What is Endoscopy?

The digestive endoscopy loss or colonoscopy has become, in damage of enema opaque (radiological study of the colon with resistance), in the most important test in the diagnosis and prevention of the colorectal cancer. It even consists of the detailed exploration of all the heavy intestine and of the part of thin intestine that is united to the colon, íleon, through a called tube endoscopy instrument..

Equal Al that happens with the gastric by pass the great advantage of the exploration is the possibility of being able to take samples from the explored zones, biopsies, to complete the study of each patient. Colonoscopy Instrument is a long tube that allows the complete exploration of all the heavy intestine. Today endoscopy instruments with technology of digital video are used that provide a great quality of the image. The exploration visualizes in a TV monitor which allows the explorer to obtain a correct and trustworthy diagnosis and to be able to record the exploration. Before making the exploration the patient must make an exhaustive cleaning of the colon. The day before the exploration will have to before take from 24 hours a laxative solution that will produce diarrea to him.

How it is made?

During both days previous to the exploration foods without remainders will be due to take avoiding solely the ingestion from meat, vegetables and fruits like kiwi. Also one will be due to take abundant I eliminate and to avoid the ingestion of prepared that contains iron. An efficient exploration depends on the correct cleaning of the colon. From 6 hours before the exploration one will be due to be in uninformed. This exploration does not need hospitalization. Since the exploration can be annoying and painful the call is used most frequently every time conscious sedación that it consists of administering by intravenous route a sedative of the type of the benzodiacepinas and an analgesic one with the purpose of making the exploration most comfortable.

The specialist introduces endoscopio through the anus beginning therefore the exploration. During same the patient the abdomen as a result of the air introduction can as large as present/display increase to explore the alimentary canal as well as pain type retortijón. The air emission by the anus can alleviate these symptoms momentarily. Once concluded the exploration the recovery takes a 3-4 hours as a result of the sedación and the explored person does not have to lead nor to make risk activities during that time. Passed 3-4 hours the recovery is complete.

Why it serves?

Like in the gastric by pass, the colonoscopy allows to confirm the existence of digestive disease or to exclude it and secondly allows the accomplishment of therapeutic acts, the call therapeutic endoscopy, that has been very useful. At the present time it is possible the extirpation of polyps and the expansion of estrecheces after the surgery or as a result of inflammatory processes of the colon. Recently and given the high incidence of colon cancer it is used like exploration to study to people with elevated risk to suffer cancer of colon or polyps of colon.

When it must be made?

The indications are varied: Emission of blood by the anus, although hemorroides are had. Intestinal suspicion of inflammatory disease: Ulcerosa Colitis and disease of Crohn. The clinical symptoms are abdominal, diarrea pain mixed with blood and fever. Constipation of recent beginning. Not diagnosed chronic Diarrea. Control of the operated patients of colorectal cancer, with an annual regularity or every two years. Patients who present/display alterations in the radiological study like estrecheces, polyps or tumors and who need the obtaining biopsies.

Control of the patients with antecedents of adenomatosos polyps or vellosos polyps of colon. The controls in agreement with the size, number and type of polyp in the biopsy will be made. In general each 2-3 is due to do years. Study of the relatives of patients with colorectal cancer: High risk. It is obligatory to make the exploration if: - familiar colónica Poliposis: It will be made annually until the operation is decided. At the present time it is possible by means of a blood analysis to know the risk of developing the tumor. - nonpolipósico familiar colorectal Cancer: 10 years will begin the explorations before the age in which it appeared the tumor in the relative.

One will control every two years. - Presence of the two or most familiar ones with colorectal cancer: Controls will be made each 3-5 years as of the 40 years. Average risk. It is necessary to make the endoscopy if: - Presence of a relative with diagnosed colorectal cancer before the 50 years. Every 5 years will be made controls being the first study 10 years before the cancer diagnosis in the relative. Low risk. It can be advisable to make the endoscopy if: - Presence of a relative of first degree (father, mother) with diagnosed colorectal cancer after the 50 years.

