Gastroenterology


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Colonoscopy

The term "colonoscopy" describes an examination in which the doctor uses an instrument to look into the colon. The colon, also known as the large bowel, is the last portion of your gastrointestinal tract. It starts at the cecum, which is connected to your small intestine, and ends at your rectum. The colon is a hollow tube, measuring four feet in length on average, and its main function is to store food byproducts prior to their elimination. A colonoscope is used in performing this procedure. A colonoscope is a long, thin, flexible tube with a miniature video camera and light at its end. The gastroenterologist will put a little bit of air into the colon as he/she inserts the scope. The camera on the end helps the physician both guide the colonoscope throughout the length of the colon and take pictures of the colon.

This procedure also allows other instruments to be passed through the colonoscope. For example, forceps may be used to painlessly remove a suspicious looking growth for analysis. During the colonoscopy, the gastroenterologist can remove polyps with a procedure called "polypectomy". In this way, a colonoscopy may help to avoid surgery or better determine what kind of surgery needs to be performed.

Colonoscopies are most commonly performed in colorectal cancer screening and prevention. It is also increasingly used to evaluate problems such as blood loss, abdominal pain, and changes in bowel habits.

Patients remain comfortable throughout the procedure with the help of intravenous sedation. The drugs enable the patients to remain awake but comfortable throughout the procedure. Because of the air that is introduced into the colon, patients may feel cramping and fullness.

The duration of the procedure is normally about 30 minutes. Afterwards, the patient will wait in the recovery room while the anesthetic wears off. Due to the lingering effects from the sedation, the patient cannot drive or work for the remainder of the day, and therefore must have a ride home. All feelings of bloating and cramping should fade within 24 hours.

ERCP

The letters ERCP stand for endoscopic retrograde cholangiopancreatography. The gastroenterologist uses an endoscope, a long, thin, flexible tube with a light and camera at the end to help guide the scope throughout the duration of the procedure. This endoscope is directed through the esophagus, the stomach, and the first part of the small intestine, called the duodenum. Once the endoscope reaches the papilla, which is the opening of the common bile duct, the physician injects dye through these ducts, enabling x-rays to be taken.

In order to understand how this procedure can be beneficial, it is important to understand how the bile duct system works. Bile, a liquid that helps digest fat, is produced by the liver and carried to the gallbladder, where it is stored, through a series of tubes called ducts. The main duct from the pancreas joins the common bile duct and allows pancreatic juices to help with further digestion in the duodenum. After eating, both bile and pancreatic juices flow through the papilla and into the duodenum, where they mix with food and play a major role in digestion.

A physician may recommend an ERCP if the patient is experiencing abdominal pain or develops jaundice (yellowing of the eyes). This procedure is helpful when these symptoms are caused by gallstones, tumors, or scar tissue obstructing the bile duct. After using x-ray imaging to discover the nature of the obstruction, the endoscopist is usually able to clear the ducts. This is done by cutting open the papilla and then either pushing or pulling the stone out, or by inserting a device, such as an inflatable balloon, to help stretch scar tissue.

The patient remains comfortable during the procedure with the help of IV sedation. The drugs will enable the patient to remain semi-conscious throughout the procedure, but will most likely prevent the patient from remembering the experience.

The duration of the procedure is normally about 40 minutes. Afterwards, the patient waits in the recovery room while the anesthetic wears off. Once the medication fades away, the patient may feel soreness in the back of the throat. Due to the lingering effects from the sedation, the patient cannot drive or work for the remainder of the day, and therefore must have a ride home.

EUS

The letters EUS stand for endoscopic ultrasonography. This procedure can be performed to examine the upper or lower part of the gastrointestinal tract. The upper GI tract includes the esophagus, stomach, and first part of the small intestine, called the duodenum; the lower GI tract includes the colon, anus, and rectum. EUS can also be used to examine other internal organs, such as the pancreas and gallbladder.

The gastroenterologist uses an endoscope or colonoscope, which are long, thin, flexible tubes with a light and camera at the end to help guide the scope throughout the duration of the procedure. During this procedure, the scope emits sound waves that create visual images of the digestive tract that a normal endoscope cannot detect.

An EUS is usually performed to aid in the diagnosis and therapy of various GI disorders. It may also be performed to assess the nature of a tumor that may have been detected at a prior endoscopic procedure or CT scan. Finally, by obtaining a sample of tissue by using a method known as "fine needle aspiration," an EUS can help to carefully diagnose diseases of the pancreas, gallbladder, and bile duct.

The patient will remain comfortable during the procedure with the help of intravenous sedation. The drug will enable the patient to remain semi-conscious but comfortable throughout the procedure.

