Endoscopy: What Is It, Who Is It Applied To, How Is It Performed, How Long Does It Last, and What Should Be Considered?

Diseases related to the digestive system are one of the extremely important health issues that significantly affect a person's quality of life, nutritional habits, immune system, and body resistance. Delays in diagnosis, particularly during the early stages, can lead to disease progression, weakened body resistance, and increased difficulty in treatment. For this reason, endoscopic methods have been developed for a detailed examination of digestive system-related diseases, and simultaneous treatment with diagnosis has become possible through advanced endoscopic applications like EMR (Endoscopic Mucosal Resection).

What Is Endoscopy?

In its literal sense, endoscopy is a type of examination method used in the diagnostic phase of many diseases, dating back to the time of Hippocrates. Today, it can be defined as the visualization of hollow organs such as the esophagus, stomach, intestines, bladder, uterus, and vagina through a flexible cable-like instrument equipped with a camera at its end. All these interventions are named differently depending on the area where the procedure is applied; however, in general usage, the term "endoscopy" is preferred specifically for the visualization of the upper and lower digestive system organs.

Especially, digestive system endoscopy has increasingly been used not just for diagnosis but for treatment as well. Therefore, endoscopy is not merely an imaging procedure; it is one of the most effective treatment options for a wide range of conditions, from gastroesophageal reflux to digestive system cancers.

In Which Situations Is Endoscopy Performed?

The endoscopy procedure applied to the upper digestive system is classified into esophagoscopy, gastroscopy, and duodenoscopy. Esophagoscopy is the detailed visualization of the esophagus, gastroscopy is for the stomach, and duodenoscopy is for the duodenum. Situations requiring endoscopic visualization of the upper digestive system for diagnostic purposes include:

Dyspepsia
Commonly defined as indigestion, this condition can be explained as a loss of function in the stomach and duodenum. Dyspepsia can lead to various digestive problems and may indicate more serious health issues when assessed alongside other complaints.

Swallowing Difficulties Such as Dysphagia and Odynophagia
Difficulties in swallowing (dysphagia) and painful swallowing (odynophagia) can indicate very serious health problems. Therefore, urgent endoscopy is recommended if these symptoms arise.

Gastroesophageal Reflux Disease
Gastroesophageal reflux is often diagnosed based on typical findings without the need for endoscopy. However, if there are associated health issues such as iron deficiency anemia, unwanted weight loss, or painful swallowing, endoscopy of the upper digestive system may be preferred.

Upper Digestive System Bleeding
If a patient exhibits symptoms indicating gastrointestinal bleeding, such as bloody vomiting and/or bloody stools, endoscopy may be performed for both diagnosis and treatment.

Unexplained Iron Deficiency Anemia
Iron deficiency anemia can be a precursor to many diseases related to the digestive system. For this reason, endoscopy of the upper and lower digestive systems is preferred in cases of unexplained iron deficiency.

Suspected Mass Presence
If a mass detected during examination of the upper abdomen is confirmed through radiological imaging, endoscopy may be required for detailed examination and diagnosis.

Achalasia
Achalasia can be briefly defined as the permanent relaxation of the muscles surrounding the esophagus and the loss of the function of the stomach opening and closing. This disease, which causes serious discomfort in individuals, benefits from endoscopic interventions during diagnosis, treatment, and follow-up.

In addition to all these, endoscopy of the upper digestive system is also performed for the diagnosis and treatment of masses and lesions related to the digestive system, removal of polypoid lesions, dilation of benign strictures, drainage of cysts in the pancreas, and advanced endoscopic interventions such as Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD).

The detailed visualization of the colon and rectum through an endoscopic device is called colonoscopy, which is commonly performed in the following situations:

Cancer Screening
Colon cancer is one of the types of cancer that is often detected late and can progress very rapidly, leading to death. Therefore, colonoscopy is preferred for routine cancer screenings, especially for at-risk individuals.

Tumors, Strictures, Ulcers, or Obstructions
Lesions, strictures, ulcers, or obstructions that occur in the colon may indicate other diseases, and some situations may require urgent intervention. In such cases, colonoscopy may be preferred for both diagnosis and treatment.

Inflammatory Bowel Disease
Inflammatory bowel disease can lead to the development of benign or malignant tumor tissue on the surface of the intestine. Therefore, individuals diagnosed with this condition and their symptomatic relatives should be monitored, and colonoscopy should be repeated at appropriate intervals.

Colorectal Polyps
Polyps and similar lesions that occur in the colon are removed after confirmation by colonoscopy. Additionally, a biopsy may be necessary for definitive diagnosis of certain diseases during colonoscopy.

How Is the Endoscopy Procedure Performed?

The endoscopy procedure must be performed under suitable conditions by experienced personnel. Prior to the procedure, the necessary anesthetic treatment is applied to the patient, and positioning is given. For upper digestive system endoscopy, regional anesthesia is typically preferred. The patient is placed on the procedure table and turned to the left side with both shoulders at the same level. A device resembling a thick cable with a camera at the end is then inserted through the mouth, progressing toward the throat and esophagus. During this time, it is essential to move as gently and slowly as possible to avoid complications such as tearing or bleeding in the digestive system mucosa.

As the camera advances within the esophagus, the examination of the digestive system is performed through the screen displaying the camera’s reflections. After this area is examined, the endoscope is advanced toward the stomach, providing detailed visualization starting from the stomach opening. If any pathological findings are detected during these procedures, a biopsy can be taken from that area and sent to the laboratory for examination.

In the endoscopy procedure applied to the colon, general anesthesia is most likely preferred. Before the procedure, a cleansing enema is performed, ensuring the complete evacuation of the intestinal surface. The patient is then positioned on their side, again ensuring that both shoulders are on the same plane, and asked to draw their knees up to chest level. After administering anesthesia, the anal opening is prepared, and the rectum and then the colon areas are visualized sequentially.

How Long Does the Endoscopy Procedure Last?

The duration of the endoscopy procedure varies based on many factors, including the patient's age, overall health status, anxiety levels, the purpose of the procedure, the method of intervention, the experience of the physician, the adequacy of the application center, and the type of anesthesia chosen during the procedure.

Procedures applied to the lower digestive system can take longer than upper digestive system endoscopies due to the need for sensitivity and the preference for general anesthesia. It is very important that the procedure is carried out as gently, slowly, and carefully as possible to avoid any complications related to the procedure. Therefore, especially for endoscopy applications in the lower digestive system, the total time may exceed one hour when including the recovery time from anesthesia. Upper digestive system endoscopies, on the other hand, are typically completed in about 30-40 minutes depending on the patient's overall health status.

Additionally, endoscopy procedures performed for treatment purposes may take a little longer than planned. Some procedures, such as the dilation of strictures found anywhere in the digestive tract, removal of foreign objects causing obstructions, detection of potential lesions, and removal of polyps from the mucosal surface, are completed in a longer time compared to standard endoscopy procedures performed for diagnostic purposes.