She has been fortunate to be among the earliest batches of surgeons in Singapore trained by the pioneers in laparoscopic surgery as well as cross-trained in endoscopy. She developed her subspeciality interest in breast conservation surgery when she was undergoing surgery training. She runs her own solo private practice at Gleneagles Medical Centre, Singapore.
GetDoc: What is endoscopy?
Dr Bertha: It includes Oesophagogastroduodenoscopy (OGD) and Colonoscopy. It is a direct, real-time visualisation of the inner lining of the gastrointestinal tract via a fibreoptic scope roughly the thickness of a finger. An OGD visualizes the oesophagus, stomach and up to the second part of the duodenum, including the ampulla of Vater. A colonoscopy typically visualizes the anus, rectum, sigmoid colon, and the rest of the colon up to the caecum and ileocaecal valve.
GetDoc: Where is endoscopy done?
Dr Bertha: It is usually a day procedure done at the Endoscopy Centre. The patient needs to register about 30 minutes before the procedure start time. Post-procedure, the patient will be reviewed in the clinic.
GetDoc: What should a patient do to prepare?
Dr Bertha: For OGD, fasting for 6 hours is required. For colonoscopy, bowel preparation is required. The fastest possible is in 4 hours’ time. However, it is more comfortable if the bowel preparation is done the day before.
GetDoc: Will it be painful?
Dr Bertha: Endoscopy is usually done under intravenous sedation and monitoring by an anaesthetist. You should not feel any pain. You may have a feeling of gas after the procedure which normally lasts a day.
GetDoc: Who needs it?
Dr Bertha: People with symptoms related to the digestive system, such as indigestion, regurgitation, bloating, belching, gastric pain, changes in bowel habits, passing of blood in the motion, or having dark and sticky motion (melaena).
GetDoc: Who may need a colonoscopy?
Dr Bertha: There are 3 groups of people that may need to undergo a colonoscopic surgery.
1) People who have symptoms that may be linked to colorectal cancer e.g. bleeding per rectum (i.e. when passing motion), recent increasing constipation with or without alternating diarrhea, change in bowel habits, change in the caliber of the stools, abdominal bloating or distension
2) People who have a family history of colorectal cancer
3) People who are 50 years or older (screening)
GetDoc: What are the risks?
Dr Bertha: Endoscopy is generally safe. There is a 0.5% risk of perforation of the colon, but this is unlikely in experienced hands. Where there are obvious non-navigable kinks or obstructions, endoscopy is usually halted for patient safety reasons, and we may need to proceed with CT scans or other further investigations.
GetDoc: Can any complications occur due to the procedure?
Dr Bertha: For OGD, rarely, some patients have strong gag response that can lead to a bit of trauma to the oropharyngeal mucosa. This can result in sore throat post-procedure and a bit of blood streaks in the saliva. Risk of perforation is possible but extremely unlikely in experienced hands. The risk is higher if a tumour is found that has already spread through the wall of the stomach or duodenum. Also, risk of perforation is higher if a therapeutic procedure needs to be done in cases such as bleeding ulcers.
For Colonoscopy, perforation is highly unlikely in experienced hands. As mentioned above, if therapeutic procedures need to be done such as polypectomy or biopsy, there is a slightly elevated risk of perforation but it is also highly unlikely in experienced hands.
In the event of a perforation, the endoscopist will inform the patient that we have to convert to laparotomy/ laparoscopy ( open the abdomen, or at least put a scope into the peritoneal cavity) to repair the perforation.
GetDoc: Are there any negative side-effects of the endoscopy procedure?
Dr Bertha: For OGD, post-procedure, some people complain of burping from the gas insufflation during the procedure. Normally, the gas is aspirated before the scope is removed from patient and this would not be an issue.
For Colonoscopy, post-procedure, some people complain of bloatedness and gas. Usually this is not a problem. Patient would pass gas naturally for a day or so after the procedure.
GetDoc: Are there any specific post-operative instructions that must be followed by the patient?
Dr Bertha: I normally review the patient post-endoscopy before sending them home. Any issues would be identified then.
GetDoc: Is the procedure Medisave claimable?
Thank you very much Dr Bertha, that was very enlightening. We hope our readers have their questions on endoscopy answered to their heart's content.
To make an appointment with Dr Bertha Woon, click here
by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.