The word “endoscopy” is derived by combining 2 Greek words: “endo” and “skopein”. “Endo” means “within” and the verb “skopein” means “to view or observe”. Putting them together gives the meaning of “to observe inside.”
Endoscopy is a therefore a procedure where the doctor uses a special instrument called the endoscope to examine the insides of the body. Endoscopy was originally used for hollow organs of our digestive system (including the oesophagus, stomach and colon), our urinary system, and our airways. As technology advances, special endoscopes have been created that allow doctors to perform endoscopy in areas where there are spaces like joints (arthroscopy) and the abdominal cavity (laparoscopy).
An endoscope is a medical device consisting of a long, thin, flexible (or rigid) tube. Within the tube, there are fibre-optics which allow light projection, as well as a video camera. These then allow the endoscope to illuminate the insides of our body and to capture a “live” video of the organ being examined. The images are projected onto a screen. Most endoscopes today have high-definition (HD) images, which give the doctor an extremely clear image of the patient’s body.
Endoscopy helps the doctor diagnose diseases. The clear images provided by the endoscope allow the doctor to see the disease. If the doctor sees an abnormality, like a tumour, he can take biopsies through the endoscope so as to know the nature of the tumour, whether it is cancerous or not.
Endoscopy also has therapeutic capability – it allows the doctor to perform treatment using the endoscope. This is because modern day endoscopes have working channels, allowing the doctor to pass special instruments like forceps, special scissors, laser fibres, etc. Doctors can inject drugs, remove foreign bodies, stop bleeding, and even cut out tumours with such instruments.
Think of “endoscopy” as an umbrella term. It is like the word “fruit”. There are many types of fruits, including apple, orange, pear, etc
Similarly, there are many types of endoscopy. One of which is gastroscopy, which is endoscopy of the esophagus, stomach and duodenum.
There are many different types of endoscopy, and these are named based on the organs that the endoscope is used to examine. Some of the common types include:
No. In fact you may not even be aware of the procedure as you will be sedated for gastroscopy and colonoscopy. Even if you can feel something, it would not be painful. Often, the person cannot remember the experience.
Sedation is not the same as General Anaesthesia. For sedation, the drugs we use are short-acting with almost no after-effects such as nausea.
Very often, the sedation medication is administered by the specialist performing the endoscopy. However, if the patient has various medical issues, an anaesthetist may be engaged to administer the sedation for patient’s safety.
No. This is because endoscopy per se is a very safe procedure. It is one of the most commonly performed procedures. Most endoscopies can be performed as a day-surgery procedure, meaning that the patient need not be admitted for an overnight stay.
Furthermore, endoscopy can only be performed by specialists who have gone through a rigorous training programme.
Well-established guidelines have been formulated to identify patients who may have certain risks factors, and for such patients, we will engage an anaesthetist to administer the sedation.
You will be asleep until the endoscopy is completed. As the sedation medication we use are quite short-acting, you will wake up quite quickly after we complete the endoscopy.
This is typically about 10 to 15 minutes for gastroscopy, and about 30 to 45 mins for colonoscopy.
This will depend on the type of endoscopy that is performed:
Other than cancerous growths, endoscopy can also detect benign growths, such as polyps. In addition to detection of polyps, the specialist can also use the endoscope to remove such polyps and send them for tests (pathology examination).
Apart from growths, what does an endoscopy test for?
Many diseases can be diagnosed using through endoscopy. Some examples include infection and inflammation. This is usually combined with biopsies, in order to get an accurate diagnosis. Doctors can also use the endoscopy to diagnose sources of bleeding into the intestine, and even perform some procedures to stop the bleeding.
Endoscopy can only be performed by specially trained doctors called endoscopists. These doctors have to go through a rigorous training programme before they are given the license (also called accreditation) by the hospital to perform endoscopy.
Only General Surgeons and Gastroenterologists can perform endoscopy of the digestive tract, namely gastroscopy, colonoscopy and sigmoidoscopy.
At Nexus Surgical, Dr Jane Tan, Dr Ho Choon Kiat, Dr Lim Khong Hee, Dr Lee Chee Wei and Dr Chan Chung Yip are trained and accredited endoscopists. They each have performed more than 1000 gastroscopies and 1000 colonoscopies in their career. Dr Ho Choon Kiat also served as the Director of Endoscopy Centre of Tan Tock Seng Hospital as well as Director of the Endoscopy Centre of Mount Elizabeth Novena Hospital previously.
Dr Lee Yee Mun is a Urologist who is accredited to perform cystoscopy.
All of them are also accepted into the Medisave / MediShield accreditation scheme. This is a scheme by the Ministry of Health Singapore, which allows patients treated by approved doctors to claim from their Central Provident Fund for payment of the endoscopy. The Ministry only allows trained endoscopists to join this scheme.
The cost of endoscopy has 2 components:
For the doctor’s fees, the Ministry of Health of Singapore has published a Fee Benchmark to guide doctors, patients and payers like insurance companies.
|Procedure||Doctor’s Fees (S$)||Anaesthetist’s Fees* (S$)|
|Therapeutic Gastroscopy (when additional treatment was given such as the removal of polyp)||1000-1600||500-750|
|Therapeutic Colonoscopy (when additional treatment was given such as the removal of polyp)||1500-2150||500-750|
*Anaesthetist’s fees are charged only if an anaesthetist is engaged to give the sedation. Sometimes this is necessary for patient’s safety.
