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GI Procedures

48 Hour pH test 3 tests are used to measure reflux of material, particularly acid, from your stomach into your esophagus: What is the 48-hour esophageal pH monitoring test? An esophageal pH test measures how often and for how long

Abdominal CT Scan What is an abdominal/pelvic CT scan? The abdominal and pelvic CT scan is used to assist in the detection of (amongst other diagnoses): Cause of fever, abdominal pain or swelling Hernias Masses and tumors, including cancer Infections

Abdominal MRI What is an abdominal MRI? A magnetic resonance imaging scan that uses powerful magnets and radio waves to create pictures of the inside of the belly area. It does not use radiation- x-rays. Why is the abdominal MRI

Abdominal X-ray What is an abdominal x-ray? A test to look at the organs in the belly area, like the spleen, stomach and intestines. Why is the abdominal x-ray performed? This test is used to diagnose pain in the abdomen

Anorectal Manometry What is anorectal manometry? Anorectal manometry is a test to evaluate rectum and the anal canal. It is one of the tests used for evaluation of constipation and fecal incontinence. This test measures the pressures of the anal

Band Ligation What is band ligation of esophageal varices? Endoscopy band ligation is used to treat enlarged veins in the esophagus, the tube connecting the throat to the stomach. If left untreated esophageal veins (varices) can spontaneously rupture and cause

Barium Enema What is a Barium enema? Barium enema is an x-ray of the large intestine that includes the colon and rectum. It was used more commonly before colonoscopies became available. This test is occasionally used to help the doctor

Capsule Endoscopy (PillCam™) What is a capsule endoscopy?Capsule endoscopy is a procedure with a camera that sits inside vitamin-sized capsule. The capsule is swallowed and travels through your digestive tract taking pictures that are transmitted to a recorder that you

Colonoscopy What is colonoscopy?Colonoscopy is a procedure used to see inside the colon and rectum, used to detect inflamed tissue, ulcers and abnormal growths. A colonoscopy also looks for early signs of colorectal cancer and can be used to diagnose

Spyglass What is SpyGlass®? The SpyGlass® system is a recently developed, well-validated method for performing cholangioscopy, the direct visual examination of the bile ducts. It is used in conjunction with Endoscopic Retrograde Cholangiopancreatography (ERCP). While ERCP provides diagnostic imaging of

Endoscopic Retrograde Cholangiopancreatography (ERCP) What is endoscopic retrograde cholangiopancreatography (ERCP)? ERCP is an endoscopic procedure used to take radiographic pictures of the Bile duct, pancreas and gall bladder. Treatment can also be done at the same time. When is the

Endoscopic Ultrasound What is Endoscopic ultrasound (EUS)?EUS is a minimally invasive endoscopic procedure that allows the doctor to see detailed images of the esophagus, stomach, pancreas, bile ducts or rectum to provide additional information obtained from CT or MRI. An

Balloon dilation Narrowed (strictured) parts in the GI tract may benefit from getting stretched and re-opened. Strictures may occur for many reasons and anywhere in the digestive system, such as the esophagus (food pipe) from excessive acid reflux. During an

Transoral Incisionless Fundoplication (TIF) What is Transoral Incisionless Fundoplication (TIF)? Transoral Incisionless Fundoplication is an endoscopic treatment designed to relieve symptoms of acid reflux (heartburn) and gastroesophageal reflux disease (GERD). TIF is one way to relieve GERD without the need

Flexible Sigmoidoscopy What is flexible sigmoidoscopy?Flexible sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum. It is used to look for cancer, changes in bowel habits, abdominal pain or bleeding, inflamed tissue, abnormal growths and ulcers.

Liver Biopsy What is a liver biopsy?A small piece of the liver (vital organ that fights infection and helps digest food) is removed and examined for signs of damage or disease. When is a liver biopsy performed?When a liver problem

Endoscopic Sleeve Gastroplasty What is Endoscopic Sleeve Gastroplasty? Endoscopic Sleeve Gastroplasty is a weight loss procedure that uses a suturing device to make the stomach smaller and shorter, helping the patient lose weight by limiting how much they can eat.

Percutaneous Endoscopic Gastrostomy What is percutaneous endoscopic gastrostomy (PEG)? Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure used to help those unable to take food in via the mouth. A feeding tube is placed in the abdomen. A gastrostomy is

Upper Gastrointestinal Endoscopy What is upper gastrointestinal (GI) endoscopy?Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to view inside the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine.

Abdominal CT Scan

What is an abdominal/pelvic CT scan?

The abdominal and pelvic CT scan is used to assist in the detection of (amongst other diagnoses):

  • Cause of fever, abdominal pain or swelling
  • Hernias
  • Masses and tumors, including cancer
  • Infections or injury
  • Kidney stones
  • Appendicitis
  • Disorders of the female organs

How do you prepare for the abdominal CT scan test?

No eating or drinking 4 to 6 hours before the test.  A special dye, called contrast, helps certain areas show up better on the x-rays.  The contrast is given through a vein (IV) in your hand or forearm. You may feel a slight burning sensation, a metallic taste in the mouth and a warm flushing of the body, all which are normal and usually go away within a few seconds. Additional contrast is given by mouth so the radiologist can tell the bowel from other structures.

