General GI

Esophagogastroduodenoscopy (EGD)

Esophagogastroduodenoscopy (EGD) allows your physician to view the inside of your esophagus (food tube), stomach and duodenum (first portion of the small intestine.) When passed through the mouth, a flexible, rubber-like coated tube, called an endoscope, will provide direct visualization of these areas. The actual procedure lasts only a short time.

Overview
This procedure diagnoses the cause of swallowing difficulties, abdominal pain, nausea, causes of upper GI bleeding, and evaluate for reflux, ulcers, tumors and other abnormalities of the upper GI tract.

What to Expect

You will arrive to the endoscopy center or the hospital after an overnight fast, with a responsible, adult driver. During the procedure, everything will be done to help you be as comfortable as possible. We will carefully monitor your blood pressure, pulse and oxygen level. The anesthetist will give you IV medication to sedate you during the procedure.

A supportive mouthpiece will be placed to help keep your mouth open during the endoscopy. While you are comfortably sedated, your doctor will gently maneuver the endoscope into position. As the endoscope is slowly and carefully inserted, air is introduced through it to help your doctor see better. During the procedure, you should feel no pain and it will not interfere with your breathing.

Your doctor will use the endoscope to look closely at your upper GI tract. In some cases, it may be necessary to take a sample of tissue, called a biopsy, for later examination under the microscope. This, too, is a painless procedure. In other cases, this endoscope can be used to treat a problem such as active bleeding from an ulcer.

Preparation
EGD / ERCP / EUS

Aftercare
Your Physician will let you know if you should continue your antacid medications during the test or stop it. Please follow your daily routine, including eating normal meals, but avoid frequent snacking, chewing gum or sucking candies.

Endoscopic Retrograde Cholangiopa Pancreatogram (ERCP)

Overview
An Endoscopic Retrograde Cholangiopa Pancreatogram (ERCP) is a procedure in which the physician uses an endoscope to see the inside of the stomach and duodenum. Dyes are injected into the ducts in the biliary tree and pancreas so they can be seen on X Ray. ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes) or abdominal pain. For example, an ERCP can be helpful when there is a blockage of the bile ducts by gallstones, tumors, scarring or other conditions that cause obstruction or narrowing (stricture) of the ducts. Similarly, blockage of the pancreatic ducts from stones, tumors, or stricture can also be evaluated or treated by an ERCP. This procedure is useful in assessing causes of pancreatitis (inflammation of the pancreas). Problems with the bile ducts or pancreas may first show up as jaundice or pain in the abdomen, although not always. Also, there may be changes in blood tests that show abnormalities of the liver or pancreas. Other special exams that take pictures using X-rays or sound waves may provide important information for use along with that obtained from ERCP.

What To Expect

Your comfort and safety are of utmost importance to us. This procedure is done in the hospital in cooperation with a team of highly trained physician of anesthesiologists, anesthetists, nurses, surgical and radiology technicians. The procedure is now done under general anesthesia to provide the safest environment for our physician’s to perform this procedure.

In the duodenum, the physician positions the instrument near the papilla, the point at which the main bile and pancreatic ducts empty into the intestine. A small tube known as a cannula is threaded down through the endoscope and can be directed into either the pancreatic or common bile duct. The cannula allows a dye to be injected into the ducts to help with diagnosis and to direct treatment. The physician then uses x-ray equipment to examine and take pictures of the dye outlining the ducts.

Some of the problems identified during ERCP can also be treated through the endoscope. For example, if a stone is blocking the pancreatic or common bile duct, it is usually possible to remove it. Stents and biopsies can also be done through the endoscope. Some of our physicians can insert a smaller camera (called Spyglass) into the bile duct in order to perfrom a more in depth evaluation and treatment.

Preparation
EGD / ERCP / EUS

Aftercare

When your ERCP is completed on an outpatient basis, you will need to remain under observation until your Physician releases you. In some cases, it may be necessary to admit you. Also, you will not be released unless you have someone to drive you home. And, you should also avoid operating machinery for a day and not drink any alcohol.

Your Physician will tell you when you can take fluids and meals. Usually, it is within a few hours after the procedure.

Because of the air used during ERCP, you may continue to feel full and pass gas for some time, and it is not unusual to have either soft stool or other brief changes in bowel habits. However, if you notice bleeding from your rectum or black, tarry stools, please call your Physician immediately.

You should also report vomiting, severe abdominal pain, weakness or dizziness, and fever over 100 degrees. Fortunately, these problems are not common.

Bravo pH Monitor

Bravo pH Monitor test is an endoscopically placed monitor that measures the pH (acid level) in the esophagus to determine if a patient has acid reflux, atypical symptoms of acid reflux, or how well acid suppressing medication is managing the condition.

Overview
The Bravo Capsule is used in the diagnosis, initial treatment and management of chronic Reflux.

