Your doctor will explain the findings to you immediately after the procedure or during a subsequent outpatient examination. However, if a biopsy is taken or a polyp is removed, it may take several days for this to be evaluated in the pathology laboratory. Moderate cramps or bloating may sometimes occur due to the air introduced into the large intestine during the examination. This will quickly improve with the release of gas. If a biopsy is taken or polyps are removed during the colonoscopy, blood thinners, aspirin, and similar medications should not be taken for a certain period. In this case, you can get information from your doctor. Do not drive a car or operate machinery, as sedatives may impair your reflexes. If you were given medication during the procedure, you would be kept under observation until most of the effects of the sedatives have disappeared (1-2 hours). After the procedure, you will need someone to help you on your way home.
If you cannot remember what your doctor said about the procedure and follow-up instructions, you can talk to your doctor that day or the next. If polyps are found during the procedure, the colonoscopy may need to be repeated regularly. Your surgeon will decide on the frequency of colonoscopy.
What Complications May Occur?
Colonoscopy and biopsy are performed safely by doctors with special training and experience in endoscopic procedures. Complications are rare but can occur. These include bleeding from the biopsy or polypectomy site or a tear (perforation) in the bowel wall. If this happens, your surgeon may need to perform abdominal surgery to repair the tear in the intestinal wall. Blood transfusions are rarely needed for bleeding. There may be a reaction to the medicines used. It is not common for the medication to cause vascular irritation, but it can cause mild stiffness that lasts for a few patients. If the temperature rises, a damp towel can help reduce this discomfort. It is essential to contact your doctor if you have severe abdominal pain, fever, chills or rectal bleeding of more than half a cup. Bleeding can also occur a few days after the biopsy.
What is Percutaneous Endoscopic Gastrostomy (PEG)?
PEG is a procedure in which a thin, bendable tube with a lighted camera at the end, called an endoscope, is inserted through the mouth, and a thin feeding tube is inserted through the anterior abdominal wall into the stomach. PEG is a nutrition method applied to improve the nutrition of patients who cannot be fed adequately by mouth for a long time (longer than 2-3 months), whose food escapes into the lungs when fed by mouth and therefore coughs, chokes, cannot swallow what they eat and therefore cannot grow. This way, feeding the patient more safely and comfortably may be possible. However, PEG was not a method to treat the disease that caused the patient to be malnourished. The first goal of enteral tube feeding is to ensure that body weight does not decrease further, to correct significant nutrient deficiencies, to provide a fluid balance of the body, to accelerate growth in children with growth retardation and to stop the deterioration in the patient’s quality of life due to inadequate oral intake of nutrients. Given these goals, using a PEG tube covers an extensive range of patients. Various examples of these diseases are given below.
Oncological disorders (cancer patients): certain obstructive tumours in the ear, nose, throat, oesophagus, and stomach.
Neurological disorders (diseases of the nervous system): Patients with dysphagia, inability to swallow after cerebrovascular stroke or head trauma and patients with brain tumours, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and cerebral palsy.
Other clinical conditions: Prolonged coma, polytrauma, extreme exhaustion in AIDS, short bowel syndrome, reconstructive facial surgery, Crohn’s disease, cystic fibrosis, chronic renal failure
Another indication for using the PEG system is the palliative drainage of gastric fluids and secretions from the small intestine in chronic gastrointestinal obstruction.
Modern PEG tubing systems of polyurethane or silicone rubber are easy to install and well-tolerated. PEG nutrition has become the preferred medium- and long-term enteral nutrition method.
How is the PEG Procedure Performed?
PEG placement is performed under sterile conditions in the operating room or endoscopy unit. It can also be performed at the bedside or in the intensive care unit. The patient should fast at least 8 hours before the PEG procedure. General anaesthesia will not be administered before the procedure, but the patient will remain drowsy, relaxed and calm throughout the procedure thanks to the sedative medication. They will not feel pain or discomfort during the procedure and will not remember the procedure. Calming the patient in this way is called “conscious sedation”. The endoscope will then pass through the oesophagus into the stomach, and the PEG tube will be inserted into the stomach using special instruments through an incision of less than 1 cm (3-4 mm) in the anterior abdominal wall. When the procedure is completed, the patient will have a PEG tube in the abdominal wall to be used for feeding. After PEG insertion, the patient will be hospitalized for a while, and the mother will be taught practically about PEG care and use.
What are the Risks of the Procedure?
After the procedure, mild complications such as abdominal pain, mild fever, restlessness, wound infection, tube displacement, leakage, blockage of the tube, etc., can be seen at a rate of 4-16%.
Severe conditions such as perforation (perforation of the gastrointestinal wall), severe bleeding, peritonitis (inflammation of the lining of the abdomen), aspiration pneumonia (which can occur when stomach contents escape into the lungs with vomiting during the procedure) can occur in 2-4% of patients and may require surgical intervention or prolonged hospitalization.
The development of most long-term complications, such as leakage from the tube due to tube damage and breakage, severe inflammation (cellulitis), eczema or granulation tissue development in the area around the abdominal wall of the tube, depends solely on the quality of care given to the inserted tubing system and can be effectively prevented if appropriate measures are taken.
