Endoscopic examination is a medical technique that uses a flexible optical instrument to observe the body's cavities and tissues. Its main purposes are to diagnose diseases, perform treatments, or collect tissue samples. This technique involves a tubular device approximately 0.5 to 1.5 centimeters in diameter, equipped with a camera and lighting system, allowing deep access into the digestive tract, respiratory tract, or urinary system to provide real-time images for lesion assessment. Modern endoscopes often incorporate lasers, electrocautery, or grasping instruments to facilitate simultaneous diagnosis and treatment, significantly reducing the need for traditional open surgeries.
Endoscopic techniques are classified based on the examined area, including gastroscopy, colonoscopy, and bronchoscopy. Common applications include hemostasis for gastrointestinal bleeding, removal of fistulas, or early cancer detection. Its minimally invasive nature makes it the preferred tool in gastroenterology, hepatology, and otolaryngology, often combined with tissue biopsies or specimen collection to enhance diagnostic accuracy.
Endoscopes are mainly divided into "diagnostic" and "therapeutic" categories. Diagnostic endoscopes utilize high-definition cameras to observe mucosal changes, detecting ulcers, tumors, or abnormal tissues. Therapeutic endoscopes are equipped with metal clips, electrocautery needles, or lasers to perform hemostasis, fistula removal, or stenosis dilation. For example, colonoscopy can remove adenomatous polyps to prevent progression to colorectal cancer.
The mechanisms vary depending on the specific procedure: gastroscopy uses carbon dioxide insufflation to expand the stomach, while bronchoscopy involves entering the lungs via the trachea. Some endoscopes incorporate ultrasound (such as endoscopic ultrasound) to assess tumor depth or use narrow-band imaging (NBI) to enhance vascular pattern recognition of precancerous lesions. All procedures are performed under anesthesia or sedation to ensure patient comfort and clear imaging.
Endoscopy is suitable for various gastrointestinal diseases, including investigation of upper gastrointestinal bleeding, polyp removal in the colon, Barrett's esophagus mucosal resection, and nasal bile duct drainage for pancreaticobiliary obstructions. For suspected gastric cancer, endoscopic mucosal resection (EMR/ESD) can remove lesions while preserving organ function.
Other indications include removal of airway foreign bodies, esophageal dilation, or hysteroscopy in gynecology. High-risk groups, such as those over 50 with familial ulcerative colitis, are recommended to undergo colonoscopy screening every 3-5 years to reduce colorectal cancer risk.
Fasting for 6-8 hours before the procedure is required, with preparation adjusted based on the area. Gastrointestinal examinations may require oral laxatives or nasal gastric lavage. During the procedure, the patient lies on their back, and the anesthesiologist selects sedatives or general anesthesia based on body weight and health status. The process lasts approximately 15 minutes to 1 hour.
Therapeutic doses are adjusted according to lesion size; for polyps larger than 1 cm, staged cauterization may be necessary. Recurrent lesions may require follow-up every 6-12 months. Patients with esophageal varices due to liver cirrhosis are advised to undergo band ligation every 1-2 years to prevent bleeding. Complex procedures like pancreatic duct drainage may require 24-hour hospitalization for observation.
Common short-term side effects include sore throat, bloating, or transient difficulty swallowing, with an incidence of about 5-10%. Serious complications include perforation (0.1-0.5%), significant bleeding (requiring vascular embolization or surgical hemostasis), and anesthesia-related issues. Symptoms of peritonitis (such as severe abdominal pain or fever) require immediate medical attention.
High-risk groups such as those with coagulation disorders may have increased bleeding risk. Prolonged procedures (over 1 hour) may increase airway obstruction risk, necessitating close postoperative monitoring of blood pressure and respiratory rate. Allergic reactions to anesthetic drugs are rare but may require emergency measures.
