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Procedures

Colonoscopy

A colonoscopy is a test that is used to detect abnormalities in the large intestine and rectum, including polyps, rectal bleeding and cancer. The procedure is done using a long, flexible tube with a tiny video camera attached that allows the doctor to view the inside of these areas. If necessary, polyps or other types of abnormal tissue can be removed through the scope. Patients with no personal or family history of colon cancer should have a screening colonoscopy every 10 years after age 50.

Procedure Preparation:
Prior to performing a colonoscopy, your colon needs to be emptied so that the doctor has a clear view during the exam. That means:
– No solid food the day before the exam.
– The day before the exam, drinks limited to clear liquids, including water, tea, coffee (no cream), broth etc. (No red liquids)
– Do not eat or drink anything after midnight the night before the exam
– Take a laxative the night prior. (Your doctor will tell you what to take)
– Ask your doctor about whether to continue or discontinue the daily medications you take
– Most patients take are given a sedative prior to the procedure
In most cases the procedure takes about an hour to complete and then, an hour for recovery. Due to the sedative, you will need someone to drive you home. You may feel bloated or gassy for a few hours after the procedure is completed.

Upper Endoscopy

An upper endoscopy or EGD is a procedure that involves inserting a thin scope with a tiny camera on the end to examine the upper digestive tract, including the esophagus, stomach and duodenum (beginning of small intestine). This test may be used to investigate digestive symptoms, such as nausea, vomiting, abdominal pain and swallowing issues. It can be used to collect tissue samples to test for a variety of diseases and conditions of the digestive system.

Prior to your procedure:
– You will need to stop eating and drinking four to eight hours prior to the procedure.
– Ask your doctor about whether you should continue using your medications (prescription and over-the-counter) prior to the procedure.
– As most people will take a sedative when undergoing this procedure, you will need to arrange to have someone drive you home afterwards.

After the procedure:
– You will be taken to recovery for an hour or so, as your sedative wears off.
– You may experience bloating, gas, cramping and a sore throat afterwards.

Capsule Endoscopy

This procedure involves the patient swallowing a standard-sized capsule that contains a tiny, wireless camera. As the camera travels through the digestive tract, it transmits thousands of images to a video monitor. This procedure was designed to examine the small intestine, an organ that is typically difficult to access. However, this procedure can allow your doctor to examine other parts of the digestive tract, as well.

This procedure can be used to:
– Screen for polyps
– Find the cause of intestinal bleeding
– Diagnose a variety of illnesses, including: celiac disease, inflammatory bowel diseases and cancer
– Provide follow-up for an inconclusive imaging test

Procedure Preparation:
– Stop eating/drinking 12 or more hours prior to procedure
– Stop or delay taking certain medications. This should be discussed prior with your doctor.
– Take it easy the day of the procedure. No heavy lifting or strenuous exercise.
– Follow any other prep instructions provided by our office.

48-hour Bravo Esophageal pH Test

Bravo is the first catheter-free test available to measure and record the pH in your esophagus, used to determine if you have gastroesophageal reflux disease (GERD).Most patients prefer this catheter-free test because it is more comfortable and allows them to continue their daily activities more easily.

Here’s how it works:
A small capsule is attached to the wall of the esophagus during an upper endoscopy. For the next two days, the capsule measures pH levels in the esophagus and transmits readings to a receiver you wear at your waist. You must also maintain a diary to record when you eat, drink, lie down, get up, etc.

To prepare for your test:-
– Stop or delay taking certain medications. This should be discussed prior with your doctor.
– The night before your test, stop eating solid food at midnight.
– Six hours prior to your exam, stop drinking clear liquids

During the testing period:

– Do not alter your daily activities during the monitoring period.
– Eat your regular meals at the usual times.
– Eat foods that tend to cause your symptoms.
– Do not get the receiver wet.
– Do not suck on hard candy or chew gum while being monitored.
– Once the monitoring period is complete, return the receiver and diary to our office where the collected information will be downloaded and analyzed.

ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and X-rays to treat problems of the bile and pancreatic ducts. ERCP is also used to diagnose problems, but the availability of non-invasive tests such as magnetic resonance cholangiography has allowed ERCP to be used primarily for cases in which it is expected that treatment will be delivered during the procedure.

