Endoscopic procedures are used by gastroenterologists for diagnosis
and treatment of a variety of gastrointestinal disorders. A
contemporary endoscope looks like a long, black, flexible tube, with
a diameter of 7 to 14 mm (0.27 to 0.59 inch) and length up to 6 feet
(some specialized endoscopes are even longer). At its tip, the
endoscope has got an image sensor, similar to those found in
high-end digital cameras. It also has got a light source and
channels through which the endoscopist may thread flexible
instruments as well as collect tissue and fluid samples. The
contemporary video endoscope is a sophisticated device, designed to
minimize patients discomfort and risk for complications.
The most commonly performed
gastrointestinal endoscopic procedures are:
EGD,
Colonoscopy,
flexible
sigmoidoscopy, and
ERCP.
For details, please click on the name of the respective procedure
above
Upper Endoscopy - EGD (Esophago
Gastro Duodenoscopy)
EGD (Upper GI Endoscopy) is a procedure during which upper digestive
tract could be examined using a lighted, flexible video endoscope.
The upper digestive tract begins with the mouth and continues with
the esophagus (food pipe), stomach and duodenum (initial segment of
the small bowel). EGD is performed for diagnostic reasons (detecting
diseases) as well as therapeutic reasons (treating diseases). The
most common indications for EGD include gastroesophageal reflux
disease (GERD), abdominal pain, intractable nausea and vomiting,
difficulties and/or pain with swallowing, peptic ulcers of the
stomach and duodenum, esophageal and gastric cancer, and upper
gastrointestinal bleeding.
EGD is a relatively short and painless procedure.
For added comfort and for minimizing the anxiety, most patients are
sedated with use of short-acting intravenous medications. Some
patients prefer not to be sedated and usually tolerate the procedure
well. In opposite to colonoscopy, no cleansing of the intestine is
necessary before EGD. However, you should not eat or drink after
midnight the night before your procedure (minimum 6 hours prior to
EGD).
At least a week prior to EGD, you should notify
the physician performing the procedure (or his nurse) if taking
medications for diabetes (oral or injectable) and/or anticoagulants
("blood thinners") such as Coumadin (Warfarin), Heparin, Lovenox (Enoxaparin),
Plavix (Clopidogrel), Pradaxa (Dabigatran)
or Ticlid (Ticlopidine). Also, you should
notify your physician of taking Aspirin, Ibuprofen, Advil, Naprosyn,
Voltaren, and other similar anti-inflammatory medications.
For details concerning the
technique, risks of the procedure, and indications for EGD please
click on this link to the
American
Gastroenterological Association
Web
site.
Colonoscopy
Colonoscopy is an endoscopic procedure during which the interior of
the colon (large bowel) is visually examined by a physician
performing the test. The colon begins in the right lower abdomen and
looks like a big question mark as it moves up and around the
abdomen, ending in the rectum. The procedure is performed with you
lying on your left side. Colonoscopy is a relatively short and safe
procedure. As opposite to some beliefs, the procedure is rarely
painful but it may be uncomfortable. For this reason, most patients
prefer to be sedated during colonoscopy. After intravenous
administration of a sedative, the flexible video endoscope is gently
inserted through the anus and moved around the bends of the colon.
Colonoscopy is performed for many different
indications. These include screening for colorectal cancer, looking
for and removing colonic polyps which are frequently precancerous,
looking for the source of an intestinal bleeding or abdominal pain,
evaluation of colonic diseases like ulcerative colitis and Crohn’s
disease, and many more. Before the procedure, the colon must be
purged using one of the several available methods of cleaning the
organ from stool and debris. The methods used in our practice are
described in details in the Colon Cleansing section on this Website.
At least a week prior to colonoscopy, you should
notify the physician performing the procedure (or his nurse) if
taking medications for diabetes (oral or injectable) and/or
anticoagulants ("blood thinners") such as Coumadin (Warfarin),
Heparin, Lovenox (Enoxaparin), Plavix (Clopidogrel), Pradaxa (Dabigatran) or Ticlid (Ticlopidine).
Also, you should notify your physician of taking Aspirin, Ibuprofen,
Advil, Naprosyn, Voltaren, and other similar anti-inflammatory
medications.
For details concerning colonoscopic technique,
risks of the procedure, and multiple potential benefits of
colonoscopy, please click on this link to the
American
Gastroenterological Association Web
Site.
Flexible Sigmoidoscopy
Flexible sigmoidoscopy is an endoscopic
procedure similar to colonoscopy. The major difference is that the
endoscope used for flexible sigmoidoscopy is much shorter that that
used for colonoscopy. The procedure is therefore easier to perform
and generally shorter. However, only about one third of the colon
(so called distal colon) is evaluated and, therefore, many
proximal lesions are missed. Moreover, the procedure is usually
performed without sedation and may, therefore, result in some
discomfort and pain.
Flexible sigmoidoscopy may be used for evaluation of distal colonic
disorders like rectal bleeding or rectal / anal pain. It may also be
used for screening for colorectal cancer. For this purpose, however,
it must be combined with other methods. Generally, the ability of
flexible sigmoidoscopy to evaluate the patient for risk for colon
cancer is much poorer than that of colonoscopy.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
Endoscopic retrograde cholangiopancreatography (ERCP) is an
endoscopic
procedure which enables the physician to evaluate the biliary tree,
the gallbladder, and the pancreatic ducts.
Biliary tree
is a system of ducts draining bile from the liver into the duodenum
(an initial segment of the small bowel). Bile is a dark yellow
liquid which helps in digestion of fat. Gallbladder is a small organ
connected to the biliary tree, and it serves as a storage container
for bile. Pancreatic ducts drain the juice produced by the pancreas
into the duodenum. Pancreatic ducts is connected to the biliary
tree. Pancreatic juice contains substances which are essential for
digestion of food in the small bowel.
ERCP is used primarily to diagnose and treat
diseases of the biliary tree and pancreatic
ducts, including gallstones, inflammatory strictures (narrowing of
the ducts), leaks (from injury or surgery), and cancer. ERCP
combines the use of X- rays and an endoscope, which is an instrument
similar to the one used for EGD and colonoscopy. Through the
endoscope, the physician can see the inside of the stomach and
duodenum, and can inject dyes into the ducts of the biliary tree and
pancreas so they can be seen on X-rays.
During the procedure patients are sedated with
intravenous medications. The risks of ERCP are higher than those of
EGD or colonoscopy and include
pancreatitis
(inflammation of the pancreas), bleeding, perforation of the
intestine or biliary tree, and infection.
At least a week prior to ERCP, you should notify
the physician performing the procedure (or his nurse) if taking
medications for diabetes (oral or injectable)
and/or anticoagulants ("blood thinners") such as Coumadin (Warfarin),
Heparin, Lovenox (Enoxaparin), Plavix (Clopidogrel),
Pradaxa (Dabigatran)
or Ticlid (Ticlopidine).
Also, you should notify your physician of taking Aspirin, Ibuprofen,
Advil, Naprosyn, Voltaren, and other similar anti-inflammatory
medications.
For details concerning the
technique and indications for ERCP, as well as risks of the
procedure, please click on this link to the
American
Gastroenterological Association Web
Site.