Our physicians are board-certified in gastroenterology and are highly trained professional specialists, having extensive experience and expertise in the care and treatment of a wide variety of gastroenterological problems. As such, they perform a number of related endoscopic procedures, mostly, but not always, on an outpatient basis.
The most common procedures performed by our physicians include Upper Endoscopy (EGD) and Colonoscopy, which utilize video endoscopic devices. In general, endoscopy refers to the use of an endoscope, a thin, flexible tube with a tiny video camera at its end which transmits its images to a video screen, allowing the gastroenterologist to diagnose and treat various diseases of the gastrointestinal tract.
Why Get Screened?
The American Cancer Society recommends that all Americans age 45 and over be screened for colon cancer even if they feel fine. People with a history of colon cancer or colonic polyps in their family may need to be screened at a younger age. In addition, anyone having symptoms such as rectal bleeding, abdominal pain, constipation, diarrhea or weight loss may need to be checked before age 45.
Studies have shown that up to 90% of all cases of colon cancer could be prevented by proper screening. Most colon cancers develop from benign non-cancerous growths called polyps. By undergoing a test called a colonoscopy, polyps can be removed before they develop into cancer. In this manner, colon cancer can be prevented. Colonoscopy is performed as an outpatient procedure. Moderate sedation is given during the procedure so there is little or no discomfort.
What is a colonoscopy?
This is an examination of the entire large intestine using a flexible, lighted instrument by specially trained gastroenterologists.
Why am I having a colonoscopy?
Your physician may be ordering this examination for a variety of reasons. Some of the more common reasons include blood that was detected in the stool, colonic polyps, abdominal pain, diarrhea, or altered bowel habits. It may also be used as a follow-up examination in someone who has had an abnormal barium enema or other chronic problems.
How do I prepare myself for a colonoscopy?
You will be given a colonoscopy prep kit and dietary instructions at the time your colonoscopy is scheduled. It is very important that the colon be properly prepared prior to the colonoscopy or the examination may be unsatisfactory.
Are there risks involved with a colonoscopy?
All procedures carry some risk. Fortunately, the occurrence of major complications is very low in this procedure when done by a trained gastroenterologist. The potential major complications include severe bleeding or possibly perforation of the colon. This occurs in less than one in a thousand cases. If biopsies or polypectomies (removal of polyps) are performed, the risk may increase. You will be given intravenous sedation before the procedure. This will help with the discomfort that may be felt when advancing the colonoscope around the colon. There is a small chance (10-15%) that the entire colon cannot be examined. This is generally seen in patients who have had previous abdominal surgery or who have severe diverticulosis. In this case, a follow-up barium enema may be ordered.
How will I feel after the colonoscopy?
You may be slightly groggy from the sedation just after the procedure. You may experience some gas discomfort which generally passes quickly. Usually you can eat or drink anything after the procedure. We ask that you not drive after the procedure, but you can go about your business as usual the next day. If you have any severe abdominal pain, fever, or vomiting, you should report this to your physician immediately.
UPPER ENDOSCOPY (EGD - Esophagogastroduodenoscopy)
What is an EGD?
This is an examination of the esophagus, stomach and the first part of the small intestine called the duodenum, using a flexible, lighted instrument.
Why am I having an EGD?
Your physician may be ordering this examination for a variety of reasons. Some of the more common reasons are evaluations of swallowing problems, chest pain, severe heartburn symptoms, persistent nausea or upset stomach. Other reasons include abdominal pain and a follow-up examination to an abnormal upper GI series.
How do I prepare myself for an EGD?
Generally, we ask you not to eat or drink anything for six hours prior to the examination. Usually you will be asked to take nothing by mouth after midnight the evening before the procedure.
Are there risks involved with an EGD?
All procedures carry some risk. Fortunately, the occurrence of major complications is very low in this procedure. The potential major complications include severe bleeding or possibly perforation. This occurs less than one in a thousand cases. You will be given intravenous sedation before the procedure and numbing spray to the back of the throat.