Make sure to tell your doctor if you have ever had a reaction to contrast or shellfish, or if you are taking diabetes medications, or if you have kidney problems, as the technique of the scan may need to be changed to prevent adverse reactions and complications.

How is the abdominal CT scan test performed?

You will lie on a table in the center of the CT scanner with your arms raised above your head.  The machine’s x-ray beam will rotate around you. You may be asked to hold your breath for short periods of time while images of your belly area are taken.  The scan usually takes 30 minutes.

Abdominal MRI

What is an abdominal MRI?

A magnetic resonance imaging scan that uses powerful magnets and radio waves to create pictures of the inside of the belly area. It does not use radiation- x-rays.

Why is the abdominal MRI performed?

An MRI can determine normal tissue versus tumors and is also used to verify results from previous x-rays for the following:

  • Cancer and tumors
  • Blood flow or vessels in the abdomen
  • The cause of abdominal pain or swelling
  • The cause of abnormal blood test results, such as liver or kidney problems
  • To look for gallstones in the bile ducts and to detect for certain pancreatic problems

How is the test performed?

The test will take 30-60 minutes and is not painful. A special dye may be given before the test through a vein (IV) in your hand or forearm so the radiologist can see areas more clearly.  Some tests do not require dye.

How do you prepare for the test?

No eating or drinking 4 to 6 hours before the scan. Because the MRI contains strong magnets, metal objects are not allowed into the room with the MRI scanner so you must tell your doctor prior to the test if you have:

  • Brain aneurysm clips
  • Certain types of artificial heart valves
  • Heart defibrillator or pacemaker
  • Inner ear (cochlear) implants
  • Kidney disease or dialysis (you may not be able to receive contrast)
  • Recently placed artificial joints
  • Certain types of vascular stents
  • Worked in a profession where metal splinters or other metal objects may still remain in your body
  • Tattoos or metallic ink

Abdominal X-ray

What is an abdominal x-ray?

A test to look at the organs in the belly area, like the spleen, stomach and intestines.

Why is the abdominal x-ray performed

This test is used to diagnose pain in the abdomen or unexplained nausea. It can also identify urinary tract problems like kidney stones or blockages in the intestine.

How the abdominal x-ray performed

In a radiology department or where x-rays are taken while lying on your back, side or standing up.

How do you prepare for the abdominal x-ray?

Inform your doctor if you are pregnant, have an IUD inserted, have had a barium x-ray or taken medications like Pepto Bismol in the last 4 days.

Risks

There is low radiation exposure so the risks are low compared to the benefits.

Anorectal Manometry

What is anorectal manometry?

Anorectal manometry is a test to evaluate rectum and the anal canal. It is one of the tests used for evaluation of constipation and fecal incontinence. This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal evacuation of bowel movements.

How do I prepare for the procedure?

You will need to fast for at least two hours before the test and give yourself an enema.

How does the procedure work?

It takes about 30 minutes. You will lie on your side while a small, flexible tube with a balloon attached is inserted into the rectum. The small balloon is inflated in the rectum to assess the normal reflex pathways.

What are the risks of Anorectal Manometry testing?

Anorectal manometry is a safe, low risk procedure and is unlikely to cause any pain. Complications are rare but in some cases perforation (tearing) or bleeding of the rectum could occur.

Band Ligation

What is band ligation of esophageal varices?

Endoscopy band ligation is used to treat enlarged veins in the esophagus, the tube connecting the throat to the stomach. If left untreated esophageal veins (varices) can spontaneously rupture and cause severe bleeding.

How is band ligation performed?

The procedure is performed during an upper gastrointestinal endoscopy. A local anesthetic is given to numb the throat and sedation medication will also be given through IV to help you relax/sleep through the procedure.

A scope is placed in the mouth down to the esophagus. When varices are found, tiny elastic bands are placed around the enlarged veins in the esophagus to tie them off so they can’t bleed. The banded varices are then eventually sloughed after a few days and the esophagus is much less likely to bleed after it’s healed.

Barium Enema

What is a Barium enema?

Barium enema is an x-ray of the large intestine that includes the colon and rectum. It was used more commonly before colonoscopies became available. This test is occasionally used to help the doctor diagnose certain problems of the large intestine.

How is the test performed?

The colon must be completely empty (your doctor will give you instructions prior to the test) and the test is performed at a radiology department.

During the test the patient lies flat on their back and on their sides for x-rays to be taken.

A small, well-lubricated enema tube is inserted into the rectum. The tube is connected to a bag that holds a liquid containing barium sulfate. The liquid helps highlight specific areas in the body under x-ray. The barium flows into your colon, x-ray pictures are taken, and the barium fluid then eventually passes out of your body with your stools.

The doctor will monitor the flow of the barium inside your colon via monitor on an x-ray fluoroscope screen. There are two types of barium enemas:

  • Single contrast-highlights your large intestine.
  • Double contrast-delivers air into the colon to expand it allowing for even better images


After the pictures have been taken you will be given a bedpan or helped to the toilet to empty your bowels and remove the barium.

How do you prepare for the test?

You must completely empty your bowels before the exam by enema or laxatives combined with a clear liquid diet

How does the test feel?

When barium enters your colon, you may feel like you need to have a bowel movement. A feeling of fullness, moderate to severe cramping and general discomfort is normal. Take deep breaths during the procedure to help you relax.

