Gastroscopy and Colonoscopy

Dr Bindu will arrange Colonoscopy and Gastroscopy as needed through the hospitals that she works.

What is endoscopy?

Endoscopy is a minimally invasive procedure that examines the inside of the digestive tract using an endoscope, a long thin flexible tube with a tiny camera attached at the end. 

• Gastroscopy (also known as upper endoscopy) is a type of endoscopy which examines the inside lining of the oesophagus, stomach and the first part of the small bowel. 
  
• Colonoscopy is a type of endoscopy which examines the inside lining of the large bowel.
  

Gastroscopy

What is a Gastroscopy?

Gastroscopy (also known as Upper GI endoscopy) is a procedure that allows the examination of the upper part of the gastrointestinal tract.

This includes

• the oesophagus (food pipe) 
• stomach, and 
• Duodenum (the first part of the small intestine), 

using a thin, flexible tube with a built-in video camera, lens and light source (gastroscope).  The images are displayed on a monitor for the surgeon.

The gastroscope is put down from the mouth, oesophagus and stomach into the duodenum. The lining is visually examined, and small samples (biopsies) are taken for further tests.

A Gastroscopy enables a diagnosis to be made upon which specific treatment can be given. If a bleeding site is identified, treatment can stop the bleeding, or if a polyp is found, it can be removed without a major operation. 

Other treatments can be given through the endoscope when necessary.

What are the Indications for a Gastroscopy?

Upper GI endoscopy can be helpful in the evaluation or diagnosis of various problems, including

• Difficulty or pain when swallowing
• Pain in the stomach or abdomen, 
• Tumours.
• G.I. bleeding- hematemesis, melena, or iron-deficiency anaemia
• Troublesome heartburn
• Persistent ulcer-like pain
• Dyspepsia
• Anorexia or weight loss
• Taking aspirin or NSAIDs
• History of gastric ulcer
• Persistent nausea, vomiting, or symptoms suggestive of pyloric obstruction
• Gastric ulcer demonstrated by barium meal
• Duodenal biopsy for suspected malabsorption

Gastroscopy for Diagnosis

Gastroscopy is usually performed to evaluate symptoms of upper abdominal pain, nausea, vomiting, weight loss, difficulty swallowing and bleeding. 

Gastroscopy is the most accurate means of detecting inflammation and ulcers of the oesophagus, stomach and duodenum.

Gastroscopy can detect early cancer, and by performing biopsies (taking small tissue samples), doctors can distinguish between benign and malignant (cancer) conditions. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. 

Gastroscopy for Treatment

Gastroscopy may be used to treat conditions present in the upper gastrointestinal tract. Various instruments can be passed through the endoscope, which allows many abnormalities to be treated directly, with little or no discomfort. For example, 

• stretching narrowed areas, 
• removing polyps or 
• treating upper gastrointestinal bleeding.

Preparation Before Your Procedure

Before gastroscopy, the stomach must be empty for a safe and accurate examination.

• have nothing to eat for six (6) hours before the examination.
• may drink plain water (only) until two (2) hours before you come to the hospital. 

The hospital will give specific information about the time to begin fasting, depending on the time of day that your test is scheduled.

Medications Before the Procedure

You will be informed (by our anaesthetist) when to stop eating and drinking or stop taking usual medicine, depending on the time of day your procedure has been scheduled.

Most medicines can be taken, as usual. However, if you are unsure, please speak to your child’s doctor/anaesthetist.

• Diabetes medications: omit your diabetes tablets on the morning of the test. If you take insulin, you should take half your usual dose. The nurses will check your blood sugar when you arrive at the hospital.
• Blood-thinning medicines: anticoagulants (blood thinners) such as warfarin (Coumadin), apixaban, etc. must be stopped for 3 to 5 days. You must discuss this with your doctor as you may need to have injections during this period.
• Antiplatelet agents such as aspirin and clopidogrel (Plavix) usually need to stop for one week. If you have stents in your heart, DO NOT stop any medicine without your cardiologist’s permission. If necessary, aspirin can be continued up to the day of the test.
• Most other drugs (for high blood pressure, cholesterol, depression, reflux, etc., can be taken up to 2 hours before coming to the hospital with some water.

What Can Be Expected During a Gastroscopy?

A gastroscopy is performed under a general anaesthetic, so your child will be asleep during the procedure. For details of the anaesthetic, please read the attached brochure.