How will I feel after the EGD?
Generally, you may be slightly groggy from the sedation just after the procedure. You may experience some gas discomfort as air is used to inflate the stomach. This generally passes quickly.
You can eat or drink anything after the procedure once the numbing medicine applied to the back of the throat has subsided. We ask that you not drive after the procedure, but you can go about your business as usual the next day. If you have severe abdominal pain, fever, or vomiting, you should report this to your physician immediately.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
What is an Endoscopic Retrograde Cholangiopancreatography?
ERCP is a specialized technique used to study the ducts of the gallbladder, pancreas, and liver. Ducts are drainage routes; the ducts from the gallbladder and liver are called bile or biliary ducts, while the duct from the pancreas is called the pancreatic duct.
What preparation is required?
The patient should fast after midnight the night before the test. This will ensure that the stomach is empty. Please inform your physician of any allergies to medications including contrast material.
What can I expect during ERCP?
An IV will be placed in your arm so you can receive sedation prior to the procedure. You will be asked to lie on your left side and a local anesthetic will be sprayed in the back of your throat. The physician will then pass an endoscope through your mouth, esophagus, stomach and into the duodenum (the first part of the small intestine). When the common opening to ducts from the liver and pancreas are visualized, a narrow catheter will be passed through the endoscope and into the ducts. The physician will then inject dye into the ducts and will take x-rays. There may be a bloating sensation due to the air that is introduced through the instrument.
What are possible complications of ERCP?
ERCP is a well-tolerated procedure when performed by gastroenterologists, who have had specialized training in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (an inflammation or infection of the pancreas), infections, bowel perforation and bleeding. Sometimes the procedure cannot be completed for technical reasons.
Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems.
What treatments can be done by doing an ERCP?
Sphincterotomy is cutting the muscle that surrounds the opening of the ducts. This cut is made to enlarge the opening. A small wire on the catheter uses electric current to cut the tissue. This does not cause discomfort since there are no nerve endings located there.
Stone removal from the bile duct is the most common treatment. These stones may have formed in the gallbladder and traveled into the bile duct or may form in the duct itself years after your gallbladder has been removed. After a sphincterotomy is performed, stones can be pulled from the duct into the bowel. A variety of balloons and baskets attached to the catheter can be passed through the scope into the ducts allowing stone removal.
Stent placement may be necessary to bypass strictures, or narrowed parts of the duct. These narrowed areas are due to scar tissue or tumors that cause blockage of normal duct drainage.
Balloon dilation is used to stretch the stricture. Dilations with balloons are often performed when the cause of the narrowing is benign. A temporary stent may be placed after dilation to help maintain the dilation.
A tissue biopsy or brushing may be taken to determine if a stricture is due to a cancer.
What can I expect after ERCP?
If ERCP is performed as an outpatient, you will be observed for complications until most of the effects of the medications have subsided. You might experience bloating or pass gas because of the air introduced during the examination. You can resume your usual diet unless instructed otherwise.
Someone must accompany you home from the procedure because of the sedatives used during the exam. Even if you feel alert after the procedure, the sedatives can affect your judgment and reflexes for the rest of the day.
Endoscopic Ultrasound (EUS)
Endoscopic UltraSound (EUS) is a procedure to obtain images and information about the digestive tract and the surrounding tissue and organs. Ultrasound testing uses sound waves to make a picture of internal organs.
During the procedure, a small ultrasound device is installed on the tip of an endoscope. An endoscope is a small, lighted, flexible tube with a camera attached. By inserting the endoscope and camera into the upper or the lower digestive tract, the doctor is able to obtain high-quality ultrasound images of organs. The EUS can get close to the organ(s) being examined. The images obtained with EUS are often more accurate and detailed than images provided by traditional ultrasound that travels from outside the body.
Uses of Endoscopic UltraSound (EUS)
- Evaluate stages of cancer
- Evaluate chronic pancreatitis or other disorders of the pancreas
- Study abnormalities or tumors in organs, including the gallbladder and liver
- Study the muscles of the lower rectum and anal canal to determine reasons for fecal incontinence
- Study nodules (bumps) in the intestinal wall
What is EUS?
