Endoscopy and Colonoscopy

Upper endoscopy

Upper endoscopy

An upper gastrointestinal (UGI) endoscopy is a procedure used to look at the interior lining of the esophagus, the stomach, and the first part of the small intestine through an endoscope. The endoscope is inserted through the mouth and then gently fed down the throat into the esophagus, stomach, and duodenum (upper gastrointestinal tract).

It is important to perform this procedure in patients prior to bariatric surgery to make sure the patients doesn’t suffer from gastroesophageal reflux disease, hiatal hernia, bacterial infection with H. pylori, ulcers, and tumors.

Endoscopy is sometimes performed in bariatric surgery patients after surgery if they experience persistent vomiting, abdominal pain, inability to feel full, decreased weight loss, gastroesophageal reflux disease. If patients develop a stricture of the gastro-jejunosotmy (connection between the stomach pouch and small intestine) it can be easily dilated in the office in our state of the art endoscopy suite.

Colonoscopy

Colonoscopy is a test that looks at the interior lining the large intestine (rectum and colon) through a thin viewing instrument called a colonoscope. A colonoscopy, inserted through the rectum, helps detect ulcers, polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, a biopsy can be performed and abnormal growths can be removed. Colonoscopy also can be used as a screening test to identify and remove pre-cancerous and cancerous growths in the colon or rectum (colorectal cancer). Colonoscopy enables visual inspection of the entire large bowel from the distal rectum to the cecum. The procedure is a safe and effective means of evaluating the large bowel. The technology for colonoscopy has evolved to provide a very clear image of the mucosa through a video camera attached to the end of the scope. The camera connects to a computer, which can store and print color images selected during the procedure.

Compared with other imaging modalities, colonoscopy is especially useful in detecting small lesions such as adenomas; however, the main advantage of colonoscopy is that it allows for intervention, because biopsies can be taken and polyps removed.

Screening for and follow-up of colorectal cancer are among the indications for colonoscopy. Although colorectal cancer is highly preventable, it is the second most common cancer and cause of cancer deaths in the United States. Both men and women face a lifetime risk of nearly 6% for the development of invasive colorectal cancer. Proper screening can help reduce mortality rates at all ages, and colonoscopy plays an important role in this effort.

Indications for Colonoscopy

Surveillance of asymptomatic people of average risk older than 50 years Recommendations vary among the leading organizations in this field, namely the American Cancer Society (ACS), the World Health Organization (WHO), the US Preventive Services Task Force (USPSTF), and the American College of Physicians (ACP). It is generally recommended, however, that average-risk adults should begin colorectal cancer screening at age 50 years, utilizing one of several options for screening, among which is colonoscopy, every 10 years. Annual fecal occult blood testing (FOBT) and periodic flexible sigmoidoscopy with follow-up colonoscopy are also recommended for average-risk screening.

Further evaluation of polyps

The finding of a polyp larger than 1 cm in diameter during sigmoidoscopy is an indication for examination of the entire colon because 30-50% of these patients have additional polyps. Though controversy continues regarding whether colonoscopy is indicated for patients with a polyp(s) smaller than 1 cm, the general belief is that most cancers arise in preexisting adenomatous polyps, which should lead to a full colonoscopic examination, regardless of size.

If clinical signs and symptoms suggest colon cancer or when screening (by radiography or sigmoidoscopy) identifies a large bowel tumor, a full colonoscopic examination should be performed to obtain biopsy samples and to search for synchronous lesions. Findings on colonoscopy may also have implications for the surgical treatment plan.

Histologic diagnosis should be based on examination of the completely excised polyp. In general, all polypoid lesions greater than 0.5 cm in diameter should be totally excised. After removal of a large (>2 cm) sessile polyp or if there is concern that an adenoma was not completely excised, repeat colonoscopy should generally be performed in 3-4 months. If residual tissue still remains, it should be resected and colonoscopy repeated again in another 3-4 months.

Personal history of prior adenomas or colon cancer

In patients with multiple benign polyps observed and removed on initial examination, a follow-up colonoscopy should be performed in 1 year to search for polyps missed on the initial examination. In patients with only one polyp observed and removed on initial examination, or if the first follow-up examination finding after multiple polypectomy is negative, the optimal follow-up interval appears to be every 3 years. If the colon is free of polyps, some authorities believe that a 5-year interval is safe.

Because of the potential implications for the operative plan, preoperative colonoscopy should be performed in patients who are to undergo bowel resection for colon cancer. Patients who have already had a large bowel cancer removed should have a colonoscopy performed 6 months to 1 year after surgery, followed by yearly colonoscopy on 2 occasions. Some authorities believe that colonoscopy should then be performed every 3 years if results of all these studies are negative.

Family history of cancer

Individuals with a family history of familial adenomatous polyposis (FAP) or Gardner syndrome are recommended to undergo genetic testing and flexible sigmoidoscopy or colonoscopy every 12 months, beginning at age 10-12 years until age 35-40 years if negative. Consider total colectomy for these individuals because they have a nearly 100% risk of developing colon cancer by age 40 years. Colonoscopy is not as effective in preventing colon cancer under these circumstances as it is with polyps in general. Individuals with a first-degree relative diagnosed with colon cancer or adenomas when younger than 60 years, or with multiple first-degree relatives diagnosed with colon cancer or adenomas, should undergo screening colonoscopy every 3-5 years initiated at a chronological age 10 years younger than the youngest affected relative.

The diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC) should be considered in people who have several relatives with colorectal cancer, particularly if one or more of the relatives developed cancer when younger than age 50 years. HNPCC is an autosomal dominant disorder with an approximately 70% lifetime risk of developing colorectal cancer. These patients should be evaluated colonoscopically every 1-2 years, beginning at age 20-25 years or at an age 10 years younger than that of onset in the index case (whichever comes first). Perform annual screening in patients older than 40 years.

Inflammatory bowel disease

Although many patients do not require colonoscopy for the diagnosis of inflammatory bowel disease, the procedure is an important aid in the follow-up care and management of patients with ulcerative colitis or Crohn disease. Colonoscopy is more sensitive than barium enema in determining the anatomic extent of the inflammatory process and is useful when clinical, sigmoidoscopic, and radiologic studies are inadequate. Colonoscopy with multiple biopsies is indicated to differentiate ulcerative colitis from Crohn disease.

The cancer surveillance schedule varies in patients with inflammatory disease. Patients with pancolitis for more than 7-10 years and patients with left-sided ulcerative colitis for more than 15 years are at an increased risk of developing colon cancer. The current recommendation for screening colonoscopy for these groups is every 1-2 years. For patients with Crohn’s disease of the colon, the same schedule of colonoscopic surveillance is warranted.

Ideally, because differentiating inflammatory changes from premalignant ones can be difficult, colonoscopy for surveillance purposes should not be performed during periods of active colitis, and biopsies from areas of less inflammation should be preferred. It has been suggested that up to 64 biopsies are needed to achieve 95% sensitivity when surveying for dysplasia in patients with inflammatory bowel disease.

New technologies including chromoendoscopy, magnification endoscopy and narrow band imaging may improve detection of dysplasia during surveillance colonoscopy and allow endoscopists to take fewer, higher-yield biopsies.

The New York Bariatric Group is proud to be able to offer these endoscopy and colonscopy services in conjunction with our bariatric surgery. Additionally, we’re at the front of developing innovative bariatric surgery techniques utilizing endoscopy. This includes the Rose Procedure of revisional bariatric surgery. Learn more by calling our office at 800-633-8446.