What are the risks?

The test involves low radiation exposure so the risks are low compared to the benefits, however a few of the very rare risks include possible perforation and abdominal gas and bloating.

Capsule Endoscopy (PillCam™)

What is a capsule endoscopy?

Capsule endoscopy is a procedure with a camera that sits inside vitamin-sized capsule. The capsule is swallowed and travels through your digestive tract taking pictures that are transmitted to a recorder that you wear on your belt or waist.

Why is the capsule endoscopy procedure used?

If other imaging tests were unuseful or unclear your doctor may recommend a capsule endoscopy as a follow up to test for:

  • Gastrointestinal bleeding of the upper GI tract and small intestine
  • Crohn’s disease
  • Cancer of the upper GI tract and small intestine
  • Celiac disease
  • Polyps of the upper GI tract and small intestine
  • The camera capsule endoscopy does not evaluate the colon (large intestine).

How to prepare for your capsule endoscopy?

No eating at least 12 hours before your capsule endoscopy and stop taking certain medications. Discuss all preparations for the procedure with your doctor or nursing staff. Be sure your doctor knows if you have a pacemaker, swallowing disorder, or stricture of the small bowel as these may be relative contraindications to routine capsule testing.

What happens after the capsule endoscopy?

  • 2 hours after-resume drinking clear liquids
  • 4 hours after-light lunch or snack
  • 8 hours after-or when you see the capsule in the toilet (which ever comes first), you don’t need to collect the capsule from the toilet it will safely flush. However, follow your doctor’s instruction for packing the antenna and recorder.

What are the risks?

The test involves low radiation exposure so the risks are low compared to the benefits, however a few of the very rare risks include possible perforation and abdominal gas and bloating.

Colonoscopy

What is colonoscopy?

Colonoscopy is a procedure used to see inside the colon and rectum, used to detect inflamed tissue, ulcers and abnormal growths. A colonoscopy also looks for early signs of colorectal cancer and can be used to diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus and weight loss. It is most often used to find and remove precancerous tissue (polyps) in order to prevent colon cancer.

What are the colon and rectum?

The colon and rectum are the two parts of the large intestine; the two terms are often used interchangeably. The large intestine is also sometimes called the large bowel. Digestive waste enters the colon from the small intestine as a semisolid or liquid. As waste moves toward the anus, the colon removes moisture and forms solid stool. The rectum is about 6 inches long and connects the colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus control bowel movements.

How do you prepare for a colonoscopy?

All solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Acceptable liquids include: fat-free bouillon or broth, strained fruit juice, water, plain coffee, plain tea, sports drinks, such as Gatorade or gelatin.

A laxative or an enema may be required the night before colonoscopy to ensure your gastrointestinal tract is emptied. Your physician will order a variety of bowel preparations designed to completely empty your colon of waste before the colonoscopy.

How is a colonoscopy performed?

During colonoscopy, patients are sedated. While lying on your left side on an examination table a long, flexible, lighted tube called a colonoscope, is inserted into the anus and slowly guided through the rectum and into the colon. The scope inflates the large intestine with air to give the doctor a better view. Images are transmitted from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The lower small bowel is frequently seen as well.

During a colonoscopy the doctor removes abnormal looking tissues and also removes polyps to test for signs of pre-cancer or cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.

It usually takes 30 minutes or less and cramping or bloating may occur during the first hour after the procedure. The sedative rapidly wears off. Patients may need to remain at the facility for 30 minutes after the procedure for recovery.

At what age should routine colonoscopy begin?

Routine colonoscopy should begin at age 50 for most people (45 for African Americans), earlier if there is a family history of colorectal cancer, personal history of inflammatory bowel disease, obesity, smoking or certain higher risk groups such as African Americans.

Spyglass

What is SpyGlass®?

The SpyGlass® system is a recently developed, well-validated method for performing cholangioscopy, the direct visual examination of the bile ducts. It is used in conjunction with Endoscopic Retrograde Cholangiopancreatography (ERCP). While ERCP provides diagnostic imaging of the bile and pancreatic duct, SpyGlass® enables the endoscopist to get a better visualization of the bile ducts and obtain a better sample of any suspicious lesions or tumors. The procedure also allows for fragmentation of bile or pancreatic duct stones using lasers or other methods.

What happens during the SpyGlass® procedure?

The SpyGlass® instrument is attached to the standard ERCP equipment and is performed during the ERCP procedure. Preparation and recovery for this procedure are the same as with ERCP. The duration of the procedure is longer, however.

 

Biliary Radiofrequency Ablation

What is Biliary Radiofrequency Ablation (RFA)?

Biliary Radiofrequency Ablation (RFA) is done during ERCP and targets malignant biliary strictures that are deemed inoperable, even if there is a prior metal biliary stent. This can occur when the bile ducts (which transport bile from the liver to the small intestine to help with digestion) get smaller, causing a buildup of bile. This leads to difficulty in digesting food, especially fatty foods and can affect absorption of vitamins A, D, E and K. Biliary RFA helps open the bile ducts.

How is Biliary RFA performed?

The patient will undergo an upper GI endoscopy to identify the location of the malignancy. The doctor will then choose the appropriate ablation catheter for the treatment. During Biliary RFA, the endoscopist applies heat to the tissue via electric current, locally destroying the malignant tissue. Radiofrequency ablation can be a safe, effective option for unresectable malignant biliary strictures.

