Endoscopic methods

Question 1

What is an endoscope?

Answer 1

Direct imaging technique inside the body

Consists of a long, thin, flexible telescope with a light source and a camera at the end

Inserted through any orifice to look at any surface of the body directly with the naked eye

Question 2

What are common systems observed via endoscopic methods?

Answer 2

GI tract 
Small incisions - laparoscopy 
Respiratory tract 
The female reproductive system 
The urinary tract 
The ear

Question 3

Which areas of the GI tract can be observed via an endoscope?

Answer 3

EGD (esophagogastroduodenoscopy) - oesophagus, stomach and duodenum

Enteroscopy - small intestine

Colonoscopy/ sigmoidoscopy - colon

Different length and diameter of scope for ways of access

Question 4

What is laparoscopy?

Answer 4

Endoscopy through a small surgical cut

The basis for minimally invasive surgery (keyhole surgery)

Most common procedure: laparoscopic cholecystectomy

Question 5

What areas of the respiratory tract can be observed?

Answer 5

Rhinoscopy - the nose

Bronchoscopy - the lower respiratory tract

Question 6

What areas of the female reproductive system can be observed using endoscopy?

Answer 6

Coposcopy - the cervix

Hysteroscopy - the uterus

Falloscopy - the fallopian tubes

Question 7

What is the endoscopic method called for observing the urinary tract?

Answer 7

Cystoscopy

Question 8

What is the endoscopic method called for observing the ear?

Answer 8

Otoscopy

Question 9

Procedure of a colonoscopy

Answer 9

Carried out usually by a consultant gastroenterologist, training gastroenterologist or endoscopy nurse

Passed specific test to screen for bowel cancer in patients with positive FOBT

Investigation involves looking directly at the lining of the bowel with a colonoscopy

Colonoscopy usually requires sedation and analgesia together with a smooth muscle relaxant

Question 10

What population normally undertakes a colonoscopy?

Answer 10

Those who tested positive in FOBT

Question 11

Which professionals carry out a colonoscopy?

Answer 11

Consultant gastroenterologist

Training gastroenterologist

Endoscopy nurse

Question 12

What is an example of a smooth muscle relaxant?

Answer 12

Buscopan

Question 13

Patient preparation for a colonoscopy

Answer 13

Information leaflet and bowel preparation pack

Clear communication prior to the procedure is very important - with nurse

Follow a low residue diet for three days before the procedure

Take a laxative to get the best view possible

Question 14

What is an example of a laxative taken in the patient preparation

Answer 14

Picolax

Question 15

Why is it important to undergo appropriate patient preparation?

Answer 15

Critical - waste of time and money if the patient does not stick to the preparation procedure, as the doctor will not get a clear view of the walls of the large intestine

Question 16

Procedure of the colonoscopy

Answer 16

Patients lie on their left side or back as the colonoscope is slowly inserted

Carbon dioxide is pumped into the colon to allow clearer visualisation of the colon wall

More soluble than air

Once the tip of the colon or the last portion of the small intestine is reached, the colonoscope is slowly withdrawn and the lining of the colon examined

Question 17

What is the duration of a colonoscopy?

Answer 17

Can last between 20-60 minutes

Depends on patient

Have to negotiate with the curvature of the large intestine

Question 18

What are the possible of a colonoscopy?

Answer 18

Id the colon cannot be fully visualised, the colonoscopy may have to be attempted again on another day using a different bowel preparation

The patient may need a CT or X-ray alternatively or cameras in pills

Question 19

What is the disadvantage of the alternative methods to colonoscopy?

Answer 19

Cannot take biopsies of the colon

Question 20

Why is bowel cancer good to treat?

Answer 20

Has an identifiable, treatable, pre-malignant stage

These are called polyps

Question 21

What are polyps?

Answer 21

Growth in the mucosa of the colon or rectum, caused by excessive cell replication

Question 22

What are the two types of polyps that exist?

Answer 22

Hyperplastic or metaplastic growth

Question 23

What is metaplasia?

Answer 23

Replacement of one differentiated adult cell type with another

May be reversible

In some cases these processes may herald the beginning of development of a neoplasm

Question 24

What is neoplasia?

Answer 24

An irreversible growth

A tumour may be benign or malignant

Question 25

What is hyperplasia?

Answer 25

Reversible increase in cell number

Question 26

How common are polyps?

Answer 26

Very common

Affects 15-30% of the population

Question 27

Clinical presentation of polyps

Answer 27

Usually asymptomatic

Can cause bleeding, pain, and changes in bowel habit

Polyps which bleed should be picked up by the gFOBT

Question 28

What should be done if polyps are detected?

Answer 28

Should be removed since they may become cancerous if left in place

Question 29

What percentage of polyps become cancer?

Answer 29

1-10%

Question 30

How are polyps removed?

Answer 30

Can be removed during colonoscopy in painless fashion

Cauterising wire loops passed down the colonoscope tube

Once retrieved they are taken to the lab to be analysed

Question 31

What is a biopsy?

Answer 31

Sample of tissue taken from the body for further investigation by cellular pathologists

Question 32

Where are most colorectal cancers located?

Answer 32

In the sigmoid colon and rectum

Accounts for 60% of colorectal cancers

Left side of the colon

Question 33

What are the possible appearances of polyps?

Answer 33

Polyploid
Infiltrative
Ulcerative

Question 34

What percentage of people who undergo colonoscopies have normal results?

Answer 34

50%

Question 35

What percentage of colonoscopies will result in a polyp being identified?

Answer 35

40%

Question 36

What percentage of colonoscopies will result in cancer being identified?

Answer 36

10%