Endoscopic Procedures

Dr Fraser performs a number of different types of specialised endoscopic procedures. These are performed in state of the art endoscopy units in premier London and Edinburgh hospitals using the latest equipment and expertly trained nurses.

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  • Colonoscopy
  • Capsule endoscopy
  • Double balloon colonoscopy
  • Double balloon enteroscopy
  • Gastroscopy
  • Endoscopic anti-reflux therapy
  • Transnasal endoscopy
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Colonoscopy

Bowel (colorectal) cancer is the 3rd most common cancer in the UK and the 2nd most common cause of cancer related death – 16,000 people die from bowel cancer each year. The UK NHS Bowel Cancer Screening Programme recommends colonoscopy for the examination of the colon in men and women from the age of 60 years with a positive faecal occult blood test (FOBT). In the USA, a colonoscopy to check for bowel cancer or polyps is offered from the age of 50 years without the need for an FOBT.

Colonoscopy can detect bowel cancer at an early stage and before symptoms develop, significantly improving the chance of recovery and long term survival. As most bowel cancer is believed to come from polyps, colonoscopy can also prevent cancer by removing polyps when these are found.

Colonoscopy is also recommended for surveillance of certain patients who are at increased risk of bowel cancer. This includes those with:

  • a family history of bowel cancer
  • a personal history of colonic polyps or bowel cancer
  • a genetic predisposition
  • inflammatory bowel disease

Special techniques can be applied during colonoscopy to improve detection of the pre-malignant changes that occur before cancer develops.

Patients with the following symptoms or signs should also consider a colonoscopy:

  • a change in bowel habit
  • chronic diarrhoea
  • rectal bleeding
  • unexplained iron deficiency anaemia

Capsule endoscopy

Capsule endoscopy is a new non-invasive form of endoscopy that is easy to have, comfortable and convenient. No sedation or analgesia are necessary. A pill-sized, video-imaging, wireless capsule is simply swallowed with water. The capsule contains a camera, light source, batteries and transmitter. During the test more than 100,000 colour images are recorded. These images are then downloaded for analysis later. 3 types of capsule are available: the oesophageal capsule, the small bowel capsule and the colon capsule.

Oesophageal capsule endoscopy

The oesophageal capsule is indicated for the investigation of gastro-oesophageal reflux disease (GORD) and liver disease usually when patients are unwilling or unable to undergo gastroscopy and other invasive procedures.

The oesophageal capsule can screen for and detect:

  • reflux oesophagitis
  • Barrett’s oesophagus
  • oesophageal varices

Small bowel capsule endoscopy

The small bowel capsule is indicated for:

  • investigation of iron deficiency anaemia
  • obscure gastrointestinal bleeding
  • known or suspected small bowel Crohn’s disease
  • refractory Coeliac disease (or where there is doubt about the diagnosis) and other disorders that lead to chronic diarrhoea and weight loss
  • detection and surveillance of small bowel tumours (e.g. polyps, GISTs, carcinoids, lymphoma)
  • identification of medication related small bowel injury (e.g. NSAID-induced enteropathy)
  • as an additional diagnostic modality when small bowel abnormalities have been identified by other investigations (such as CT, MRI or barium X-rays)

Colon capsule endoscopy (capsule colonoscopy)

Colon capsule endoscopy is a safe, reliable and effective method for imaging the colon and has a high sensitivity and specificity for detection of bowel polyps. While conventional colonoscopy remains the gold standard, the colon capsule may be considered as an alternative procedure in certain situations. Indications for capsule colonoscopy include:

  • incomplete (failed) conventional colonoscopy when complete examination of the colon is necessary
  • patients at average risk of colonic neoplasia without alarm symptoms (who are unwilling to undergo conventional colonoscopy)
  • patients who are unable to undergo conventional colonoscopy
  • monitoring of mucosal healing in response to medical treatment in patients with known and uncomplicated IBD (e.g. ulcerative colitis)

Double balloon colonoscopy

Double balloon colonoscopy (DBC) is a new kind of colonoscopy that uses two balloons to help make insertion of the colonoscope through the colon much easier. DBC is particularly useful when:

  • patients find conventional colonoscopy too uncomfortable
  • patients have a very long, mobile colon which can make reaching the end of the colon difficult using conventional colonoscopy
  • patients have a fixed and tethered colon due to previous surgery (e.g. hysterectomy) or bad diverticular disease
  • sedation needs to be avoided or minimised (double balloon colonoscopy is usually well tolerated without this)

Double balloon enteroscopy

Double balloon enteroscopy (DBE) is a new endoscopic technique for examining the small bowel. Two inflatable balloons are used to help the enteroscope (a long, thin type of endoscope) travel through the small bowel. Abnormalities found at capsule endoscopy are often investigated by DBE. Depending on the indication, DBE may also offer patients an alternative to surgery.

