Gastrointestinal Endoscopy

• Gastroscopy - Upper Scope Test

• Colonoscopy - Lower Scope Test

Gastroscopy - Upper Scope Test

After a careful medical assessment, your doctor has recommended that you should have a gastroscopy examination, a non-surgical technique that can aid in diagnosing problems of the upper digestive system. Based on the results of this exam, your doctor can then suggest the best course of treatment for your problem. More accurate than a barium x-ray and much simpler than exploratory surgery, gastroscopy is a safe and highly effective diagnostic technique.

Understandably, most patients are a bit apprehensive about the idea of "swallowing a scope." However, with the help of modern medical instruments and sedation, patients usually tolerate this test with ease. After the test is completed, most patients are pleasantly surprised by how easy it was. We have written this information to answer any questions that you may have about gastroscopy. If you have additional questions or concerns after reading it, please feel free to consult your doctor.

REASONS FOR THE EXAM

Disorders of the upper digestive tract are quite common in our stressful society. Various factors such as diet, environment, and heredity contribute to these conditions. Gastroscopy is often useful in diagnosing and treating problems such as:

• Abdominal pain
• Bleeding from the digestive tract
• Cancers of the stomach or esophagus
• Chronic heartburn and indigestion
• Diagnosis and removal of stomach polyps
• Dilatation of esophageal strictures
• Gastritis, or stomach inflammation
• Hiatal hernia
• Removal of swallowed objects
• Trouble swallowing
• Treatment of the "Ulcer Bacteria"
• Ulcers of the esophagus
• Ulcers of the stomach and ulcers of the duodenum
• Unexplained chest pain

THE SCOPE

Gastroscopy is a medical term that has two parts: gastro for "stomach," and scopy for "looking." Gastroscopy, then, is a diagnostic test that enables the doctor to look inside your stomach. The instrument used to perform this simple test is the gastroscope; a long, thin, flexible fiberoptic tube. Within the end of this remarkable device is a miniaturized color TV camera with a wide angle lens. By passing this "scope" into your stomach, your doctor can directly examine the lining of your upper digestive system on a television monitor. The technical name for this test is Esophago-Gastro-Duodenoscopy. To simplify things the shortened form of the name GASTROSCOPY is usually used, or the initials EGD. The examination is quick and painless. There is no incision.

ALTERNATE TESTING

As part of your evaluation, your family doctor may have already ordered a barium x-ray of your upper digestive system - an UPPER GI SERIES. This x-ray exam may have been helpful in directing attention to an area of possible abnormality. But x-rays often do not fully reveal what is wrong. In fact, it is believed that the standard Upper GI x-ray may miss up to 30% of peptic ulcers.

Fortunately, gastroscopy permits a much more accurate view of your upper digestive system. Rather than studying an indirect x-ray "shadow picture" of your stomach, gastroscopy allows your doctor to directly view your upper digestive tract in "living color" and to examine the lining in remarkable detail. Thus, it is much more accurate.

HOW CAN YOU HELP?

Your cooperation is essential for a successful examination. There are certain things that you can do before the test to help:

Preparation

Your stomach must be empty during gastroscopy so that your doctor's view is not blocked by particles of food. If your test is scheduled in the morning, you must not eat or drink anything after midnight the night before the test. You may gargle and brush your teeth in the morning.

If your test is scheduled in the afternoon, you may have only liquids - such as juice, coffee, tea, broth - for breakfast. Then begin fasting. You should not eat or drink anything for at least 6 hours before the exam.

Medications

You may continue to take any important medications that your personal physician has prescribed - even on the morning of the test. Simply take them with a small sip of water at least two hours before your appointment. This allows time for the tablets to dissolve completely. You should not take any antacids on the day of the test. If you are a diabetic on insulin, call for special instructions. Do not use tobacco within two hours of your test since this tends to affect the natural color of your stomach lining.

What To Wear

You will have to change into a patient gown before the examination. If this test is being done on an outpatient basis, you should wear loose, comfortable, casual clothing that is easily removed and folded. Avoid girdles, pantyhose, or tight-fitting garments. Please leave your jewlery, valuables, and high heels at home.

Transportation

To minimize any discomfort, you will receive a sedative injection before the examination. As this medication will make you drowsy for several hours, you cannot safely drive a car for the remainder of the day. Therefore, if this test is being done on an outpatient basis, a family member or friend must accompany you to the office in order to drive you home. If possible, you should choose someone with whom the doctor can freely discuss the results of your test. We request that your companion remain in the office during the test. You should plan to arrive fifteen minutes before your appointment and to stay approximately two hours.

