What is Scope?

A flexible scope is a long, thin, flexible tube about 1 cm in diameter and about 1 to 1.5m long that is designed to be introduced into a natural orifice (mouth or anus) and be advanced forward to view one or more internal organs.

A scope has a video camera at its tip that sends a live video image to a monitor. It also has a channel to blow air or suck fluid and take biopsies or remove polyps.

Colorectal Cancer Screening

Cancer of the Colon and Rectum is now the most prevalent cancer in Singapore and is still rising. The lifetime risk of an individual developing colorectal cancer is approximately 1 in 20, and is among the highest in the world. The majority of colorectal cancers are still diagnosed at the advanced stage. Screening aims to detect and treat at an early stage when the tumour is confined to the wall or just inner lining or even before a cancer develops (polyp stage).

Detection and removal at the polyp stage (pre-cancer) can be performed purely through a scope and no surgery is required. Removal at an early stage will require surgery (either laparoscopic or open) and probably not require chemo or radio-therapy and with a cure rate over 90% as opposed to advanced cancers (spread to the lymph nodes or abdomen or other organs) with a low cure rates and diminished survival chances.

Screening for colorectal cancer has been proven to improve survival and large studies in North America and Europe have shown colorectal cancer deaths decreasing.  


Fecal Occult Blood Test (FOBT)
This test requires a small specimen of stool to test for microscopic blood. If blood is present, e.g. from a polyp or tumour, colonoscopy is recommended. If the stool test is normal, it needs to be repeated every year. It should be performed yearly on anyone who requires screening.
Barium Enema X-ray
Barium enema is an X-ray procedure used to examine the colon. Barium liquid which is visible on X-ray is pumped into the colon with air and an outline of the colon is shown.

It is able to detect cancers and larger polyps and if an anomaly is detected, a colonoscopy will be required to take biopsies or remove polyps.

Barium enema is not the preferred screening tool because it may miss small polyps or cancers. It is usually recommended by patients who are too ill to go for a colonoscopy. e.g the eldery.
Colonscopy is considered the most accurate examination of the colon and rectum and is used both as a diagnostic and screening tool. It is a very safe procedure and in screening has a less than 1 in 1000 risk of a major complication such as bleeding or perforation.

Read more about Colonoscopy >>
General Population
Colorectal cancer may occur at any adult age but most patients are over the age of 50 years old. Screening should thus begin at 50 years of age and yearly stool occult blood test and colonoscopy (every 5 years).

Read more about Colonoscopy >>
People with Increased Risk
If you have a relative with colon cancer with polyps, you should get screened at an age 5 years younger than that relative (1st degree relative).
Stomach Cancer Screening

Gastroscopy (or endoscopy) is an examination of the oesophagus (gullet or food pipe), stomach and duodenum (upper part of the small bowel) using a flexible telescope called a gastroscope.

When necessary, during the examination, a number of small procedures can also be carried out. These procedures may include:

  • taking a small tissue sample (biopsy)
  • stopping bleeding from an ulcer
  • removal of polyps
Read more about Gastroscopy >> 
Indications For Scopes


  1. Upper abdominal pain or bloating
  2. Difficulty in swallowing
  3. Nausea or vomiting
  4. Gastro-oesophageal reflux
  5. Upper gastro-intestinal bleeding (black stools or occult blood or anaemia)
  6. Screening or evaluation of abnormal findings from blood tests or x-rays

The alarm symptoms

Patients who are young (under 40 yr. old) and have abdominal pain or reflux may be managed with medication initially and that is all that may be needed initially, unless the problem persists beyond 2 weeks despite treatment. They should however have a scope immediately if they have any of the following upper GI alarm symptoms:

  1. Difficulty in swallowing
  2. Nausea or vomiting
  3. Upper gastro-intestinal bleeding (black stools or occult blood or anaemia)
  4. Unintended loss of weight or appetite

Patients with these alarm symptoms should go for a gastroscopy immediately as there may be an underlying malignancy.


  1. Evaluation of lower abdominal pain or bloating
  2. Change in bowel habits
  3. Lower gastro-intestinal bleeding (fresh or altered blood or occult blood or anaemia)
  4. Screening or evaluation of abnormal findings from blood tests or x-rays


All endoscopic procedures will be performed by an experienced endoscopist.