Visualising the Digestive Tract: Endoscopy

 

Ms. Rashmi Sharma

Clinical Instructor, Army College of Nursing, Jalandhar Cantt.

 

ABSTRACT:

Owing to rise in gastrointestinal problems, endoscopy has become widely used test these days. Some of the modifiable factors like: adapting sedentary lifestyle, consumption of fast food, less exercise, alcohol consumption, smoking and much more indeed made man susceptible to deadly gastric problems. Plethora of diseases can be identified through endoscope and can be managed at the same time. Gastro patients often require visualization their GI tract to rule out the disease progression and its complications. For this, blood tests along with endoscope enabled health care professionals to commence the treatment more effectively. Endoscopy is often performed at OPD level and carries dual function: diagnostic as well as therapeutic. GI tract is visualized over camera and remedial action is taken to prevent further illness. Endoscopy is given different names on the basis of organs visualised like esophagogastrodudenoscopy, colonoscopy, ERCP and bronchoscopy. Most people only have mild discomfort, similar to indigestion or a sore throat post endoscopy.⁷

 

 

 

INTRODUCTION:

In general, endoscope is designed as a flexible tube with light, camera and ports to insert instrument for diagnostic and therapeutic purpose. This endoscope is utilised to examine the cavities, linings of various organs. For instance, procedure performed to view lungs (bronchioles) is called bronchoscopy. Similarly in cystoscopy urinary tract is visualised by using endoscope. To view biliary system (pancreas, bile ducts) Endoscopic Retrograde CholangioPancreatography¹ is performed by the team.

 

Definition:  

The process of viewing esophagus, stomach and duodenum (upper GI tract) through endoscope is called esophagodudenoscopy.¹

 

Examining lower intestinal tract (colon) through endoscope (called colonoscope) is called colonoscopy or sigmoidoscopy (for sigmoid colon).

ERCP: endoscope is inserted to visualise the biliary system.

 

PROCESS OF INSERTING ENDOSCOPE:

Upper GI Endoscopy or Esophagogastrodudenoscopy:

Endoscope is inserted through mouth→ patient advised to swallow it→ passes down to throat to esophagus→ throughout the procedure camera on endoscope allows visualisation of tract on screen; pictures are clicked for reference.²

 

Surgical interventions can be performed by passing the instrument through additional port in the endoscope. To exemplify, esophaegeal varices (enlarged veins in the esophagus prone to bleed and can lead to blood loss) can be identified as endoscope travel down through esophagus; abnormally enlarged veins lying are viewed as huge plexuses of veins. By inserting surgical ligation band through additional port around these veins strangulate it and make it to shed.² Thus, endoscopy allows diagnosing the problem and treating it. Further biopsy can be taken for examining tissues for microganisms or abnormal growth.

 

Colonoscopy:

Process of visualising colon with the help of colonscope(usually 4 foot long with camera, light and ports like endoscope). It is advanced in colon through rectum and allows visualisation of small intestine to some extent only. It helps in diagnosing colon polyp, obstruction, colon cancer as biopsy can be taken and sent for investigation. It may take upto 15-60 mins.³

 

Patient must be advised to empty bowel with the help of laxatives as stool in intestine obscure the lining of colon. Over the counter medicine, blood thinners must be stopped.

 

Procedure:

Patients lie on their left side or back → colonoscope is slowly introduced and advanced to terminal ileum→ then colonoscope is slowly withdrawn, and the lining of the colon is carefully examined. If the entire colon, for some reason, cannot be visualized, the physician may decide to try colonoscopy again at a later date with or without a different bowel preparation or may decide to order an X-ray or CT of the colon.³

 

Complications: perforation, infection, bleeding, side effects of anaesthesia, chest pain, bloody stool, difficulty in swallowing, indigestion, heart burn, a patient may experience.

 

ERCP:

Endoscopic retrograde cholangiopancreatography is used to eliminate disease of biliary tract (liver, gall bladder, pancreas). This may be performed ubder general anaesthesia or sedatives.  A special endoscope is inserted till duodenum then a catheter is advanced into biliary system through an opening of biliary tract. A contrast is introduced and x rays are performed to rule out gall bladder stones from bile duct, obstruction or any disease process. Simultaneously, therapeutic actions are performed like sphinctertomy, stent placement to maintain patency of biliary tract.⁵ The most common reasons for ERCP include: Yellow skin or eyes (jaundice), light stool and dark urine, Stones in the bile or pancreas duct, A lesion or tumor in the pancreas, gallbladder, or liver.⁶  Complications include: stomach ache, fever, vomiting, or other signs of infections.

 

CAPSULE ENDOSCOPY:

A capsule is given to patient to swallow with a glass of water. Capsule contains camera that keep on clicking pictures of tract as it passes. Sensors are attached on waist that records images. Patient is advised not to consume anything during the procedure except clear liquids. Fasting is important before any type of endoscopy to see the lining of GI tract. A person can resume normal routine within 4 to 5 hours.⁴

 

Complications: very rare, if capsule is stucked it may cause pain, bloating

 

Other types:

Bronchoscopy:

Observing airways, trachea, bronchi with the help of endoscope.

 

Hysteroscopy:

Scanning uterus, using hysteroscope.

 

Cystoscopy:

Visualising urinary bladder using cystoscope. 

 

ROLE OF NURSE IN GI ENDOSCOPY:

Pre-procedure:

Instruct patients to be empty stomach. Administer laxative if necessary. Check vitals. Administer sedative like lignocaine spray. Remove dentures.

 

During Procedure:

Proper position i.e like side lying or supine and instruct patient to cooperate and allowing passing tube.

 

CONCLUSION:

Endoscopic visualisation has enabled health care professionals to diagnose and halt the disease progression. This tool is a great invention to manage the deadly diseases. However, same time a person must be guided to adopt healthy lifestyle including diet and exercise in order to create healthy society. Consumption of healthy food may put end to number of diseases, hence health care professionals must impart education create awareness among people about healthy lifestyle.

 

REFERENCES:

1.      https://en.wikipedia.org/wiki/Endoscopy

2.      https://www.mayoclinic.org/tests-procedures/endoscopy/about/pac-20395197

3.      https://www.medicinenet.com/colonoscopy/article.htm

4.      https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/capsule-endoscopy#:~:text=A%20capsule%20endoscopy%20is%20a,a%20belt%20around%20your%20waist.

5.      https://www.webmd.com/digestive-disorders/digestive-diseases-ercp#1

6.      https://www.sages.org/publications/patient-information/patient-information-for-ercp-endoscopic-retrograde-cholangio-pancreatography-from-sages/

7.      https://www.nhs.uk/conditions/endoscopy/

 

 

 

Received on 06.11.2020         Modified on 30.11.2020

Accepted on 19.12.2020       ©A&V Publications All right reserved