PROCEDURES AND DIAGNOSTICS
A colonoscopy is an endoscopic procedure that visually examines the entire colon with a videoscope. The inside of the colon is then examined for any abnormalities that may exist. During this procedure, polyps may be safely removed.
WHAT’S A POLYP?
A polyp is extra tissue that grows inside your body. Colon polyps grow in the large intestine. The large intestine, also called the colon, is part of your digestive system. It’s a long, hollow tube at the end of your digestive tract where your body makes and stores stool.
Most polyps are not dangerous. Most are benign, which means they are not cancer. But over time, some types of polyps can turn into colon cancer. Usually, polyps that are smaller than a pea aren’t harmful. But larger polyps could someday become cancer or may already be cancer. To be safe, doctors remove all polyps and test them.
WHY DO I NEED A COLONOSCOPY?
This procedure is commonly performed for evaluation of abnormal radiographic studies, removal of polyps, assessment of bleeding and screening for colon cancer.
Colonoscopy screening is considered to be the “gold standard,” or the most effective colorectal cancer screening test. A long, flexible tube with a tiny camera is used to examine the inside of the colon and rectum, to find and remove polyps or cancer. This test is usually done every 10 years. You should have a colonoscopy screening for colon cancer if you are over the age of 50. For those with a family history of colon cancer, rectal cancer, or polyps screening should begin at age 40.
Colonoscopy is also indicated for patients with inflammatory bowel disease, GI hemorrhage, polyp removal, screening for colon cancer and evaluation of abnormal x-rays of the GI tract.
An alternative exam to assess the colon is the barium enema.
An oral laxative solution is given the day before the procedure. This will cleanse the waste from the colon. It is important that the preparation be followed completely. This procedure examines the inside of the colon. Thus, if feces are retained, or the preparation is inadequate, areas of the colon that may be of importance to your health may be missed or misinterpreted. Usually the preparations given for these are excellent. If you have specific difficulties with laxatives or the preparations, please inform your physician beforehand so that alternatives can be addressed.
Please make sure that your physician knows well beforehand if you are taking any blood thinners. Specific instructions regarding the preparation are available in the section regarding preparations for procedures.
RISKS OF THE PROCEDURE
Colonoscopy is a safe and highly effective technique. In experienced hands, this procedure has the following risks:
Allergic reaction to a medication
Perforation of the Colon
Bleeding can occur up to 10 days after the procedure if polyps are removed. The chance of bleeding will increase depending upon the number, location, and size of polyps (if any) that are removed. Some patients have bleeding from hemorrhoids after the procedure. If any significant or persistent bleeding occurs notify the doctor immediately.
An allergic reaction to a medication rarely can occur. This is usually identified early, since blood pressure, heart rate; oxygen saturation and general clinical condition are monitored during the entire procedure.
Perforation of the colon is a rare complication that occurs when a hole is put through the colon. This can be associated with the removal of polyps or simply passing the endoscope through the colon. This will usually result in a patient being treated in the operating room. Overall, colonoscopy is a well-tolerated procedure that has many benefits and few complications when done for appropriate reasons by an experienced gastroenterologist.
In general, this procedure takes on average 15-30 minutes to perform. The procedure may take longer depending upon the intervention that may be required for any individual patient.
During the procedure, a video endoscope will be inserted into the anus. The scope will then be advanced through the inside of the colon to the cecum (last part of the colon). Inspection, removal of polyps, etc. usually occur during withdrawal of the endoscope.
Patients undergoing this procedure usually receive a combination of intravenous anesthetics. These are usually Demerol (meperidine), Versed (midazolam) or Fentanyl. The exact combination, dose, and frequency of each of these are individualized for each patient. In most cases, patients do not remember their procedure or are adequately sedated such that the discomfort is well tolerated.
During the procedure, the nurse assisting your physician with the procedure will continuously monitor your heart rate, oxygen saturation, and blood pressure. Thus, should any difficulties occur, your physician and his team will be aware of the change quickly.
After the procedure, the physician will discuss the results with the family and/or the patient. In many cases, the patient will not recall having talked with their physician. This is a natural, and understandable, event since some medications used during the procedure will induce temporary amnesia.
After the procedure, patients are returned to a recovery area where they are monitored during their stay for 30 – 60 minutes. When the patient is stable, he or she will be discharged.
Patients must have someone to drive him or her home after conscious sedation (analgesics) has been administered.
Most patients will be lethargic and forgetful during the afternoon after the procedure. During this period of time, someone should be available to check in with the patient to ensure their safety. No driving, complicated or important decisions or alcoholic beverages are allowed on the day of the procedure. By the next morning, most patients are able to continue with their daily activities.
To assist our patients, a written explanation of the procedure and its findings, in lay terms, will be given to the patient. Recommendations will be made regarding any further testing, treatments or office visits.
