Gastroenterology

Procedures & Preparations

Colonoscopy

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 to examine the colon in a procedure known as a colonoscopy. 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 air introduced into the colon may cause cramping and feeling of fullness.

A colonoscopy typically takes about 30 minutes. Afterwards, the patient is moved to a recovery room while the anesthetic wears off. Patients should not drive or work for the remainder of the day, and, must, therefore have a ride home. All feelings of bloating and cramping should fade within 24 hours.

Preparation for Colonoscopy (PDF)

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ERCP

During an endoscopic retrograde cholangiopancreatography, or ERCP, the gastroenterologist uses an endoscope, a long, thin, flexible tube with a light and camera at the end, 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.

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 in identifying 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 usually prevent the patient from remembering the experience.

The procedure normally takes about 40 minutes. Afterwards, the patient waits in the recovery room while the anesthetic wears off. Soreness in the back of the throat is not uncommon once the anesthesia dissipates. 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.

Preparation for ERCP (PDF)

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EUS

Endoscopic ultrasonography, or EUS, is used 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.

EUS involves the use of an endoscope or colonoscope, long, thin, flexible tubes with a light and camera at the end, to help guide the scope throughout the duration of the procedure. However, these scopes are different than those used in colonscopy and ERCP: they emit sound waves that create visual images of the digestive tract that a normal endoscope cannot detect.

EUS is used to aid in the diagnosis and treatment of various GI disorders. It may also be used to assess the nature of a tumor that may have been detected during a prior endoscopic procedure or CT scan. In conjunction with examination of a tissue sample obtained using a procedure called a "fine needle aspiration," EUS can help 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 procedure normally lasts about 45 minutes. Afterwards, the patient will wait in the recovery room while the anesthetic wears off. Once the medication dissipates, the patient may feel soreness in the back of the throat or some abdominal cramping and fullness depending on which type of scope was used during the procedure. 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.

Preparations for EUS
Upper EUS (PDF)
Rectal EUS (PDF) 

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Flexible Sigmoidoscopy

“Sigmoidoscopy" is a procedure that allows the physician to examine the inside of 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 to perform 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. Air introduced to the colon during the procedure, may cause feelings of fullness and cramping, but acute pain is very rare.

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

Preparations for Flexible Sigmoidoscopy
Sigmoidoscopy Fleet Enemas (PDF) 
Sigmoidoscopy Magnesium and Enema (PDF)

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Liver Biopsy

A liver biopsy is used to determine the presence of inflammation, fibrosis and to help diagnose 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 tiny piece of liver tissue.

After the procedure, the patient is kept in recovery for four hours for monitoring. If the patient experiences any pain or discomfort, a nurse can administer pain medications. Since these medications 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.

Preparation for Liver Biopsy (PDF)

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Upper GI Endoscopy

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 procedure normally takes 10-15 minutes. Afterwards, the patient waits in the recovery room while the anesthetic wears off. Once the medication dissipates, 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.

Preparation for Upper GI Endoscopy (PDF)

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Capsule Endoscopy

Capsule endoscopy allows examination of the entire small intestine by ingesting a vitamin-pill sized video capsule with its own camera and light source. During the eight-hour exam, the patient is free to move about. While the video capsule travels through the body, it sends images to a data recorder on a waist belt worn by the patient. 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 x-rays. In certain chronic gastrointestinal diseases, this method can also help to evaluate the extent to which the small intestine is involved or monitor the effect of therapy.

Preparation for Capsule Endoscopy
GoLytely
NuLytely 
HalfLytely  

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Double Balloon Enteroscopy

Double balloon enteroscopy is a new method of examining the small intestine that previous techniques could not reach. Double balloon enteroscopy employs a high- resolution video endoscope with latex balloons attached at the tips that can be 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 enteroscopy 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.