Career Spotlight – Adventures in Endoscopy

Imagine taking a look inside your body. Do you see healthy living tissue or is there something worrisome under the surface? How do you suppose your body looks compared to that of a close friend or even the stranger walking down the street?  Fortunately, you don’t have to rely on your imagination alone to find answers to these questions.

As an endoscopy/bronchoscopy nurse, I am able to use modern medical technology to look underneath the surface to see the awesome beauty of healthy digestive and respiratory systems or the core deterioration of diseased organs and tissues.

The main tool of our trade is a scope. A scope is essentially a long plastic tube with a built-in fiber optic camera and channel through which tools are passed. Each procedure requires its own scope. A shorter and narrower endoscope is used for upper GI procedures (i.e. examining the esophagus, stomach, and duodenum), a longer thicker colonoscope for lower GI procedures (i.e. examining the colon and ileum), and a diminutive bronchoscope to view the root-like bifurcations of the lungs.

As a procedural specialty, endoscopy nursing requires you to be familiar with a wide array of GI and Respiratory disorders. With between 5-10 cases per shift, each day brings a new challenge. Some days are full of routine screenings where the most we may do is remove a small polyp, an overgrown, sometimes precancerous, bit of tissue, or take a few stomach biopsies to further study the tissues of that organ. Other days, however, put the full grandeur of the human organism on display. A few case studies may be illustrative.

Patient PJ came to the hospital complaining that she had not eaten for 3 days. No matter what she put in her mouth, it would come right back up again. An endoscopy revealed that her esophagus and stomach appeared normal with healthy, uniform, pink tissue. However, as the scope was advanced towards the the valve between the stomach and the duodenum of the small intestine (i.e. the pylorus), it appeared as though that critical passage was missing! Upon further inspection, it turned out that a large edematous ulcer had completely sealed off the connection between the patient’s stomach and small intestine, blocking all food from passing through the digestive tract. An emergent intervention was performed later that day in the OR.

Patient MD suddenly developed extreme weakness, fever, and multi organ dysfunction. Her blood pressure had to be maintained by IV medication, she was found to be septic, and oddly, there were traces of fecal matter in her urine. The patient, who had a history of diverticular disease (in which little pouches are formed in the lining of the otherwise smooth colon), was scheduled for a colonoscopy. During the colonoscopy, it was found that one of her diverticula had perforated her bowel and resulted in a fistula between her bowel and her bladder. The perforation was repaired immediately and the patient went on to a full recovery.

Patient SJ was a lifelong smoker with chronic airway disease. Recently she had developed a heavy cough with thick secretions and a CT scan showed an opaque area in her left lung. A bronchoscopy was performed. Upon entering the branches of the lungs, which look like splitting and burrowing tree roots, the scope was blocked by a thick stringy mucus. The lungs were carefully cleaned and suctioned so an aspiration needle could be used to take tissue samples of the opacity. Using samples from the mucous and from the lung mass, the patient was diagnosed with pneumonia and lung cancer. Treatment was started promptly.

As you can see, endoscopic and bronchoscopic procedures can be relatively mundane or critically life saving. As an endoscopy nurse, my job is to comfort and care for my patients, while assisting the doctors in performing the safest intervention possible. According to the U.S. Preventative Screening Task Force, adults between the ages of 50 and 75 should have regular screening colonoscopies. So, chances are, you too may one day end up in my procedure room. Let’s see what’s inside!