Performing gastroscopies, looking at the inside of the stomach, and colonoscopies, looking at the inside of the colon, is an important part of a general surgeon’s work.
The most common indication for colonoscopy is to screen for polyps or cancer if you don’t have any symptoms and to exclude these conditions when you have changes in bowel habit or microscopic blood in the stool.
I‘ve been booked to undergo a colonoscopy, what can I expect?
Prior to colonoscopy, you need a thorough bowel cleansing to allow the endoscopist to see the mucosa, the lining of the bowel, clearly. This occurs the day before the procedure during which you’ll only drink liquids, as well as consume 2 litres of special, bowel-cleansing fluid. Click here for more on preparing for your colonoscopy.
On the day of the procedure, you’ll be admitted to hospital. Once settled in the ward, you’ll be given an enema before going to the GI unit.
In the GI unit, monitors that check the oxygen saturation in your blood, as well as blood pressure will be connected. You’ll be placed on a drip and intravenously sedated. These are mandatory with colonoscopy, but optional with gastroscopy simply because a colonoscopy is almost always quite uncomfortable. This form of sedation is technically called deep sedation or, in layman’s terms, light anaesthetic. Once sedated, you’ll seldom have any discomfort during the procedure and come round only once it’s completed.
During the procedure your surgeon will carefully look through your entire colon and, if needed, remove any polyps that may be found. If a polyp is too large to remove via the endoscope, or if possible cancer is encountered, a biopsy is taken for evaluation by a pathologist. The tumour is then injected with permanent ink so it can be identified from outside the bowel during eventual surgery.
Afterwards, you’ll be transferred back to the ward where your surgeon will feedback on what was found during the procedure.
What about gastroscopies?
Gastroscopies are commonly performed to evaluate upper digestive tract symptoms like heartburn or stomach pain. This can be done with no sedation at all, or if preferred, you may request sedation for the procedure.
Apart from not eating or drinking for 6 hours before the procedure, no special preparation is needed.
Having a gastroscopy is similar to having a colonoscopy, except you won’t be given an enema.
Does everyone with heartburn need a gastroscopy?
Definitely not. Only if your heartburn is severe and ongoing, doesn’t respond to conventional medicine or has been present for a long time, is it necessary to evaluate via gastroscopy.
But I’ve heard that heartburn can cause cancer?
To answer this question the condition known as ‘Barrett’s Esophagus’ should be discussed. In the 1950s a doctor named Norman Barrett first described how some people with long-standing reflux disease (caused by bile and acid running into the swallowing pipe because the valve that’s supposed to keep it out doesn’t close properly) later develop a change in the lining of their swallowing pipe. The altered lining consists of cells that would normally only appear in the small bowel and often heartburn symptoms actually disappear. However, the big downside of this is that cancer develops far more commonly in the changed lining.
Doctors don’t really know why some people develop this and others don’t, but it’s important to know that this condition almost always develops in white, middle-aged men. And if you’re overweight, have a hiatal hernia and chronic reflux symptoms, your risk is even higher.
It’s recommended that if you’re a middle-aged, white man who’s had significant reflux at some stage in your life, remember heartburn often disappears when the Barretts change occurs, you should have a once-off screening gastroscopy. As for the rest of us, we only need to undergo a gastroscopy if our doctor requests one.