Endoscopy is a diagnostic and therapeutic tool that combines optical technology with medical instruments. Through a flexible, bendable tube equipped with a camera and lighting, it allows direct visualization of the internal cavities or organs of the human body. Its main purposes include early detection of lesions, tissue sampling, hemostasis, or foreign body removal. Compared to traditional open surgery, endoscopy offers advantages such as minimal trauma and rapid recovery, and is commonly used in the fields of gastrointestinal, respiratory, and urinary systems.
This technology can be divided into diagnostic endoscopy and therapeutic endoscopy. Diagnostic procedures are used to observe lesion morphology, while therapeutic endoscopy can directly perform polyp removal, bleeding control, or stricture dilation. Modern endoscopes also incorporate staining, ultrasound, or high-resolution imaging techniques to enhance lesion detection, making them indispensable tools in modern medicine.
Upper gastrointestinal endoscopy (gastroscopy) involves inserting the scope through the mouth into the esophagus, stomach, and duodenum, allowing direct observation of mucosal changes and in vivo tissue sampling. Colonoscopy is performed via the anus into the colon for colorectal cancer screening and polyp removal. Bronchoscopes examine the respiratory tract, while arthroscopes are used for knee joint diagnosis. The endoscope's working channel can accommodate metal clips, lasers, or electrocautery devices to directly treat lesions.
Advanced techniques such as Narrow Band Imaging (NBI) enhance contrast of blood vessels and mucosal structures, while Endoscopic Ultrasound (EUS) can penetrate organ walls to assess tumor depth and lymph node status. Treatment mechanisms include visual-guided procedures, tissue biopsies, hemostatic clipping, and endoscopic mucosal resection (EMR) or submucosal dissection (ESD) for early cancer lesions.
Indicated for evaluation of unexplained upper gastrointestinal bleeding, dysphagia, chronic abdominal pain, and other symptoms. In colorectal cancer screening, colonoscopy is the gold standard for detecting adenomatous polyps. Patients with Barrett's esophagus require regular endoscopic surveillance for precancerous changes. Endoscopy can also immediately dilate strictures or remove foreign bodies in cases of gastrointestinal narrowing or obstruction.
Therapeutically, endoscopy can be used for gastric bleeding hemostasis, bile duct stone removal, creation of intestinal bypass, or performing Endoscopic Retrograde Cholangiopancreatography (ERCP) for pancreatitis treatment. Its applications span the digestive, respiratory, and urinary systems, making it a key technique shared across multiple specialties.
Fasting for at least 8 hours before the procedure is required; some procedures may require bowel preparation or sedation. Patients are usually positioned laterally or supine, with the instrument slowly inserted into the cavity. The duration of therapeutic procedures varies from 15 minutes to several hours depending on complexity, with complex surgeries requiring anesthesia team cooperation. The dosage of local anesthetics or sedatives should be adjusted based on age and liver/kidney function, with lower doses administered in stages for elderly patients.
Therapeutic endoscopy may involve the use of hemostatic clips (averaging 2-4 clips per bleeding site), laser energy parameters (e.g., Nd:YAG laser power 0.5-1.5 Joules), or electrocautery power (0.3-0.8 Amperes). Physicians will adjust equipment specifications according to lesion size and location, such as selecting different bending angles of colonoscopes to accommodate intestinal anatomy.
Compared to imaging studies, endoscopy allows direct tissue biopsy for pathological analysis, reducing misdiagnosis. Recovery time is short, and patients can usually be discharged on the same day, significantly reducing medical costs. In therapeutic applications, endoscopic treatment has similar 5-year survival rates to traditional surgery but with over 40% lower complication rates.
Main risks include perforation (incidence 0.1-0.5%), bleeding (more common after therapeutic procedures), anesthesia-related complications, and others. Some patients may experience blurred vision due to incomplete bowel preparation, increasing procedure difficulty. Patients with hypertension or coagulation disorders may have rebleeding risks after hemostasis.
