Diagnostic Endoscopy

This refers to methods that with the aid of optical instruments the internal examination of hollow organs such as the stomach and intestine, or body cavities e.g. the abdominal cavity is possible. Due to the close examination of the "inner surfaces", whereby today's high resolution units are also capable of very high enlargement, the experienced examiner can determine whether any kind of illness is evident.

Due to the fact that in certain cases the onset of illness begins in the mucous membrane without causing any change to the surface, the extraction of small mucous membrane particles for detailed histological examination by the Pathologist is necessary for the identification of an illness of this nature and the precise determination of the type of change. This sample extraction is called biopsy; there is no risk and the patient experiences no discomfort. Examinations of this nature can be conducted whilst the patient is awake, worried patients can be given a drug on the day before or on the day of the examination (premedication); during the examination the patient can be made drowsy with a sedative or alternatively be given a short anaesthesia, which results in the patient sleeping.

The principles of "gentle endoscopy" include the patient experiencing no discomfort during the examination and being subjected to no risk due to the examination. In our joint clinic experienced Anaesthetists work together with experienced Endoscopists to ensure this. It is particularly important to point out that after every form of premedication or medication such as sedatives or short anaesthesia, there may be a slight impairment to ones capability to react. For this reason one should not drive a vehicle or operate dangerous machinery (e.g. crane, plane etc.) for at least 6 hours after - or better still the entire day of - the examination. The examinations conducted in the joint clinic are described below.

Endoscopy of the upper digestive tract

(commonly known as gastric examination) In the scope of this examination a flexible endoscope that has a video chip fitted to its tip is used to illuminate the pharyngeal cavity, the oesophagus, the stomach, the duodenum, and often also the beginning of jejunum; the video image is observed by the examiner and assistant on a monitor. This enables representation of the slightest of changes to the mucous membrane and due to the possibility of significant enlargement and vital staining as well as virtual staining (observation with light determined wavelengths), almost microscopic evaluation.

The results offered by this examination are supplemented through regular extraction of tiny mucous membrane particles from the jejunum or lower duodenum, the gastric antrum, the body of the stomach, the oesophagocardial junction, possibly the oesophagus and from macroscopic irregularities. In this way all forms of inflammation to the stomach mucous membrane (gastritis), the oesophagus, many forms of infection to the small intestine, particularly gluten intolerance, benign and malignant ulcers and tumours, bleeding, injuries, foreign bodies, and infections can be identified or excluded.

In many cases the illness can be simultaneously treated (e.g. gastric bleeding, polyps etc.). Further information in this respect can be found at therapeutic endoscopy. In order for these examinations to be of high diagnostic quality, it is important that the stomach is empty before the respective examination.

Preparation:

The stomach must be empty for a gastric examination. This means that the last meal should be taken 6 hours before the examination. Regular medication is permissible and can be taken with a sip of water. The only exception is medication for the reduction of blood sugar. Therefore, caution: all medication except diabetes tablets and insulin injections can be taken before the gastric examination with a sip of water.

A list of the medication that has been taken should be brought to the examination. If anticoagulants have been taken it is of great importance that the examiner is informed once again directly before the examination.

Endoscopy of the ileum

(commonly known as examination of the colon) In the scope of this examination an endoscope that has a video chip fitted to its tip together with a high resolution monitor is used to examine the entire colon, the valve between the colon and the small intestine (ileocecal valve = Bauhin's valve), the final section of the small intestine (terminal ileum), and the appendix.

By continually observing all of the sections of the intestine on the monitor, the examiner and assistant can detect whether any irregularities are evident. Additionally small samples of the intestine mucous membrane are also extracted for the purpose of detecting or excluding illnesses that are not visible on the surface of the mucous membrane; this is by means of a histological examination of the mucous membrane structure by the Pathologist.

Colon polyps that are identified during the examination can be immediately removed endoscopically (polypectomy) and are retained for histology. Due to the fact that in almost all cases intestinal cancer develops from intestinal polyps (adenoma - carcinoma - sequence), the polypectomy represents a true method for eliminating the danger of cancer. Along with the polypectomy, the endoscopy of the ileum also provides the possibility for other therapeutic interventions (see therapeutic endoscopy).

Preparation:

The stomach must be empty before an endoscopy of the ileum is conducted (see also gastric examination). Additionally the colon must be emptied on the evening before the examination. In this respect there are many different methods. The pharmaceutical industry has made a line of products available for this purpose. Some of the better known preparations are listed below.

ERCP

(=endoscopic retrograde cholangio - pancreaticography) is the endoscopic examination of the biliary tracts and the pancreatic tract. The examining Doctor uses a special optic instrument and advances to the opening of the biliary tracts and the pancreatic tract. This is called the papilla vateri. A fine catheter is used to inject a contrast agent into the biliary tract or the pancreatic tract; the contrast is then followed by means of radioscopy. If irregularities such as stones in the biliary tract are detected, during the same procedure the papilla can be split and the stone removed by means of a cup. Also the flow of bile or pancreatic juice can be assured by inserting a small tube into the tracts.

For the purpose of this examination, the joint clinic uses endoscopes of the newest generation from Fuji and Olympus as well as the newest digital x-ray device from Siemens (Arcoskop), which is specifically designed for this purpose.