EACP (Antegrade and Rendezvous)

Hepaticogastrostomy I Choledochoduodenostomy

In some cases, the bile ducts are not accessible through regular ERCP, often due to severe stricture or cancer of the bile duct or pancreas. In this situation, patients would typically get tubes placed through the skin into the bile ducts in the liver. The tube is connected to a bag that needs to be periodically emptied in the sink or toilet. These tubes may risk infection, cause pain, leak, and need to be exchanged from time to time. To avoid this, the bile ducts can be accessed internally to avoid external biliary drainage and preserve natural flow of bile. This procedure typically involves using internal endoscopic ultrasound to precisely visualize the internal anatomy and allow placement of a stent for internal drainage. Patients may return to work the day after the procedure.

Cholecystogastrostomy I Cholecystoduodenostomy

When the gallbladder gets infected, it typically needs to be surgically resected. However, patients who are too sick for surgery (like those who have metastatic cancer) or patients who decline surgery, would typically have a tube inserted from the skin into the gallbladder. This tube may be inadvertently pulled, cause pain, leak, get infected and affect quality of life. Instead, the gallbladder can be drained internally by use of endoscopic ultrasound to locate the gallbladder precisely to allow placement of a stent for internal gallbladder drainage.

Photodynamic Therapy and Laser Therapy

During ERCP, biliary duct stones may be encountered. On occasion, the stones are so large that they cannot safely be removed in one piece. A stent in the bile duct might be placed but repeat ERCP may show a persistently large stone. To remove these stones, a specialized technique called Photodynamic therapy and Laser therapy can be used to safely break up the stones and restore normal biliary flow. Patients may return to work the day after the procedure.

Ampullectomy

The ampulla connects the pancreas and bile duct to the small intestine. It serves as a gate that allows digestive enzymes to enter the duodenum (the first part of the small intestine that helps to further digest food) during meals. Precancerous lesions on the ampulla can occur and even block the bile duct, causing jaundice and/or icterus (yellowing of the skin and eyes). In the past, this was typically treated with a major surgery called a Whipple procedure. However, advanced training allows of FDHS third-space endoscopists allows them to remove the ampulla endoscopically. This procedure, called an Ampullectomy, is minimally invasive, provides the physicians greater control and vision during surgery, and allows for a safer, less invasive and more precise treatment.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is endoscopic retrograde cholangiopancreatography (ERCP)?

ERCP is an endoscopic procedure used to take radiographic pictures of the Bile duct, pancreas and gall bladder. Treatment can also be done at the same time.

When is the ERCP procedure necessary?

Usually an ERCP is given for one of these reasons:

  • Abnormal liver test/ Jaundice.
  • Abdominal pain related to pancreas and bile duct.
  • Gallstones
  • Bile duct or pancreatic tumors.

How do you prepare for an ERCP procedure?

Fasting is required, do not eat or drink after midnight prior to the test. Make sure to let your physician know all the medications you are taking especially blood thinners. Antibiotics may be required at the time of the procedure.

How is ERCP performed?

This procedure is done in a hospital setting. Patients are given sedation through IV so there is no discomfort during the procedure. While lying on your abdomen, a small tube is passed through your mouth into the small bowel. Using a small catheter, dye is injected into the bile duct or the pancreatic duct and X rays are taken. During the procedure your physician may decide to obtain biopsies/brushings / remove gallstones or place a stent to drain the bile duct or pancreas.

What is the recovery for the Procedure?

After the procedure it will take about 60 minutes for sedation medication to wear off. Sore throat and bloating are normal right after the procedure. You may be observed for 3-4hrs after the procedure before you are discharged home.

What are the risks of the Procedure?

Risks and benefits have to be evaluated prior to the procedure. Risks include bleeding, infection, pancreatitis (inflammation of pancreas) and rarely perforation (hole in the bowel).

Endoscopic Ultrasound

What is Endoscopic ultrasound (EUS)?

EUS is a minimally invasive endoscopic procedure that allows the doctor to see detailed images of the esophagus, stomach, pancreas, bile ducts or rectum to provide additional information obtained from CT or MRI. An EUS can also be used for taking samples of abnormal tissue using a fine needle.

How is EUS performed?

A thin, flexible tube (endoscope) is passed through the mouth and into the stomach and duodenum or through the rectum. The endoscopes ultrasound probe emits sound waves that pass through the lining of the GI tract, creating an image of the bowel or adjacent organs.

What can I expect from the EUS procedure?

EUS is performed on an outpatient basis; you will be sedated and not allowed to drive after the procedure. It takes about 30 to 45 minutes and recovery time is another 40 minutes.

What are the possible complications associated with EUS?

EUS is a very safe procedure and although complications occur, they are rare when doctors with specialized training and experience perform the EUS examination. You may have a sore throat, which usually resolves within a day or two.

Consult your doctor for all the risks associated with the EUS procedure.

Balloon dilation

Narrowed (strictured) parts in the GI tract may benefit from getting stretched and re-opened. Strictures may occur for many reasons and anywhere in the digestive system, such as the esophagus (food pipe) from excessive acid reflux. During an endoscopy, your doctor will pass a catheter across the narrowing to increase it to the desired size. Patients with a disease called achalasia, a disorder that makes it difficult for food and liquid from the esophagus into your stomach, may need more aggressive dilation called pneumatic dilation.

