Dr. Ertan Beyatlı

How is an endoscopy done?

(Update: ) - Digestive System Diseases

What is an endoscopy?

Endoscopy (a tube in colloquial language) is a tube that shows the inside of the organs with the help of light. The word "endo" means "inside" and the suffix "scopy" means "viewing".

How long does an endoscopy take?

Endoscopy (Interior) - It is a very short process (approximately 5 minutes). Endoscopy In order to suppress and prevent the reflex of the patient beforehand, a narcotic spray is sprayed towards the mouth and the root of the tongue (local anesthesia).

left side lying position
left side lying position

Many positions assigned to the patient to carry out the procedure have been described. Among these, the most widely used is the left side lying position. In some cases, the patient's left arm is taken back from the shoulder, in some cases it is left in a neutral position as seen in the photo. The position provides comfort for the patient and helps the physician to examine the upper digestive system in detail.

Although these factors seem simple, they are important in terms of performing an adequate and efficient operation. The main purpose here is not only to perform the endoscopy procedure, but to detect an existing pathology!

Many endoscope maces are available to perform this procedure; for example Olympus, Pentax, Fujifilm.

How is it done?

Endoscopy procedure, which is performed in accordance with its experienced and method, is completely painless. Therefore, I have to say clearly that fear of endoscopy in some patients is completely unnecessary and unwarranted. The air given to inflate the stomach and intestines during the procedure may give a very slight nausea sensation.

plastic mouthguard - mouthguard
Disposable Plastic mouthguard - mouth guard

When starting the procedure, a plastic mouthguard is placed in the patient's mouth. The purpose of this is that the device is not bitten by the patient and the procedure is performed more easily.

The endoscopy instrument is advanced over the tongue and oropharynx ve epiglottis region is displayed.

Oropharynx and epiglottis area
Oropharynx and epiglottis area

At this stage, the posterior cavity of the mouth, the airway from the nose, the vocal cords (cord vocalis), larnx, pharynx are displayed. At this stage, the patient is asked to swallow his saliva and into the esophagus just behind the windpipe (esophagus) is entered. While the swallowing reflex closes the windpipe, it allows the esophagus to open.

Image of esophagus (top) and stomach lid (bottom)
Image of esophagus (top) and stomach lid (bottom)

When the lower part of the esophagus is reached, the valve between the stomach and the esophagus (LES = Lower Esophageal Sphincter or CSS = Cardioesophageal Sphincter) is displayed. At the beginning of the pathologies to be displayed here, the lid is loose (LES / KÖS Slack) or inflammation and irritation of the esophagus due to the return of stomach acid (reflux) (esophagitis).

Anatomical parts of the stomach
Anatomical parts of the stomach

After the LES is passed, the stomach is entered. The fundus, cardia, corpus, antrum and pylor regions of the stomach are examined. Important diseases to be seen in the stomach are:Antral Gastritis) or all (pangastrit) inflammation, the formation of deep or superficial wounds (peptic ulcer), inflammation due to bile (alkaline reflux gastritis), polyps, and benign (benign) or bad (malignant) tumors and narrowing of the stomach outlet (pyloric stenosis or Gastric outlet obstruction).

H. Pylori
H. Pylori

At this stage, Helicobacter Pylori (H.Paylori) test (CLO test = Campylobacter-like organism testBiopsy can be taken. Helicobacter Pylori The microbe can cause a wide range of problems in the stomach, from simple gastritis to stomach cancer.

Then, passing through the pylorus region, to the upper part of the small intestine (duodenum) is entered. Here again, as in the stomach, inflammation (duodenitis), wound (Duodenal ulcer), polyps, and benign (benign) or bad (malignant) tumors can be seen. At the same time, the door in the duodenum where the bile ducts open to the intestine (Ampulla of vater) is displayed.

When the device is withdrawn, the J maneuver is performed in the stomach and the valve between the stomach and esophagus is viewed from the inside. With this maneuver, the degree of laxity in the valve and the gastric hernia (hiatal hernia, sliding hiatus hernia, paraesophageal hernia), if any, can be detected.

The regions examined during the endoscopy procedure, respectively, the esophagus (esophagus), stomach (gastric) and the beginning part of the small intestine (duodenum) is the name of the process Esophago-gastro-duodenoscopy.

It is called Esophagoscopy when only the esophagus is examined, and Gastroscopy when only the stomach and esophagus are examined.

