not cancerous), but your doctor cannot tell this just by their appearance. Polyps can be removed by burning (electrocution) or with a wire loop (snare). If there are many polyps or they are very large, your surgeon may do this more than once with repeated procedures. Areas of bleeding can be detected and controlled by giving certain medicines or by burning blood vessels (with electric current). A biopsy does not necessarily indicate cancer, but removing the polyp is important for the prevention of colon cancer.
What happens after the procedure?
Your doctor will explain the findings to you immediately after the procedure or during a subsequent outpatient clinic visit. However, if a biopsy was taken or a polyp was removed, it may take a few days for it to be evaluated in the pathology laboratory. Sometimes moderate cramps or bloating may occur due to the air introduced into the large intestine during the examination. This will quickly resolve with the release of gas. If a biopsy is taken or polyps are removed during the colonoscopy, blood thinners, aspirin and similar medications should not be used for a certain period of time. You can get information from your doctor in this case. Do not drive a car or operate any machinery as sedatives may impair your reflexes. If you were given medication during the procedure, you will be kept under observation until most of the effects of the sedatives have disappeared (1-2 hours). You will need someone to help you go home after the procedure.
If you cannot remember what your doctor told you about the procedure and follow-up instructions, you can talk to your doctor that day or the next day. If polyps are found during the procedure, the colonoscopy may need to be repeated at regular intervals. Your surgeon will decide on the frequency of colonoscopy.
What Complications May Occur?
Colonoscopy and biopsy is a procedure performed safely by specially trained doctors who are experienced in endoscopic procedures. Complications are rare but can occur. These include bleeding from the biopsy or polypectomy site or a tear (perforation) in the bowel wall. If this occurs, your surgeon may need to perform abdominal surgery to repair the tear in the bowel wall. Blood transfusions are rarely needed for bleeding. There may be a reaction to the medicines used. It is not common for the medication to cause vascular irritation, but it may cause a mild stiffness that lasts for a few patients. If there is an increase in temperature, a damp towel may help to reduce this discomfort. It is very important to contact your doctor if you have severe abdominal pain, fever, chills or rectal bleeding of more than half a cup. Bleeding may also occur a few days after the biopsy.
What is Percutaneous Endoscopic Gastrostomy (PEG)?
PEG is a procedure in which a thin, bendable tube with a lighted camera at the end, called an endoscope, is inserted through the mouth and a thin feeding tube is inserted through the anterior abdominal wall into the stomach. PEG is a feeding method applied to improve the nutrition of patients who cannot be fed adequately by mouth for a long time (longer than 2-3 months), whose food escapes into the lungs when fed by mouth and therefore coughs, chokes, cannot swallow what they eat and therefore cannot grow. In this way, it may be possible to feed the patient more safely and comfortably. The first goal of enteral tube feeding is to ensure that body weight does not decrease further, to correct significant nutrient deficiencies, to maintain fluid balance in the body, to accelerate growth in children with growth retardation and to stop the deterioration in the patient's quality of life due to inadequate oral nutrition. Given these goals, the use of a PEG tube covers a wide range of patients. Various examples of these diseases are given below.
Oncological disorders (cancer patients): Certain obstructive tumors in the ear, nose and throat or in the esophagus and stomach.
Neurological disorders (diseases of the nervous system): Patients with dysphagia, inability to swallow after cerebrovascular stroke or head trauma and patients with brain tumors, Parkinson's disease, amyotrophic lateral sclerosis (ALS), cerebral palsy.
Other clinical conditions: Prolonged coma, polytrauma, extreme exhaustion in AIDS, short bowel syndrome, reconstructive facial surgery, Crohn's disease, cystic fibrosis, chronic renal failure.
Another indication for the use of a PEG system is palliative drainage of gastric fluids and small intestinal secretions in chronic gastrointestinal obstruction. Modern PEG tube systems made of polyurethane or silicone rubber are easy to insert and well tolerated. PEG feeding is now the preferred method of medium- and long-term enteral nutrition.
How is the PEG procedure performed?
PEG placement is performed under sterile conditions in the operating room or endoscopy unit. If necessary, it can also be performed at the bedside or in the intensive care unit. The patient should fast at least 8 hours before the PEG procedure. General anesthesia will not be administered before the procedure, but the patient will remain drowsy, relaxed and calm throughout the procedure thanks to the sedative medication. The patient will not feel pain or discomfort during the procedure and will not remember the procedure. This sedation of the patient is called “conscious sedation”. Then, the endoscope will pass through the esophagus into the stomach and the PEG tube will be inserted into the stomach using special instruments through an incision less than 1 cm (3-4 mm) in the anterior abdominal wall. When the procedure is completed, the patient will have a PEG tube in the abdominal wall to be used for nutrition. After the PEG insertion, the patient will be hospitalized for a while and the mother will be taught about the care and use of the PEG.
What are the Risks of the Procedure?
After the procedure, mild complications such as abdominal pain, mild fever, restlessness, wound infection, displacement of the tube, leakage, obstruction of the tube can be seen in 4-16%.
Serious complications such as perforation (perforation of the gastrointestinal wall), severe bleeding, peritonitis (inflammation of the lining of the abdomen), aspiration pneumonia (may occur when stomach contents escape into the lungs with vomiting during the procedure) may occur in 2-4% of patients and may require surgical intervention or prolonged hospitalization.
The development of most long-term complications, such as leakage from the tube due to tube damage and breakage, severe inflammation (cellulitis), eczema or granulation tissue development in the area around the abdominal wall of the tube, depends solely on the quality of care given to the inserted tube system and can be effectively prevented if appropriate measures are taken.
Patients who require PEG insertion because of malnutrition due to underlying diseases are at high risk for endoscopy. For this reason, medical problems such as low blood oxygen and low blood pressure may develop due to sedation drugs administered during the endoscopic procedure. Medication may need to be administered to counteract the effects of sedatives and, in the worst case, life-saving interventions (such as CPR, artificial respiration) may be required.
What are the Alternative Methods?
Nasogastric tube feeding with a nasogastric (NG) tube inserted through the nose and the tip inserted into the stomach: This method is applied to patients who are thought to be able to feed by mouth after a while (6-8 weeks), but it is not preferred because it may cause wound formation in the nose, esophagus and even stomach when used for a long time. Displacement of the NG tube and not being recognized can cause life-threatening problems (such as nutrients escaping into the lungs).
Surgical gastrostomy Surgical gastrostomy is the process of placing a tube in the stomach by performing an operation under general anesthesia. It may be necessary for patients who cannot have a PEG, who do not accept PEG or for medical reasons (patients who need reflux surgery in the same session).
Radiologic gastrostomy can be performed by an experienced radiologist in specialized centers under the guidance of ultrasonography and/or fluoroscopy (irradiation).