THE gastroscopy, also known as an upper gastrointestinal endoscopy, involves checking the esophagus, stomach, and duodenum, which are parts of the original small intestine. This procedure is carried out with the patient under complete sedation, ensuring that he is not disturbed throughout the examination and is effectively controlled by the doctor.

THE colonoscopy, also known as a lower gastrointestinal endoscopy, involves checking the colon and terminal ileum, parts of the final part of the small intestine. And this procedure is performed with the patient under full sedation, for the same reasons of non-discomfort and efficiency that have provided significant benefits to both patients and doctors.

Why should a patient proceed with an endoscopy?

Endoscopies are performed either for diagnostics either for therapeutic purposes. A therapeutic endoscopy is defined as one performed with the purpose of intervention to treat an underlying condition such as a gastric bleed or the removal of a colon polyp.

“The main goal of diagnostic endoscopies is the early detection of lesions, the identification of possible malignant tumors, but also the diagnosis of benign diseases that may, however, cause serious problems in the near or distant future.

A typical example is gastric or duodenal ulcers, which can be benign conditions, but can cause life-threatening bleeding. Then with endoscopic intervention, the bleeding will stop as quickly as possible, causing the least possible problems for the patient.
In addition, an important goal, especially of colonoscopy, is the detection of polyps in the large intestine, which can be precursors of cancer,” says Mr. Konstantinos Delis Director Gastroenterologist at Metropolitan Hospital & Doctor of the School of Medicine of the National and Kapodistrian University of Athens (EKPA).

Are there any risks during an endoscopy?

The main risks associated with endoscopies are bleeding and extremely rarely perforation. THE bleeding it can rarely appear during biopsy or mainly in invasive procedures such as the removal of a polyp both during the operation or delayed, up to 14 days after, but mainly in the first twenty-four hours. In the vast majority of cases this is successfully treated with appropriate endoscopic techniques.

THE perforation is an extremely even rarer complication of endoscopy. It can be caused during a diagnostic endoscopy but mainly during a painful and difficult interventional procedure. It can be treated endoscopically, however there is a good chance that surgery will be required to repair it.

What should I know about polyps and colon cancer?

“Even today, colon cancer remains a common condition, being the third most common cancer in both men and women. Once the diagnosis is made, there is a series of tests, such as blood and imaging tests, and then treatment, which usually includes surgery and possibly chemotherapy.

However, the aim of modern medicine is to avoid these procedures which are painful and bring psychological stress to the patient. Current knowledge shows that before cancer develops, it is preceded by the development of polyps. It usually takes several years for a polyp to develop into cancer. Thanks to the colonoscopy, we have the possibility to intervene before the disease progresses, through early diagnosis and removal of the polyp (polypectomy) at a very early stage, thus ensuring the avoidance of a future surgery.

It should be noted that there are different types of polyps. Some are completely harmless and do not turn into malignancy (eg, hyperplastic polyps), while others have the potential to develop into malignancy (adenomatous polyps). At present, it is not possible to predict with certainty which polyp (of those with the potential to develop into malignancy) will eventually develop into malignancy, and for this reason all those found during endoscopy are removed for the purpose of patient prophylaxis.

After the removal of each polyp, a histological examination is performed and, depending on the result, the recheck interval is determined. A review is usually required after three years. Overall, colonoscopy is currently the best available means for the prevention, early diagnosis, and treatment of colon cancer,” the expert points out.

When should I have my first colonoscopy?

“All of us, regardless of the appearance of symptoms,” he emphasizes, “should undergo the first colonoscopy at the age of 50, while recently there are recommendations for the age of 45. However there are exceptions. Such an exception e.g. are the first-degree descending relatives of patients with colon cancer, who must be first presented 10 years earlier than the age at which the first relative developed the malignancy. In any case, however, the person responsible for the most appropriate recommendation is the attending gastroenterologist.”

What is third space introspection?

“His introspection third space is a pioneering and innovative development in the therapeutic endoscopy of the digestive tract mainly in the esophagus and stomach but also the large intestine. These subtle third space procedures belong to the category of advanced endoscopy and are considered minimally invasive.

Traditional endoscopic treatments of the digestive tract, such as polyp removal, are usually performed through endoscopes (gastroscopes and colonoscopes) within the lumen of the gastrointestinal tract, which is considered the first place. In contrast, the second space it is the one inside the abdomen that extends outside the wall of the gastrointestinal tract and is usually the area for surgical interventions, both classical and laparoscopic.

In recent years, a new field has emerged, the third space, which refers to an artificially created tunnel (tunnel) in the wall of the organs of the gastrointestinal tract. This new category of procedures, known as third space procedures, is performed right inside the wall of the organs of the digestive tract, such as the esophagus, stomach or small intestine. Third space introspection is also known as submucosal endoscopyas it is carried out under the mucous membrane, i.e. the internal lining of these organs” clarifies Mr. Darlis and concludes by explaining the operations that belong to the third space.

“The interventions of the third space include:

• the POEM to tackle achalasia of the esophagus

• the Z-POEM for the treatment of Zenker’s diverticulum of the esophagus
• the STER for the removal of submucosal tumors, i.e. those located on the wall of the esophagus or stomach, etc.”

*The Metropolitan Hospital has a model Gastroenterology Clinic, which is fully equipped and organized to a high standard. With its highly qualified scientific and nursing staff and its state-of-the-art equipment, the Gastroenterology Clinic is always available for patients, offering assistance in any case requiring medical care, 24 hours a day. At the Clinic, diagnostic and, if necessary, therapeutic endoscopic procedures are carried out, such as gastroscopy, colonoscopy, ERCP, small bowel inspection with an endoscopic capsule, endoscopic ultrasound, percutaneous endoscopic gastrostomy, intragastric obesity balloon and of course the modern operations of the third space.