When the duodenum is examined, it is called Duodenoscopy, where it is considered to be the same as the Esophago-gastro-duodenoscopy procedure because the esophagus and stomach are already displayed (i.e. Duodenoscopy = Esophago-gastro-duodenoscopy = Upper GI Endoscopy)

A frame during the endoscopy procedure
A frame during the endoscopy procedure

In many patients, endoscopy can be performed under general anesthesia or anesthesia. During this procedure, which takes a very short time such as 3-5 minutes on average, the patient is given various medications intravenously by the anesthesia team (fenatanil, dormicum, propofol, buscopan, metpamid, etc) thanks to sleep.

Since the drugs administered cause temporary memory loss in the patient, patients do not remember anything after the procedure.

When is it done? (Endoscopy Indications)

  • Upper digestive complaints - loss of appetite, indigestion, nausea, rancidity, burning, stomach pain)
  • Anemia (anemia)
  • Oral or rectal blood (Hematemez, Hematocesia, Melana)
  • Occult Blood in Stool (Occult Blood in Stool GGK)
  • For early cancer screening in all people over the age of 50
  • For control purposes (Stomach polyp, GastritisCancer reflux, Ulcer)

Is it better to be put to sleep or alive?

fainting endoscopy procedure
Endoscopy procedure with anesthesia (by being put to sleep)

Endoscopy can be performed under both local and general anesthesia. The important thing here is that the patient is comfortable and relaxed. The more relaxed the patient is, the shorter and smoother the procedure can be done. Endoscopies performed by an experienced physician without being anesthetized have several advantages for both the patient and the doctor:

  • Processing time is short (3-5 minutes)
  • After the procedure, the patient can return home or work immediately. He can drive a car.
  • It does not require a courier.
  • No medication should be administered intravenously.
  • Biopsy can be taken during the procedure when necessary.
  • The opportunity to examine in detail the diseases (eg ulcer, polyps, gastritis, reflux) detected during the procedure
  • Possibility to take biopsy from more than one region in endoscopic oncological screening and controls (eg stomach cancer, colon CA, etc.).
  • To be able to perform the procedure under more controllable conditions, especially in patients with hypertension, heart and lung diseases.
  • Providing comfort and convenience in therapeutic endoscopies (therapeutic applications, biopsy taking, polypectomy, balloon dilatation, stent placement, PEG insertion ... etc.)

Endoscopy only [hose down the stomach] or [release a hose into the stomach] is not an operation. It is the most valuable and only method for diagnosing many digestive system diseases. Moreover, it is a simple, painless and short procedure… Op.Dr.Ertan BEYATLI

esophagitis, gastritis, ulcer and hernia in the same patient

To do or to diagnose?

To do, to look, to see, to diagnose. These four overrides must be complete. Noticing a disease during the procedure and making a diagnosis are separate. Because endoscopy is a subjective procedure. The result of the endoscopy depends entirely on the experience and knowledge of the physician, depending on where he looks, what he sees, and how he evaluates and diagnoses which image.

We can see this difference of opinion even in the most dangerous diseases. For example, there are concrete cases where one center reported normally results in bad illness in another center. Therefore, some points should be taken into consideration in order to get maximum efficiency from the Endoscopy procedure:

  • There should be a reason to have an endoscopy.
  • The procedure should be an experienced physician.
  • Adequate patient information should be provided by the physician performing the procedure. Before the procedure, the patient should not have question marks in his head.
  • A video report or a CD about the process should be obtained.

TDK medical terms of Turkish Language Association 2013 = Endoscope: Insight, Endoscopy: Interior Look

Youtube Videos:

How to do an endoscopy video (with anesthesia) - Dr. Ertan BEYATLI

What is Surgical Endoscopy?

In short, it means closed surgery method. It refers to the operation of any part of the body using a special instrument (endoscope - laparoscope) during the operation. In other words, it means to perform surgery through a very small incision in the body. In English sources it is also known as Minimal Invasive Surgery (or laparoscopic surgery).

Thanks to the rapidly increasing endoscopic and laparoscopic interventions, shorter surgeries, less hospitalizations and the opportunity to return to normal life and work life earlier are provided.

How much does it cost?

The cost of the endoscopy procedure can vary depending on many factors. These include the general health status of the patient, the center or hospital applied, and the physician factor. Insurances pay certain fees for endoscopy and the remaining costs are covered by the patients.

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