Stenting (esophageal, gastric, duodenal, colonic)

Stents are cylinder-shaped metal tubes that are placed across a blockage in the GI tract. The stents come in different sizes and lengths, and allows your digestive system to resume normal transit of food and liquids. These stents can be placed anywhere in the digestive tract (esophagus, stomach, small intestine, and large intestine). Reasons why these stents might be placed is for: Esophageal cancer patients who cannot swallow, lung cancer that is compressing the esophagus, post-operative leaks, pancreatic cancer that blocks the small intestine and colon obstruction from cancer).

EUS-guided liver biopsy

When liver enzymes are abnormal and blood tests may are not conclusive, your doctor may want to obtain a piece of liver tissue to analyze under the microscope. This typically helps pinpoint the cause o the problem. This is typically done with the patient awake; a needle is inserted through the skin and into your liver (percutaneous liver biopsy). With advanced training, this can now be done through endoscopy while the patient is fully sedated and asleep. Tissue obtained has been shown to be equal to a percutaneous liver biopsy. This is a great option for patients who already need an upper endoscopy to assess other digestive structures. Patients may return to work the day after the procedure.

Transoral Incisionless Fundoplication (TIF)

What is Transoral Incisionless Fundoplication (TIF)?

Transoral Incisionless Fundoplication is an endoscopic treatment designed to relieve symptoms of acid reflux (heartburn) and gastroesophageal reflux disease (GERD). TIF is one way to relieve GERD without the need for invasive surgery, and fundoplication refers to manipulating the lining of the stomach and esophagus to restore the body’s natural protection against acid in the esophagus.

What happens during a TIF procedure?

During a TIF procedure, the endoscope is fed through a special TIF device that allows the endoscopist to reconstruct the anti-reflux valve between the stomach and the esophagus (the body’s natural barrier to reflux). It requires no incision and leaves no scar. Results are rapid and patients generally can resume normal activities within a few days.

ARMS (anti-reflux mucosectomy)

In reflux disease (for example, GERD), the bottom of the esophagus is too loose and allows too much food and fluid to reflux into the esophagus causing heartburn, regurgitation, damage, ulcers and even precancerous changes in the esophagus. An ARMS procedure removes the mucosa at the junction between the bottom of the esophagus and top of the stomach. Patients may return to work the day after the procedure.

pH-Impedance testing and Bravo pH testing

The esophagus is a complex organ that requires specialized tests. The 24-hour pH impedance tests to see if the patient has reflux disease (GERD). This involves a flexible and small catheter inserted into your nose to reach the stomach. The 48-hour Bravo pH testing involves endoscopically placing a capsule into the lower esophagus to measure if reflux and the degree of acidity.

Esophageal Manometry

Patients with difficulty or pain swallowing or chest pain not related to the heart be referred for a “motility study.” Esophageal manometry is a test that allows us to measure how the patient’s esophagus is contracting, how much, and how often. Patients must be awake for this procedure.

EndoFLIP (Endolumenal functional lumen imaging probe)

EndoFLIP is a new technique that measures the area across the lower esophagus and the pressure inside of it. The ratio is measured and called distensibility (or stiffness). During an upper endoscopy, the patient is sedated and the endoscopist will place the catheter across the lower esophagus and into the stomach. The balloon is inflated with water and pressure measurements are taken. The procedure is typically 10-15 minutes long. This is a great alternative when patients need an esophageal manometry test but cannot tolerate it or decline to do it from discomfort.

FilmArray

The FilmArray is a PCR test that detects gastrointestinal pathogens including viruses, bacteria and parasites that cause infectious diarrhea. (PCR stands for polymerase chain reaction, which detects genetic material from a specific organism – such as a virus.) This is an at-home stool test that may be ordered by your gastroenterologist to further assist with diagnosis and treatment of a GI illness. After you complete the test and it is reviewed by our FDHS Pathology Department, your provider will contact you with results of the test.

Process

If your provider orders a FilmArray test, you will be given the FilmArray test kit at the office for you to take home and complete. It’s important that you complete the collection and send the kit via FedEx as soon as possible. There is a short window of time after collection that the specimen can be accurately reviewed.

Esophageal Manometry

Patients with difficulty or pain swallowing or chest pain not related to the heart be referred for a “motility study.” Esophageal manometry is a test that allows us to measure how the patient’s esophagus is contracting, how much, and how often. Patients must be awake for this procedure.

FedEx Delivery Instructions

Specimens must be collected and mailed (or dropped off) to FedEx ASAP. As noted in the Patient Instructions, there is a preaddressed/prepaid FedEx ClinPak mailing envelope in the FilmArray kit.

Call 1-800-GO-FEDEX to schedule a pick-up or drop the completed kit off at your nearest FedEx drop-off.

Please send by end of day Thursday. Do NOT send on Friday or the weekend.

*Please complete this step ASAP to avoid having to repeat sample collection*

Flexible Sigmoidoscopy

What is flexible sigmoidoscopy?

Flexible sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum. It is used to look for cancer, changes in bowel habits, abdominal pain or bleeding, inflamed tissue, abnormal growths and ulcers.

What is the sigmoid colon?

