Endoscopy is a medical procedure in which a doctor uses a long, thin, flexible tube to look inside parts of the body.
The tube, known as an endoscope, has a light and camera at one end so the doctor can inspect the area and check for any signs of disease. In some cases, special instruments can be attached to the endoscope to take samples of tissue (known as a biopsy) to be analysed in a laboratory. Instruments can also be attached to the endoscope to allow things to be removed, e.g. polyps.
The endoscope can be inserted through one of the body’s natural openings, e.g. the mouth or anus; or via small cuts in the skin to examine other areas (called keyhole surgery).
Why is an endoscopy performed?
A doctor may perform an endoscopy to:
- Investigate symptoms: endoscopy can be used to investigate the cause of certain symptoms: e.g. abnormal bleeding, persistent abdominal pain, difficulty or pain when swallowing, continuous nausea or diarrhoea, unexplained weight loss.
- Diagnose medical conditions: To help diagnose medical conditions: the doctor can use the endoscope to remove a sample of tissue and and send the sample to a lab for analysis (biopsy).
- To treat problems: special instruments can be passed down the endoscope to remove blockages or growths such as polyps or fibroids, drain away excess fluid or open up narrow areas. Doctors can repair damaged cartilage, repair hernias, insert small devices (stents) to keep areas open, or even remove small infected organs – for example, the appendix, gallbladder and some cancers can often be removed via keyhole surgery using an endoscope.
- To monitor changes or problems: endoscopies may be repeated at regular intervals as part of screening programs (e.g. bowel cancer screening), or to monitor an area after treatment.
Endoscopy procedures can reduce the need for open surgery (traditional surgery where a large opening is made to examine and treat problems). Open surgery is often associated with a greater risk of pain and bleeding and a longer recovery time.
What are the types of endoscopy?
Several types of endoscopes have been developed to examine different parts of the body. Different procedures which use endoscopes that are inserted through a natural opening in the body include:
- Gastroscopy or upper endoscopy: a gastroscope is inserted into the mouth and used to examine the upper parts of the digestive tract e.g. the oesophagus (food pipe), stomach and first part of the small intestine.
- Colonoscopy: endoscope is inserted into the anus and used to examine lower parts of the digestive tract e.g. the rectum and colon. Sometimes, a shorter tube is used to examine just the lower part of the colon (the sigmoid colon). This procedure is called a sigmoidoscopy.
- Bronchoscopy: the bronchoscope is inserted into the mouth or nose and passed down the throat to examine the airways and lungs.
- Cystoscopy: a cystoscope is inserted into the urethra (the tube that carries urine) and used to examine the bladder. Another procedure known as cystoscopy is when a hysteroscope is inserted into the vagina and used to examine the uterus and fallopian tubes.
A newer type of endoscopy is called a capsule endoscopy. It involves swallowing a capsule that is about the size of a large pill. The capsule contains a small camera and light source, and can wirelessly transmit images of the digestive system back to the doctor. The capsule is disposable and is expelled from the body naturally when the person goes to the toilet. It can be useful to look for problems in the small bowel that may be difficult to visualise in other ways.
In other types of endoscopy, several cuts are made in the skin so that the endoscope can examine other areas of the body, for example:
- Arthroscopy: an arthroscope is used to look inside joints such as the knee, shoulder, ankle or hip. May be done to investigate persistent joint pain, swelling or stiffness.
- Laparoscopy: a laparoscope is used to look into the abdomen and pelvis. The procedure is commonly used to help diagnose and treat a wide range of medical conditions.
Preparation for an endoscopy
An endoscopy is usually done at a hospital or specialised medical clinic. Some types of endoscopy require more extensive preparation than others. For example, depending on what part of the body is being examined, a person may have to avoid eating and drinking before the endoscopy. The hospital or clinic will advise people about how long they should fast before the procedure and whether they can or should have any fluids.
Some people will need to drink a special solution to clear their bowels, e.g. before a colonoscopy. Some people may also need to stop some medicines they are taking or alter the timing of when they take certain medicines. However, a person should never stop or alter any medicines without first checking with their doctor. Some people may also require antibiotic treatment before an endoscopy.
During the endoscopy
An endoscopy is not usually painful, but a person may feel some discomfort during the procedure.
Some endoscopies (e.g. arthroscopy) may require a general anaesthetic, but many types only require a local anaesthetic to numb a specific part of the body. Some people will also be offered a sedative to help them relax. After taking a sedative the person may be slightly aware of what is going on but won’t usually remember very much.
When the person is ready, the doctor guides the endoscope carefully and gently into the body through a natural opening or through small cuts made in the skin. The location depends on what area is being examined. The images from the endoscope’s camera are transmitted to a screen (e.g. computer or television) so that the doctor can see what is inside. The doctor may pass instruments down the endoscope to remove small tissue samples, make repairs or remove abnormal growths. The doctor will then gently remove the endoscope. If any incisions have been made, these are then closed.
Depending on the type of endoscopy, the procedure usually takes up to 60 minutes to perform.
After the endoscopy
After the endoscopy a person will usually need to rest quietly for about 30 minutes, at least until the effects of the sedative or anaesthetic have worn off. A person can usually go home on the same day of the procedure. Someone who has had a sedative will not be able to drive afterwards, and should arrange to get someone else to take them home.
The hospital or clinic will provide information about what to expect after the endoscopy, and what things to watch for that may require further medical attention.
What are the risks associated with endoscopy?
Complications from an endoscopy are very uncommon. Some people may feel soreness or tenderness after the procedure, but this usually settles quickly.
Complications may include:
- Piercing a hole or tearing in the area being examined.
- Excessive bleeding.
People who have been sedated may occasionally have some side effects, for example they may feel sick or vomit, feel a burning sensation at the site of the injection, have trouble breathing, or develop low blood pressure or an irregular heartbeat.
2. NHS Choices. Endoscopy (revised July 2014). http://www.nhs.uk/Conditions/Endoscopy/Pages/Introduction.aspx. Accessed April 2016.
3. Mayo Clinic. Upper endoscopy (revised June 2015). http://www.mayoclinic.org/tests-procedures/endoscopy/basics/definition/prc-20020363. Accessed April 2016.