Month: November 2018

Endoscopy Overview

Endoscopy Overview

ENDOSCOPY OVERVIEW — An upper endoscopy, often referred to as endoscopy, EGD, or esophago-gastro-duodenoscopy, is a procedure that allows a physician to directly examine the upper part of the gastrointestinal (GI) tract, which includes the esophagus, the stomach, and the duodenum (the first section of the small intestine)
The physician who performs the procedure, known as an endoscopist, has special training in using an endoscope to examine the upper GI system, looking for inflammation (redness, irritation), bleeding, ulcers, or tumors.
REASONS FOR UPPER ENDOSCOPY — The most common reasons for upper endoscopy include:

●Unexplained discomfort or pain in the upper abdomen.
●GERD or gastroesophageal reflux disease (often called heartburn.)
●Persistent nausea and vomiting.
●Upper gastrointestinal (GI) bleeding (vomiting blood or blood found in the stool that originated from the upper part of the GI tract). Bleeding can be treated during the endoscopy.
●Iron deficiency anemia (low blood count associated with a low iron level in the blood) in someone who has had no visible bleeding.
●Difficulty swallowing; food/liquids getting stuck in the esophagus during swallowing. This may be caused by a narrowing (stricture) or tumor or because the esophagus is not contracting properly. If there is a stricture, it can often be dilated with special balloons or dilation tubes during the endoscopy.
●Abnormal or unclear findings on an upper GI x-ray, CT scan, or MRI.
●Removal of a foreign body (a swallowed object).
●To check healing or progress on previously found polyps (growths), tumors, or ulcers.

ENDOSCOPY PREPARATION — You will be given specific instructions regarding how to prepare for the examination before the procedure. These instructions are designed to maximize your safety during and after the examination and to minimize possible complications. It is important to read the instructions ahead of time and follow them carefully. Do not hesitate to call the physician’s office or the endoscopy facility if there are questions.
You may be asked not to eat or drink anything for up to eight hours before the test. It is important for your stomach to be empty to allow the endoscopist to visualize the entire area and to decrease the possibility of food or fluid being vomited into the lungs while under sedation (called aspiration).
You may be asked to adjust the dose of your medications (such as insulin) or to stop specific medications (such as blood thinning medications) temporarily before the examination. You should discuss your medications with your physician before your appointment for the endoscopy.
You should arrange for a friend or family member to escort you home after the examination. Although you will be awake by the time you are discharged, the medications used for sedation may cause temporary changes in the reflexes and judgment and interfere with your ability to drive or make decisions (similar to the effects of alcohol). Patients who receive sedation are often required to be accompanied home after the procedure.

WHAT TO EXPECT DURING ENDOSCOPY — Prior to the endoscopy, the staff will review your medical and surgical history, including current medications. A physician will explain the procedure and ask you to sign consent. Before signing consent, you should understand the benefits and risks of the procedure, alternatives to the procedure, and all of your questions should be answered.

If you are going to receive sedation for the procedure, an intravenous line (a needle inserted into a vein in the hand or arm) will be inserted to deliver medications. You may be given a combination of a sedative (to help you relax) and a narcotic (to prevent discomfort), or other medications that are commonly used for sedation.
Your vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful. Oxygen is often given during the procedure through a small tube that sits under the nose and is fitted around the ears. For safety reasons, dentures should be removed before the procedure.

Although most patients are sedated for the examination, many tolerate the procedure well without any medication. Usually, these patients are given a medication to numb the back of their throats (either a gargle or a spray) just prior to the endoscopy to prevent gagging during the passage of the instrument. This may be offered to patients felt to be at higher risk for receiving sedation. Otherwise, if you are interested in having your endoscopy in this sedation-free manner, you should discuss this with the doctor beforehand to see if this is a possibility for you.

THE ENDOSCOPY PROCEDURE — The procedure typically takes between 10 and 20 minutes to complete. The endoscopy is performed while you lie on your left side. A plastic mouth guard is placed between the teeth to prevent damage to the teeth and endoscope.

The endoscope (also called a Gastroscope) is a flexible tube that is about the size of a finger. The endoscope has a lens and a light source that allows the endoscopist to see the inner lining of the upper gastrointestinal (GI) tract, usually on a TV monitor. Most people have no difficulty swallowing the flexible Gastroscope because of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination.
An alternative procedure called trans nasal endoscopy may be available in some facilities. This involves passing a very thin scope (about the size of a drinking straw) through the nose. You are not sedated but a medication is applied to the nose to prevent discomfort. A full examination can be performed with this instrument.
The endoscopist may take tissue samples called biopsies. Obtaining biopsies is not painful. The endoscopist may also perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon what is found during the examination. Air or carbon dioxide gas is gently introduced through the endoscope to open the esophagus, stomach, and intestine, allowing the endoscope to be passed through these areas and improving the endoscopist’ s ability to see completely. You may experience mild discomfort as air is pushed into the stomach and intestinal tract. This is not harmful; belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths just before and during the procedure may help you to relax.

