DxD Session held on 27 August 2018.
Dr Quan answered questions from readers on:
- What can be diagnosed with an endoscopy
- Procedure for endoscopy
- Causes of gallstones
- Symptoms of gallstones
- Treatment options for gallstones in Singapore
- Cost of endoscopy in Singapore
Endoscopy is a procedure where your doctor inserts a narrow flexible tube equipped with a camera through your mouth to examine your digestive tract.
New advances in medical technologies allow endoscopists to do not only diagnostic procedures (identification and confirmation of disease situations) but also therapeutic (treatment of disease conditions such as removal of bile duct stones) endoscopies that would be minimally invasive.
Hi Ding Lee,
Endoscopy is a technique widely employed by different medical specialties to investigate problems arising from the different organ systems in our body. These organ systems include the nose & throat by ENT specialists, the urinary tract by urologists and most common of all, the digestive tract by gastroenterologists.
So it is understandable to get a little mixed up with the different types of endoscopes available. I will highlight the commonly used endoscopes below and try to explain more on their functions.
Routine gastroscopes used for the upper digestive tract, for example, can help to diagnose stomach ulcers, inflammation, tumour growth and to arrest bleeding from ulcers.
Besides clinching diagnoses such as gastric ulcers, colonic polyps, or cancers, modern endoscopes can certainly be used to treat many different digestive conditions.
Gastric Ulcer Small Intestine Polyp Bleeding gastric varices
By removing a growth known as polyp in the large intestine through the process of Colonoscopy and Polypectomy, colon cancer death rates has been shown to be reduced by more than 50%.
In cases with active bleeding from the digestive tract, endoscopy is now the first line treatment to arrest the bleeding. Gallstones which have migrated into the bile duct can now be removed by a special endoscope through a process called ERCP. (Find out more about ERCP here)
Hi Si Yi,
Endoscopy is minimally invasive. The risk of endoscopy is much lower than most surgery and most, if not all procedures, are carried out under some form of sedation or anaesthesia.
This means that patients would sleep through the entire procedure and therefore not be aware or have no recollection of the procedure upon completion.
The risk of endoscopy varies according to the type of procedure. A straightforward upper digestive endoscopy, for instance, can be completed in 15 minutes and carries very low risk of 1 in 10 thousand while colonoscopy carries a risk of 1 in a thousand.
The possible complications range from mild pain to bleeding and perforation. Based on our experience, serious complications rarely happen with routine upper and lower endoscopy.
Endoscopy is recommended only if there is a strong reason to do so. The type and urgency of an endoscopic procedure depends on the nature and severity of your medical condition, which may be reflected in your presenting symptoms, medical history, family history or abnormal blood tests or scans.
Common indications for endoscopy include persistent abdominal pain, suspected blood in your stools, raised serum tumour markers, personal or family history of colonic polyps and so on. Other indications include cancer screening and abnormal scan findings discovered incidentally, and the list goes on.
I am sorry to hear that. This is indeed a tough question and I am not sure if I can provide a satisfactory answer. You must be aware that despite undergoing the same rigorous training which qualifies a doctor to perform a particular procedure, each of us has different skill-sets and strengths, which defines our ability to perform procedures in the safest and most comfortable manner.
In my humble opinion, just be mindful that a “popular” name on magazines or provided by some insurance agents may or may not be the best person who will perform the procedure with utmost care and compassion.
Do speak with your friends or relatives and ask for their feedback. Find out from the “inner circle” if you happen to have a doctor friend who has no vested interest in that area. You may be surprised to find information that could turn out to be very different from what you already know.
Hi Wai Ma,
Endoscopy is carried out by doctors who are competent to do the procedure. The level of complexity depends on the reason for the endoscopy and the type of endoscopical procedure you plan to undergo. Diagnostic upper digestive endoscopy, for instance, is relatively easy and safe to perform.
Endoscopy of the bile ducts (e.g. Spyglass Cholangioscopy), on the other hand, can be challenging and carries much higher risks of complications, thereby requiring more years of training to master.
SpyGlass Cholangioscope for laser stone fragmentation
Although it is true that restructured hospitals need to conduct training for their resident doctors, these trainings are done under direct supervision of a competent endoscopist most if not all the time.