Of course, if this test is being done on a hospital inpatient basis, a driver will not be needed. After the examination, you will simply return to your hospital bed to sleep off the remainder of the medication.

Your Permission

If you have any questions about this test, do not hesitate to ask the GI Assistant, nurse, or doctor. To signify that you completely understand what this test involves, you will be asked to sign a written consent form, or "permit," before the test begins.

LOOKING INSIDE...

To make this examination more comfortable, the GI Assistant will then spray the back of your throat with a liquid anesthetic. This may taste slightly bitter and will produce a numbness in your mouth and throat. This effect will last approximately one half hour. Then you will be positioned comfortably on your left side on the padded examination table. A small painless oximeter probe will be placed on your fingertip to monitor your pulse rate and breathing function during the exam.

To maximize your comfort during the examination, you will then be given an intravenous injection of Demerol, a pain killer, combined with Versed, a mild tranquilizer. If you are allergic to either of these medications, please inform your doctor. These medications will make you drowsy and relaxed. You will not be deep asleep like a general anesthetic, but your doctor will give you sufficient medication to induce a pleasant "twilight sleep." In this manner, you should feel no discomfort during the test. Upon awakening, you will probably have little recollection of the procedure, itself. Once you are very relaxed, the doctor will gently insert the flexible gastroscope. Since this scope does not enter your "windpipe," it will not interfere with your ability to breathe. The most frequent fear expressed by patients is that they will be unable to swallow the scope because of gagging. Fortunately, the medications given prior to the procedure usually prevent this from happening. Even the most apprehensive patients tolerate the procedure quite well.

A small mouthpiece will then be placed between your teeth enabling you to relax your jaws. To better see the lining of your upper digestive tract, your stomach is then gently filled with a small quantity of air. While this air may cause the sensation of abdominal fullness, it should not be painful. Your doctor can now begin to inspect the lining of your esophagus, stomach, and duodenum, an exam that takes about fifteen minutes.

TAKING SPECIMENS

If your gastroscopy reveals any abnormal condition such as an ulcer, your doctor may photograph it. This picture provides a permanent record for your medical chart and also enables your other doctors to see what is wrong. If necessary, a videotape of the procedure may be recorded for later review.

To better evaluate areas of abnormality, your doctor may take a biopsy. This procedure is performed painlessly with a miniature forceps. After passing the forceps through a hollow channel inside the gastroscope, your doctor simply snips off a tiny sample of tissue for laboratory analysis. If a small growth called a polyp is found, it can often be removed for analysis. This is done by using a thin wire-loop snare which cuts off the polyp and then cauterizes the base using electric heat. This is also painless.

Be assured that your doctor's decision to take a biopsy does not necessarily mean that cancer is suspected. Biopsies of the digestive tract are routinely taken to investigate other problems such as inflammation and ulcers.

If you have difficulty swallowing and the doctor finds a narrowed area in your esophagus, it may be possible to dilate this "stricture" during this exam with a small balloon dilator.

AFTER THE TEST

You will then be able to return home with your companion's assistance. Since you will still be somewhat drowsy and uncoordinated, you will be taken in a wheelchair to your car by the office personnel.

Since the effects of the sedatives may take up to 24 hours to wear off completely, you should plan to go directly home - not to a restaurant. Have a light meal, and rest for several hours. After the sedation has completely worn off, you may resume your normal diet. However, you will not be able to go to work, drive your car, or operate any dangerous machinery for the remainder of the day. You may experience a mild sore throat after gastroscopy. If this occurs, anesthetic throat lozenges, such as Cepacol or Sucrets, are helpful.

IS THIS TEST DANGEROUS ?

While every medical procedure involves some degree of risk, the frequency of complications during gastroscopy is extremely low. With the modern flexible fiberoptic instruments now available, gastroscopy has become a safe and simple method of examining the upper digestive tract. When performed by a physician who is specially trained and experienced in this procedure, the benefits of gastroscopy far exceed its risks.

Your doctor is a GASTROENTEROLOGIST. In addition to standard medical training, he has received special instruction in diseases of the digestive system and has been thoroughly trained in the safe and proper operation of the gastroscope. The combination of this experience and your cooperation should make this test as safe and simple as possible. However, as with all medical procedures, complications can sometimes occur.