The sigmoid colon is the last one-third of the colon. The colon absorbs nutrients and water and forms solid stool.

What is the rectum?

The rectum is about 6 inches long and connects the sigmoid colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus help control bowel movements.

How is flexible sigmoidoscopy different from colonoscopy?

A colonoscopy shows the entire colon where the flexible sigmoidoscopy only shows the last third of the colon at best.

How do you prepare for a flexible sigmoidoscopy?

Before the test a clear liquid diet 1 to 3 days before the procedure must be followed so that the entire gastrointestinal tract is emptied. A laxative or an enema may also be required the night before a flexible sigmoidoscopy to ensure all solids are removed.

How is a flexible sigmoidoscopy performed?

During the examination you will lie on your left side while a long, flexible, lighted tube called a sigmoidoscope is inserted into the anus. The procedure normally takes about 20 minutes. Cramping and bloating are normal and may occur during the first hour after the procedure.

Liver Biopsy

What is a liver biopsy?

A small piece of the liver (vital organ that fights infection and helps digest food) is removed and examined for signs of damage or disease.

When is a liver biopsy performed?

When a liver problem is difficult to diagnose with blood tests or imaging, a liver biopsy is performed.

How is a liver biopsy performed?

There are three main types of liver biopsies used at outpatient facilities and hospitals.

  • Percutaneous liver biopsy: This is the most common technique for collecting a liver sample.  A hollow needle is inserted through the abdomen into the liver to remove a small piece of tissue.  This may be performed with the aid of radiographic imaging such as CT scan to guide the biopsy.
  • Transvenous liver biopsy: This method is used when a person’s blood clots slowly or when excess fluid is present in the abdomen.  A small incision is made in the neck and a specially designed hollow tube called a sheath is inserted into the jugular vein. The doctor threads the sheath down the jugular vein (along the side of the heart) and into one of the hepatic veins where the liver is located.
  • Laparoscopic liver biopsy: A tissue sample is obtained from a specific area or from multiple areas of the liver with special tools to pass through the incisions.

How long does it take to recover from a liver biopsy?

Most patients fully recover from a liver biopsy in 1 to 2 days. Patients should avoid intense activity, exercise, or heavy lifting during this time.

Endoscopic Sleeve Gastroplasty

What is Endoscopic Sleeve Gastroplasty?

Endoscopic Sleeve Gastroplasty is a weight loss procedure that uses a suturing device to make the stomach smaller and shorter, helping the patient lose weight by limiting how much they can eat. The procedure is minimally invasive and incisionless, which reduces risks and allows the patient to return to daily activities more quickly.

Like other weight-loss procedures, Endoscopic Sleeve Gastroplasty requires permanent, healthy changes to ensure its long-term success.

What happens during the Endoscopic Sleeve Gastroplasty procedure?

Endoscopic sleeve gastroplasty can be performed as an outpatient procedure and general anesthesia is used. The endoscopist uses a suturing device attached to an endoscope to access the stomach, allowing for an incisionless procedure. The physician then places sutures in the stomach to change structure of the stomach, restricting the stomach volume and limiting the amount of food the patient can consume.

Who is a candidate for Endoscopic Sleeve Gastroplasty?

This procedure may be an option if the patient has a body mass index of 30 or more, and diet and exercise changes have been unsuccessful. This can also be an option for patients who need surgery for other reasons, including weight loss, but are too sick for surgery. Patients can expect about 20 percent weight loss with this procedure.

Endoscopic Sleeve Gastroplasty does not use surgical incisions. Most patients return home the same day and can resume daily activity one to three days after the procedure. Patients can expect a full recovery after four weeks.

Having an Endoscopic Sleeve Gastroplasty does not exclude you from having bariatric surgery. This procedure can be done in patients who have prior sleeve, whether it was done surgically or endoscopically. Tightening of the stomach can also be done endoscopically in patients who have had Roux-en-Y gastric bypass surgery. Patients may return to work the day after this procedure as well.

Endoscopic Balloon Placement

What is Endoscopic Balloon Placement (also known as intragastric balloon)?

Endoscopic Balloon Placement (intragastric balloon) is a weight loss procedure that aims to reduce the amount of food consumed by increasing the feeling of being full. This is achieved through a minimally invasive procedure.

What happens during the Endoscopic Balloon Placement procedure?

During the procedure, the endoscopist inserts a soft yet durable, saline-filled balloon into the stomach via endoscopy. This method is designed to jump-start the weight loss process, and the balloon will be removed from the stomach after six months. Most of the weight is lost during the first four months of treatment, and patients lose an average of 15 percent of their body weight during the six-month placement.

What is the recovery time?

Some discomfort during the first few days after the procedure is common, however, this should dissipate if you follow the portion size recommendations provided by your gastroenterologist. You may be able to feel the balloon when you gently press down on your stomach.

Percutaneous Endoscopic Gastrostomy

What is percutaneous endoscopic gastrostomy (PEG)?

Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure used to help those who are unable to take food in via the mouth. A feeding tube is placed in the abdomen. A gastrostomy is the surgical opening in the stomach where the endoscope is passed to help with placing and securing the tube.

What is the purpose of percutaneous endoscopic gastronomy?

