Gastroenterology Procedures

In a colonoscopy, the physician passes the endoscope through your rectum and into the colon to examine the tissue of the colon wall for abnormalities such as polyps. What is a colonoscopy? Colonoscopy lets your doctor examine the lining of your large intestine (colon) for abnormalities by inserting a thin flexible tube, as thick as your finger, into your anus and slowly advancing it into the rectum and colon. This instrument, called a colonoscope, has its own lens and light source and it allows your doctor to view images on a video monitor. Why is colonoscopy recommended? Colonoscopy may be recommended as a screening test for colorectal cancer. Colorectal cancer is the third leading cause of cancer deaths in the United States. Annually, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States and 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year. Colonoscopy may also be recommended by your doctor to evaluate for symptoms such as bleeding and chronic diarrhea. The endoscope is a thin, flexible tube with a camera and a light on the end of it. During the procedure, images of the colon wall are simultaneously viewed on a monitor. What preparations are required? Your doctor will tell you what dietary restrictions to follow and what cleansing routine to use. In general, the preparation consists of limiting your diet to clear liquids the day before and consuming either a large volume of a special cleansing solution or special oral laxatives. The colon must be completely clean for the procedure to be accurate and comprehensive, so be sure to follow your doctor’s instructions carefully. Can I take my current medications? Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform your doctor about medications you’re taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Also, be sure to mention allergies you have to medications. What happens during colonoscopy? A colonoscope is a medical device used by expert physicians to look inside the colon and rectum. The expert physician controls the movement of the flexible tube using the endoscope handle. Colonoscopy is well-tolerated and rarely causes much pain. You might feel pressure, bloating or cramping during the procedure. Typically, your doctor will give you a sedative or painkiller to help you relax and better tolerate any discomfort. You will lie on your side or back while your doctor slowly advances a colonoscope along your large intestine to examine the lining. Your doctor will examine the lining again as he or she slowly withdraws the colonoscope. The procedure itself usually takes less than 45 minutes, although you should plan on two to three hours for waiting, preparation and recovery. In some cases, the doctor cannot pass the colonoscope through the entire colon to where it meets the small intestine. Your doctor will advise you whether any additional testing is necessary. What if the colonoscopy shows something abnormal? If your doctor thinks an area needs further evaluation, he or she might pass an instrument through the colonoscope to obtain a biopsy (a small sample of the colon lining) to be analyzed. Biopsies are used to identify many conditions, and your doctor will often take a biopsy even if he or she doesn’t suspect cancer. If colonoscopy is being performed to identify sites of bleeding, your doctor might control the bleeding through the colonoscope by injecting medications or by cauterization (sealing off bleeding vessels with heat treatment) or by use of small clips. Your doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination. These procedures don’t usually cause any pain. Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches. What are polyps and why are they removed? Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches. Your doctor can’t always tell a benign polyp from a malignant (cancerous) polyp by its outer appearance, so he or she will usually remove polyps for analysis. Because cancer begins in polyps, removing them is an important means of preventing colorectal cancer. How are polyps removed? Your doctor may destroy tiny polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments. Your doctor will use a technique called “snare polypectomy” to remove larger polyps. Your doctor will pass a wire loop through the colonoscope and remove the polyp from the intestinal wall using an electrical current. You should feel no pain during the polypectomy. What happens after a colonoscopy? You will be monitored until most of the effects of the sedatives have worn off. You might have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly when you pass gas. Your physician will explain the results of the examination to you, although you’ll probably have to wait for the results of any biopsies performed. If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You should be able to eat after the examination, but your doctor might restrict your diet and activities, especially after polypectomy. Your doctor will advise you on this. What are the possible complications of colonoscopy? Colonoscopy and polypectomy are generally safe when performed by doctors who have been specially trained and are experienced in these procedures. One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but it’s usually minor. Bleeding can stop

