What is endoscopic therapy?
Endoscopic therapy is a general term for treatments performed using an endoscope. An endoscope is a small, tube-like instrument that is inserted into the body through a tiny incision or a body opening, such as the mouth.
An endoscope has a lighted camera that transmits pictures of the inside of your body to a video screen viewed by the doctor. Doctors use an endoscope to examine and treat many conditions. The endoscope guides minimally invasive treatments that are performed using small instruments or medications.
Types of endoscopic therapy
Endoscopic therapy is used with the following procedures:
Arthroscopy treats joints and involves inserting an endoscope through a small incision near a joint.
Bronchoscopy treats the airways and lungs. It is performed by inserting an endoscope through the mouth or nose into the windpipe and lungs. Your doctor can take tissue or fluid samples for diagnosis, as well as remove inhaled foreign objects from the lungs.
Colonoscopy and sigmoidoscopy treat the large intestine. These procedures involve inserting an endoscope into the large intestine through the anus.
Cystoscopy and ureteroscopy treat the urethra, bladder and ureters of the urinary system. These procedures are performed by inserting an endoscope through the urethra and into the bladder and possibly the ureters.
Endoscopic retrograde cholangiopancreotography (ERCP) is an endoscopy performed through the mouth. The endoscope is passed into the esophagus, stomach and duodenum. It treats gallstones and pancreatitis.
Laparoscopy treats the abdomen or pelvis. It involves inserting an endoscope through a small incision in the abdominal or pelvic area.
Upper gastrointestinal endoscopic therapy treats the esophagus, stomach and duodenum, the first section of the small intestine. If only the esophagus is involved, it is called an esophagoscopy. If all of these organs are involved it is called an esophagogastroduodenoscopy (EGD). The procedure involves inserting an endoscope through the mouth into the esophagus and possibly the stomach and duodenum.
Other procedures that may be performed
Endoscopic therapy includes examining the body area and taking computerized pictures that are saved in your medical record. Your doctor may also perform a biopsy, which is the removal of a sample of tissue to be examined for disease or cancer.
Why is endoscopic therapy performed?
Your doctor may recommend endoscopic therapy to treat the following diseases and conditions:
Abdominal, gynecologic and pelvic organ conditions, such as hernia repair and removal of the appendix, gallbladder, spleen, uterine fibroids, endometrial tissue, ovarian cysts, ectopic pregnancy, and abdominal or pelvic tumors or cancer
Lower gastrointestinal conditions, such as removal of colon polyps and treatment of bleeding from the colon
Lung and airway conditions, such as draining a lung abscess; placement of a stent to keep an airway open due to obstruction form a growing tumor; removal of a foreign object or excessive fluid or mucus in the airway; and opening of a narrowed airway
Upper gastrointestinal conditions, such as removal of polyps and foreign objects; widening of a narrowed esophagus; treatment of hypertensive lower esophageal sphincter, Barrett's esophagus, and esophageal cancer; treatment of bleeding due to esophageal varices and peptic ulcers; and removal of gallstones
Urinary system conditions, such as the removal of kidney stones
Who performs endoscopic therapy?
Doctors who perform endoscopy therapy are specialized in a specific area of medicine and type of endoscopy procedure. They include:
Critical care medicine doctors specialize in the diagnosis and management of life threatening conditions.
Gastroenterologists are internists or pediatricians who specialize in diseases of the digestive system.
General and pediatric surgeons specialize in the surgical care of diseases, injuries and deformities affecting the abdomen, breasts, digestive tract, endocrine system and skin.
Obstetricians-gynecologists (Ob/Gyns) specialize in conditions and diseases of the female reproductive system.
Orthopedic surgeons specialize in diseases and conditions of the bones and joints.
Pulmonologists are internists or pediatricians who specialize in lung diseases.
Thoracic surgeons specialize in chest surgery.
Urologists and pediatric urologists specialize in diseases of the urinary and reproductive systems.
How It's Done
Your endoscopic therapy will be performed in a doctor’s office, hospital, or outpatient surgical setting. Some types of endoscopic therapy use sedation or nerve block anesthesia. Some procedures are more complex and require general anesthesia and a hospital stay.
The endoscopic therapy technique varies depending on the procedure, your symptoms or diagnosis, and other factors. Endoscopic therapies are performed by inserting the endoscope through a small incision or through an opening in the body, such as the mouth:
Arthroscopy involves inserting an endoscope through a small incision near a joint. It is performed by an orthopedic surgeon. It uses a general, spinal, or local anesthetic, depending on the type of procedure.
Bronchoscopy involves inserting an endoscope through the mouth or nose into the windpipe and lungs. It is done by a pulmonologist or a thoracic surgeon. The procedure is performed using general anesthesia or sedation, depending on the treatment.