The purpose of a percutaneous endoscopic gastronomy is to help feed those that can’t swallow food. The percutaneous endoscopic gastronomy provides fluids, nutrition and medications directly into the stomach.

How is percutaneous endoscopic gastronomy done?

Local anesthesia is given to anesthetize the throat then an endoscope is passed through the mouth, throat and esophagus into the stomach.

A small incision is made in the abdomen and a needle is pushed through the skin and into the stomach. The tube for feeding is then pushed through the needle and into the stomach. Lastly, the tube is secured with a bumper against the skin.

Peroral Endoscopic Myotomy (POEM)

What is POEM?

POEM (Peroral Endoscopic Myotomy) is an endoscopic procedure used to treat swallowing disorders, most commonly Achalasia, a rare disorder that makes it difficult for liquid and food to pass into the stomach. POEM is a minimally invasive procedure that provides long-term relief of symptoms, allowing patients to eat and drink without discomfort. Patients remain in the hospital overnight and are generally sent home the next day.

What happens during the POEM procedure?

During the procedure, the endoscopist creates a small tunnel in the esophagus to target the muscle fibers of the lower esophageal wall and the point of connection between the stomach and the esophagus. This process helps permanently relax the tight esophageal muscles and open areas of the esophagus that have narrowed.

Zenker’s Peroral Endoscopic Myotomy (Z-POEM)

What is Z-POEM?

Z-POEM is an adaptation of POEM for achalasia that is used to treat Zenker’s diverticulum. Zenker’s diverticulum is a pouch that forms at the back of the throat, where the esophagus and pharynx meet. The cause is unknown but could result from increased pressure in the esophagus that causes the muscles to tear or malfunction. Eventually, a pocket forms in the throat and can lead to serious complications including trapped food, dysphagia (difficulty swallowing), weight loss and inhalation of gastric contents into the lower respiratory tract.

What happens during the Z-POEM procedure?

The Z-POEM procedure involves cutting the narrow band of muscle between the pharynx and esophagus, which helps the pouch flatten out and returns the esophageal wall to its normal state. Once the procedure is complete, the entry site is closed with clips. Patients remain in the hospital overnight and are generally released the following day after ensuring there is no leakage. Complications are rare and Zenker’s diverticulum symptoms generally completely resolve after three months.

Gastric Peororal Endoscopic Myotomy (G-POEM)

What is Gastric Peroral Endoscopic Myotomy (G-POEM)?

Gastric Peroral Endoscopic Myotomy (G-POEM) is an innovative way to treat patients with gastroparesis using endoscopy. Gastroparesis is a debilitating disorder, with limited treatment options, that paralyzes the stomach and slows or stops digestion entirely. Symptoms of gastroparesis can include severe vomiting, bloating, abdominal pain, malnutrition and dehydration.

 

What happens during the G-POEM procedure?

The endoscopist will use a thin, flexible endoscope to access the patient’s stomach. Then, they will make an incision and create a tunnel between the layers of the stomach to reach the pyloric muscle (the pylorus contracts when food and liquid need to get digested in the stomach, then opens to let food and liquid pass into the small intestine. In patients with gastroparesis, this mechanism is delayed or halted altogether). Once the channel is created, the endoscopist makes an incision on the muscle to create an opening for food to pass freely into the small intestine.

G-POEM can significantly improve patients’ symptoms and quality of life.

Endoscopic Mucosal Resection (EMR)

What is Endoscopic Mucosal Resection (EMR)?

Endoscopic Mucosal Resection, also known as EMR, is a highly specialized procedure to remove or resect early-stage cancers, precancerous tissue or other abnormal cells from the lining of the digestive tract including the esophagus, small intestine, stomach and colon. EMR can help diagnose the stage of growth and remove diseased tissue, ideally eliminating the need for more invasive surgeries.

What happens during the EMR procedure?

An EMR procedure is performed using an endoscope, a long, flexible instrument about 1/2 inch in diameter. The tip of the endoscope is equipped with a lens and a light source, allowing for close inspection of the tissue. Through the endoscope, instruments are then used to lift and remove the lesion.

Patients are generally discharged the same day of the procedure, and rarely need pain medications and/or an oral numbing solution. Patients may return to work the day after the procedure, although a modified diet is often recommended for the first few days after the procedure to allow for healing.

What conditions are treated by EMR?

Your gastroenterologist may recommend EMR if you have any of the following:

  • Barrett’s esophagus with high grade dysplasia or superficial esophageal adenocarcinoma (a type of esophageal cancer)
  • Stomach polyps or masses
    Polyps or masses on the duodenum (part of the small intestine)
  • Colon or rectal polyps

Endoscopic Submucosal Dissection (ESD)

What is Endoscopic Submucosal Dissection (ESD)?

Endoscopic Submucosal Dissection (ESD) is a minimally invasive, advanced procedure that completely removes cancerous lesions from GI tract without removing the organ involved, allowing patients to recover faster and maintain quality of life.

 

What happens during an ESD?

ESD is performed by endoscopically marking the boarders of the lesion. A fluid is injected into the lining of the GI tract tissues to elevate the lesion. The lesion then then removed completely, typically in a single piece.

What is the difference between EMR and ESD?