The duration of the procedure is normally about 45 minutes. Afterwards, the patient will wait in the recovery room while the anesthetic wears off. Once the medication fades away, the patient may feel soreness in the back of the throat or some abdominal cramping and fullness. Due to the lingering effects from the sedation, the patient cannot drive or work for the remainder of the day, and therefore must have a ride home.

Flexible Sigmoidoscopy

The term "sigmoidoscopy" means looking inside the sigmoid colon. The colon, also known as the large bowel, is the last portion of your gastrointestinal tract. The sigmoid is the section of the colon closest to the rectum and anus. The colon, a hollow tube, measures four feet in length, 20 inches of which is the sigmoid colon. The function of the sigmoid colon, like the remainder of the colon is to store food byproducts until its elimination.

A colonoscope is used in performing this procedure. A colonoscope is a long, thin, flexible tube with a miniature video camera and light at its end. The gastroenterologist will infuse a little bit of air into the colon as he or she inserts the scope. The camera on the end helps the physician both guide the colonoscope throughout the length of the sigmoid colon and take pictures of the colon.

Flexible sigmoidoscopies are most commonly performed to evaluate problems such as blood loss, pain and changes in bowel habits. The patient will remain awake throughout the procedure. The patient may elect to watch the procedure on a television monitor above the bed. Due to the air that is introduced to the colon during the procedure, the patient may feel slight fullness and cramping, but usually not any acute pain.

The duration of the procedure is normally 10-15 minutes. Afterwards, the patient may drive home and resume normal activities.

Liver Biopsy

A liver biopsy is generally performed to help in the evaluation of the liver. It can be used to determine the presence of inflammation, fibrosis, and other findings that may aid in diagnosing various liver diseases.

During this procedure, the patient is fully conscious. A physician numbs the area around the liver using a local anesthetic (similar to that used by a dentist), and then using a long, narrow needle obtains a small piece of liver. This small piece, usually 2 cm in length, is less than 1/5,000 of the whole liver, and the liver easily repairs itself within 2-3 days.

After the procedure, the patient is kept in recovery for 4 hours for close monitoring. If the patient experiences any pain or discomfort, a nurse can administer pain medications. Since these medications do have a lingering effect, the patient will not be able to drive or work for the remainder of the day, and therefore must have a ride home.

Upper GI Endoscopy

The term "endoscopy" refers to a technique used for looking inside the body. An upper GI endoscopy looks at the upper part of the gastrointestinal tract including the esophagus, the stomach, and the first part of the small intestine, called the duodenum. The esophagus is a hollow tube that carries the food to the stomach and small intestine for digestion.

The gastroenterologist uses an endoscope, a long, thin, flexible tube with a light and camera at the end to help guide the scope throughout the duration of the procedure. The camera on the end helps the physician both guide the endoscope throughout the length of the upper GI tract, and take pictures.

Gastroenterologists commonly perform this procedure as a way to evaluate and diagnose various problems, such as chronic heartburn (acid reflux), difficulty swallowing, stomach or abdominal pain, bleeding, ulcers, and tumors.

The patient remains comfortable during the procedure with the help of intravenous sedation. The drug enables the patient to remain awake and comfortable throughout the procedure.

The duration of the procedure is normally 10-15 minutes. Afterwards, the patient waits in the recovery room while the anesthetic wears off. Once the medication fades away, the patient may feel soreness in the back of the throat. Due to the lingering effects from the sedation, the patient cannot drive or work for the remainder of the day, and therefore must have a ride home.

Capsule Endoscopy

Capsule endoscopy with PillCamTM SB video capsule allows examination of the entire small intestine. You will ingest a vitamin-pill sized video capsule, which has its own camera and light source. During the eight hour exam, you are free to move about. While the video capsule travels through your body, it sends images to a data recorder you wear on a waist belt. Afterwards the doctor will view the images on a video monitor. Capsule endoscopy helps determine the cause for recurrent or persistent symptoms such as abdominal pain, diarrhea, bleeding or anemia undiagnosed by other techniques including endoscopy, colonoscopy and xrays. In certain chronic gastrointestinal diseases, this method can also help to evaluate the extent to which your small intestine is involved or monitor the effect of therapy.

Double Balloon Enteroscopy

Double balloon endoscopy is a new endoscopic method of examining the area of the small intestine that previous techniques could not reach. Double balloon endoscopy employs a high resolution video endoscope equipped with latex balloons attached at the tips, which are inflated and deflated with air from a pressure-controlled pump system. A sequence of inflation/deflation cycles allow the scope to be advanced further into the small intestine. This technique can be performed using either an oral or anal route.

Indications for double balloon endoscopy include obscure gastrointestinal bleeding, Crohn's disease, unexplained diarrhea, but also pancreaticobiliary disease in patients with altered anatomy such as Roux-en-Y, access to the excluded stomach after bariatric surgery and incomplete colonoscopy.
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