Endoscopic ultrasound (EUS) is a minimally invasive endoscopic procedure that allows your doctor (gastroenterologist/endoscopist) to obtain detailed images of digestive system organs. EUS provides more information than that obtained with CT or MRI imaging. It can be used to take needle biopsies from abnormal digestive organ areas, avoiding exploratory surgery. It can also be used to take sample fluid from a cyst.
How is EUS performed?
A thin, flexible tube (endoscope) is passed through the mouth and into the stomach and duodenum. The tip of the endoscope contains a built-in miniature ultrasound probe and emits sound waves. These sound waves pass through the lining of the stomach and duodenum creating a visual image of the pancreas and surrounding tissue. EUS may be used to obtain a needle biopsy of the pancreas or to sample fluid in a pancreatic cyst. This is done by passing a very thin needle from the endoscope into the pancreas under continuous ultrasound monitoring. This technique is called EUS-fine needle aspiration (EUS-FNA) and does not hurt.
Where is EUS performed?
EUS is performed in Outpatient Services at Lexington Medical Center – at either the West Columbia or St. Andrews campus. Procedures are performed by appointment and by your gastroenterologist. As you will be receiving intravenous (IV) sedation you will not be allowed to drive after the procedure. It is important that you have a family member or friend take you home and plan to stay with you at home after the examination as sedatives can affect your judgement and reflexes for up to twenty-four hours.
Can I eat before the procedure?
If your procedure is scheduled before 12 pm, do not eat or drink anything after midnight. If your procedure is scheduled after 12 pm you may have clear liquids until 8 am on the day of the test.
Should I take my medications?
If you are taking medication for high blood pressure, seizures, or if you are taking prednisone, you may take these medications in the morning on the day of the procedure or at least two hours before the procedure with a sip of water. Do not take water/fluid pills after midnight on the night before your procedure. If you take aspirin or anticoagulant medications, such as warfarin (Coumadin), heparin or clopidogrel (Plavix), contact your prescribing physician for instructions on when to stop taking your medication prior to your procedure. In general non-steroidal anti-inflammatory medications (naproxen, ibuprofen, etc.) should not be taken for one week prior to an EUS examination. If you have any other EUS medication questions, call our office at (803) 794.4585.
Will I be awake for the procedure?
The EUS procedure is performed using intravenous sedatives and helps you relax. Depending on the sedation used, you may not remember the procedure. Most patients consider the procedure only slightly uncomfortable, while some fall asleep during it.
How long does the procedure take and what happens afterwards?
The actual procedure takes approximately 45-60 minutes. Most patients are discharged 3-4 hours after they arrive. Following the procedure, you will be monitored in the recovery area until the effects of the sedation have worn off. You will be able to eat after the procedure.
Will I be admitted for the procedure?
The procedure is performed as an outpatient procedure. Most people are able to go home one to two hours after completion of the procedure.
When will I be given the results of the EUS?
Your gastroenterologist will usually be able to give you the preliminary results of the EUS on the same day as the procedure. If an EUS-FNA has been performed, these results take between five to seven days to return. 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 and usually resolves within a day or two. Sometimes people feel a little bloated due to the air inserted by the instrument. Other potential but uncommon complications of EUS include a reaction to the sedatives used, aspiration of stomach contents into your lungs and complications affecting the heart or lungs. One major, but very uncommon complication of EUS is where there is a tear in the lining of the stomach or duodenum, called a perforation. This is very rare but can require surgery to repair the tear. If an EUS-FNA is performed, where a needle is passed into the pancreas to take a sample, there is a small risk of bleeding, pancreatitis or infection. To decrease the risk of infection, we routinely prescribe antibiotics for patients in whom EUS-FNA was performed on a pancreatic cyst.
If you have any other questions about your EUS procedure, please do not hesitate to contact our office at (803) 794.4585.