On 4 September, 2021, Seniors Today hosted yet another Health Live Webinar and had the pleasure of hosting Dr Prasanna Shah for the fourth time on our platform.
Dr Prasanna Shah is a leading Consultant Interventional Gastroenterologist and is attached to the Breach Candy, Jaslok and Saifee Hospitals in Mumbai. He has vast experience in therapeutic endoscopy and now metabolic correction endoscopy for weight loss.
Dr Prasanna Shah is a leading gastroenterologist and he answered questions on Endoscopy and Colonoscopy during this week’s webinar.
Endoscopy is a form of an investigation where a thin, slender tube with a camera and a source of light at one end is introduced through the mouth of the patient, visualizing the food pipe, stomach and a part of the small intestines. Endoscopy is also called the OGDscopy which is the oesophago-gastro-duodenoscopy. It is an upper GI endoscopy.
Endoscopy is a broad term, wherein we have the OGDscopy and the colonoscopy.
The upper GI endoscopy helps us visualize the upper part of the gastrointestinal system up to the 2nd-3rd part of the duodenum.
Colonoscopy is also a form of investigative procedure where a slender tube with a camera and source of light is introduced. The tube used in colonoscopy is much longer than the one used in endoscopy. Colonoscopy helps us visualize the whole of the colon which includes the rectum, sigmoid colon, splenic flexure, transverse colon, hepatic flexure, ascending colon and the caecum which is the start of the colon and the IC valve where the start of the small intestine ends and joins the large intestine and we can also see the last 10-20 cms of the small intestine.
Endoscopy and colonoscopy are procedures that are done from the infant age group to the elderly. They are safe procedures. The complication rate for a colonoscopy or endoscopy is very low.
They are both OPD procedures and thus do not require admission unless something needs to be checked, repaired or further investigated or if it is causing you a problem and you require admission for relief of your symptoms.
The upper GI endoscopy is divided into 2 types
- Diagnostic: this is done to diagnose and identify the problem. We also look for pathology of the food pipe, stomach or duodenum. This can be an inflammation, ulcer, infection, cancer, Barrett’s esophagus, any hernia or strictures. We can also see if the patient has celiac disease, inflammatory bowel disease, malabsorption disorders. We can also take biopsies.These have next to nil complication rates.
- Therapeutic: depending on the procedure being performed, they can have procedure related complications or side effects that are 0.001-0.1% of all the endoscopies done worldwide.
Dr Shah says he prefers doing his endoscopic procedures under short conscious sedation wherein you’re numb from the neck down and once the procedure is done, you are woken up and are good to leave in another 45-60 mins. You come walking, you leave walking.
During the procedure, your vitals and important parameters such as your pulse, blood pressure, and oxygen saturation are monitored. If at any point during the procedure, any blip is found, the procedure is stopped and corrective measures are taken.
Few things to keep in mind before you arrive for your endoscopy:-
- You should brush your teeth and come to the endoscopy
- You can take your medications for hypertension before the procedure. You will however have to stop your medication for blood thinners, diabetes prior to the endoscopy.
- You have to be fasting for at least 6 hours before you OGDscopy or colonoscopy.
- In case you’re very thirsty or parched, you can have half a glass of water 2-3 hours prior to the endoscopy.
In an OGDscopy or an upper GI endoscopy, you do not need any special preparation, the only preparation you need is that you come fasting.
In a colonoscopy, the patients are given a special preparation either a day prior to the colonoscopy or on the same day. These preparations are large volume laxatives where you drink around 1.5-2 liters of the preparation by mixing it in water and you consume the water. When you consume this preparation, it will cause diarrhea, it is called drug induced diarrhea. You do not have to worry about this diarrhea; this is essentially washing/ cleaning the colon.
This is an important step, because visualization of polys and other structures of the inside of the colon become difficult if the colon is smeared with stool/feces.
If you are over the age of 50, it is important that you get a screening colonoscopy even if you’re completely asymptomatic because polyps can be asymptomatic but have the tendency to turn cancerous.
If screening endoscopy at 50 is normal, you should get a repeat colonoscopy at 60 years of age, and depending on what the findings are, get a repeat colonoscopy again every 3 or 5 years as advised by the American Gastroenterology Association.
Similarly, there are screening guidelines for OGDscopies, to look for Barret’s oesophagus. Barrett’s oesophagus is a precancerous condition where there is a tongue-like projection of the mucosa which you see in the lower end of the food pipe which can later become cancerous and later cause problems. You can get a screening endoscopy for Barret’s oesophagus if you’re over the age of 50, have GERD/ reflux problems, acidity and are obese.
Dr Shah informs us that there have been papers that said and stated that colon hydro-therapy or a “colon cleanse” as it is also called is beneficial. But Dr Shah says that he would like to reserve his opinion on the topic as he has in his experience seen patients who had some complication from the colon hydrotherapy. He says that is just as beneficial if you keep yourself hydrated, eat a good fiber rich diet, exercise, and avoid stress.
There are a couple of procedures that are done endoscopically for weight loss.
Crohn’s disease is an inflammatory bowel disease which can be detected during endoscopy/ colonoscopy where you see ulcerations in the ileum or the colon. The cause for it is likely to be thought to be inflammatory which can be caused by contaminated food, water or milk.