Patients requiring PEG insertion because they cannot feed due to their underlying disease are in the high-risk group for endoscopy. For this reason, medical problems such as low oxygen in the blood and low blood pressure may develop due to sedation drugs administered during the endoscopic procedure. Medication may need to be administered to counteract sedatives’ effects; in the worst case, life-saving interventions (such as CPR and artificial respiration) may be necessary.
What are Alternative Methods?
Feeding with a nasogastric tube (NG) inserted through the nose and the tip inserted into the stomach: This is a method applied to patients who are thought to be able to feed by mouth after a while (6-8 weeks), but it is not preferred because it may cause scar formation in the nose, oesophagus and even stomach when used for a long time. Dislodging the NG tube and going unnoticed can cause life-threatening problems (such as nutrients getting into the lungs).
Surgical gastrostomy: Surgical gastrostomy is an operation under general anaesthesia to insert a tube into the stomach. It may need to be applied in patients who cannot have PEG, who do not accept PEG or for medical reasons (in patients who need reflux surgery in the same session).
Radiologic gastrostomy: An experienced radiologist can perform this procedure in specialised centres using ultrasonography and/or fluoroscopy (irradiation).
Experienced physicians perform all endoscopic interventions for diagnosis and treatment in the Endoscopy Unit of Private Medikar Hospital, equipped with modern video endoscopy devices. All interventions in our unit are performed with sedation (sleep state) or anaesthesia (narcosis) when necessary to ensure patient comfort.
All of the following procedures can be performed in our endoscopy unit:
1. Upper Gastrointestinal System Endoscopy
2. Rectoscopy
3. Sigmoidoscopy and colonoscopy
4. Diagnosis and treatment of upper (stomach and duodenum) and lower gastrointestinal (large intestine) bleeding (Sclerotherapy, band ligation)
5. Diagnosis and treatment of upper and lower gastrointestinal tract strictures (Balloon dilatation, stenting)
6. Removal of polyps from the upper and lower gastrointestinal tract (polypectomy)
7. Diagnosis and treatment of reflux disease
a. 24-hour pH monitoring
b. Esophageal impedance application
8. Treatment of obesity
a. Endoscopic Intragastric balloon application
9. Endoscopic feeding tube placement
10. Percutaneous endoscopy gastrostomy tube insertion
11. Diagnosis and treatment of haemorrhoids (Surgery and infrared coagulation)
What is Upper Gastrointestinal (GI) Endoscopy?
Upper GI endoscopy (also known as gastroscopy, EGD or esophagogastroduodenoscopy) is a procedure that allows evaluation of the lining of the upper parts of the digestive tract: the oesophagus, stomach and duodenum (the first part of the small intestine). The bendable lighted tube, as thick as your little finger, is sent through your mouth into your stomach and duodenum.
Why is Upper GI Endoscopy Performed?
Upper GI endoscopy is often used to evaluate symptoms such as persistent upper abdominal pain, nausea, vomiting, difficulty swallowing or chest pain. It is an excellent application to find the cause of bleeding from the upper digestive tract. It is also used to evaluate and follow up on the oesophagus or stomach after surgeries. It is more accurate than imaging methods (medicated films, tomography, etc.) in detecting inflammation, ulcers or tumours of the oesophagus, stomach and duodenum. An upper endoscopy can detect cancer early and allows tissue samples (biopsy) to be taken from suspicious areas to distinguish between cancer-related and non-cancerous conditions. Tissue samples taken using special instruments are sent to the laboratory for examination. A biopsy is taken for many reasons and does not necessarily mean cancer is suspected. Guiding various auxiliary instruments through the endoscope can treat many abnormal conditions with little or no discomfort. It can widen narrowed areas, remove polyps, remove ingested substances or treat bleeding in the upper digestive tract. Safe and effective control of bleeding reduces both the need for blood transfusion and the need for surgery.
Is a Preparation Necessary?
Your stomach must be empty. It would be best if you did not eat or drink anything until about 8 hours before the procedure. Your doctor can change your fasting time by evaluating the time of the procedure to be applied to you during the day. Care should also be taken with medication. For the safety of the procedure, you must inform your doctor about the medications you use, the diseases and surgeries you have undergone and your allergies before the procedure. The use of aspirin, vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin should be discussed with your doctor before the endoscopy procedure. It is essential to warn your doctor if you have had to take antibiotics before dental interventions because you may also need to take antibiotics before a gastroscopy. In addition, if you have a severe illness, such as heart or lung disease, that requires special attention during the procedure, you should discuss this with your doctor. During the procedure, you will be sedated (put to sleep with sedatives). Sedatives will affect your decision-making and reflexes throughout the day. Therefore, you should ensure that you have someone to help you on your return home. It would be best not to drive or operate machinery until the next day. It would be best not to make any important decisions or sign anything.
What Procedures Are Performed During Upper GI Endoscopy?
