Upper Endoscopy and Colonoscopy


If you are told that you need to have an upper endoscopy, colonoscopy or both, there are certain things that you should be aware of before the day of the procedure. This article details some of the indications for the procedures and the steps needed to prepare for these studies.

Endoscopy is simply a procedure that involves using a small camera mounted on a narrow tube to look at areas inside of the body. Gastroenterologists (GI doctors) routinely use this tool to directly see areas within the GI tract. An upper endoscopy is used to see the throat, esophagus, stomach and first part of the small intestine (called the duodenum). A colonoscopy has its intended target in the name, the colon. Many people know the other name for the colon, the large intestine. It is important to note that much of the small intestine (the lower part of the duodenum, the ileum and most of the jejunum) cannot be reached by normal endoscopy techniques.

Bleeding in the GI tract is the main cause for upper endoscopy and colonoscopy. In fact, if someone has anemia (too few red blood cells in the blood) that is not explained by some other reason, they usually have both procedures. The main reason that a suspected GI bleed needs to be investigated by endoscopy is because the intestines could hold a large amount of blood and endoscopy is one of the best ways to see it. Otherwise the blood could accumulate unnoticed but create symptoms in the patients just like a hemorrhage from a cut in the arm or leg. The other reason that bleeding is investigated thoroughly is that it sometimes indicates the presence of a GI cancer. Keep in mind that there are many reasons for bleeding in the GI tract and while cancer is important, it is not nearly the most common cause.

Colonoscopy may be performed as a routine screening test. People over the age of 50 should have a screening colonoscopy every ten years. People with certain risk factors may need surveillance colonoscopies at any earlier age or more frequently.

The quality of the findings obtained during colonoscopy has almost everything to do with you, the patient. Realize that endoscopy is nothing more than a camera mounted on the end of a long, flexible tube and that the goal of endoscopy is to see the walls of the stomach and intestines. If there is food or fecal matter in the GI tract at the time of the procedure, very little can be done to remove it. This means that the test will be inconclusive and will likely need to be repeated. What can you do to improve the chances that the study will be successful? Follow the doctor’s instructions precisely. This will usually involve two directions that may sound easy but seem to be a challenge for many patients.

The first direction is to avoid eating anything except clear fluids for eight to twelve hours before the procedure. Many people can abide by this instruction, but you will be surprised by how many that cannot. The physician lowers the endoscope only to find that breakfast is in the way.

The second direction is more of a challenge. The doctor will prescribe a solution that needs to be consumed the day before the colonoscopy. It is meant to stimulate your bowels to empty completely. Why is drinking it so difficult? The solution usually tastes bad and a large amount has to be consumed in a short period of time. Also, it causes diarrhea by design, which people do not enjoy. The night before the procedure is spent evacuating the bowels. While this may be difficult, if done properly the doctor will be able to see all of the internal anatomy, make an accurate diagnosis and even perform some minor surgical procedures during the endoscopy.

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