The main risks are perforation, or a tear, of the stomach or esophagus lining and bleeding. Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Typically minor in degree, such bleeding may simply stop on its own or be controlled by cauterization. Seldom does surgery become necessary. Fortunately, both perforation and bleeding are extremely rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases you may have. Consequently, you should inform your doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is well to remember that each of them occurs quite infrequently. Your doctor can further discuss the above risks with you with regard to your particular need for gastroscopy.

HOW ABOUT AIDS ?

Due to the recent extensive coverage of AIDS in the media, some individuals have been concerned that they might contract AIDS through this examination. Be assured that this is not the case. All our instruments are extensively cleaned and undergo high level disinfection between each case. Only techniques known to kill all disease-causing bacteria and viruses including the AIDS virus are employed in this process.

A VALUABLE TOOL...

In summary, gastroscopy is a valuable tool for the diagnosis and treatment of diseases of the upper digestive tract. Abnormalities suspected by X-ray can be confirmed and studied in detail during this procedure. Even when X-rays are normal, the cause of such symptoms as abdominal pain and internal bleeding can often be determined by gastroscopy. This technique is useful in the diagnosis and follow-up of patients with peptic ulcers and also allows dilatation of esophageal strictures. Gastroscopy is an extremely safe and worthwhile procedure that is very well tolerated. If you have any questions or concerns regarding this procedure, do not hesitate to consult your doctor.

Colonoscopy - Lower Scope Test

After careful assessment, your doctor has decided that a colonoscopy is necessary to better evaluate and treat your condition. Since your cooperation is essential for a successful examination, it is important that you understand exactly what is to be done and why. If you have any additional questions or concerns after reading this article, please ask your doctor.

What Is Colonoscopy?
Colonoscopy is a medical term that has two parts - colono which refers to the colon, or large intestine, and scopy which means "looking into." Therefore, colonoscopy is a test that enables your doctor to look inside your colon. The instrument used to perform this test is the colonoscope: a long, flexible tube about the width of your index finger. Within the end of this tube is a miniaturized color-TV camera with a wide-angle lens. After passing this "scope" through the rectum and into your colon, your doctor then directly examines the lining of your lower digestive tract on a television monitor. In this manner, it is possible to evaluate intestinal inflammation, ulceration, bleeding, diverticulitis, colitis, colon polyps, tumors, etc.

As part of your assessment, you may have undergone a barium enema examination of the colon, or "lower GI series." This technique, which utilizes x-rays, is helpful in identifying any areas of possible abnormality. X-rays are only shadows, however, and often do not fully demonstrate what is wrong. For example, the barium enema x-ray may miss nearly forty percent of colon polyps.

In the past, you also may have undergone a proctoscopic examination of the lower colon and rectum. Performed with a short, rigid, hollow tube, this limited procedure enabled the doctor to examine only the last ten inches of the large intestine. In most offices, the proctoscope has now been replaced by the flexible sigmoidoscope. This newer device enables your doctor to examine the last two feet of the colon while its flexibility affords the patient much greater comfort than does the rigid type of scope.

The colonoscope offers a still greater advantage. With this longer flexible instrument, your doctor is usually able to directly examine the entire length of your colon - all five feet of its numerous twists and turns. In this manner, your doctor can be most certain about the condition of your colon.

How You Can Help
Your cooperation is essential for a successful examination. There are certain things you can do to help before the test begins:

• Preparation
  A colonoscopy exam requires a thorough cleansing of the large intestine so that nothing impedes your doctor's view. The colon must be completely free of all solid waste. Since particles of stool can interfere with the examination, you will require a special dietary and laxative preparation on the day prior to the test. To be sure that you fully understand all aspects of the preparation, the GI Assistant or a member of the Nursing staff will review the preparation with you. It is critical that you follow the instructions as given. If the colon is not clean, the test - as well as the preparation - may have to be rescheduled. A few hints: It is best not to be constipated before the laxative preparation. This may lead to a temporary backup of the laxative solution, cramps, bloating, nausea, and vomiting. If you tend to be constipated, take one or two ounces of Milk of Magnesia the day before the laxative prep to "open up your pipes." This will make the actual preparation easier. If you develop mild distress during your prep, simply stop it for an hour or two and then resume it where you left off. If you develop severe abdominal cramps or persistent nausea and vomiting, stop the prep and call our office to reach our doctor on call. Of course, the laxative preparation will cause you to have many bowel movements. This may cause some rectal irritation and a small amount of bleeding. Many patients find that using Charmin Plus toilet tissue minimizes such rectal irritation. A nonprescription 1% hydrocortisone cream may also be soothing when applied to the rectal area after each bowel movement. Please avoid foods with many small seeds for a few days before the exam. They tend to linger in the colon and can clog our instruments. In addition, you must avoid all red-colored Jello products during your preparation as their red dye masks the lining of the colon.