RECOVERY FROM ENDOSCOPY — After the endoscopy, you will be observed for a period of time, generally less than one hour, while the sedative medication wears off. Some of the medicines commonly used cause some people to temporarily feel tired or have difficulty concentrating. You typically will be instructed not to drive and not to return to work for the balance of the day of the procedure.

The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This usually resolves quickly. Some patients also have a mild sore throat. Most patients are able to eat shortly after the examination.

ENDOSCOPY COMPLICATIONS — Upper endoscopy is a safe procedure and complications are rare. The following is a list of some possible complications:
●Aspiration (inhaling) of food or fluids into the lungs, the risk of which can be minimized by not eating or drinking for the recommended period of time before the examination.
●Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the team ensures a safer examination.
●The medications may produce irritation in the vein at the site of the intravenous catheter. If redness, swelling, or discomfort occurs, you should call your endoscopist or primary care provider, or the number given to you at discharge.
●Bleeding can occur from biopsies or the removal of polyps, although if bleeding occurs, it is usually minimal and stops quickly on its own or can be easily controlled.
●The endoscope can cause a tear or hole in the area being examined. This is a serious complication but fortunately occurs extremely rarely.
The following signs and symptoms should be reported immediately:
●Severe abdominal pain (more than gas cramps)
●A firm, distended abdomen
●Vomiting
●Any temperature elevation
●Difficulty swallowing or severe throat pain
●A crunching feeling under the skin of the neck

AFTER UPPER ENDOSCOPY — Most patients tolerate endoscopy very well and feel fine afterwards. Some fatigue is common after the examination, and you should plan to take it easy and relax the rest of the day.
The endoscopist can describe the result of the examination before you leave the endoscopy facility. If biopsies have been taken or polyps removed, you should call for results at a time specified by the endoscopist, typically within one week.

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Colonoscopy Overview

Colonoscopy Overview

COLONOSCOPY OVERVIEW — A colonoscopy is an exam of the lower part of the gastrointestinal tract, which is called the colon or large intestine (bowel). Colonoscopy is a safe procedure that provides information other tests may not be able to give. Patients who require colonoscopy often have questions and concerns about the procedure.
Colonoscopy is performed by inserting a device called a colonoscope into the anus and advancing through the entire colon. The procedure generally takes between 20 minutes and one hour.
Other tests that are sometimes used to screen for colon cancer, like virtual colonoscopy (also called CT colonography),

More detailed information about colonoscopy is available by subscription..
REASONS FOR COLONOSCOPY — The most common reasons for colonoscopy are:

●To screen for colon polyps (growths of tissue in the colon) or colon cancer
●Rectal bleeding
●A change in bowel habits, like persistent diarrhea
●Iron deficiency anemia (a decrease in blood count due to loss of iron)
●A family history of colon cancer
●A personal history of colon polyps or colon cancer
●Chronic, unexplained abdominal or rectal pain
●An abnormal x-ray exam, like a barium enema or CT scan

COLONOSCOPY PREPARATION — Before colonoscopy, your colon must be completely cleaned out so that the doctor can see any abnormal areas. This is vitally important to increase the chances that your doctor will identify abnormalities in your colon. If your colon is not completely cleaned out, the chances your doctor will miss abnormalities increases. Your doctor’s office will provide specific instructions about how you should prepare for your colonoscopy. Be sure to read these instructions as soon as you get them so you will know how to take the preparation and whether you need to make any changes to your medications or diet. If you have questions, call the doctor’s office in advance.

You will need to avoid solid food for at least one day before the test. You should also drink plenty of clear fluids on the day before the test. You can drink clear liquids (a liquid you can hold up to the light and see through) up to several hours before your procedure, including:

●Water
●Clear broth (beef, chicken, or vegetable)
●Coffee or tea (without milk)
●Ices
●Gelatin such as Jell-O (avoid red gelatin)

Avoid drinking red liquids. Your doctor may also ask you to avoid high fiber foods including seeds and nuts for the week before the procedure.

To clean the colon, you will take a strong laxative and empty your bowels. You may be asked to take the entire preparation the night before the test, or you may be asked to take it in two doses, with the second dose taken four to six hours prior to the colonoscopy. Taking the preparation in two “split” doses may help get the colon even cleaner. This may require you to wake up early in the morning to complete the preparation. The instructions you are given will tell you how you should take the preparation.

A commonly used preparation is a 4-liter (1 gallon) solution that is purchased at the pharmacy with a prescription. There are several low-volume (2- to 3-liter) preparations on the market as well. Some doctors prefer citrate of magnesia (also called magnesium citrate), a 300 mL (10 ounce) bottle that requires no mixing and is over-the-counter. Packets of powdered laxative are available that are mixed with a smaller volume of water. Sodium phosphate-based preparations are now usually avoided due to concerns over safety.