Contraindications include severe coagulation disorders (INR >1.5), aortic aneurysm, or heart failure. Pregnant women should evaluate radiation exposure risks, and recent myocardial infarction patients should delay the procedure. Patients should discontinue anticoagulants 48 hours before the examination and have their cardiopulmonary function assessed by an anesthesiologist.
Post-procedure, fasting for 2-4 hours until numbness in the throat subsides is recommended, and mechanical operations should be avoided within 24 hours. If black stools, persistent vomiting, or fever over 38.5°C occur, immediate medical attention is necessary. Long-term follow-up should be every 3-5 years to prevent recurrence of lesions.
Endoscopic treatments are often combined with medications, such as post-procedure use of hemostatic agents or antibiotics to prevent infection. When performing hemostasis, avoid concurrent use of anticoagulants, which may require temporary discontinuation of warfarin or NOACs for 72 hours. In case of perforation during endoscopy, emergency surgery is required, necessitating collaboration with surgical teams.
Regarding imaging interactions, CT scans can locate lesions but cannot perform biopsies. Ultrasound is non-invasive but less accurate for deep tumors, requiring confirmation via endoscopy. Surgical treatments are typically reserved for complex lesions, such as stage III esophageal cancer, which may require combined endoscopy and chemotherapy.
Clinical studies show that endoscopic removal of colonic polyps reduces colorectal cancer risk by up to 90%, and early gastric cancer ESD has an 85% five-year survival rate. A 2019 study in Gastroenterology reported a 92% success rate for endoscopic hemostasis, with lower infection rates compared to traditional surgery.
In patients with liver cirrhosis, band ligation via endoscopy can reduce mortality from esophageal variceal bleeding to below 10%. Compared to traditional X-ray angiography, endoscopy achieves a diagnostic accuracy of 98% for gastrointestinal ulcers and allows simultaneous tissue biopsy for pathological analysis.
If patients cannot undergo endoscopy, non-invasive options include:
Alternative treatments such as injection hemostasis or radiological embolization may be used for patients contraindicated for endoscopy. However, these methods may prolong treatment or increase the need for subsequent surgery, making endoscopy the preferred option.
Patients should fast for 8 to 12 hours before the procedure and stop anticoagulants (such as aspirin) as directed by the doctor. If anesthesia is used, a companion should accompany the patient home, and a consent form must be signed before the examination. Patients with diabetes or cardiopulmonary diseases should inform the doctor in advance to adjust medication plans.
How can throat discomfort or bloating after endoscopy be alleviated?Some patients may experience temporary sore throat or mild bleeding points due to the endoscope passing through the esophagus, which can be relieved by lozenges. Bloating is usually caused by insufflation during the procedure and will subside naturally within a few hours. If bleeding persists beyond 48 hours or severe abdominal pain occurs, seek medical attention immediately.
When can normal diet and activity be resumed after treatment?It is generally recommended to try cold liquid foods 1-2 hours after the procedure. If there are no discomforts, gradually transition to soft and regular foods. For invasive procedures like biopsies or hemostasis, hard foods should be avoided for one week. Mild activities can resume the next day, but heavy lifting should be avoided for 24 hours.
What is the risk rate of complications from endoscopic treatment and how are they managed?The overall complication rate is below 5%, with common issues being sore throat or mild abdominal pain. Serious complications like perforation or significant bleeding occur in about 0.1-0.5% of cases. If symptoms such as persistent vomiting blood, severe abdominal pain, or fever over 38°C occur, immediate hospital review is necessary. Modern endoscopic techniques have greatly reduced risks, but preoperative assessment remains essential.
What should be monitored during follow-up examinations after endoscopic treatment?Doctors will schedule follow-ups based on the treatment type, such as re-examining colon polyps after 6-12 months. Watch for changes in bowel habits, unexplained weight loss, or blood in stool. If symptoms persist (such as ongoing stomach pain or difficulty swallowing), return for evaluation to determine if a second endoscopy or biopsy is needed.
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