• The procedure takes about 15 – 30 minutes.
• Your doctor will review why a gastroscopy is being performed, whether any alternative tests are available, and possible complications from the procedure. 
• Upper GI endoscopy is usually performed on an outpatient basis.
• Like a Colonoscope, an endoscope is a long, thin, flexible tube with a tiny video camera and light at the end. 

By adjusting the various controls on the endoscope, the endoscopist can safely guide the instrument to examine the inside lining of the upper digestive system carefully. The high-quality picture from the endoscope is shown on a TV monitor, which gives a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.

An anaesthetist will put a small cannula (plastic tube) into your vein and give you medicine so that you are sedated or asleep.

While you are in a comfortable position on your left side, the endoscope is passed through your mouth and then, in turn, through the oesophagus, stomach and duodenum. 

The endoscope does not interfere with your breathing during the test. Most patients are asleep during the procedure and do not remember it.

What happens after the Gastroscopy?

After the test, you will be monitored in a recovery area until most of the effects of the anaesthetic have worn off. 

Your throat may be sore for a while, and you may feel bloated right after the procedure because of the air introduced into your stomach. 

You will be given something to eat and drink when you are awake. In most cases, your doctor will inform you of your test results on the day of the procedure. However, the results of any biopsies taken will take several days.

What Happens After Paediatric Gastroscopy?

After the procedure, your child/you will be watched in the recovery area for one or 2 hours until the medicines wear off.

• A surgeon would be able to inform the results on the day of the procedure briefly. A follow-up appointment would be made to discuss the results from any biopsies or samples taken, as it may take several days to get results.
• A light diet such as sandwiches, pasta, soups and jelly can be started. A full diet can be resumed once your child feels well enough.
• Babies can start breastfeeding and drink formula or water as soon as they are awake from the procedure, as indicated by the nurses.
• Your child needs to rest for the remainder of the day following the procedure but should be able to resume their normal activities the day after the procedure.
• Discharge instructions as below should be carefully read and followed.

Recovery from Gastroscopy Procedure

You will need to arrange to have someone accompany you home from the examination. Until the following day, we recommend patients do not:

• Drive a car
• Work machinery
• Consume alcohol
• Sign legal documents
• Make important decisions

If any of your questions have not been answered here, please feel free to discuss them with the endoscopy nurse or your doctor before the procedure begins.

What Are The Risk Or Side Effects?

Endoscopy is safe. Complications can occur, but they are rare when the test is performed by doctors with specialised training and experience in the procedure.

Although complications can occur after a gastroscopy, they are rare when performed by doctors who are specially trained in gastroscopy. In Australia, very few people experience serious side effects from gastroscopy.

• Your/ child’s throat might be sore and feel bloated due to the air introduced into your / child’s stomach during the procedure.
• A small amount of blood might be seen in your child’s saliva after gastroscopy. However, very rarely blood in the vomiting or black tar-like stools could indicate major bleeding.
• In very rare situations, the stomach lining could be torn, which may require an operation to repair it.
• Reactions to sedatives are also possible, but again are very rare.
• In very few cases, if the gastroscopy could not be completed, it may need to be repeated.

You may administer pain relief such as paracetamol every 4 to 6 hours for one to two days if needed. Read the bottle for the correct dose for your child according to the age. Ask someone if you need help.

Do not give any medicine with paracetamol in it more than four times in 24 hours.

What are the Possible Complications of Gastroscopy?

Bleeding may occur from a biopsy site or where a polyp has been removed. This is usually minimal and rarely requires blood transfusions or surgery. Localised irritation of the vein where the medication was injected may cause a tender lump lasting for several weeks, but this will go away eventually.

Applying heat packs or hot, moist towels may help relieve discomfort. Other potential risks include a reaction to the sedatives/anaesthetic used and complications from heart or lung disease. Major complications, e.g. perforation (a tear that may require surgery for repair) are very uncommon and occur less often than once in 10,000 tests.

You need to recognise early signs of any possible complications. If you begin to run a fever after the test, have trouble swallowing, or have increasing throat, chest or abdominal pain, let your doctor know promptly or contact your local Emergency Department.

When Do I Seek Help?

If you / your child has the following symptoms in the hours or days after the gastroscopy, you should contact the rooms or proceed to the closest emergency department.

