Upper and lower endoscopy

Role

Upper GI endoscopy (gastroscopy) and lower GI endoscopy (colonoscopy, flexible sigmoidoscopy) provide direct visualisation and biopsy capability of the GI mucosa - the primary diagnostic and increasingly therapeutic tool across most of gastroenterology practice
Colonoscopy screening programs have demonstrably reduced colorectal cancer incidence and mortality through detection and removal of precancerous adenomas; upper endoscopy is central to investigating dyspepsia, dysphagia, and upper GI bleeding

Direct mucosal visualisation allows real-time assessment of inflammation, ulceration, bleeding, and mass lesions, combined with targeted biopsy for histological diagnosis - providing information neither imaging nor non-invasive testing alone can match for mucosal disease

Upper endoscopy indications: dysphagia, alarm-symptom dyspepsia, suspected upper GI bleeding, Barrett's oesophagus surveillance, coeliac disease diagnosis (duodenal biopsy)
Colonoscopy indications: colorectal cancer screening/surveillance, unexplained iron deficiency anaemia, rectal bleeding, change in bowel habit with alarm features, IBD diagnosis and surveillance
Adequate bowel preparation is essential for colonoscopy quality (poor preparation reduces adenoma detection rate substantially) and patient-specific preparation regimens/timing should be reviewed if a prior colonoscopy had inadequate preparation

Therapeutic capability extends diagnostic endoscopy directly into treatment: polypectomy, haemostasis for bleeding, dilatation of strictures, and stent placement - much of modern GI intervention occurs through the endoscope rather than requiring separate surgical intervention
Complication risks (perforation, bleeding, sedation-related events) are generally low but relevant to informed consent and patient selection, particularly for therapeutic (higher-risk) procedures compared with diagnostic-only examination

Colorectal cancer screening programs, Barrett's oesophagus surveillance, IBD diagnosis and monitoring, adenoma detection rate as a quality metric

Adenoma detection rate (the proportion of screening colonoscopies in which at least one adenoma is found) is a key, tracked quality metric for colonoscopy given its direct link to interval (missed) cancer rates - a technically complete colonoscopy with poor mucosal visualisation or a rushed withdrawal technique can still miss clinically significant lesions

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