Colonoscopy is a procedure used to see inside the colon and rectum.

What problems can colonoscopy detect?

Colonoscopy can help doctors diagnose the reasons for

• Unexplained changes in bowel habits
• Abdominal pain
• Bleeding from the anus
• Unexplained weight loss

Colonoscopy can also detect inflamed tissue, ulcers, and abnormal growths.

The procedure is used to look for early signs of colorectal cancer. The doctor can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.

Colonoscopy can be used to:

• Remove polyps (polypectomy)
• Dilate narrowed segments (stricture dilation) of the large intestine and place metallic stents across them (colonic stenting)
• Banding for hemorrhoids (piles banding)

How is Colonoscopy Performed?

During a colonoscopy, patients lie on their left side on an examination table. The doctor inserts a long, flexible, lighted tube called a colonoscope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.

Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Bleeding and puncture of the large intestine are possible but they are uncommon complications during colonoscopy.

ERCP enables the physician to diagnose problems in the gallbladder, bile ducts, and pancreas. The liver is a large organ that makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and also secretes hormones such as insulin.

Applications:

ERCP is primarily used as a therapeutic procedure for the treatment of diseases of

Bile Duct

• extraction of bile duct stones by balloon/basket (balloon/basket extraction)
• by crushing large bile stones and retrieving them (mechanical lithotripsy)
• relieving jaundice due to bile duct narrowing by dilating passage with a balloon (balloon dilation)
• treatment of bile duct infection (cholangitis) by draining pus by cutting open bile duct opening (biliary sphincterotomy) and placing stents /catheter in bile duct for free drainage of bile into the duodenum ( plastic stent/ENBD placement)
• stopping leakage of bile in bile duct injuries as a result of trauma and surgery
• metallic stent placement for relief of itching and jaundice in the bile duct, pancreatic, gallbladder cancers (metallic stent placement)

Pancreas

• relief of pain in chronic pancreatitis
• by removal of pancreatic duct stones
• dilating the narrowed pancreatic duct
• placing of stents to facilitate drainage of infected fluid collection in pancreatitis (Pseudocyst drainage)

How is ERCP performed?

ERCP combines the use of X-rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X-rays.

For the procedure, you will lie on your left side on an examining table in an X-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the examination. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on X-rays. X-rays are taken as soon as the dye is injected.

Endoscopic Ultrasonography [EUS] is an imaging technique that combines endoscopy with ultrasonography. EUS is performed using an endoscope with a small ultrasound machine attached to the tip of the endoscope. The endoultrasound probe is passed through the mouth or anus to the area to be examined under endoscopic view. The ultrasound component is then utilized to examine the walls and the surrounding structures of the upper and lower gastrointestinal tract. The esophagus, stomach, duodenum, and rectum are the organs that are studied by this equipment. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the mediastinum, gallbladder, biliary tract, and pancreas.

Benefits of EUS

• EUS provides detailed images of the anatomy of the digestive tract.
• EUS can be performed to further evaluate the pancreas when abnormalities are noted on CT or conventional abdominal ultrasonography.
• EUS can also be performed to evaluate abnormal areas in the esophagus, stomach and duodenum noted on either endoscopy or an X-ray examination.
• EUS is the only investigation that shows the gastrointestinal wall as a layered structure as seen in microscopic examination of tissues. This feature is helpful to understand the exact nature of the pathology.

Applications of EUS

• EUS can help determine the extent of certain malignancies of the gastrointestinal tract. These include cancer of the esophagus, pancreas, stomach, and rectum. EUS provides information as to the depth of involvement of cancer.
• EUS shows if malignant cells have invaded the walls of the GI tract or whether malignancy has spread to adjacent lymph nodes or nearby vital structures such as major blood vessels.
• EUS is the only investigation that can identify lymph nodes smaller than 1cm. EUS can help determine the need for or avoidance of surgical procedures.
• EUS helps to differentiate a malignant lymph node from a tuberculous lymphnode particularly in the mediastinum.

Applications of EUS in Evaluation of the Common Bile Duct

• EUS is a very useful tool to evaluate CBD. Abnormalities like tumours, stones, and dilatation of CBD can be detected.
• Microlithiasis in CBD and gallbladder can be detected and EUS is the only test that detects microlithiasis. Microlithiasis of the gallbladder is an important cause of biliary pancreatitis.

EUS for Management of Pseudocyst of Pancreas

EUS is the most appropriate treatment of choice for the drainage of the pseudocyst of the pancreas. EUS can clearly show the type of cyst, its contents, and also whether there is any blood vessel on the needle track during the puncture. It is possible to deploy a stent inside the cyst from the stomach.

The list of Diagnostic and Therapeutic Procedures performed in the Endoscopy Unit:

• Upper GI – Esophagus (Food pipe), Stomach & part of Small Intestine:
  -Diagnostic Upper GI Endoscopy
  -Therapeutic Upper GI Endoscopy

• Liver, Gall Bladder & Pancreas:
  -ERCP : Diagnostic
  -Therapeutic ERCP
• Small Intestine:
  -Diagnostic Small Intestinal Endoscopy (push enteroscopy)
• Large Intestine:
  -Diagnostic Colonoscopy
  -Therapeutic Colonoscopy
  -Diagnostic Sigmoidoscopy
  -Therapeutic Sigmoidoscopy (Rigid) with banding
• Endosonography:
  -Endosonography with FNAC
  -Endosonography therapeutic
• Others:
  -PEG (Percutaneous Endoscopic Gastrostomy)
  -Psedocyst Drainage
  -Pancreatic Necrosectomy