Depending on the type of endoscopy you plan to have, the preparations can be merely a 6 to 8 hour fasting to drinking 2 to 3 litres of bowel prep fluid overnight. In general, most doctors have their own advice on how to prepare you for the endoscopy process. Please follow their advice closely so that you will get the best outcome from your endoscopy.
One simple tip that I provide my own patients for colonoscopy is to chill their bowel prep solution in the fridge after preparing. A few drops of lime juice may go a long way in making the drink more palatable.
Hi Yoke Peng,
First, you need to understand that capsule endoscopy was first designed to allow doctors to look into problems arising from the small intestine where routine endoscopy fails to reach, due to the length of the entire small bowel.
Over time, newer capsule endoscopes were developed to study the oesophagus and large intestine for cases when routine endoscopy cannot be carried out. This system powers itself and takes pictures at variable rates and wirelessly transmits the signals back to the data collector.
The doctor will then retrieve the many thousands of pictures taken and run through them quickly like a movie clip to detect any pathology in the digestive tract.
Hi Jun Kai,
For routine upper and lower digestive endoscopy, the recovery period is fast and estimated to be completed within 1 to 2 hours. One may experience some light headedness and unsteady gait for a short period of time, until the sedatives wear off.
Depending on what is done, there may be a sensation of gas in the abdomen and a mild throat discomfort, especially after a gastroscopy.
Endoscopy is only recommended when there is reason to do so. The reason for endoscopy may be related to personal past history (e.g. colonic polyps), family history (e.g. history of digestive cancer within the family), abnormal scan or blood results found incidentally or when one reaches a certain age which qualifies him or her to have a cancer screening colonoscopy done (e.g. > 50 yrs).
All the above reasons are not related to the presence of any symptom and they are by no means exhaustive.
The cost of an endoscopy in Singapore can range anywhere from $500 to $11,000. It varies a great deal depending on the type of procedure you plan to do. In general, there are a few components which will affect the final bill size for endoscopy.
The common components are:
- Doctor’s professional fee
- Hospital facility fee, sedation fee (if applicable)
- Fee for tissue samples taken for examination and related accessories (if applicable)
- Miscellaneous fees for other items used in relation to the procedure, e.g. gauze
I am sorry to hear that. Failure in completing any endoscopic procedure may be due to unavoidable reasons such as anatomical changes after a surgery, narrowing of the intestinal lumen due to scarring or tumour growth, or other medical reasons when patient’s health may be at risk during the procedure.
Rarely, patients with especially sensitive intestines may not be able to tolerate the discomfort or bloating and the procedure may have to be postponed to another day with an anaesthetist to provide support for deeper sedation.
The most common investigation to detect the presence of gallstones is an ultrasound scan of the abdomen. Your doctor may also recommend some blood tests to look for problems related to the stones.
At times, a CT scan may be proposed to you if your doctor is also looking out for possible tumour growths in your abdomen.
When there is a suspicion of a gallstone being migrated into the bile duct, a special MRI scan known as MRCP may be required to study the bile ducts specifically.
In general, gallstones do not disappear easily without any treatment. In fact, once gallstones developed, they tend to increase in size and numbers over the years.
The good news is that most patients with gallstones remained well without symptoms and the current recommendation for these cases is to maintain vigilance.
In approximately 10 to 15% chance, people with gallstones develop abdominal discomfort or pain. If there is no other plausible explanation for the pain, surgical removal of the gallstones and the gallbladder is the recommended treatment.
For symptomatic gallbladder stones, the right approach is surgical removal of the gallbladder together with the stones. This method is time proven and offers the best long term outcome, provided the patient is both fit and also keen for surgery.
Unfortunately, there is no effective, alternate method of removing gallstones at the moment. In selected cases with only a few small gallstones, medical treatment to dissolve the stone may be possible. This treatment requires oral medication for a long time and the result is not guaranteed, making it less attractive to both doctors and patients.
The primary function of the gallbladder is to temporarily store and, at the same time, concentrate the bile juice within. Unknown to many, bile juice is secreted by the liver and not the gallbladder. After leaving the liver, the bile juice enters and leaves the gallbladder through the cystic duct which connects the liver ducts to the gallbladder.
We now understand that the gallbladder functions very similarly to a store room for spare bile. As such, removing the gallbladder will not have a great impact on one’s health and certainly should not cause a drastic deterioration.
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