Refrigerating the solution can make it easier to drink, but do not put ice in the solution since it will melt and you will have to drink even more fluid. Drinking the solution through a straw, adding sugar-free powdered flavor packets (ex. Crystal Light), and taking half the preparation the night before and the other half later (four to six hours before your colonoscopy) may also make it easier to drink. Drinking this solution may be the most unpleasant part of the exam. Watery diarrhea is the desired result. This may occur shortly after drinking the solution or may be delayed for several hours. The result should be diarrhea that looks like urine. If you become nauseated or vomit while drinking the solution, call your doctor or nurse for instructions. Tips that can help with nausea and vomiting include temporarily stopping drinking the solution, walking around, and resuming drinking at a slower pace.
Medicines — You can take most prescription and nonprescription medicines right up to the day of the colonoscopy. Your doctor should tell you what medicines to stop. You should also tell the doctor if you are allergic to any medicines.

Some medicines increase the risk of heavy bleeding if you have a polyp removed during the colonoscopy. Ask your doctor how and when to stop these medicines, including warfarin/Coumadin, Clopidogrel/Plavix, or any other anticoagulant (blood thinning) medicine. Do not stop these medications without first talking with your doctor.
Transportation home — Most patients are given a sedative (a medicine to help you relax) during the colonoscopy, so you will need someone to take you home after your test. Your doctor may prefer that an anesthesiologist administer the sedative and monitor you during the colonoscopy. Although you will be awake by the time you go home, the sedative/anesthetic medicines cause changes in reflexes and judgment that can interfere with your ability to make decisions, similar to the effect of alcohol. You will not be able to drive home or go back to work after the examination if you received sedation for the procedure. You should be able to return to work the next day.

WHAT TO EXPECT — Before the test, a doctor will review the procedure with you, including possible complications, and ask you to sign a consent form.

An IV line will be inserted in your hand or arm. Your blood pressure, heart rate, and breathing will be monitored during the test.

THE COLONOSCOPY PROCEDURE — You will be given fluid and medicines through the IV line. With sedation/analgesia provided during the colonoscopy, many people sleep during the test, while others are very relaxed, comfortable, and generally not aware. Your doctor may request an anesthesiologist give you an anesthetic agent (for example, Propofol), which is a stronger sedative and will put you to sleep while you are being closely monitored.

The colonoscope is a long black flexible tube, approximately the diameter of the index finger. The doctor will gently pump air or carbon dioxide and sterile water or saline through the scope into the colon to inflate it and allow the doctor to see the entire lining. You might feel bloating or gas cramps as the air opens the colon. Try not to be embarrassed about passing this gas (it is just air), and let your doctor know if you are uncomfortable. You may feel like you have to go to the bathroom, which is a normal feeling during the procedure.
During the procedure, the doctor might take a biopsy (small pieces of tissue) or remove polyps. Polyps are growths of tissue that can range in size from the tip of a pen to several inches. Most polyps are benign (not cancerous). However, some polyps can become cancerous if allowed to grow for a long time. Having a polyp removed does not hurt.

RECOVERY FROM COLONOSCOPY — After the colonoscopy, you will be observed in a recovery area, usually for about 30 to 60 minutes until the effects of the sedative medication wear off. The most common complaint after colonoscopy is a feeling of bloating and gas cramps. You should pass gas and not feel embarrassed doing this either during or after the procedure. This will relieve your feelings of bloating and cramping. You may also feel groggy from the sedation medications. You should not return to work, drive, or drink alcohol that day. Most people are able to eat normally after the test. Ask your doctor when it is safe to restart aspirin and other blood-thinning medications.

COLONOSCOPY COMPLICATIONS — Colonoscopy is a safe procedure, and complications are rare but can occur:
●Bleeding can occur from biopsies or the removal of polyps, but it is usually minimal and can be controlled.
●The colonoscope can cause a tear or hole in the colon. This is a serious problem that sometimes requires surgery to repair, but it does not happen commonly.
●It is possible to have side effects from the sedative medicines like nausea or vomiting.
●Although colonoscopy is the best test to examine the colon, it is possible for even the most skilled doctors to miss or overlook an abnormal area in the colon.
You should call your doctor immediately if you have any of the following:
●Severe abdominal pain (not just gas cramps)
●A firm, bloated abdomen
●Vomiting
●Fever
●Rectal bleeding (greater than a couple of tablespoons [30 mL])

AFTER COLONOSCOPY — Although many people worry about being uncomfortable during a colonoscopy, most people tolerate it very well and feel fine afterward. It is normal to feel tired afterward. Plan to take it easy and relax the rest of the day.
Your doctor can describe the results of the colonoscopy as soon as it is over. If s/he took biopsies or removed polyps, you should call for results within one to two weeks if your doctor has not already contacted you.

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