PROCEDURES

ENDOSCOPY PROCEDURES

Colonoscopy

What is a Colonoscopy?
Colonoscopy is a procedure that enables your physician to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it slowly into the rectum and colon.

What preparation is required?
The colon must be completely clean for the procedure to be accurate and complete. Your physician will give you detailed instructions regarding the dietary restrictions to be followed and the cleansing routine to be used. In general, preparation consists of either consumption of a large volume of a special cleansing solution or several days of clear liquids, laxatives, and enemas prior to the examination. Follow your doctor’s instructions carefully. If you do not, the procedure may have to be canceled and repeated later.
What about my current medications?
Most medications may be continued as usual, but some medications can interfere with the preparation or the examination. It is, therefore, best to inform your physician of your current medications as well as any allergies to medications several days prior to the examination. Aspirin products, arthritis medications, anticoagulants (blood thinners), insulin, and iron products are examples of medications whose use should be discussed with your physician prior to the examination.

What can be expected during colonoscopy?
Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at times during the procedure. Your doctor may give you medication through a vein to help you relax and better tolerate any discomfort from the procedure. You will be lying on your side or on your back while the colonoscope is advanced slowly through the large intestine. As the colonoscope is slowly withdrawn, the lining is again carefully examined. The procedure usually takes 15 to 60 minutes. In some cases, the passage of the colonoscope through the entire colon to its junction with the small intestine cannot be achieved. The physician will decide if the limited examination is sufficient or if other examinations are necessary.

What if the colonoscopy shows something abnormal?
If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

What are polyps and why are they removed?
Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to several inches. The majority of polyps are benign (noncancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer.

How are polyps removed?
Tiny polyps may be totally destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. The doctor passes a wire loop (snare) through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which could require emergency surgery.

What happens after a colonoscopy?
After a colonoscopy, your physician will explain the results to you. If you have been given medications during the procedure, someone must accompany you home from the procedure because of the sedation used during the examination. Even if you feel alert after the procedure, your judgment and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery.

You may have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly with the passage of flatus (gas). Generally, you should be able to eat after leaving the endoscopy, but your doctor may restrict your diet and activities, especially after polypectomy.

What are the possible complications of colonoscopy?
Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One possible complication is a perforation or tear through the bowel wall that could require surgery. Bleeding may occur from the site of biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely, blood transfusions or surgery may be required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may rarely cause a tender lump lasting for several weeks, but this will go away eventually. Applying hot packs or hot moist towels may help relieve discomfort. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain. fever and chills, or rectal bleeding of more than one- half cup. Bleeding can occur several days after polypectomy.
Stomach Problems — Human Colon Section in Tallahassee, FL

Flexible Sigmoidoscopy

Flexible sigmoidoscopy 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 with the use of an endoscope. This examination is typically used to evaluate complaints of rectal bleeding, constipation, diarrhea and pain in the left lower quadrant or pelvis.

It is important for your doctor to have a clear view of your colon during the examination, you will be given instructions from your physician as to the preparation to use prior to the examination.
The examination is a quick procedure with minimal complications. Usually, patients are not sedated for this procedure. During the procedure, you may experience the sensations you feel prior to a bowel movement. You will be asked to 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. The scope has a camera on the distal tip which enables the physician to carefully examine the lining of your colon. If anything unusual is in your rectum or sigmoid colon, such as a polyp or inflamed tissue, the physician can remove a sample using an instrument inserted into the scope. The tissue can then be sent to the lab for evaluation.

Flexible sigmoidoscopy takes 10 to 20 minutes. Flexible sigmoidoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at various times during the procedure and for a short period after the procedure.

Bleeding and puncture of the colon are possible complications of flexible sigmoidoscopy. However, such complications are uncommon.

Most medications can be continued as usual. You should inform your physician if you are taking blood thinners or if you require antibiotics prior to undergoing dental procedures.

Capsule Endoscopy

Small Bowel Capsule Endoscopy

Capsule endoscopy assists in diagnosing gastrointestinal conditions such as bleeding, malabsorption, abdominal pain, tumors, Crohn’s Disease, infectious enteritis, celiac sprue, and drug-induced ulceration. Capsule endoscopy can help your physician determine the cause for recurrent or persistent symptoms such as diarrhea, bleeding or anemia. The physician can also use capsule endoscopy to obtain motility data such as gastric or small bowel passage time, help to evaluate the extent to which your small intestine is involved or monitor the effect of therapy.

The capsule endoscope utilizes a wireless video camera, small enough to swallow, to perform painless endoscopic imaging of the small intestine. Thousands of video images of the gastrointestinal tract are transmitted by sensors attached to the patient’s abdomen. These images are stored on a data recorder worn by the patient and later downloaded onto a computer for viewing by the physician.

Upper GI Endoscopy

Upper endoscopy is a procedure performed to enable your physician to examine the lining of the upper part of your gastrointestinal tract. The upper part of your gastrointestinal tract includes your esophagus, stomach, and duodenum. The upper endoscopy is performed to diagnose and, in some cases, treat problems of the upper digestive system. The procedure is performed using a flexible endoscope. The flexible endoscope is a long, thin, flexible tube with a tiny camera and light on the end. The endoscope projects high-quality pictures on a monitor which enables the physician to carefully examine the inside lining of the upper digestive system.

Why is upper endoscopy done?
The upper endoscopy is performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract.
What preparation is required?
You should have nothing to eat or drink, including water, after midnight the day before your procedure. Your physician will be more specific about the time to begin fasting, depending on the time of day your test is scheduled.

You will need to inform your physician of your current medications as well as any allergies several days prior to the procedure. You need to inform your physician if you have a pacemaker or defibrillator or any major disease that might require special attention during the procedure.

Arrangements to get home after the test:
If you are sedated, you will need to arrange to have someone to drive you home after the examination. The sedatives may affect your judgment and reflexes the rest of the day, you should not drive, operate any machinery, or make any important decisions.

What can be expected during the upper endoscopy?
Your physician will review with you why this test is being performed, whether any alternative tests are available and possible complications from the procedure. You will have medication given through an IV to sedate you, a latex-free mouthpiece will be placed between your teeth to protect your teeth and the instrument. The endoscope will be passed through the mouthpiece, then the esophagus, stomach, and duodenum. The endoscope does not interfere with your breathing during the test. Your blood pressure, heart rhythm, and oxygen saturation will be carefully monitored throughout the procedure.

What happens after endoscopy?
After the test, you will be monitored in the recovery area until most of the effects of the medication have worn off. You will be given instructions regarding how soon you can eat and drink and guidelines for resuming normal activities.

Occasionally, minor problems may persist, such as a mild sore throat, bloating, or cramping; these should disappear within 24 hours or less.

In most cases, your physician can inform you of your test results on the day of the procedure; however, the results of any biopsies or cytology samples taken will take two to three days.

What are the possible complications of upper endoscopy?
Endoscopy is generally safe. Complications can occur but are rare. Bleeding may occur from a biopsy site or where a polyp was removed. Localized irritation of the vein where the medication was injected may rarely cause a tender lump lasting for several weeks. Applying heat packs or hot moist towels may help relieve the discomfort. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Perforation (a tear that might require surgery) could possibly occur but is very uncommon.

It is important to recognize the early signs of any possible complications. If you begin to run a temperature after your procedure, begin to have trouble swallowing, or have increasing throat, chest, or abdominal pain, let your physician know immediately.
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