It is certainly not a cakewalk. But this exploration saves lives.
“There is nothing worse for a gastroenterologist than to tell a healthy 60-year-old that he has advanced colon cancer. It is the second deadliest cancer. Early treatment saves 9 times out of 10, but only 30% of French people get tested!” When he brings up the subject, Dr. Jérémie Jacques, head of the endoscopy unit at the University Hospital of Limoges, does not take off. Admittedly, digestive endoscopy is no picnic. But it has reduced the incidence of colorectal cancer and its mortality. And it could do much better if screening participation increased significantly.
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In practice, we talk about gastroscopy for the upper parts of the digestive tract and colonoscopy for the colon. For doctors, this digestive endoscopy is available in diagnostic or interventional endoscopy. The first, which is by far the oldest, can be motivated by clinical signs or by screening due to risk factors (age, personal or family history). In addition to the physical examination which consists in introducing the long flexible tube that is the endoscope into the rectum, we have had videocapsules for about ten years, that is to say devices the size of a tablet which, once swallowed, can take images of the digestive tract and transmit them to an external recording system worn over the shoulder: for the time being reserved for the exploration of the small intestine, they are in the process of being evaluation for examination of the esophagus and colon.
Short and light anesthesia
The second option, called interventional, has been developing for thirty years. Thanks to a whole series of instruments associated with the endoscope, the gastroenterologist can cut polyps, destroy tumors, repair surgical perforations, etc. Its field of intervention is constantly expanding: today we can enter the intestinal wall or cross it to suck up necrotic areas, but also intervene on the pancreas and the bile ducts, remove stones, etc. And many small operations are performed on an outpatient basis, under short and light anesthesia. If the patient can bear it, it is even possible to dispense with sedation for quick examinations that only last a few minutes – in the rectum and the lower part of the colon, for example.
In any case, a minimum of preparation is nevertheless necessary. Whether examining and/or operating on the esophagus or the colon, the patient must be strictly fasting (without drinking, eating or smoking) for at least six hours. And before undergoing a colonoscopy, it is imperative to rid the intestines of their contents, emptying which is carried out by the prior absorption of a purge of 2 to 4 liters depending on the product. Finally, a medical or surgical history or the taking of certain medications may justify hospitalization to avoid and monitor the occurrence of exceptional complications (perforation of the walls of the digestive tract, haemorrhage, etc.).
But Dr. Jacques is keen to point this out: “France has a level of expertise in this area recognized worldwide, and today, in our country, no one should be operated on other than by endoscopy for benign polyps of the digestive tract, whatever their size. .”