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Procedure
Descriptions
Colonoscopy
EGD
ERCP
Flex Sig
Capsule Endoscopy
Endoscopic Ultrasound
Your
physician will provide your personalized preparation
instructions regarding any of the tests you have scheduled.
Colonoscopy
Colonoscopy (koh-luh-NAH-skuh-pee) lets the physician
look inside your entire large intestine, from the lowest
part, the rectum, all the way up through the colon to
the lower end of the small intestine. The procedure
is used to look for early signs of cancer in the colon
and rectum. It is also used to diagnose the causes
of unexplained changes in bowel habits. Colonoscopy
enables the physician to see inflamed tissue, abnormal
growths, ulcers, and bleeding.
For the procedure, you will lie on your left side on
the examining table. You will probably be given
pain medication and a mild sedative to keep you comfortable
and to help you relax during the exam. The physician
will insert a long, flexible, lighted tube into your
rectum and slowly guide it into your colon. The
tube is called a colonoscope (koh-LON-oh-skope). The
scope transmits an image of the inside of the colon,
so the physician can carefully examine the lining of
the colon. The scope bends, so the physician can
move it around the curves of your colon. You may
be asked to change position occasionally to help the
physician move the scope. The scope also blows
air into your colon, which inflates the colon and helps
the physician see better.
If anything abnormal is seen in your colon, like a polyp
or inflamed tissue, the physician can remove all or
part of it using tiny instruments passed through the
scope. That tissue (biopsy) is then sent to a
lab for testing. If there is bleeding in the colon,
the physician can pass a laser, heater probe, or electrical
probe, or can inject special medicines through the scope
and use it to stop the bleeding.
Bleeding and puncture of the colon are possible complications
of colonoscopy. However, such complications are
uncommon.
Colonoscopy takes 30 to 60 minutes. The sedative
and pain medicine should keep you from feeling much
discomfort during the exam. You will need to remain
at the facility for 1 to 2 hours until the sedative
wears off.
EGD
Upper endoscopy enables the physician to look inside
the esophagus, stomach, and duodenum (first part of
the small intestine). The procedure might be used
to discover the reason for swallowing difficulties,
nausea, vomiting, reflux, bleeding, indigestion, abdominal
pain, or chest pain. Upper endoscopy is also called
EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).
For the procedure you will swallow a thin, flexible,
lighted tube called an endoscope (EN-doh-skope). Right
before the procedure the physician will spray your throat
with a numbing agent that may help prevent gagging.
You may also receive pain medicine and a sedative
to help you relax during the exam. The endoscope
transmits an image of the inside of the esophagus, stomach,
and duodenum, so the physician can carefully examine
the lining of these organs. The scope also blows
air into the stomach; this expands the folds of tissue
and makes it easier for the physician to examine the
stomach.
The physician can see abnormalities, like inflammation
or bleeding, through the endoscope that don't show up
well on x rays. The physician can also insert
instruments into the scope to treat bleeding abnormalities
or remove samples of tissue (biopsy) for further tests.
Possible complications of upper endoscopy include bleeding
and puncture of the stomach lining. However, such complications
are rare. Most people will probably have nothing
more than a mild sore throat after the procedure.
The procedure takes 20 to 30 minutes. Because
you will be sedated, you will need to rest at the facility
for 1 to 2 hours until the medication wears off.
ERCP
Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik
REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee)
(ERCP) enables the physician to diagnose problems in
the liver, gallbladder, bile ducts, and pancreas. The
liver is a large organ that, among other things, makes
a liquid called bile that helps with digestion. The
gallbladder is a small, pear-shaped organ that stores
bile until it is needed for digestion. The bile
ducts are tubes that carry bile from the liver to the
gallbladder and small intestine. These ducts are
sometimes called the biliary tree. The pancreas is a
large gland that produces chemicals that help with digestion
and hormones such as insulin.
ERCP is used primarily to diagnose and treat conditions
of the bile ducts, including gallstones, inflammatory
strictures (scars), leaks (from trauma and surgery),
and cancer. ERCP combines the use of x rays and
an endoscope, which is a long, flexible, lighted tube.
Through the endoscope, the physician can see the inside
of the stomach and duodenum, and inject dyes into the
ducts in the biliary tree and pancreas so they can be
seen on x rays.
For the procedure, you will lie on your left side on
an examining table in an x-ray room. You will
be given medication to help numb the back of your throat
and a sedative to help you relax during the exam. You
will swallow the endoscope, and the physician will then
guide the scope through your esophagus, stomach, and
duodenum until it reaches the spot where the ducts of
the biliary tree and pancreas open into the duodenum.
At this time, you will be turned to lie flat on your
stomach, and the physician will pass a small plastic
tube through the scope. Through the tube, the
physician will inject a dye into the ducts to make them
show up clearly on x rays. X rays are taken as
soon as the dye is injected.
If the exam shows a gallstone or narrowing of the ducts,
the physician can insert instruments into the scope
to remove or relieve the obstruction. Also, tissue
samples (biopsy) can be taken for further testing.
Possible complications of ERCP include pancreatitis
(inflammation of the pancreas), infection, bleeding,
and perforation of the duodenum. Except for pancreatitis,
such problems are uncommon. You may have tenderness
or a lump where the sedative was injected, but that
should go away in a few days.
ERCP takes 30 minutes to 2 hours. You may have
some discomfort when the physician blows air into the
duodenum and injects the dye into the ducts. However,
the pain medicine and sedative should keep you from
feeling too much discomfort. After the procedure,
you will need to stay at the hospital for 1 to 2 hours
until the sedative wears off. The physician will
make sure you do not have signs of complications before
you leave. If any kind of treatment is done during
ERCP, such as removing a gallstone, you may need to
stay in the hospital overnight.
