Gastroenterology

What is Gastroenterology?

Gastroenterology involves the diagnosis and treatment of disorders of the digestive tract. This includes the esophagus, stomach, small intestine, colon and rectum, pancreas, liver, gallbladder and biliary system.

Patient Benefits of Gastroenterology

  • Making valid decisions much easier in regards to diagnostic and procedure findings
  • Better outcome for early treatment. (Eg: Colorectal Polyps, Colorectal Carcinoma, Inflammatory bowel disease, Peptic Ulcer disease and GERD)

Common Reasons for Referral to a Gastroenterologist

  • Heartburn
  • Colon cancer screening
  • Abdominal pain
  • Weight loss
  • Diarrhea
  • Constipation
  • Difficulty swallowing
  • Diseases of the liver

Endoscopic Retrograde EholangiopanCreatography (ERCP)

What is ERCP?

Endoscopic Retrograde EholangiopanCreatography, or ERCP, is a specialized technique used to study the ducts of the gallbladder, pancreas and liver. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. This explanation will give you a basic understanding of the procedure - how it's performed, how it can help, and what side effects you might experience. It can't answer all of your questions, since a lot depends on the individual patient. Please ask about anything you don't understand.

During ERCP, an endoscope will be passed through your mouth, esophagus, and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After identifying the common opening to ducts from the liver and pancreas, a narrow plastic tube called a catheter will be passed through the endoscope and into the ducts. X-ray contrast material (dye) will be injected into the pancreatic or biliary ducts so that X-rays can be taken.

What preparation is required?

You should fast for at least eight hours (preferably overnight) before the procedure to make sure you have an empty stomach, which is necessary for the best examination.

You should talk to us about medications you take regularly and any allergies you have to medications, or intravenous contrast material. Although an allergy doesn't prevent you from having ERCP, it's important to discuss it with us prior to the procedure.

What can I expect during ERCP?

You will be given a sedative to make you more comfortable. Most patients are asleep for the procedure. Some patients also receive antibiotics before the procedure. You will lie on your left side on an X-ray table. The endoscope will be passed through your mouth, esophagus, stomach and into the duodenum. The instrument does not interfere with breathing, but you might feel a bloating sensation because of the air introduced through the instrument.

What are possible complications of ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (inflammation of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. 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. Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. We will discuss your likelihood of complications before you undergo the test.

What can I expect after ERCP?

If you have ERCP as an outpatient, you will be observed for complications until most of the effects of the medications have worn off. You might experience bloating or pass gas because of the air introduced during the examination. You can resume your usual diet unless you are instructed otherwise.

Someone must accompany you home from the procedure because of the sedatives used during the examination. Even if you feel alert after the procedure, the sedatives can affect your judgment and reflexes for the rest of the day.

Please contact us promptly if you are experiencing any complications due to the procedure.

Colonoscopy

What is a colonoscopy?

A colonoscopy is an outpatient procedure in which the inside of the large intestine (colon and rectum) is examined. A colonoscopy is commonly used to evaluate gastrointestinal symptoms, such as rectal and intestinal bleeding, abdominal pain, or changes in bowel habits. Colonoscopies are also performed in individuals without symptoms to check for colorectal polyps or cancer. A screening colonoscopy is recommended for anyone 50 years of age and older, and for anyone with parents, siblings or children with a history of colorectal cancer or polyps.

What happens before a colonoscopy?

To complete a successful colonoscopy, the bowel must be clean so that the physician can clearly view the colon. It is very important that you read and follow all of the instructions given to you for your bowel preparation well in advance of the procedure. Without proper preparation, the colonoscopy will not be successful and the test may have to be repeated.

If you feel nauseated or vomit while taking the bowel preparation, wait 30 minutes before drinking more fluid and start with small sips of solution. Some activity (such as walking) or a few soda crackers may help decrease the nausea you are feeling. If the nausea persists, please contact your health care provider.

You may experience skin irritation around the anus due to the passage of liquid stools. In order to prevent and treat skin irritation, you should:

  • Apply Vaseline or Desitin® ointment to the skin around the anus before drinking the bowel preparation medications; these products can be purchased at any drug store.
  • Wipe the skin after each bowel movement with disposable wet wipes instead of toilet paper. These are found in the toilet paper area of the store.
  • Sit in a bathtub filled with warm water for 10 to 15 minutes after you finish passing a stool; after soaking, blot the skin dry with a soft cloth, apply Vaseline or Desitin ointment to the anal area, and place a cotton ball just outside your anus to absorb leaking fluid.

