Saint James Hospital is endowed with the latest equipment in Endoscopy by top brands such as Pentax, Given Image and Olympus. Gastroenterology procedures can be performed in full due to a complete line of accessories that come with these sophisticated instruments. Areas that can be investigated in the endoscopy department at Saint James Hospital include the esophagus, stomach, intestines, bronchus and lungs, cervix, the urinary bladder and the cholangiopancreato duct system. As a result of the full range of endoscopes and accessories available in the unit, no limitations or restrictions exist for any endoscopic procedure. We are also equipped with a Paediatric Gastroscope and Colonoscope for our young patients.

Both diagnostic and therapeutic procedures are performed in the unit, and we have also been pioneers in performing first-time procedures in Malta: that of expandable esophageal stenting, colonic tattooing and Capsule Endoscopy.

The importance of these scopes may be described as follows:

a) Through these sophisticated instruments, the consultant is capable of actually obtaining a high-definition visual interpretation of the intrinsic part of the human organ being tested.

b) The endoscopist may also take biopsies (tissue samples), remove minor growths, inject interstitial treatment, implant stents, and cauterise bleeding tissues among other procedures and interventions.

To enhance and support the effect of these visual interpretations, Saint James Hospital is embellished with video and photographic recording equipment. Thus, real time and high quality pictures may actually be obtained on monitor, which will undoubtedly enhance the diagnostic power of the endoscopist performing these tests.

Standards applied in our Endoscopy Unit are based on those applied by American accredited heath authorities, mostly in disinfection and processing of endoscopes. These standards have been upgraded following the recent acquisition of the fully automated state-of-the-art disinfection processor.

An issue that is given high priority at the Saint James Hospital Endoscopy Unit is patient education and information. It is standard practice that our clients are discharged with full reporting and all necessary information in relation to findings. We give great importance to the fact that our clients are discharged with all their queries sorted. The educational and informative field is supported by numerous pre-printed leaflets and audio-visual services on all the possible post-Endoscopic findings.

All endoscopic procedures are carried out in a specifically designed and dedicated endoscopy suite, where full monitoring throughout each procedure is done. Clients are assessed before, during and after each endoscopic procedure, by specialised and certified nurses.

Procedures carried out in the Endoscopy Unit include:

• Gastroscopy
• Colonoscopy
• Proctology {including Banding and Injection of Haemorrhoids}
• Capsule Endoscopy
• Gastric Balloon
• Colon Hydrotherapy
• pH Impedance Study
• Expandable Esophageal Stent
• Stretta procedure
• ERCP {Endoscopic Retrograde CholangioPancreatography}
• BiB Insertion {IntraGastric Balloon for weight loss}
• Bronchoscopy
• Flexible Hysteroscopy
• Flexible Cystoscopy
• Aclasta Infusion {for low Bone Density}

ENDOSCOPY – MEDICAL TECHNOLOGY IN DIAGNOSTICS

As far back as records show, the care of the sick has constituted a role in everyday life. In the fourth century, a Hindu physician called B.C.Charaka referred to the ‘aggregate of four” as the principle behind this care. This is composed of the physician, the nurse, the patient, and the drug/equipment.

As early as the time of Hippocrates, specific mention was made of the Gastrointestinal Tract in medicine. Hippocrates recorded use of a candle to inspect the rectum. In 1795, Bozzini documented the use of a rigid sigmoidoscope. Almost 100 years later, Kussmaul made the first attempt to visualise the stomach with a rigid tube. In 1932, Rudolph Schindler designed a semiflexible instrument. In 1958, Hirschowitz, Curtis, Peters and Pollard published their report of a new Gastroscope, the fiberscope, which revolutionised gastroenterology.

But what is endoscopy? Endoscopy is the visual examination of internal ducts and organs (mostly the digestive system) by the use of high tech dedicated equipment, while using natural access. This means that through the mouth one can access the upper part of the gastrointestinal tract – esophagus, stomach and first part of the small intestines. Through the back passage, one can easily visualise the large intestines and possibly the last few inches of the small intestine.

Modern flexible fibreoptic instruments have the same basic features as those developed in the early fifties. The simplicity, ease of use, and safety of the earlier instruments caused rapid adaptation of this new technology. And progress has not ceased there. Endoscopy is a very dynamic speciality within the field of medicine. For over ten years now, we don’t mention fibreoptics for imaging anymore; CCDs have taken over completely and this has enhanced the imaging and documentation aspect of endoscopy. The procedure is now seen on full high definition and large monitors and is easily recordable on DVDs. This has also helped to develop endoscopes, which are now more ergonomic, thinner and flexible, and obviously much more patient friendly.

But what has really revolutionalised diagnostics in Gastroenterology is Capsule Endoscopy. A state of the art technology, originally a military project, the capsule has managed to break the last frontier towards the full examination of the whole gastrointestinal tract. Wireless capsule endoscopy allows painless endoscopic imaging of the entire small bowel, but more significantly, the examination of the intestine takes place in the physiological state (the natural process of organ function). The capsule has a cylindrical shape, with a diameter of 11mm, and a length of 26mm (the size of a vitamin capsule). The procedure is fully ambulatory, meaning that the client can perform the test at home or even while at work. There is only the need to carry a belt around the waist for eight hours, throughout which 60,000 images are sent from the capsule to a Data recorder attached to the belt by radio frequency signals.

Saint James Hospital is very proud of the high-tech systems furnishing the Endoscopy departments at Sliema, Zabbar, and Tripoli. Our endoscopy units have both Olympus and Pentax systems, while the Branch at Sliema is proud to host the first Capsule Endoscopy on the island by GIVEN Image.

At Saint James Hospital we are in a position to visualise the whole gastrointestinal tract and perform both diagnostic and therapeutic procedures in our dedicated GI units.