Thursday, September 23, 2010

7.4 GI Tract Scopies/Hands On View

Physician's Notebooks 7 - - See Homepage
4. New View of the GI Tract – The Scopies - Update 22 December 2018
The flexible internal laser-light scope has changed the approach to GI diagnosis. Where before, a delay because of fear of x-ray, now a more rapid approach. Symptoms can have the esophagus, stomach and duodenum checked quickly by scope passed into throat to far duodenum. Photos can be taken, tissue biopsy done, small tumor removed or bleeding vessel in ulcer cauterized or tied off. Stone stuck in tip of common bile duct from Gall Bladder can be removed and the ducts outlined by dye via the scope. From below starting at the anus, an inserted colonoscope can view the whole colon up from the anus, and can find early cancer or polyp and cure it by removal, or can find diverticulosis or ulcerative colitis and can diagnose infection of colon. Small intestine still cannot be directly reached but a swallowed capsule with tape videocam can give a view.

My Experience with Colonoscopy: My instruction sheet says to take fluid diet for 2 days and no breakfast, and the night before I am given laxative. I show up at clinic 8 AM and, after getting into gown with opening in rear, I drink down a gallon jug of clear liquid. It is salty bitter and unpleasant. I use bedside commode for Bowel Movements (BM) that follow. When the BM is clear like water, I am ready for to be colonoscoped. 

Comment: Purpose is to clean out the colon. If you do not follow instruction the test will be imperfect because small cancer may be hidden from the scope behind pieces of feces. 
Just before being taken for scopy, an IntraVenous is started in my forearm and the anesthetist gives me tranquilizer through the IV. I get sleepy. I am put on rolling stretcher to procedure room and get onto exam table on my side. The scope is inserted through my anus and advanced up into colon. It is not bad until mid colon; then I get low abdomen pain like expanding pressure, and it forces an end to it. My doctor tells me there is too much feces in my mid colon. As the scope is being pulled out, the doctor notes an opening of a diverticulum in the descending colon, discovering my diverticulosis. 
Comment: Importance of strict preparation is pointed up here I did not follow it and suffered. 
Second Colonoscopy: Because of finding diverticulosis, I went for barium x-ray exam of colon. It showed many diverticuli. I decided to get a repeat colonoscopy quickly. But I switched to a world-class scopist. 
Comment: Here is where one sees need for colonoscopy and also a barium enema x ray. In my case the scope functioned as screener, picking up one diverticulum, and the x-ray with barium was a delineator. Because diverticuli are outpouching from inner wall of colon, their small inner openings are easily overlooked by scope. But barium gets into them and shows the long tubular shape nicely on the x-ray.  (Note this is a bit unusual. Generally, colonoscopy is replacing barium enema x-ray)
With 2nd colonoscopy I follow instructions. My world-class scopist, having the recent barium x-ray before him, and knowing I’d had a painful, shortened colonoscopy previously, chose to put me to sleep by IV injection. One instant I am gazing at a pretty nurse in mirror, wondering what she thinks preparing my asshole for passage of the scope; next I lie in bed in recovery, feeling pleasant and hearing the doctor say that all went perfect and he had pushed scope to my appendix and inspected every nook and cranny of colon down to the anus-rectum edge and seen nothing more than the openings of my diverticuli. No cancer and one more anxiety of life relieved. Hurrah for colonoscopy expertly done!
        Comment: The importance of good anesthesia/anti-pain sedation and world class scopist is seen here.
My Esophago-Gastro-Duodenoscopy - in text "upper GI scopy": For years I was bothered by chest discomfort at night. I thought it might be from stomach juice into lower esophagus, GastroEsophageal Reflux Disease (GERD), so I decided to get upper GI scopy to check, and also for cancer and peptic ulcer. But I felt fear of having the snakelike scope shoved down my throat. I found a world-class upper GI scope doctor, and decided to swallow my fear as well as his scope. I was nervous as I approached hospital that morning. But in contrast to the unpleasantness before colonoscopy, the upper GI scopy only required my missing breakfast. In fact the whole procedure turned out easy. A nurse  sprayed local anesthetic in back of throat; then with me lying on right shoulder elevated on pillow, and biting on tongue-depressor scope-guide, the scope is passed into mouth and swallowed, helped by gentle push. I am awake, feel no pain, fear or discomfort and watch on TV monitor.
   As he inspects my esophagus, stomach and duodenum, my GI scopist gives comment what he is looking at and I am seeing on the TV monitor. Then he snaps photos, and in 10 minutes I am free of the scope and feeling good because the outcome shows normal except mild G-E reflux from small hiatus hernia. No cancer. Another lifetime anxiety paranoia relieved.
   A well-considered-and-prepared-for upper GI scopy can be close to fun. Key is to find world-class scope doctor and team.

Note: A good preliminary to be sure you need a scopy is to do a simple check of your stools for blood, which is called a Hemeoccult test. All you need to do is give your doctor a sample of 2 or 3 days of your bowel movement in a screw top bottle and ask for the test. Consistently negative tests mean it is not necessary to get a GI scopy. A finding of blood in the stool is an indication for a scopy. 
END OF CHAPTER. To read next now, click 7.(5-6) Stomach, Esoph, Duoden/GERD/Ulcer/Cancer

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