The doctor’s fees are also affected by the insurance the patient is using to pay for the procedures. Each insurance company has its own schedule of fees for its panel of specialists. The specialists at Nexus Surgical belong to most of the insurance panels in Singapore. For the full list, please click here.
As for Facility Fee, generally it is more expensive to have the endoscopy performed in a hospital compared to having it in a Day Surgery centre.
The total bill for the procedure is then obtained by adding the Doctor’s fee to the Facility fee. Medisave may be used to pay part of the bill, subjected to the Medisave cap.
Average total bill size for endoscopy in the private sector in Singapore.
|Procedure||Cost (before GST) (S$)||Medisave claimable (S$)|
|Gastroscopy||2139||Up to 650|
|Colonoscopy||2590||Up to 1250|
The above cost estimates are for basic endoscopy only. If additional treatment is given, such as the removal of polyps, the cost will be higher.
You can visit the Ministry of Health’s website for more details:
Firstly, sedative drugs will be administered to you during the endoscopy so that you will be comfortable, relaxed and pain-free. This is not the same as General Anaesthesia.
Most of the time, the sedation is administered by the specialist who is performing the endoscopy.
However, there are some patients for whom it will be safer to engage an anaesthetist. Some of the common medical reasons for engaging an anaesthetist are:
Endoscopy allows the doctor to view the insides of a patient in real-time and with high-definition colour images. This allows the detection of even very small polyps <5mm. Furthermore, endoscopy allows the doctor to perform treatment like removing polyps.
CT scan produces images in different shades of grey. Very small polyps may be missed. Even if a polyp is detected, the CT scan cannot remove the polyp. Therefore from a diagnostic and therapeutic point of view, the endoscopy is better.
However, the endoscopy does carry some risks, though very small. Such risks include injury to the intestine (perforation). CT scan does not carry such risks. Therefore, for certain patients, a CT scan may be safer.
As the patient will be sedated during the endoscopy, we usually tell our patients to fast from food for about 6 hours before their endoscopy.
However, with regards to plain water, sips of water are permissible, especially if the patient has to take his or her usual daily medications, like medication for high blood pressure, etc. However, if possible, the last drink of water should be 2 hours before the endoscopy.
They should refrain from milk feeds at least 4 hours before the endoscopy.
First and foremost, be relaxed. Endoscopy is a very safe procedure and you will be sedated during the procedure, and therefore you will be comfortable.
As for the specific preparations, it all depends on what type of endoscopy you are going for and what time is the Endoscopy.
If you are going for Gastroscopy, which is Endoscopy of the Oesophagus, stomach and duodenum, you need to fast from food at least 6 hours before the procedure. However you can still drink plain water till about 2 hours before the procedure.
If you are going for Colonoscopy, which is Endoscopy of the colon and rectum, in addition to the fasting instructions which is similar to Gastroscopy, you will have to take some bowel cleansing medications to clear your colon of faeces. This is very important. It allows the doctor to have a clear examination of your colon
The type of anaesthesia is called Moderate Sedation. Moderate sedation can effectively reduce the patient’s anxiety and discomfort, and gives the doctor an ideal environment for a detailed examination. The patient will usually sleep throughout the procedure.
Under moderate sedation, the patient still breathes on his own. The patient is also rousable, and therefore can be awakened quite quickly at the end of the procedure.
This is different from General Anaesthesia. When under general anaesthesia, the patient will need assistance to maintain his airway and support his breathing. They are also not rousable, even with painful stimuli. They will take some time to regain full consciousness following the end of the general anaesthesia.
Between 3 to 5 workings days.
There is almost no down time after the Endoscopy.
Whether you are going for a Gastroscopy or a Colonoscopy, you will feel quite well when you wake up from the moderate sedation. However, because you have received sedation, you are advised against driving or operating heavy machinery for the rest of the day. You are also advised against making critical decisions or signing important documents for the rest of the day.
However you can eat as per normal.
Therefore, we usually only issue a 1-day Hospitalization Leave for the patient.
Endoscopy (whether Gastroscopy or Colonoscopy) is recommended whenever the patient complained of symptoms, and we need the Endoscopy to look for the underlying reasons. As long as there is a medical reason, we will offer it, regardless of the patient’s age.
However, if we are talking about screening – looking for a disease in the absence of symptoms and based on the patient’s risk profile – there is some age recommendation.
Screening Colonoscopy to look for colon cancer is recommended for everyone, both male and female, starting at age of 50. If there is a family history of colon cancer, then the screening Colonoscopy should begin at 10 years prior to the youngest case in the family, or age 40 years, whichever earlier.
How about screening Gastroscopy? As the cases of stomach cancer in Singapore is very low, the Health Promotion Board does not recommend screening Gastroscopy. However, because of the high incidence of stomach cancer in Japanese and Koreans, these people are encouraged to go for Gastroscopy screening every 2 to 3 years starting from age 40 years.