What happens during a colonoscopy?

During a colonoscopy, an experienced physician uses a colonoscope (a long, flexible instrument about 1/2 inch in diameter) to view the lining of the colon. The colonoscope is inserted into the rectum and advanced through the large intestine. If necessary during a colonoscopy, small amounts of tissue can be removed for analysis (a biopsy) and polyps can be identified and entirely removed. In many cases, a colonoscopy allows accurate diagnosis and treatment of colorectal problems without the need for a major operation.

  • You are asked to wear a hospital gown and remove eyeglasses.
  • You are given a pain reliever and a sedative intravenously (in your vein); you will feel relaxed and somewhat drowsy.
  • You will lie on the left side, with your knees drawn up towards your chest.
  • A small amount of air is used to expand the colon so the physician can see the colon walls.
  • You may feel mild cramping during the procedure; cramping can be reduced by taking slow, deep breaths.
  • The colonoscope is slowly withdrawn while the lining of your bowel is carefully examined.
  • The procedure lasts from 30 minutes to one hour.

What happens after a colonoscopy?

  • You will stay in a recovery room for observation until you are ready for discharge.
  • You may feel some cramping or a sensation of having gas, but this quickly passes.
  • If medication has been given, a responsible adult must drive you home; avoid alcohol, driving, and operating machinery for 24 hours following the procedure.
  • Unless otherwise instructed, you may immediately resume your normal diet, but we recommend you wait until the day after your procedure to resume normal activities.
  • If polyps were removed or a biopsy was taken, avoid taking aspirin, products containing aspirin, or anti-inflammatory drugs (such as ibuprofen [Advil®, Motrin®], naproxen [Naprosyn®] or indomethacin [Indocin®]) for two (2) weeks after the procedure to help decrease the risk of bleeding; you may take acetaminophen (such as Tylenol®) if needed.
  • If you are taking Coumadin®, Plavix®, Ticlid®, or Agrylin®, the physician performing your colonoscopy will advise you when it is safe to resume your blood thinners.
  • If a biopsy was taken or a polyp was removed, you may notice light rectal bleeding for one to two days after the procedure; large amounts of bleeding, the passage of clots, or abdominal pain should be immediately reported.

Endoscopy & Pancreatic-Biliary Disorders

The Section for Endoscopy and Pancreatic - Biliary Disease is devoted to excellence in patient care, research and education in the fields of gastrointestinal endoscopy and pancreatic disease.

Endoscopes are flexible tubes that can be passed through the mouth or rectum, and allow direct viewing of the surfaces of the esophagus (food pipe), stomach, intestine and colon.

Endoscopic examinations allow physicians to diagnose and treat a variety of intestinal disorders, including abdominal pain, vomiting, and bleeding from the intestinal tract. In addition, benign growths of the colon which can be precursors of colon cancer may be detected and removed.

Special adaptations of the endoscope allow stones to be removed from the bile duct (drainage tube for digestive juices of the liver and gallbladder) and pancreas. A new technique, known as endoscopic ultrasound, allows very high detailed views of the gastrointestinal tract, as well as neighboring structures such as the pancreas.

Pancreatic disease may manifest itself in many ways, including painful masses, acute intermittent attacks of pain, or chronic inability to digest food due to insufficient production of pancreatic digestive enzymes. Our section employs a multidisciplinary approach to the care of these patients, meaning specialists from many different departments work together to plan your care. Specialists in gastroenterology collaborate with colleagues in surgery, anesthesiology, and radiology.

Identifying Diseases of the Small Bowel with Video Capsule Endoscopy

If you require an endoscopy, you may be a candidate for wireless capsule endoscopy. This new procedure, called Pillcam, is an alternative to traditional endoscopy. It is used in select patients to diagnose and evaluate esophagitis, gastroesophageal reflux disease (GERD), and Barretts esophagus. This procedure may not be covered by some insurance.

The Pillcam allows non-invasive visualization of the small intestine without many of the limitations associated with conventional endoscopic and X-ray procedures.