Severe complications include: gas embolism causing pneumothorax, allergic reactions to anesthesia, long-term issues such as intestinal strictures. Elderly patients may experience arrhythmias triggered by scope stimulation, requiring preoperative ECG assessment. Post-procedure, sore throat or abdominal distension may occur within 24 hours, usually resolving within 2-3 days.
Fasting for more than 12 hours is basic preparation; diabetic patients should adjust hypoglycemic medication timing. Patients with pacemakers or electronic hearing aids should avoid magnetic devices. Severe coagulation disorders (PT-INR >1.5) or prolonged clotting times should be corrected before therapeutic procedures.
Contraindications include uncontrolled bleeding tendencies, severe peritonitis, intra-abdominal infections, and uncooperative patients with altered consciousness. Patients with prior abdominal radiation therapy have increased intestinal fragility, requiring extra caution during procedures.
Patients on anticoagulants (e.g., warfarin) should discontinue medication 5-7 days prior or switch to low-molecular-weight heparin bridging therapy. Use of NSAIDs requires assessment of gastric mucosal protection. When using antibiotics post-procedure to prevent infection, interactions with antifungal medications should be considered.
Regarding radiological examinations: after lesion detection via endoscopy, further assessment with CT or MRI is common. However, Barium X-ray may impair visualization of the intestine, so endoscopy should be prioritized over X-ray.
Colorectal adenoma removal reduces colorectal cancer incidence by up to 90%. Early gastric cancer treated with endoscopic submucosal dissection (ESD) has a 5-year survival rate exceeding 95%. Hemostasis success rates with combined endoscopic injection and clipping reach 98%, outperforming drug therapy success rates of 75%.
Multicenter studies show that endoscopic treatment reduces hospitalization days by 60% compared to traditional surgery and lowers 30-day complication rates below 3%. In Barrett's esophagus, endoscopic mucosal resection can completely remove dysplastic lesions, avoiding total gastrectomy.
Ultrasound or computed tomography (CT) scans can preliminarily screen for lesions but cannot obtain tissue samples or perform direct treatment. Traditional open surgery can address complex lesions but involves large trauma and long recovery. Capsule endoscopy is non-invasive but cannot provide immediate treatment, and radiography has limited ability to identify submucosal lesions.
In some cases, virtual bronchoscopy can replace conventional bronchoscopy, but tissue sampling still requires direct visualization. Medical teams will choose the most appropriate treatment based on lesion location, patient physical condition, and equipment availability.
Before endoscopy, fasting for 6 to 8 hours is usually required, and anticoagulant medications should be discontinued as per medical advice to reduce bleeding risk. Patients should be accompanied by family members on the day of the procedure, as anesthesia or sedatives may temporarily affect memory. Patients with diabetes or cardiopulmonary conditions should inform the doctor in advance for appropriate anesthesia adjustments.
Is nausea or bloating after endoscopy normal? How can it be relieved?Mild nausea, sore throat, or bloating are common and usually resolve within a few hours. Nausea can be alleviated by resting on the side or drinking small amounts of water; bloating results from air insufflation during the procedure, and gentle walking can help expel gas. If severe abdominal pain or vomiting blood occurs, seek medical attention immediately.
What dietary adjustments are recommended after endoscopic mucosal resection?Fasting for the first 2 hours post-procedure, then switching to cool liquid diets (such as iced juice) to reduce throat discomfort. Avoid hot foods and hard foods within 24 hours; opt for soft diets. If a large area was resected, the doctor may recommend a low-fiber diet for one week to prevent wound tearing.
How long does the recurrence risk increase after polyp removal?The risk of recurrence depends on the nature of the original polyp. Patients with adenomatous polyps should undergo follow-up every 3 to 5 years. If the lesion was broad-based or highly atypical, the interval may be shortened to 6 months to 1 year. Regular endoscopic surveillance is key to preventing recurrence.
Are there differences in anesthesia methods between different types of endoscopy (e.g., colonoscopy vs. gastroscopy)?Colonoscopy often uses mild sedation or painless anesthesia due to longer duration and potential discomfort from bowel looping; gastroscopy typically involves local spray anesthesia of the throat combined with mild sedation. The medical team will select the most appropriate anesthesia based on patient age, cardiopulmonary function, and scope scope.
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