• Vomited more than 2 to 3 times
• Vomit with more than 2 to 3 MLS. (half teaspoon) of bright red blood in it
• Passing black tar-like stools
• Fever (Temperature above 38 degrees Celsius)
• Increasing throat, chest or abdominal pain
• Difficulty swallowing
• Any other symptoms that cause concern

Who Can I Contact If You Have Any Questions?

Please contact the rooms during weekdays. After hours proceed to the closest emergency department or your family doctor. In an emergency, contact the ambulance service by calling triple zero (000).

Colonoscopy

What is a Colonoscopy?

A Colonoscopy is an endoscopic procedure used to view or examine the inside surface of the large intestine (colon and rectum) or large bowel. 

A Colonoscopy is a procedure performed to detect irregularities such as

• inflamed tissue, 
• ulcers, and
• abnormal growths. 

Specifically, a Colonoscopy helps in the diagnosis of

• colorectal cancer, 
• bowel disorders, 
• abdominal pain, 
• inflamed tissue, 
• ulcers, and 
• anal bleeding.

Colonoscope Device

An instrument called a colonoscope is used during a colonoscopy. This instrument includes:

• A long thin, flexible tube
• A small camera and light at the end, and
• Other instruments can be added

By adjusting the various controls on the colonoscope or endoscope, your doctor can safely guide the instrument to carefully examine the inside lining of the digestive system or the upper or lower gastrointestinal tract. 

If necessary other instruments can be inserted through the Colonoscope that allows various therapeutic procedures to be carried out during a Colonoscopy procedure. 

Such therapeutic procedures may include 

• Biopsy - taking tissue samples (biopsies) and
• Polypectomy - removal of polyps (benign wart-like growths).

Polyps or growths are removed during a Colonoscopy and can be sent later for diagnostic testing to a pathology lab.

About Your Colonoscopy Procedure

Colonoscopy is performed usually with sedation by an anaesthetist 

The colonoscope is inserted into the bottom end of the anal canal. The colonoscope gently moves up through the rectum and then the colon until it reaches the caecum (junction of the small and large intestine).

The colonoscope is then withdrawn slowly as the camera shows pictures of the colon and rectum on a high-quality screen for a clear and detailed view.

Irregularities During Colonoscopy

Occasionally, narrowing of the bowel or other diseases may prevent the instrument from being inserted through the full length of the colon. 

As colon cancer arises from pre-existing polyps (benign tumours), it is advisable that if any polyps are found, they are removed at the time of examination. 

Most polyps can be burnt off by placing a wire snare around the base and applying an electric current.

How Longs Does a Colonoscopy Take?

You will be in the facility for approximately 2 hours.

Consent Forms for Colonoscopy

Because of the risk of cancer, it is recommended that all polyps found be removed at the time of colonoscopy. 

Due to sedation, it will not be possible to discuss the removal at the time, therefore if you have any queries regarding polyp removal, please discuss this before the procedure. 

For the colonoscopy to be performed, a consent form is required to be signed by you on the day of the procedure.

How do I prepare for a colonoscopy?

• Bowel preparation. You must follow a special diet and take bowel preparation medication before your procedure. Printed instructions will be provided at the time of your booking, or click here for instructions. 
• Fasting. You must stop drinking and eating for approximately 6 hours before the procedure. The hospital will contact you one working day before your procedure to advise fasting time. 
• Medications. You will be given instructions on stopping your blood-thinning and diabetes medications.

Risks and Complications with Colonoscopy

For inspection of the bowel alone, complications of colonoscopy are very uncommon. Most surveys report complications of 1:1000 examinations or less.

Complications that can occur include:

• intolerance of the bowel preparation solution
• reaction to the sedatives, while uncommon and can be avoided by administering oxygen during the procedure and monitoring pulse and oxygen levels in the blood.
• Perforation (making a hole in the bowel) or major bleeding from the bowel is extremely rare, but if it occurs may require surgery. 
• When operations, such as removal of polyps, are carried out at the time of the procedure, there is a slightly higher risk of perforation or bleeding from the site where the polyp was removed. 

Several rare side effects can occur with an endoscope procedure. If you wish to have full details of such complications explained, please discuss this with the doctor before the examination. 

In the unlikely event of a haemorrhage occurring, a blood transfusion may be necessary. 

It is important to realise that no test is perfect and small lesions and rarely even cancers can be missed during colonoscopy. The rate of missed cancer in international literature is 0.01%. For this reason, a follow-up colonoscopy is often recommended. If there is a change in your symptoms, these should be discussed with your doctor, even if you have previously had a colonoscopy.