Endoscopy is a widely used diagnostic technique that allows doctors to view the inside of your digestive tract without the need for surgery. It plays a major role in detecting gastrointestinal conditions early and accurately. Your doctor may recommend an upper, lower, or capsule endoscopy depending on your symptoms and medical history. While all three are considered safe and effective, each involves a different method, preparation process, and diagnostic purpose. Understanding the main types of endoscopy helps you prepare for the procedure and make informed choices about your health.
What is included in an upper endoscopy?
- Examines the upper digestive tract: Upper endoscopy, also known as gastroscopy, is used to inspect the oesophagus, stomach, and duodenum. These are the upper sections of your digestive system. It’s often used to investigate persistent indigestion or difficulty swallowing.
- Uses a flexible camera inserted through the mouth: A thin, flexible tube with a light and a camera is gently passed through your mouth and throat while you are sedated. The camera transmits real-time images to a monitor, allowing the doctor to examine the lining of your upper digestive tract.
- Helps diagnose common digestive conditions: This endoscopic procedure helps diagnose a wide range of upper GI conditions, including ulcers, inflammation, coeliac disease, and growths that may require biopsy. It can also help evaluate causes of bleeding or chronic reflux symptoms.
- Requires fasting before the test: Patients are generally required to avoid eating or drinking for six to eight hours before the endoscopic procedure. This ensures the stomach is empty, which helps improve visibility and reduces the risk of aspiration during the procedure.
What is a lower endoscopy?
Focuses on the colon and rectum
Of the types of endoscopy, this is one used to examine the lower part of the digestive system, specifically the colon and rectum. It includes procedures like colonoscopy and sigmoidoscopy, which are commonly used for bowel screening.
Involves insertion through the rectum
A flexible camera tube is inserted through the rectum to view the inside of the large bowel. This allows doctors to check for inflammation, bleeding, polyps, or signs of colorectal cancer. Sedation is often used to reduce discomfort.
Used for screening and investigation
Lower endoscopy is the gold standard for colorectal cancer screening and is also used to investigate symptoms like blood in the stool, chronic diarrhoea, or unexplained weight loss. It’s highly accurate in detecting abnormalities.
Requires thorough bowel preparation
You’ll be asked to follow a specific bowel cleansing routine, which may involve a liquid diet and strong laxatives the day before the procedure. Having a clean bowel ensures clear visibility for the doctor and improves test accuracy.
What is capsule endoscopy?
- Uses a swallowable camera pill: Capsule endoscopy involves swallowing a small, pill-sized camera that travels through your digestive system. It captures thousands of images as it passes, offering a full internal view without the need for tubes or sedation.
- Provides imaging of hard-to-reach areas: Unlike traditional scopes, capsule endoscopy can access the entire small intestine. This area is difficult to examine with upper or lower endoscopy, making the capsule option ideal for finding hidden causes of bleeding or more.
- Sends images to an external recorder: The capsule transmits images wirelessly to a recording device you wear around your waist. These images are later reviewed by a gastrointestinal specialist to detect signs of disease, damage, or abnormalities in the small bowel.
- Involves preparation and patient safety checks: You’ll be asked to fast beforehand and may need to avoid certain medications. In some cases, a patency capsule is used first to check for blockages. While rare, the capsule can become stuck in patients with narrowed bowel sections.
How do these procedures compare?
Entry method varies by procedure type
Upper endoscopy is performed through the patient’s mouth, lower endoscopy through the rectum, and capsule endoscopy is simply swallowed. Each method is tailored to examine specific parts of the digestive system.
The exam area determines the test choice
Upper endoscopy looks at the oesophagus and stomach. Lower endoscopy inspects the colon and rectum. Capsule endoscopy offers a view of the entire small intestine, making it suitable when other tests are inconclusive.
Sedation is used in some procedures
Upper and lower endoscopies typically involve light sedation to ensure the patient’s comfort. Capsule endoscopy does not require sedation, as the process is passive and non-invasive once the capsule is swallowed.
Recovery time and activity level differ
Recovery after different types of endoscopy is usually brief, though you may need rest while sedation wears off. Capsule endoscopy allows most people to return to their normal daily activities immediately afterwards.
Which types of endoscopy might be right for you?
Your symptoms guide the test recommendation
Gastrointestinal specialists consider your symptoms carefully before choosing the most suitable test. For instance, difficulty swallowing may lead to upper endoscopy, while blood in the stool may require a lower endoscopy.
The purpose of the test matters
Endoscopy is used for both diagnosis and screening. If the goal is to screen for cancer, a colonoscopy may be used. If it’s to identify the cause of ongoing stomach pain, gastroscopy or capsule endoscopy might be better suited.
Clinical judgement supports the decision
Your gastrointestinal specialist will take your medical history, current symptoms, and any past test results into account when deciding which type of endoscopy to recommend. In some cases, more than one test may be needed.
Preparation and follow-up are essential
Regardless of the types of endoscopy, careful preparation is important to get accurate results. After the procedure, your doctor will explain any findings and what the next steps might be for treatment or further investigation.
FAQs
Yes, endoscopy can help identify infections by allowing tissue samples to be taken during the procedure for laboratory testing.
Most patients can resume a light diet shortly after the procedure, but specific dietary advice will depend on what was done and whether any biopsies were taken.
For upper or lower endoscopy involving sedation, it’s recommended to take the day off. Capsule endoscopy typically does not interfere with your ability to work.
After the capsule passes through your system, the recorded images are downloaded and reviewed by a trained specialist who prepares a report for your referring doctor.
Feeling unsure about which type of endoscopy is right for you?
If you’re unsure which type of endoscopy you might need, you’re not alone. It’s normal to have questions, especially when facing unfamiliar symptoms or new procedures. The best place to start is by speaking with your doctor.
Whether it’s an upper, lower, or capsule endoscopy, each test is designed to examine specific areas of your digestive system. Understanding the purpose behind the recommendation can help ease uncertainty and guide your next steps.
Getting an endoscopic investigation is an important part of diagnosing digestive issues early. With the right information and support, you can feel more prepared and confident about your care.
MEET DR. SUHIRDAN
Interventional Gastroenterologist and Hepatologist
Bsc (Med) | M.B.B.S. (Hons) | FRACP
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