With DBE it is possible to:

  • take tissue biopsies of abnormalities to make a diagnosis
  • treat bleeding from the small bowel (e.g. due to angioectasias or AV malformations)
  • dilate strictures or stenoses causing obstruction (e.g. due to Crohn’s disease, NSAIDs or surgery)
  • remove polyps especially for patients with polyposis syndromes (e.g. Peutz-Jeghers Syndrome or Juvenile Polyposis Syndrome)
  • retrieve foreign objects (e.g. retained capsule endoscopes)
  • place feeding tubes (known as direct percutaneous endoscopic jejunostomy)

More information on DBE is available at www.doubleballoonenteroscopy.com

Gastroscopy

This is a form of endoscopy when an endoscope (also known as a gastroscope) is passed through the mouth and oesophagus (gullet) into the stomach. A local anaesthetic throat spray is often used with or without short acting sedation to make the procedure, which lasts only 8-10 minutes, more comfortable. Gastroscopy is an excellent test for the investigation of acid reflux, dyspepsia (indigestion), possible hiatus hernia, when stomach ulcers are suspected or if biopsies need to be taken (e.g. duodenal biopsies to look for coeliac disease).

 Indications for gastroscopy

  • For the investigation of heartburn caused by acid reflux, indigestion (dyspepsia), difficulty swallowing (dysphagia), painful swallowing (odynophagia), upper abdominal pain or weight loss (for possible stomach ulcers or cancer), anaemia and gastro-intestinal bleeding
  • Surveillance of patients with Barrett’s oesophagus
  • Take biopsies (Barrett’s oesophagus, Helicobacter pylori, coeliac disease)
  • To perform therapy (balloon dilatation of strictures and achalasia, botox injection, endoscopic mucosal resection, polypectomy)
  • To assess the anatomy of the stomach (for hiatus hernia or before anti-reflux surgery)
  • To investigate abnormalities seen at x-ray (after barium swallow)

Endoscopic anti-reflux therapy

The traditional way to treat patients suffering from chronic gastro-oesophageal (acid) reflux usually means taking long-term anti-acid tablets or undergoing invasive surgery. Endoscopic anti-reflux therapy is a new acid reflux treatment.

Endoscopic anti-reflux therapy provides several advantages:

  • minimally invasive – no incisions in the abdominal wall, no surgery
  • the procedure is done under short acting GA and takes 1 hour or less
  • minimal post-operative pain
  • safe with significantly less complications than surgery
  • same-day discharge
  • rapid recovery and return to work
  • alomost no dietary adjustment
  • the procedure is repeatable
  • anti-reflux surgery can still be performed in future if necessary

The Stretta Procedure

The Stretta endoscopic anti-reflux procedure is a minimally invasive therapy for acid (gastro-oesophageal) reflux. State of the art technology delivers radiofrequency energy to strengthen the lower oesophageal sphincter and prevent acid reflux from occurring.

Stretta has an excellent safety profile with a low risk of complications compared to other forms of anti-reflux therapy, including surgery. It is performed under a short acting general anaesthetic and takes 60 minutes. Patients go home the same day.

Please note: not all patients with acid reflux meet the criteria for endoscopic anti-reflux therapy. While mild to moderate reflux sufferers may be suitable, those patients with large hiatus hernias or severe reflux may not be.

For more information on the Stretta endoscopic anti-reflux procedure go here.

Transnasal endoscopy

Transnasal endoscopy (TNE) is a new kind of endoscopy that is much more comfortable for patients. An ultrathin gastroscope is passed via the nose, rather than the mouth, into the stomach after local anaesthetic spray to the nasal passages.

TNE avoids the common side effects of conventional gastroscopy (through the mouth) such as gagging, retching and nausea because the transnasal approach minimises contact with the back of the tongue. Therefore no sedation is usually needed.

  • No need to be accompanied for the test
  • No sedation required
  • No gagging or retching
  • Quick recovery
  • Return to work straight away
  • Driving a car, operating machinery, drinking alcohol allowed after test

Having a TNE

Having a TNE is straightforward and only takes a few minutes:

  • Fast for 4 hours
  • A few minutes before TNE, drink a small amount of water with bubble-breaker to clean the stomach
  • Apply local anaesthetic spray to nose
  • Insert transnasal endoscope
  • Examine the upper gastrointestinal tract (oesophagus, stomach and duodenum)
  • Take photos
  • Perform biopsies and CLO test for Helicobacter pylori
  • Withdraw transnasal endoscope
  • Return home or back to work

Indications for TNE

  • As for conventional gastroscopy
  • To assess the gullet (oesophagus) in patients with head or neck cancers
  • Placement of feeding tubes or feeding tube extensions into the stomach or small bowel (jejunum) via the nose or the mouth
  • For patients who need a gastroscopy who do not want or cannot have sedation (e.g. because of heart or lung disease or in pregnancy)
  • For patients who cannot tolerate endoscopy through the mouth (e.g. as this causes excessive gagging or retching)