It will be made colonoscopy every 5 years from the 40-50 years. Therapeutic endoscopy: Polipectomía: It consists of the extirpation by means of a cut of the colónicos polyps with a special bow. It is made with electrical current that produces heat. An analysis of the coagulation of the blood needs before their accomplishment. Expansion of a estenosis: It is a little frequent indication. It is used in estrecheces that are after the surgery. The colonoscopy allows the introduction of balls that once placed in the estenosis are swollen with air or water and can widen this estenosis.

What factors interfere in the results?

The execution of reconnaissance without previous preparation diminishes very many the diagnóstica yield since the colon will be full of lees and will prevent a correct visualization.

What doctor must make the test?

The exploration must be made by a specialistic doctor in Digestive Apparatus with specific formation in the accomplishment of endoscopy. Habitually it needs the aid of a ATS-DUE.

It requires some special preparation on the part of the patient?

The patient to have to be in uninformed at least 6 hours before the exploration and to before make a preparation of careful cleaning of the colon taking prepared from the day previous to the exploration and taking a poor diet in remainders from two days.

What contraindications have?

The circumstances are few that prevent their accomplishment: In the sudden acute colitis and the acute inflammation of the divertículos of colon by the risk of perforation of the colon. In the perforation of the colon diagnosed previously.

It can have complications?

The colonoscopy is a safe method but it can very trigger effects nonwished in a percentage under (0.2-1%). Between the complications it is necessary to emphasize: Perforation of the colon, to trigger a digestive hemorrhage when cutting a polyp or passage of digestive germs to the blood. Mortality is very low (0.01-0.03%).

The digestive endoscopy is a diagnóstica and therapeutic technique that has allowed to improve the diagnóstica precision and to reduce the necessity of operations. Actually daily the two more habitual techniques are two: High the digestive endoscopy that allows the exploration until the second portion of the duodeno. It is the famous tube that is introduced by the mouth by means of sedación... and soon it is the colonoscopy or digestive endoscopy loss, that is another flexible tube that is introduced by the anus and is indicated to explore the rectum and the colon.

The colonoscopy has allowed many patients to prevent and "to cure" a colon cancer. There it is the example of the people with familiar poliposis. The techniques of diagnostic and therapeutic endoscopy have progressed of a considerable way in the last years, which makes conceive a very satisfactory future for this type of techniques. It helps to know plus Doctor Ramon Abbot, endoscopista and Commander us of the Unit of Digestive endoscopy of Clinical TOP of Barcelona. Every time more endoscopys are made. A endoscopy is an ample term, that it means "vision of the interior of", therefore, within the endoscopy concept we would introduce the otoscopia of the otorrino, the colposcopia, the broncoscopia of the neumólogo. The one that more relevance has because she is the one that practices and is the one more that allows ampler accesses to the digestive apparatus is the digestive endoscopy.

Within the digestive endoscopy we would have two parts: the high part, digestive endoscopy high or gastroescopia through the mouth to explore esophagus, estomago and duodeno and the digestive endoscopy loss, or colonoscopy, that allow us through the anus to explore the rectum, the sigma and the rest of the colon until arriving at the bottom of the blind person coat. A endoscopy by the high diagnóstica and therapeutic yield becomes that it has. From the beginning of the medicine handicap in the digestive apparatus has been had great and is that the symptoms do not go parallel to the degree of gravity of the disease, nor so single they go parallel to the disease; so that we can be found a patient who has tremendous pains and however it does not have a pathology or it has a banal pathology and other that does not have symptoms and has a colon cancer.

Therefore, the degree of gravity and the level of pain or annoyance do not go parallel. This was a great difficulty for the clinical one because, although a palpación in the abdomen could be done, towards questions type, will be a ulcera, it will be a cancer, it will be a gastritis? or simply one hernia.