Flex Sig
Flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) enables
the physician to look at the inside of the large intestine
from the rectum through the last part of the colon,
called the sigmoid or descending colon. Physicians
may use the procedure to find the cause of diarrhea,
abdominal pain, or constipation. They also use
it to look for early signs of cancer in the descending
colon and rectum. With flexible sigmoidoscopy,
the physician can see bleeding, inflammation, abnormal
growths, and ulcers in the descending colon and rectum.
Flexible sigmoidoscopy is not sufficient to detect
polyps or cancer in the ascending or transverse colon
(two-thirds of the colon).
For the procedure, you will lie on your left side on
the examining table. The physician will insert
a short, flexible, lighted tube into your rectum and
slowly guide it into your colon. The tube is called
a sigmoidoscope (sig-MOY-duh-skope). The scope
transmits an image of the inside of the rectum and colon,
so the physician can carefully examine the lining of
these organs. The scope also blows air into these
organs, which inflates them and helps the physician
see better.
If anything unusual is in your rectum or colon, like
a polyp or inflamed tissue, the physician can remove
a piece of it using instruments inserted into the scope.
The physician will send that piece of tissue (biopsy)
to the lab for testing.
Bleeding and puncture of the colon are possible complications
of sigmoidoscopy. However, such complications
are uncommon.
Flexible sigmoidoscopy takes 10 to 20 minutes. During
the procedure, you might feel pressure and slight cramping
in your lower abdomen. You will probably feel
better afterward when the air leaves your colon.
Capsule Endoscopy
Capsule Endoscopy lets your doctor examine the lining
of the middle part of your gastrointestinal tract, which
includes the three portions of the small intestine (duodenum,
jejunum, ileum). Your doctor will use a pill sized video
capsule called an endoscope, which has its own lens
and light source and will view the images on a video
monitor. You might hear your doctor or other medical
staff refer to capsule endoscopy as small bowel endoscopy,
capsule enteroscopy, or wireless endoscopy.
Capsule endoscopy helps your doctor evaluate the small
intestine. This part of the bowel cannot be reached
by traditional upper endoscopy or by colonoscopy. The
most common reason for doing capsule endoscopy is to
search for a cause of bleeding from the small intestine.
It may also be useful for detecting polyps, inflammatory
bowel disease (Crohn's disease), ulcers, and tumors
of the small intestine.
As is the case with most new diagnostic procedures,
not all insurance companies are currently reimbursing
for this procedure. You may need to check with your
own insurance company to ensure that this is a covered
benefit.
Your doctor will prepare you for the examination by
applying a sensor device to your abdomen with adhesive
sleeves (similar to tape). The capsule endoscope is
swallowed and passes naturally through your digestive
tract while transmitting video images to a data recorder
worn on your belt for approximately eight hours. At
the end of the procedure you will return to the office
and the data recorder is removed so that images of your
small bowel can put on a computer screen for physician
review.
Most patients consider the test comfortable. The capsule
endoscope is about the size of a large pill. After ingesting
the capsule and until it is excreted, you should not
be near a MRI device or schedule a MRI examination.
You will be able to drink clear liquids after two hours
and eat a light meal after four hours following the
capsule ingestion, unless your doctor instructs you
otherwise. You will have to avoid vigorous physical
activity such as running or jumping during the study.
Your doctor generally can tell you the test results
within the week following the procedure; however, the
results of some tests might take longer.
Although complications can occur, they are rare when
doctors who are specially trained and experienced in
this procedure perform the test. Potential risks include
complications from obstruction. This usually relates
to a stricture (narrowing) of the intestine from inflammation,
prior surgery, or tumor. It's important to recognize
early signs of possible complications. If you have evidence
of obstruction, such as unusual bloating, pain, and/or
vomiting, call your doctor immediately. Also, if you
develop a fever after the test, trouble swallowing or
increasing chest pain, tell your doctor immediately.
Be careful not to prematurely disconnect the system
as this may result in loss of image acquisition.
Endoscopic
Ultrasound
Endoscopic
Ultrasound (EUS) combines endoscopy and ultrasound in
order to obtain images and information about the digestive
tract and the surrounding tissue and organs. Endoscopy
refers to the procedure of inserting a long flexible
tube via the mouth or the rectum to visualize the digestive
tract (for further information, please visit the Colonoscopy
and Flexible Sigmoidoscopy articles), whereas ultrasound
uses high-frequency sound waves to produce images of
the organs and structures inside the body such as ovaries,
uterus, liver, gallbladder, pancreas, aorta, etc.
Traditional ultrasound sends sound waves to the organ(s)
and back with a transducer placed on the skin overlying
the organ(s) of interest. images obtained by traditional
ultrasound are not always of high quality. In EUS a
small ultrasound transducer is installed on the tip
of the endoscope. By inserting the endoscope into the
upper or the lower digestive tract one can obtain high
quality ultrasound images of the organs inside the body.
Placing the transducer on the tip of an endoscope allows
the transducer to get close to the organs inside the
body. Because of the proximity of the EUS transducer
to the organ(s) of interest, the images obtained are
frequently more accurate and more detailed than the
ones obtained by traditional ultrasound. The EUS also
can obtain information about the layers of the intestinal
wall as well as adjacent areas such as lymph nodes and
the blood vessels.
Other uses of EUS include studying the flow of blood
inside blood vessels using Doppler ultrasound, and to
obtain tissue samples by passing a special needle, under
ultrasound guidance, into enlarged lymph nodes or suspicious
tumors. The tissue or cells obtained by the needle can
be examined by a pathologist under a microscope. The
process of obtaining tissue with a thin needle is called
fine needle aspiration (FNA).
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