   

• Medications
  Medications containing iron or Metamucil-like fiber can impair your doctor's view of the colon. If possible, they should be temporarily discontinued several days before the test. If you are taking chronic aspirin or Persantine therapy, diabetic medication, or the blood-thinner Coumadin, you will require special preparation and adjustment of your medicines before the test. Please call our office for instructions. All other routine medications may continue to be taken with a small sip of water, even on the day of the exam.

   

• What To Wear
  You will have to change into a patient gown before the examination. If this test is being done on an outpatient basis, you should wear, loose, comfortable, casual clothing that is easily removed and folded. Avoid girdles, pantyhose, or tight-fitting garments. Please leave your jewlery, valuables, and high heels at home. Transportation To minimize any discomfort, you will receive an injection before the colonoscopy. As this medication will make you drowsy for several hours, you cannot safely drive a car for the remainder of the day. Therefore, if this test is being done on an outpatient basis, a family member or friend must accompany you to the office in order to drive you home. If possible, you should choose someone with whom the doctor can freely discuss the results of your test. We request that your companion remain in the office during the test. You should arrive several minutes before your appointment and plan to stay approximately two hours.

  If the test is being done on an inpatient basis, a driver will not be needed. After the test, you will simply return to your hospital room to sleep off the remainder of the medication. You will be asked to remain in bed several hours to allow the sedation to wear off completely.

   

• Your Permission
  If you have any questions or concerns about this test, do not hesitate to ask your doctor about them. To signify that you completely understand what this test involves, you will be asked to sign a written consent form, or "permit," before the test begins.

   

Your doctor will then examine and lubricate the rectal opening to allow simple passage of the colonoscope. This will not be painful, but is mildly uncomfortable for a few seconds. After the colonoscope is properly positioned, your doctor gently guides the scope through the colon, a process that takes approximately one-half hour. To improve visualization, your doctor gently infuses air into the colon. This may cause a sensation of abdominal fullness, but should not be painful. In fact, many patients actually fall asleep during the examination. As the test progresses, you may be asked to change your position now and then to facilitate the passage of the colonoscope through the colon. 

Occasionally, passage of the colonoscope through the entire colon is impossible. While this may be caused by a blockage, it is most often caused by an extra "loop" of colon, adhesions from previous abdominal surgery, or severe diverticulosis. In such cases, a limited examination may be sufficient if the area of suspected abnormality has been visualized. If not, a barium enema x-ray (lower GI) may also be necessary.

Taking Specimens
If colonoscopy reveals any unusual condition such as inflammation, an ulcer, a tumor, or a polyp, your doctor may photograph it. This photo provides a permanent record for your medical chart and allows your other doctors to see what is wrong. With the advent of video-colonoscopy, it is now also possible to record the examination on a videocassette for later review when necessary. To better evaluate any areas of suspected abnormality, your doctor may take a brushing or biopsy of the colon lining. A brushing involves the passage of a tiny nylon brush through the center of the colonoscope. The brush rubs against the lining of the colon and retrieves bits of tissue for later analysis. To take a biopsy, the doctor passes a metal forceps through the scope and snips off a tiny sample of colon tissue for laboratory analysis. Both procedures are totally painless for the patient. Be assured that the decision to take a biopsy does not necessarily mean that your doctor suspects cancer. Biopsies of the digestive tract are often taken to look for other problems such as inflammation and ulcers.

Removing Colon Polyps
The lining of the colon and rectum is normally smooth. Sometimes, however, growths known as "colon polyps" appear on the lining of the large intestine. Varying in size from pinheads to growths several inches in diameter, polyps do not usually produce any symptoms. Contrary to popular belief, polyps affect both men and women equally. Most colon polyps are initially non-cancerous. Nevertheless, as colon polyps continue to grow, they often develop into cancer of the colon. Colon cancer has become quite common in our society. In fact, nearly 1 in every 20 adult Americans will develop colon cancer in their lifetime. Colon cancer is now the leading cause of cancer deaths in nonsmokers. Only lung cancer takes a greater toll. It is not widely known that colon cancer now kills more women than breast cancer and more men than prostate cancer. But, there is good news. Research has confirmed that the single best prevention for colon cancer is the early detection and removal of all colon polyps!!! In the past, colon polyps located beyond the range of the proctoscope could only be removed by a major abdominal operation. Of course, this procedure required about a week of hospitalization and over a month of time lost from work for recovery. Fortunately, medical technology now permits the simple removal of most colon polyps. Should a small polyp be discovered during your colonoscopy, the polyp can usually be removed immediately. This prevents a potential colon cancer while eliminating the need for major surgery.