You have been referred to have an endoscopic ultrasonography, or EUS, which will help your doctor evaluate or treat your condition. Upper EUS can be used to diagnose conditions of the esophagus, stomach and duodenum. What is EUS? Endoscopic ultrasonography (EUS) allows your doctor to examine your esophageal and stomach linings as well as the walls of your upper and lower gastrointestinal tract. The upper tract consists of the esophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study other organs that are near the gastrointestinal tract, including the lungs, liver, gall bladder and pancreas. Endoscopists are highly trained specialists who welcome your questions regarding their credentials, training and experience. Your endoscopist will use a thin, flexible tube called an endoscope that has a built-in miniature ultrasound probe. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will use the ultrasound to use sound waves to create visual images of the digestive tract. Why is EUS done? EUS provides your doctor with more information than other imaging tests by providing detailed images of your digestive tract. Your doctor can use EUS to diagnose certain conditions that may cause abdominal pain or abnormal weight loss. EUS is also used to evaluate known abnormalities, including lumps or lesions, which were detected at a prior endoscopy or were seen on x-ray tests, such as computed tomography (CT) scan. EUS provides a detailed image of the lump or lesion, which can help your doctor determine its origin and help treatment decisions. EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive or conflicting. Why is EUS used for patients with cancer? EUS helps your doctor determine the extent of the spread of certain cancers of the digestive and respiratory systems. EUS allows your doctor to accurately assess cancer’s depth and whether it has spread to adjacent lymph glands or nearby vital structures, such as major blood vessels. In some patients, EUS can be used to obtain a needle biopsy of a lump or lesion to help your doctor determine the proper treatment. How should I prepare for EUS? For EUS of the upper gastrointestinal tract, you should have nothing to eat or drink, usually for six hours before the examination. Your doctor will tell you when to start this fasting and whether it is advisable to take your regular prescription medications. For EUS of the rectum or colon, your doctor will instruct you to either consume a colonic cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. The procedure might have to be rescheduled if you don’t follow your doctor’s instructions carefully. EUS provides more information than other imaging tests by providing detailed images of your digestive tract. What about my current medications or allergies? You can take most medications as usual until the day of the EUS examination. Tell your doctor about all medications that you’re taking and about any allergies you have. Anticoagulant medications (blood thinners such as warfarin or heparin) and clopidogrel may need to be adjusted before the procedure. Insulin also needs to be adjusted on the day of EUS. In general, you can safely take aspirin and non-steroidal anti-inflammatory medications (ibuprofen, naproxen, etc.) before an EUS examination. Check with your doctor in advance regarding these recommendations. Check with your doctor about which medications you should take the morning of the EUS examination, and take only essential medications with a small sip of water. If you have an allergy to latex, you should inform your doctor prior to your test. Patients with latex allergies often require special equipment and may not be able to have a complete EUS examination. Do I need to take antibiotics? Antibiotics are not generally required before or after EUS examinations. However, your doctor might prescribe antibiotics if you are having specialized EUS procedures, such as to drain a fluid collection or a cyst using EUS guidance. Practices vary among doctors, but for an EUS examination of the upper gastrointestinal tract, some endoscopists spray your throat with a local anesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes less than 60 minutes. Many do not recall the procedure. Most patients consider it only slightly uncomfortable, and many fall asleep during it. An EUS examination of the lower gastrointestinal tract can often be performed safely and comfortably without medications, but you’ll receive a sedative if the examination will be prolonged or if the doctor will examine a significant distance into the colon. You will start by lying on your left side with your back toward the doctor. Most EUS examinations of the rectum generally take less than 45 minutes. You should know that if a needle biopsy of a lesion or drainage of a cyst is performed during the EUS, then the procedure will be longer and may take up to two hours. Using an endoscope with a built-in ultrasound probe, your doctor will use sound waves to create visual images of the digestive tract. What can I expect during EUS? Practices vary among doctors, but for an EUS examination of the upper gastrointestinal tract, some endoscopists spray your throat with a local anesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes less

Endoscopy can provide an accurate diagnosis of conditions such as a bleeding duodenal ulcer. Why Should You Choose an ASGE Member for Your Endoscopic Procedure? Having an ASGE member perform your endoscopic procedures ensures that you are in the hands of someone who is highly trained. Physicians and surgeons who are members of the American Society for Gastrointestinal Endoscopy (ASGE) have highly specialized training in endoscopic procedures of the digestive tract, including upper GI (gastrointestinal) endoscopy, flexible sigmoidoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). ASGE members undergo a rigorous application and screening process and are recognized by the medical community as knowledgeable, experienced experts in gastroenterology and GI surgery who, in addition, have advanced training in gastrointestinal endoscopic procedures. ASGE members have demonstrated proof of rigorous endoscopic training. The American Society for Gastrointestinal Endoscopy is the only medical society that requires documentation of specific training in GI endoscopic procedures. In an upper endoscopy, the physician passes an endoscope through the mouth and into the esophagus, stomach and duodenum. How will your GI endoscopist work with your primary care physician? ASGE physicians usually work on referral from your primary care physician. Your GI endoscopist will communicate with your primary care physician about the results of your endoscopic procedure. Together, they will determine what is appropriate for treatment, follow-up visits and/or if future endoscopic exams are needed. Is your physician an ASGE member? Ask. Make the best choice. If you need an endoscopic procedure, ask your primary care doctor to recommend a specialist in gastrointestinal endoscopy who is also an ASGE member. ASGE members are distinctively qualified to perform the gastrointestinal endoscopic procedures that your primary care physician or other healthcare provider recommends and to work with you and your primary care provider on issues of digestive health. Find an endoscopist in your area. ASGE can help you find a GI endoscopist in your area. It’s easy. Visit the ASGE Web site at www.asge.org and click on the Find an Doctor. By typing in your zip code, the Find a Doctor program will give you a list of the ASGE members in your area. Remember, you can always ask if your physician is an ASGE member. Need more information on endoscopy or colonoscopy? ASGE offers additional materials on GI endoscopy and endoscopic procedures including brochures on Upper GI Endoscopy, Endoscopic Ultrasound, ERCP, Flexible Sigmoidoscopy and Colonoscopy on the ASGE Web site at www.asge.org as well as other useful information on digestive health and gastrointestinal problems. In a lower endoscopy, the physician passes the endoscope through the rectum and into the colon. Make the Best Choice for Your Endoscopic Procedure-An ASGE Gastrointestinal Endoscopist ASGE Active Physician Members have met the following rigorous requirements: Be certain your physician meets the high standards of ASGE membership.