What To Expect
You will undergo an upper endoscopy while under sedation. During the procedure, if there is significant inflammation or damage in the esophagus, the physician will not proceed with capsule placement. However, if the lining of the esophagus appears normal, a catheter will be inserted into your esophagus, and the pH capsule will be temporarily attached to the lining of the esophagus. This capsule measures the pH level in the esophagus and transmits the date wirelessly to a portable receiver that you keep near you. The test period lasts about 48 hours. The capsule is small therefore you may eat normally and go about your daily routine. You will be given a diary to write down the times when you have reflux systems (for example, coughing, heartburn, regurgitation), either while eating or when lying down. After the test is completed, you return the diary and the Bravo Receiver to your Physician. The data is then uploaded to a computer, and analyzed by your Physician to diagnose your condition.

Preparation
Bravo On Medication
Bravo Off Medication

Aftercare
Your Physician will let you know if you should continue your antacid medications during the test or stop it. Please follow your daily routine, including eating normal meals, but avoid frequent snacking, chewing gum or sucking candies. Keep the Bravo receiver at arms length at all times, but avoid getting it wet. Make sure to press the appropriate buttons every time symptom occurs, when you either eat or lay down. Please remember to return the receiver and your diary at the end of the study.

Capsule Endoscopy

Capsule Endoscopy records images of the digestive tract through the use of a tiny camera inside a vitamin sized capsule that is swallowed by the patient. The pictures are transmitted to a recorder, which allows the physicians to see the small intestine, an area that is not easily accessible with a conventional endoscopy.

Preparation
Capsule Endoscopy

Esophageal Manometry

Esophageal Manometry is a test that shows the functionality of the esophagus. It measures the rhythmic muscle contractions that occur in the esophagus when one swallows. Abnormalities in the contractions and strength of the muscle or in the sphincter, at the lower end of the esophagus, can result in pain, heartburn and/or difficulty swallowing. This test is used to diagnose the conditions that can cause these symptoms.

Overview
The esophagus is the tube that carries food and liquids from the throat to the stomach. Although it appears to be a simple organ, the esophagus is not rigid. The wall contains muscle that rhythmically contracts when you swallow. This allows the passage of the food and liquid to be carried down the esophagus to the stomach. Another important part of the esophagus is the lower valve muscle (LES). This is a specialized muscle that remains closed most of the time, it only opens to allow the food and liquids to move down the esophagus or when the patient belches or vomits. This muscle protects the lower part of the esophagus from caustic stomach acid and bile. These substances can cause heartburn and over time can lead to damage and scarring in the esophagus. There are a number of symptoms that originate in the esophagus. These including difficulty swallowing food or liquid, heartburn, and chest pain. Additionally, an x-ray (barium swallow or upper GI series) or endoscopy may show abnormalities that need to be studied further by manometry.

What To Expect
The procedure will take about an hour to complete. While seated in a chair or lying on your side, thin soft tubing is gently passed through the nose, and sometimes the mouth. Upon swallowing, the tip of the tube enters the esophagus and the technician then quickly passes it down to the desired level. There is usually some slight gagging, but is controlled by either dry or wet swallowing. Pressure recordings are made and the tubing is then removed. Patients can resume their regular activities including eating and drinking.

Preparation
Manometry / Motility

Flexible Sigmoidoscopy

The flexible sigmoidoscopy is an endoscopic procedure that allows a physician to look at the inside of the large intestine from the rectum to the sigmoid or descending colon.

Overview
This procedure is performed to help find the cause of lower gastrointestinal symptoms including diarrhea, rectal bleeding or constipation, as well as evaluate for early signs of cancer in the lower colon and rectum.

What To Expect
During the procedure, the physician will insert a sigmoidoscope, which is a short, lighted tube, into your rectum and slowly guide it into your colon. Using air to inflate the colon and a monitor, the doctor can visualize the inside of the rectum and the lower colon. Simple therapeutic objectives, including biopsies, removal of polyps or cauterization can be performed.

Preparation
If your physician has ordered a flexible sigmoidoscopy, follow these instructions beginning the day before your procedure.
Flex Sig – Fleet Enema
Flex Sig – Tap Water Enema

Hemorrhoidal Banding

Hemorrhoidal banding is a simple, painless, and effective method to eradicate hemorrhoids as an alternative to traditional surgical methods.

Overview
The procedure uses a non-surgical device for the treatment and removal of hemorrhoids, which can be performed comfortably without sedation. For optimal results, three treatments are scheduled at least 10 days apart.

What To Expect
The physician will place a tiny rubber band around the internal hemorrhoids to cut off the blood supply. The hemorrhoid then shrinks and falls off within a short time, usually without you noticing. In most cases, patients can return to work immediately after the procedure.