The endoscopy allows us to explain and to put each thing in its site. The size of endoscopy instrument in the last 35 years has varied 1 millimeter, which means that the thickness of endoscopio is not what causes the annoyances: the Japanese already removed in their day, 25 years ago, endoscopio of 7 millimeters that denominated endoscopy pedriático, but had a problem; to the so thin and flexible being he did not pass esofágico the sphincter superior, did not happen reason why mouth of Kilian is denominated, the superior esophagus and it needed rigidity. Therefore, he has ended up himself working with endoscopio of 9-10 millimeters for high the digestive endoscopy and of about 11 millimeters for the digestive endoscopy loss.

The size of endoscopy, the thickness of endoscopy is not what more annoying, which more annoying is the injection of the air and the passage of the angles of the colon, that then produces a distension and that distension produces pain. The sedación plays a very important role for the comfort of the patient. Every time less endoscopy without sedación practice and when this happens it is because not it can. A endoscopy unit is a very ample unit, with much personal, much people working; one works jointly with anatomopatólogos, pathologists and anesthetists are needed more and more close. All this requires "to turnover" of individuals that are moved within one or several rooms.

The patient when sedado being requires of "recovering" within "boxes" where they can be it controlling, she requires a pursuit infirmary, etc. Nowadays, this is a movement very different from that we had only 10 years ago. A high endoscopy, since is introduced endoscopio until it is extracted, if surgical endoscopy does not have to make no activity of biopsy nor no therapeutic intervention, usually it lasts between 7-8 minutes.

The patient completely is slept during this time and she awakes after awhile. The drugs which it at this moment has are the opposite of which they were years ago, they have a so short time of average life in the organism that the problem of the anesthetist is that the patient does not wake up before time; the amount necessary is injected millimeter to millimeter to maintain the dream state.

The endoscopy medic and the anesthetist work jointly for injects the necessary amount so that the patient wakes up seconds after to have retired endoscopy . A colonoscopy can last about 15 minutes of average, since the colon is longer and will depend on the anatomy of each patient. There are patients with the very long colon and even, sometimes, it has not been possible to get to reach the end of the colon. With a endoscopy all the intraluminal pathology can be seen, the pathology that measures a repercussion inside the light of esofago, estomago, duodeno and colon. If there is esofagitis, if there are infections by innocent, fistulas, estenosis.. it is a clear and precise diagnosis.

The endoscopy has the highest reliability. The great advance of endoscopy is, thanks to a applied technology, to be able to treat some pathologies. It allows to expand when there is a estenosis, with a mechanical and pneumatic expansion; it allows to control a recent intervention to verify that all this good, allows to fulgurar an injury that it is bleeding, every time goes less people to operating room by a digestive hemorrhage, allows to resecar a polyp, to even clean to the biliary route, nailed calculations and resecciones of great tumors, for example in the rectum by transanal route. Endoscopy is recommended like prevention in patients with familiar antecedents of colon cancer, patients with familiar antecedents with polyps and patients of 50 years or more of age. The patients with symptoms like the bled one by the anal sphincter, although 80 % of the cases of bled are due to the hemorroides.

Thanks to the hemorroides, that do not have anything to do with the cancer, the patient can be put, of more than 50 years, with antecedents, etc. In situation that allows us to explore the interior of the colon and we are going to him to be able to diagnose a polyp that yes it has to do with the cancer. Most of the polyps they are benign. The polyps of colon and the polyps of the digestive apparatus practically we divided them in two groups: those that are pre-malignant, that is to say, that we know that with time they can get to develop to a cancer and those that are not pre-malignant; that they are those that by many years that happen it is not going to pass nothing.

What it happens is that that we do not know it until we did not watch it after the microscope and for it it is necessary to extirpate it whole, since the polyp can be benign in a 95% and to have a fragment that is malignizado. If the doctor has indicated to him to be made this exploration, must practice since this one does not become by divertimento, but to do a good to him to the patient because a reasonable doubt is had of which it can have that person.