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Endoscopy: An Introduction and its Different Types

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An endoscopy is a minimally invasive medical procedure, performed by specially trained doctors, to examine the insides and linings of the body’s organs. 

Variations exist in the way an endoscopy is performed, depending on the organ being investigated, and the purpose of the procedure. Typically, it involves the insertion of an endoscope into the body. The site of insertion depends on the type of endoscopy being done. An endoscope is a long, slim, rigid or flexible, tube-like instrument with a light and small camera attached at one end. During an endoscopy, the doctor moves the scope through an organ cavity, while the camera projects real-time images of the organ onto a monitor, so physicians can look at the organ’s interior more clearly. 

When might you need an Endoscopy? 

An endoscopy can be warranted for the following reasons:

  1. Diagnosis – For further investigation of abnormal symptoms to determine the presence of any underlying disease (e.g., imaging, biopsy). 
  2. Treatment – Used to aid certain medical proceedings (e.g., tumour removal, laser therapy, medication administration).
  3. Screening – Recommended by clinicians for select patient groups (e.g., colonoscopy for screening of colorectal cancer).

What are the Different Types of Endoscopies?

There are many kinds of endoscopies, each developed specifically to look at a distinct part/area of the body. The table below gives a brief overview of the various types of endoscopies available, and when they might be used. 

Endoscopy Type Purpose
Anoscopy:

Anoscope inserted through the anus to look at the anus and/or rectum.

  • Investigate the presence of bloody stools, anal itching, growths or tears, painful defecation, and inflammation.
Arthroscopy:

Arthroscope inserted via a small opening over the joint of interest. 

  • Investigate persistent joint issues (e.g., pain, inflammation), joint injuries/damages. 
  • Surgical repair of damaged joints.
Bronchoscopy:

Bronchoscope inserted through the mouth to examine the trachea and lungs. 

Colonoscopy:

Colonoscope inserted into the anus to see the entire length of the colon and rectum. 

  • Screening for colon cancer.
  • Investigate rectal bleeding, changes to normal bowel habits, unintended weight loss. 
  • Biopsy
  • Polyp/tumour removal
  • Stenting
Colposcopy:

Colposcope placed at vagina opening after dilation with a specialized tool, to look inside the vagina and cervix. Scope is not inserted. 

  • Investigate abnormal cervical cancer screening results, unusual vaginal bleeding (e.g., bleeding after sexual intercourse).
Cystoscopy:

Cystoscope inserted into the urethra to see the urethra and bladder. 

  • Investigate urinary issues (e.g., incontinence, retention, urgency, pain), blood in urine, frequent infections, abnormal imaging results or urine cell samples.
  • Biopsy
  • Urine sampling. 
  • Removal of stents, unusual tissues, stones, tumours (e.g., transurethral resection of bladder tumour (TURBT)).  
  • Administration of medications (e.g., injecting medicines to treat urinary leakage). 
Oesophagoscopy:

Oesophagoscope inserted through the mouth to look in the esophagus

  • Investigate difficult or painful swallowing. 
  • Biopsy
  • Oesophagal dilation.
Flexible Sigmoidoscopy:

Sigmoidoscope inserted into the anus to see inside the sigmoid colon

  • Screening for bowel cancer
  • Investigate rectal/anal bleeding, persistent stomach pains, diarrhoea or constipation, abnormal change in bowel habits, low blood/iron counts. 
  • Biopsy
  • Tumour/polyp removal.
  • Treatment of haemorrhoids
Gastroscopy

Gastroscope inserted via the mouth to examine the oesophagus, stomach, until the beginning of the small intestines. 

Hysteroscopy:

Hysteroscope inserted through the vagina and cervix to look inside the womb. 

Laparoscopy:

Laparoscope inserted into an opening in the abdomen to see inside the belly and pelvis. Additional small cuts may be made to insert surgical tools. 

  • Keyhole surgery performed to investigate and treat a variety of conditions (e.g., gynaecological, gastrointestinal, and urological diseases).
  • Biopsy
Laryngoscopy:

Laryngoscope inserted through the nose/mouth to look at the voice box, vocal cords, and throat. 

  • Investigate swallowing or breathing difficulties, voice changes, bad breath, persistent cough or throat pain, abnormal imaging results. 
  • Biopsy
  • Tumour/growth removal
Mediastinoscopy:

Mediastinoscope inserted into an opening in the breastbone to see the mediastinum

  • Biopsy
  • Lymph node removal
  • Cancer staging 
Neuroendoscopy:

Neuroendoscope inserted through the mouth, nose, or an opening in the skull to access certain parts of the brain.

  • Biopsy
  • Tumour removal
Proctoscopy:

Proctoscope inserted into the anus to look inside the rectum and anus.  

  • Screening for bowel cancer
  • Investigate rectal/anal bleeding, persistent stomach pains, diarrhoea or constipation, abnormal change in bowel habits. 
  • Biopsy
  • Tumour/polyp removal
  • Treatment of haemorrhoids
Thoracoscopy:

Thoracoscope inserted into a small opening made in the chest to examine the pleura

  • Investigate breathing difficulties, coughing blood, abnormal chest X-rays or CT scans.
  • Biopsy
  • Removal of tumour, excess fluid
  • Administration of medication
  • Assist in video-assisted thoracic surgery (VATS).
Ureteroscopy:

Ureteroscopy inserted in the urethra to look into the ureter and kidneys.

  • Investigate urinary blockage
  • Biopsy
  • Ureter/kidney stone removal. 
  • Treatment of abnormal tissues/tumour

The table above is not exhaustive, and might not include all forms of endoscopies, and their purposes.

Advancements in Endoscopies

Developments in technology have brought about newer methods of endoscopy such as: 

Wireless capsule endoscopy

In this technique, the patient is required to swallow a capsule, about the size of a large vitamin pill, that contains a camera, light, batteries, a radio transmitter, and an antenna. 

As the capsule passes through the body, pictures of the interior of the oesophagus, stomach, and small intestines are taken. The images are then transmitted to a recording device worn around the patient’s waist. Once completed, the recorded images may be downloaded onto a computer for the doctor to examine. 

The capsule is disposable and typically stays in the body for about 8 hours. It is most often used to investigate small intestinal bleeding. 

When doing this procedure, patients should not come into close contact with an MRI machine or schedule any MRI investigations. 

Advantages:

  • Non-invasive unlike conventional endoscopic methods. 
  • Does not require sedation and is painless. 
  • Able to reach parts of the small intestine that traditional endoscopies cannot. 

Disadvantages:

  • Can be difficult to swallow and pass out the capsule. 
  • Possibility of the capsule getting stuck in narrower areas in the bowels, causing a blockage. 
  • This method cannot be used to obtain a biopsy, or to carry out any treatments (e.g., polyp/tumour removal).

Virtual Endoscopy

This technique makes use of multiple computed tomography (CT) scans of a part/area of the body that are combined by a computer to give a more complete picture. This method is still being studied, and not routinely recommended. 

Advantages:

  • Non-invasive unlike conventional endoscopic methods. 
  • Does not require sedation and is painless. 

Disadvantages:

  • Exposes patient to radiation. 
  • Expensive
  • Traditional endoscopy might still be warranted subsequently (e.g., for polyp/tumour removal).

In conclusion, there are many different endoscopies available. Your clinician will discuss with you which kind of endoscopy you will need based on your condition.

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