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GASTROSCOPY &
COLONOSCOPY
What is a Gastroscopy?
Gastroscopy is a very safe outpatient procedure and takes less than 10 minutes. It is a simple test in which a thin, flexible fibreoptic telescope is inserted through the mouth and into the stomach for a complete visualization of the cause of your symptoms. No preparation is required other than fasting for 6 hours. You will be given a local anaesthetic spray to numb the throat and an intravenous sedation.
Gastric (stomach) cancer can often remain asymptomatic for a long time, especially in the early stages. As such, it usually presents late. The usual symptoms are vague upper abdominal pain or discomfort. It can also cause early satiety (fullness after a small meal), vomiting, loss of weight, loss of appetite, fatigue, or anaemia (low blood count due to bleeding).
Occasionally, it may present as an emergency with severe pain from perforation, or bleeding (vomiting of blood or passage of black stools due to altered blood).
Stomach/ gastric cancer (GC) is the 4th most common cancer related death in male, and the 5th most common cancer related death in female, in Singapore. In addition, 75% of all the GC in the world occurs in Asia. The number of new GC cases remains high and are still rising in Asia because of the increase in aging population. At the time of diagnosis, most GC (up to 45%) are diagnosed at stage 4 (which means the cancer has spread from where it started to another organ). Hence, the key to survival is early diagnosis.
Indication for Gastroscopy
- Difficulty swallowing/ dysphagia or painful swallowing/ odynophagia
- Persistent dyspepsia/ acid reflux not controlled after 2 weeks of treatment/ antacids/ PPI
- Unexplained weight loss/ upper abdominal mass/ pain
- Persistent vomiting
- Iron deficiency anaemia
- Patients aged ≥40 years with unexplained & persistent recent-onset dyspepsia
- Abnormal findings on barium studies, CT or US scanning
Other Indications
- Patients with haematemesis (vomiting blood) and/or melaena (passing black stool)
- To confirm healing of oesophageal or gastric ulcer
- Surveillance of high risks/premalignant conditions eg gastric intestinal metaplasia/ dysplasia, Barrett’s oesophagus/ dysplasia – these may need endoscopic treatment.
- Small bowel biopsies to investigate malabsorption
- Screening in patients with a family history of oesophageal/ gastric cancer
- Surveillance or screening in patients with FAP because of the risk of duodenal polyps
- Surveillance for oesophago-gastric varices in patients with suspicion of portal hypertension/ liver disease/ cirrhosis on liver biopsy or varices on imaging)
- Elevated tumour marker
If you have recent onset of “gastric pain” or any of the symptom mentioned above, and you have not been investigated before, a gastroscopy is recommended.
What is a Colonoscopy?
Colonoscopy is a procedure where the inside of the colon is examined by passing a flexible fibreoptic camera tube through the length of the colon via the anus. The procedure is usually performed under sedation – so you will be comfortable and pain free. If a growth/ polyp in the colon is detected, your doctor will remove the growth completely if possible and send it for further testing to rule out cancer. Colonoscopy has been shown to be very safe and is the best way to rule out and screen for colorectal cancer.
Indication for Colonoscopy
Symptoms suggestive of colorectal cancer (CRC):
- ≥40 years old with rectal bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting for 6 weeks or more
- Patients at any age with altered blood or blood mixed in stool
- ≥60 years old with rectal bleeding persisting for 6 weeks or more without a change in bowel habit and without anal symptoms
- ≥60 years old with a change in bowel habit to looser stools and/or more frequent stools persisting for 6 weeks or more without rectal bleeding
- Men of any age with unexplained iron deficiency anaemia
- Non-menstruating women with unexplained iron deficiency anaemia