Colonoscopy and sigmoidoscopy involve inserting an endoscope into the large intestine through the anus. They are generally performed by a gastroenterologist or surgeon. A sedative is often used to minimize anxiety and discomfort.
Cystoscopy and ureteroscopy involves inserting an endoscope through the urethra and into the bladder and possibly the ureters. These procedures are generally performed by a urologist. A local anesthetic is used to numb the urethra.
Endoscopic retrograde cholangiopancreotography (ERCP) involves inserting an endoscope through the mouth into the esophagus, stomach and duodenum. A sedative is often used to reduce anxiety and discomfort. A local anesthetic may be used to numb the throat.
Laparoscopy involves inserting an endoscope through a small incision in the abdominal or pelvic area. It is generally performed by an abdominal surgeon, general surgeon, or an obstetrician-gynecologist. General anesthesia or spinal anesthesia is used so that you will not feel pain during the procedure.
Upper gastrointestinal endoscopic therapy involves inserting an endoscope through the mouth into the esophagus, stomach, and possibly the duodenum, the first section of the small intestine. It is generally performed by a gastroenterologist. Sedation is often used to reduce anxiety and discomfort. A local anesthetic may be used to numb the throat.
Will I feel pain?
Your comfort and relaxation is important to both you and your care team. You may feel brief discomfort with some procedures. Your doctor will treat your pain or discomfort. Tell your care team if you are uncomfortable in any way.
You will have one or more of the following medications to keep you comfortable during endoscopic therapy:
General anesthesia is a combination of IV medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Pain medication is given intravenously (through an IV) or orally.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
Sedation is usually given through an IV. It makes you drowsy and relaxed. In some cases, deeper sedation may be used, called conscious sedation. It makes you more relaxed. Patients who have conscious sedation are usually unaware of the procedure and may not remember it.
Topical anesthesia is applied to the surface of the skin or mucosa. Examples include gargling or spraying the throat with an anesthetic to help numb it and reduce the gag reflex.
What are the risks and potential complications of endoscopic therapy?
As with all surgeries, endoscopic therapy involves risks and the possible complications. Complications are uncommon but may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of endoscopic therapy
Complications of endoscopic therapy include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Perforation or tear of the tissue
Potential complications of specific endoscopic therapy procedures
Potential complications are related to the type of endoscopic therapy:
Colonoscopy and sigmoidoscopy can result in nausea, vomiting, rectal discomfort, puncture of the large intestine, bleeding, and dehydration due to taking enemas and laxatives before the procedure.
Endoscopic retrograde cholangiopancreotography (ERCP) can result in puncture of the upper gastrointestinal tract, pancreatitis, difficulty swallowing, and sore throat and bleeding due to local tissue trauma
Laparoscopy can result in blood vessel or organ damage, which may require further surgical repair.
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during your recovery
Notifying your doctor right away of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my endoscopic therapy?
You are an important member of your own healthcare team. The steps you take before your surgery can improve your comfort and outcome and help obtain the most accurate test results.
You can prepare for an endoscopic therapy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following preoperative instructions, such as not eating or drinking before a procedure, or taking a laxative or enema as directed.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), certain vitamins, diabetes medications, and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Having endoscopic therapy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before endoscopic therapy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need endoscopic therapy? Are there any other options for treating my condition?
Will I need further treatment after endoscopic therapy?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain?
When will I get the results of my test or tissue biopsy if one was taken?
When should I follow up with you?
When and how should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my endoscopic therapy?
Knowing what to expect after an endoscopic therapy can help you get back to your everyday life as soon as possible.
How will I feel after the endoscopic therapy?
What you experience after endoscopic therapy will vary depending on the procedure, your health history, and other factors.
You will have discomfort or pain after some procedures. Be assured that modern pain control methods are very effective. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
You might feel drowsy for about 24 hours if you had narcotic pain medications, a sedative, or general anesthesia. You may also have some nausea. Tell your doctor or care team if you are nauseated so it can be treated.
You may have some numbness for a short period after endoscopic therapy with regional or local anesthesia (nerve block). Tell your doctor or care team if you feel numbness longer than expected for your particular procedure.
When can I go home?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will go home the same day as an outpatient procedure. You will be drowsy and cannot drive for 24 hours. You will need a ride home, and someone should stay with you for the first day.
A hospital stay may be required after extensive procedures, such as some types of arthroscopy, bronchoscopy, and laparoscopy.
When should I call my doctor?
It is important to keep your follow-up appointments after an endoscopic therapy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bloody urine or difficulty urinating, especially if it increases after you get home or does not go away as expected
Change in alertness, such as passing out, unresponsiveness, or confusion
Cough that does not go away
Fever. You should not have a fever after a minor endoscopic procedure, but a low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after a major laparoscopic surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication
Sore throat or hoarseness that lasts longer than expected
Unexpected drainage, pus, redness or swelling of your incision