Unless otherwise stated, you will be sprayed with a numbing medicine before the procedure begins, and medication will be administered through your vein to relax you during the procedure. You will be lying comfortably on your side, and the endoscope will be passed slowly through your mouth and into your oesophagus, stomach and duodenum. To get a better view of the inner surface of the stomach, air will be blown into your stomach during the procedure. The procedure usually takes 15-60 minutes. The endoscope itself does not prevent you from breathing. Most patients sleep during the procedure, and very few are disturbed by the procedure.
What Happens After the Procedure?
You will be monitored in the endoscopy unit for 1-2 hours, during which any sedatives will wear off. You may feel a little pain in your throat for 1-2 days. You may feel gas and bloating in your abdomen after the procedure due to the air given to your stomach for better evaluation during the procedure. After leaving the endoscopy unit, you can eat and take your medication unless advised otherwise. If your doctor has not taken a biopsy during the procedure, they will inform you on the day of the procedure. If a biopsy has been taken, the results may take more than a few days. If you cannot remember the doctor’s recommendations about the result of your procedure or after the procedure, you can contact your doctor later to find out what to do.
What Complications May Occur?
Gastroscopy and biopsy performed by teams trained and specialized in endoscopy are safe. However, complications are rare. These include bleeding from the biopsy or polypectomy site and perforation of the digestive tract wall. Blood transfusions are rarely necessary due to bleeding. Reactions to the drugs used during the procedure may develop. Damage to the vessels where the medication is given is rare but can cause tenderness lasting for several weeks. Warm, moist towels can reduce this discomfort. You need to recognize the early signs of these possible complications, and you should contact your surgeon if you have symptoms such as difficulty swallowing, chest pain, severe abdominal pain, fever, chills, and rectal bleeding of more than half a glass.
What is Lower Gastrointestinal System Endoscopy-Colonoscopy?
Colonoscopy is a procedure that allows your doctor to evaluate the surface of the large intestine. A soft, bendable tube, about the thickness of an index finger, is gently inserted through the anus and advanced through the large intestine (rectum and colon) to assess the bowel wall.
Why is Lower Gastrointestinal System Endoscopy-Colonoscopy Performed?
A colonoscopy is usually performed to evaluate changes in bowel habits, bleeding and unexplained abdominal pain, to remove and control polyps in patients known to have polyps (formations growing on the wall of the large intestine) or who have previously had polyps removed, to control before or after some surgical procedures, to evaluate changes in the surface of the large intestine in diseases known as inflammatory diseases, as part of the screening programme in patients with suspicion of polyps or tumours in large intestine graphics and other imaging methods, or with a family history of polyps or colon cancer.
Is a Preparation Necessary?
The stool in the large intestine must be completely cleared for the procedure to be performed and for a complete evaluation. For this purpose, it is recommended to consume clear (pulp-free) food a few days before the procedure (3-4 days) and not to take foods with pulp. In addition, special cleansing solutions or laxatives to clean the bowel and enemas before the procedure will be recommended. Your doctor or endoscopy nurse will instruct you on these medicines or solutions. It is particularly recommended to follow the instructions for use carefully. If the preparation is insufficient, the procedure may be unsafe and must be rescheduled. Since you will lose fluid during this period, it is recommended to drink plenty of water. If you cannot complete your preparation, you must contact your doctor and the unit that made the appointment. You can continue with many of your medicines. It would be best to inform your doctor of any medications you are taking, such as aspirin, blood thinners, non-steroidal anti-inflammatories, vitamin E and insulin, before the procedure, as with any other medication you are taking. Some medicines must be stopped or changed at least one week before the procedure. If you need to take antibiotics before dental procedures, you must warn your doctor, as you may also need to take antibiotics before a colonoscopy. During the procedure, you will probably be severely sedated (you will be put to sleep with sedatives). Sedatives will affect your judgment and reflexes for the rest of the day. It would be best not to drive or use machinery until the next day. Therefore, you should have someone to help you on your return home. It would be best not to make any important decisions or sign anything.
What Procedures Are Performed During Colonoscopy?
The procedure is usually well tolerated, but discomforts such as pressure, flatulence, bloating, cramping, or pain may be felt at various times due to the air or manipulations to get better images during the procedure. Your doctor will give you intravenous medication to relax, and you will be better able to tolerate (complete) the procedure without discomfort. You usually lie on your side or your back while the colonoscope travels through the large intestine. However, if necessary, you may be asked to change position with staff assistance. The surface of the large intestine is carefully examined as the device is inserted and withdrawn. The procedure is usually completed in 30 to 60 minutes. Rarely the entire surface of the large intestine cannot be visualized, and your doctor may recommend a barium colon X-ray.
What to do if an abnormality is observed during the procedure?
If your doctor sees an area that requires more detailed evaluation, they may take a biopsy and send it to the laboratory for analysis. This is done by inserting a special instrument through the colonoscope to take a small sample from the surface of the large intestine. Polyps are usually removed. Most polyps are benign (not cancerous), but your doctor cannot tell this just by appearance. Polyps can be removed by burning (electrocution) or with a wire loop (snare). If the number of polyps is high or very large, your surgeon can do this with repeated procedures more than once. Areas of bleeding can be detected and controlled by giving certain medications or burning the blood vessels (by electric current). A biopsy does not necessarily indicate cancer, but removing the polyp is essential for preventing colon cancer.