A copy of the endoscopic record is sent to all our referring physicians. Thus, your primary care physician will be aware of your procedure, the results and your gastroenterologist’s recommendations.
BRAVO PH MONITORING SYSTEM
The Bravo pH Monitoring System is used to investigate and document the pH levels in the esophagus over 24-48 hours in patients with acid reflux type symptoms. This test is performed at the hospital in the GI department. During Upper Endoscopy (EGD), the doctor places a small pH capsule at the base of the esophagus. Please see Upper Endoscopy (EGD) instructions for more information. You will carry a receiver on your waistband. This receiver gathers data of the pH levels in your esophagus during testing. You will be asked to keep a diary log of your symptoms and activities during the 24-48 hours of testing. Since you will be sedated for placement of the capsule, you will need someone to drive you home. You will be sent home after a short recovery time at the hospital. You should resume normal activities as tolerated during the next 24-48 hours. At the end of 24-48 hours, you will be asked to return the receiver and your diary log to the nurses at the hospital at your designated time. No driver is necessary for this visit. The test data will be uploaded to a computer. A report will be printed and sent to the ordering physician for interpretation. The capsule will naturally fall off the wall of your esophagus and pass through your system. You should not have an MRI within 30 days of this test. Patients with pacemakers, implantable defibrillators or neurostimulators should not have a Bravo pH test. Please ask your doctor or nurse if you have any questions.
Your stomach must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours beforehand. You may be asked to stop certain medications for several days prior to your test. Your doctor or nurse will be able to let you know if medications will need to be held. Also, you must arrange for someone to take you home – you will not be allowed to drive until the next day due to the sedatives. Your physician may give you other special instructions.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
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 it, 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. A small catheter with a hot wire is placed through the bile duct and then an 8 to 10 mm cut is made to enlarge the opening. At that point, a balloon catheter or basket is passed in order to retrieve a stone, or a plastic or mesh stent may be placed to relieve remove an obstruction. Also, tissue samples (biopsy) can be taken for further testing, if necessary.
Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. Pancreatitis may occur in up to 5% of cases and more likely if the papilla opening is cut in order to remove gallstones. 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.
Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home–you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.
Kansas Medical Clinic now offers FibroScan® technology – a screening tool for the liver disease.
Examination with FibroScan®, also called transient elastography, is a technique used to assess liver stiffness (measured in kPa correlated to fibrosis) without invasive investigation. The result is immediate, it shows the condition of the liver and allows your provider to diagnose and monitor liver disease progression. Exam results help to anticipate various complications, as well as to monitor and assess the damage caused by conditions such as cirrhosis. The FibroScan® examination is painless, quick and easy. During measurement, you feel a slight vibration on the skin at the tip of the probe.
WHAT DOES THE FIBROSCAN® EXAMINATION CONSIST OF?
You lie on your back, with your right arm raised behind your head. The physician applies a water-based gel to the skin and places the probe with a slight pressure
The examination includes 10 consecutive measurements made at the same location
The result is delivered at the end of the examination, it’s a number which can vary from 1.5 to 75 kPa. Your doctor will interpret the result
WHAT DOES THE RESULT MEAN?
Your physician interprets the result according to your history and underlying disease.
WHO CAN PRESCRIBE THE FIBROSCAN® EXAMINATION?
Your physician or hepatologist will indicate the most appropriate time for you to have the examination.
WHAT DIFFERENCE DOES FIBROSCAN® MAKE TO ME?
Fibroscan® provides immediate results, it’s easy and fast (5-10 minutes)
The exam is painless and non-invasive
In case of close follow-up, the examination can be safely repeated
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 feel better afterward when the air leaves your colon.
The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe, so the physician will probably tell you to drink only clear liquids for 12 to 24 hours beforehand. A liquid diet to means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. The night before, or right before the procedure, you may also be given an enema, which is a liquid solution that washes out the intestines. Your physician may give you other special instructions.
HELICOBACTER PYLORI BREATH TEST
The Helicobacter Pylori Breath Test is a non-invasive procedure that enables the physician to test for the presence of helicobacter pylori bacteria in the stomach. The test is performed at KMC Gastroenterology by trained nursing personnel.
This procedure is intended for patients who have previously tested positive for helicobacter pylori bacteria and are still experiencing recurring symptoms after antibiotic therapy.
The patient ingests a small capsule. After 7-10 minutes, the patient inflates a mylar balloon and the breath sample is analyzed by machine. The test takes approximately 10-15 minutes total and results are often available on the day of the exam.
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, infection, tumors, 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 remove samples of tissue (biopsy) for further tests or treat bleeding abnormalities.
Possible complications of upper endoscopy include bleeding, perforation, or mild sore throat. However, such complications are rare. The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 30 to 60 minutes, or until the medication wears off.
Your stomach and duodenum must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours beforehand. Also, you must arrange for someone to take you home–you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.