Flexible Sigmoidoscopy

When your doctor wants to explore possible causes of chronic diarrhea, abdominal pain, or rectal bleeding or screen for colon cancer, he may suggest a flexible sigmoidoscopy. This test is used to examine the lower part of the large intestine and the rectum. The procedure is done using a thin, flexible tube with a tiny video camera attached that allows the doctor to view the inside of these areas. If necessary, tissue samples can be removed through the scope. This procedure doesn’t give the doctor a view of the complete colon the way a colonoscopy does.

Procedure Preparation:
Prior to performing a flexible sigmoidoscopy, your colon needs to be emptied so that the doctor has a clear view during the exam. That means:
– No solid food the day before the exam.
– The day before the exam, drinks limited to clear liquids, including water, tea, coffee (no cream), broth etc. (No red liquids)
– Do not eat or drink anything after midnight the night before the exam
– Take a laxative the night prior. (Your doctor will tell you what to take)
– Ask your doctor about the daily medications you take

In most cases the procedure takes just 15 minutes or a bit more to complete. After the exam, you may have mild abdominal discomfort, feel bloated or pass gas to clear the air in your colon.

PEG

Percutaneous endoscopic gastrostomy (PEG) is a method of placing a tube into the stomach percutaneously, aided by endoscopy. This procedure is done when patients are having difficulty swallowing, as an effective way to provide food and liquid directly into the stomach. Once inserted, the PEG tube The PEG tube rests in the stomach and exits through the skin of the abdomen.

Planning for the procedure:
– Review all medications you are taking—both prescription and over-the-counter— with your doctor. Some medications need to be ceased a full week prior to the procedure.
– No eating or drinking for a minimum of eight hours prior to the procedure.
– You cannot drive for 24 hours following the procedure. Please arrange for transportation home.
– You may need to stay overnight in the hospital after the procedure, so come prepared.

After the procedure:
– You will be observed closely for any complications.
– The PEG tube will be secured to your abdomen with tape.
– For the first day or two, drainage around the PEG tube is expected.
– A sterile gauze dressing will be placed around the incision and should be changed periodically until the area has healed. Then, be sure to keep the area clean by washing with soap and water.
– You will be trained on how and what to use to feed yourself through this.
– The area in your abdomen where the PEG tube was inserted may have minor soreness. Your doctor will advise you how to treat the soreness.
– Often these tubes can last for two to three years before needing to be replaced.

Hemorrhoid Banding

For internal hemorrhoids that occur in the lower rectum, your doctor may recommend hemorrhoid banding, considered to be the most effective nonsurgical treatment for internal hemorrhoids This procedure—called rubber band ligation—is done by tying off the hemorrhoid at its base with rubber bands. This cuts off the blood flow to it, causing it to shrink, die and, in a week or so, fall off.
Afterward:
– There may be pain and soreness for 24 to 48 hours after the procedure.
– Over-the-counter pain medication, such as acetaminophen is recommended.
– A sitz bath, where you sit in a shallow tub of warm water, may also be recommended.
– Mild bleeding may occur seven to ten days later when the hemorrhoid falls off. It should be slight and stop by itself.

PH/Manometry

This procedure involves two tests. The first is the esophageal manometry that is used to measure how well your esophagus (food tube) is working. This test can help reveal causes of heartburn, swallowing issues and chest pain by measuring how your esophagus muscles work. The procedure involves placing a small, flexible tube through the nose and into the esophagus and stomach. Your nose and throat will be numbed, and the procedure will last for approximately 30 to 40 minutes.

The second procedure is the ambulatory pH procedure. This test measures the amount of acidic stomach contents and gas (reflux) that back up into the esophagus. Because reflux can be different throughout the day, we measure you constantly over a 24 hour period. To do so, a recording device is attached during tube insertion. Then, you are asked to keep a simple diary over a 24 hour period.

Prepping for the procedure:
– Ask your doctor about whether you should continue using your medications (prescription and over-the-counter) prior to the procedure.
– Do not eat or drink anything three hours before your procedure.

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