Introduction

Viewing the body cavities with tubes is called endoscopy, whether esophagogastroduodenoscopy (gastroscopy or upper intestinal endoscopy) or colonoscopy (endoscopy of the large intestine). Recently, the term endoscopy has been used to refer to upper intestinal endoscopy and not colonoscopy. Although originally considered complementary to a barium x-ray, endoscopy is now often used as the primary tool for evaluating the gastrointestinal (GI) tract. Conventional x-rays cannot identify color changes (eg, in gastritis), bleeding, or vascular malformations. GI endoscopy is particularly valuable in elderly patients because their symptoms may be atypical.

Indications

Endoscopy can be used diagnostically (eg, to visually define and biopsy abnormalities) and therapeutically (eg, to remove stones from the bile duct and to place a stent through a bile duct compressed by a malignant tumor, which may avoid the need for surgery). Endoscopy performed early for GI bleeding may help the physician determine if early surgery is necessary.

Procedure

Before endoscopy, food and drink may have to be avoided to allow the stomach to empty, or a purgative may be needed to cleanse the colon. Because transient bacteremia infrequently occurs during endoscopy, patients at high risk of infection--those with valvular heart disease (eg, rheumatic heart disease, valvular prosthesis), neutropenia, or a surgical shunt for renal dialysis--should receive antibiotics (usually ampicillin or gentamicin) before the procedure.

Most endoscopies are performed while the patient is sedated. Usually, benzodiazepines are given for sedation; doses may need to be reduced by 50 to 75% for elderly patients. During the procedure, the physician or assistant should monitor skin color, pulse, and respirations often. Continuous monitoring of oxygen saturation levels with a pulse oximeter may benefit the elderly patient.

Complications

The elderly usually tolerate endoscopy well, but complications are more common than in younger patients. Not only are older tissues more fragile and more easily traumatized, but elderly patients generally have other medical conditions (eg, heart failure) that may be exacerbated by the preparation or the procedure. Elderly persons may also find aggressive cleansing protocols difficult to tolerate. The current trend is to perform elective examinations on an outpatient basis rather than to admit patients to the hospital. When cathartics are prescribed to cleanse the colon, the patient's hydration needs to be maintained.