The doctor removes the polyp quite simply by placing a wire loop, or "snare," around the polyp's base and slowly tightening the loop. As the polyp is severed, a mild electric current cauterizes the tissue to prevent bleeding. There is no pain or any sensation as the polyp is removed. Polyp removal can usually be done on an outpatient basis. Moreover, since there is no incision, you may usually resume normal activity the next day. Click here to see our Endoscopic Photo Atlas with some examples of what your doctor sees inside your colon during colonoscopy.

After The Test
After an outpatient colonoscopy, you will be asked to rest awhile in the recovery room. Your companion will be asked to sit with you while the effects of the sedative begin to wear off. Once you are more alert, the doctor will meet with you to discuss the findings and any needed treatment. You will then be able to return home with your companion's assistance. However, since you will still be somewhat drowsy and uncoordinated, you will be taken directly to your car in a wheelchair by the office personnel. It is important that you go directly home; do not stop to eat along the way. Although you may resume a regular diet at home, you should eat lightly at first, and then gradually increase your intake of foods as tolerated. Since air was placed in the colon during the examination, you may experience the discomfort of mild "gas pains" for several hours until the gas is expelled. Because of the sedation's lingering effects, you should not drive, operate any machinery, drink alcohol, or engage in any vigorous activity for the remainder of the day. If the test is performed on an inpatient basis, you will be taken back to your hospital bed for recovery. If any specimens or polyps were extracted during the examination, the doctor will contact both you and your personal physician when the laboratory results become available. Further treatment or tests, if necessary, will be discussed at that time.

Is This Test Dangerous?
While every medical procedure involves some degree of risk, complications rarely occur in patients undergoing colonoscopy. With the advent of flexible fiberoptic instruments, this test has become a safe and simple method of directly examining the lower digestive tract. When performed by a physician who is specially trained and experienced in the procedure, the benefits of colonoscopy far exceed the risks.

Your doctor is a Gastroenterologist. In addition to standard medical training, he has received special instruction in diseases of the digestive system and has been thoroughly trained in the safe and proper operation of the colonoscope. The combination of his expertise and your cooperation should make this test as safe and simple as possible. However, as with all medical procedures, complications can occur.

The principal risks are perforation of the colon (a tear through the bowel wall) or bleeding. Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of either a biopsy or polyp removal. Typically minor in degree, such bleeding may stop on its own or be controlled by cauterization. Occasionally, surgery is necessary. Fortunately, both perforation of the colon and bleeding are quite rare. Because bleeding may sometimes occur up to three weeks after a colon polyp has been removed, you should not plan to travel to any remote areas without medical access during this period of healing.

Other possible risks include drug reactions and complications related to other diseases that you may have. Consequently, you should inform your doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is not serious. If inflammation occurs, applying warm compresses to the area is usually helpful. While any of these complications may occur, it is well to remember that each of them occurs quite infrequently. Your doctor will be happy to discuss the above risks with you further, especially with regard to your particular situation and need for colonoscopy.

How About AIDS?
Due to the recent extensive coverage of AIDS by the media, some patients have expressed the concern that they might, in fact, contract AIDS through this examination. Be assured that this is not the case. All our instruments are thoroughly cleaned and undergo high-level disinfection after each use. Only techniques known to kill all disease-causing bacteria and viruses, including the hepatitis and AIDS virus, are employed in this process.

A Valuable Tool....
In summary, colonoscopy is a valuable tool for the diagnosis and treatment of many diseases of the large intestine. Even when x-rays are normal, the cause of symptoms such as rectal bleeding or change in bowel habits may be determined by colonoscopy. It is also useful in the diagnosis and follow-up care of patients with colitis. Through colonoscopy, the detection and removal of colon polyps, and thus the prevention of colon cancer, are made possible. Periodic colonoscopy is a valuable tool in monitoring patients with previous polyps, colon cancer, or a family history of colon cancer. In essence, colonoscopy is a safe and worthwhile procedure that is extremely well tolerated. If you have any questions about your need for colonoscopy, do not hesitate to ask your doctor.