ESD is usually used for larger tumors that have a high likelihood of aggressive cancer invading the other submucosa tissue and for lesions that can’t be removed by EMR due to scarring or damage. EMR is beneficial for most pre-cancerous lesions, is simpler to perform and uses a smaller number of devices. The main disadvantage of EMR is that fragmentary resection (cutting out tissue) is required for larger lesions. As a result, some patients who are treated with EMR may require additional surgery. EMR also carries a higher recurrence rate than ESD. ESD allows for complete removal of lesions regardless of size, which provides a recurrence rate of less than one percent. However, ESD is requires specialized training as it is technically more demanding and is a longer procedure.

 

Submucosal Tunneling with Endoscopic Resection (STER)

What is Submucosal Tunneling with Endoscopic Resection (STER)?

Submucosal Tunneling with Endoscopic Resection (STER) is a procedure used to treat gastrointestinal smooth muscle tumors, previously known as gastrointestinal leiomyoma or gastrointestinal stromal tumors. These tumors form in the deep muscle layer of the GI wall and are covered by mucous membrane. They can have malignant potential.

What happens during the STER procedure?

The endoscopist creates a tunnel between the mucosa and the smooth muscle, resecting the small muscle tumor in the channel while maintaining the mucosal covering. This method is an effective way to remove these types of difficult tumors with little trauma and fewer complications for the patient. This is an outpatient procedure and patients are typically discharged home the same day.

Endoscopic Full Thickness Resection (EFTR)

What is Endoscopic Full Thickness Resection (EFTR)?

Endoscopic Full Thickness Resection, or EFTR, is a minimally invasive procedure to remove cancerous tissue penetrating the deeper layers of the submucosa or deep muscle of the GI tract. “Full thickness” refers to how much of the GI wall is removed. With procedures like EMR and ESD, only the superficial layers may be removed. EFTR, on the other hand, aims to resect deeper tissues to ensure complete tumor removal.

EFTR is typically an outpatient procedure, and many patients return home the next day. Patients who undergo EFTR generally have faster recoveries than those who undergo more invasive surgery.

What happens during the EFTR procedure?

There are many existing EFTR techniques and devices that the endoscopist may choose to use depending on the case. EFTR requires advanced training and technique.

Upper Gastrointestinal Endoscopy

What is upper gastrointestinal (GI) endoscopy?

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract that includes the esophagus, stomach, and duodenum—the first part of the small intestine.

What problems can upper GI endoscopy detect?

  • Ulcers
  • Abnormal growths
  • Precancerous conditions such as Barrett’s esophagus
  • Esophageal strictures
  • Inflammation such as gastritis
  • Hiatal hernia

When is upper GI endoscopy used?

An upper GI endoscopy is used to biopsy the tissue in the upper GI tract by removing a small piece of tissue to examine with a microscope. This procedure helps determine the cause of symptoms like abdominal pain, nausea or vomiting, reflux, weight loss and bleeding. It is frequently used to diagnose the cause of swallowing difficulties.

Upper GI endoscopy can also be used to remove objects like food, and to treat conditions such as bleeding ulcers.

How to Prepare for Upper GI Endoscopy

No eating or drinking 8 hours before the procedure. Also avoid smoking and gum chewing. Some medications and vitamins may be prohibited so tell your doctor about all of your health conditions before your upper GI endoscopy. You will be sedated for this procedure so driving is not permitted for 12 to 24 hours after an upper GI endoscopy.

How is upper GI endoscopy performed?

Patients are sedated to numb the throat and calm the gag reflux. Then an endoscope with a small camera is fed down the esophagus into the stomach and duodenum. A video image is transmitted to a monitor to view the intestinal lining. During the upper GI endoscopy air is pumped through the endoscope to inflate the stomach making it easier to see. The doctor can also use special tools during the procedure to perform biopsies, stop bleeding and to remove abnormal growths.

48 Hour pH test

3 tests are used to measure reflux of material, particularly acid, from your stomach into your esophagus:

What is the 48-hour esophageal pH monitoring test?

An esophageal pH test measures how often and for how long stomach acid enters the esophagus (tube from mouth to stomach). The test is used to determine if you have gastroesophageal reflux disease (GERD), which is when stomach contents (particularly acid) backs up into your esophagus. A thin tube with a monitor is inserted through your nose or mouth into your stomach. You will wear this monitor on a strap for two days to track the acidity level, and you will be asked to write down symptoms you experience over that 48-hour period. These will be matched with reflux events detected by the monitor.

What is the Bravo pH test?

This test also measures acid reflux into the esophagus but instead of a tube placed through your nose into the stomach a small sensor is clipped to your esophagus under sedation using endoscopy and measures acidity in a wireless fashion for 48 hours. You will also be asked to keep a diary of your symptoms.

What is the Impedance pH test?

Some reflux is not due to acid and this test, which also involves placing a small catheter through your nose into the esophagus, measures this unusual type of reflux.

Which test is right for me and how do I prepare for it?

Based on your symptoms your gastroenterologist will decide which test will provide the answers he/she needs to decide what treatment you should receive for your reflux symptoms. To prepare for the test you will be asked to avoid eating, drinking or smoking after midnight before the test. It is very important to alert your physician if you have a pacemaker or heart defibrillator or a history of bleeding problems or if you are on blood thinners. Because certain drugs may affect test results, you may be asked to stop taking some medications such as acid suppressants, certain blood pressure medications, alcohol, antacids and corticosteroids.