There are a variety of symptoms in a patient that might signal that an endoscopy is required. In this case, it was bleeding from the gastro – intestinal tract. This can manifest as black colored bowel movements, in the absence of any medications like Iron tablets, or Peptobismol. Sometimes it can manifest as unexplained anemia (low hemoglobin) and part of the work up of this condition is to look for a source of silent blood loss from the stomach or intestine.
During the endoscopy, we are carefully scanning for signs of bleeding. The endoscopy would show the source of bleeding, in this case varices (enlarged and tortuous veins) in the esophagus and stomach. It can also show signs of recent bleeding from the surface of the dilated and tortuous veins, and this makes the diagnosis of anemia and the source of actual blood loss more certain.
To view a video clip illustrating an example of a diagnostic and therapeutic endoscopy, click here.
At the start of the video you see the scope being introduced. It goes over the tongue (as indicated by bubbly saliva) and into the esophagus opening (which is on the top left of the screen, resembling the dark entrance of a cave).
At about 4.4 seconds, a blue varix (a partial dilated, engorged vein located just under the mucosa lining the esophagus), comes into view on the bottom of the frame. Great care is taken to ensure that they do not rupture since they could bleed and cause torrential hemorrhage.
At 7 seconds you see the tip of the endoscope enter the stomach. The intensity of the light seems to decrease since the stomach is not a narrow tube, but a large cave.
At 18 seconds the opening of the pylorus becomes visible. This is a ring like sphincter that guards the entrance to the duodenum, the first part of the small bowel.
At 22.5 seconds the scope has entered the duodenum, which has the appearance of the folds of mucosa which are arranged more transversely.
The rest of the study is during the withdrawal of the scope.
At 37 seconds the scope is back in the stomach and is now being retroflexed to look from below, upwards at the junction of the esophagus and the stomach. The black tube is the scope itself. The opening through which it emerges into the stomach is the ‘esophagi-gastric junction’.
The reason this area is carefully examined is because sometimes the varices in the esophagus extend down into the stomach. If they bleed into the stomach the large reservoir capacity of the stomach can accommodate a liter or more of blood before the patient feels any discomfort. The stomach may soon collapse if the patient’s heart cant stand the rush/speed of blood loss.
The endoscopist twirls the scope as he looks at this area carefully from all sides.
At 1.04 minutes into the video the scope is withdrawn into the esophagus.
The view of structures in the esophagus is often better on the way out.
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