Upper Gastrointestinal System Endoscopy
What Is Upper Gastrointestinal System (GIS) Endoscopy?
By performing upper gastrointestinal system endoscopy, your physician can evaluate upper part of your gastrointestinal system (esophagus, stomach, duodenum). This procedure is performed by your physician using a device in the form of a flexible and thin tube with a light and camera on the tip, also called the endoscope. The images obtained with the camera on the tip of the endoscope are magnified and transferred to a larger screen as a video. In spite of being commonly defined as gastroscopy, physicians and healthcare professional call this procedure upper gastrointestinal system endoscopy or esophagogastroduodenoscopy.
Why Is Upper GIS Endoscopy Performed?
Thanks to upper gastrointestinal system endoscopy, the physicians can evaluate persistent upper abdominal pain, nausea, vomiting or dysphagia (swallowing difficulty). It is the best method to evaluate the hemorrhages originating from upper gastrointestinal system. The endoscopy is more definitive for diagnosis of inflammation within esophagus, stomach or duodenum, ulcer and tumors (gastric cancer and other tumors) compared to other radiogram-based tests. Upper GIS endoscopy is also preferred to collect small tissue fragments (biopsy). By means of pathological analysis performed on the biopsy sample, it is possible to make a differentiation between benign and malignant tissues. Note that biopsy may be requested for a lot of reasons, even though your physician does not think you have a malignant disease! For instance, Helicobacter pylori, a bacteria causing ulcer in stomach, can be diagnosed with taking biopsy samples. Moreover, upper GIS endoscopy is also performed to treat pathologies of upper gastrointestinal system. In some cases, treatments that cause rarely or mildly discomfort are possible with the devices sent through the endoscope. For example, the treatments such as dilatation of a narrowed area, removing of polyps (mostly benign enlarged mucosa) or stop the bleeding can be performed thanks to the endoscopy.
How Should I Prepare For The Procedure?
The stomach should completely be empty before the endoscopy for the best conditions. Therefore, patients are not supposed to eat or drink anything, including water, at least 6 hours before the procedure. Your physician will tell specify how long you should fast. Inform your physician clearly about the medications you regularly take as dose adjustment may be needed before or during the procedure. If you are allergic to a medication or have a chronic disease related to heart or any other organ, you have to let your physician know prior to the procedure. If you are recommended to take antibiotics for dental treatment, again inform your physician before the endoscopy, because antibiotic prophylaxis may be needed.
What Should I Expect From Upper GIS Endoscopy?
Initially, a local anesthetic medication is sprayed on your throat or a sedative medication is intravenously administered. A mouthpiece is placed in your mouth in order to prevent from harming your teeth and damaging the device. After you are given a left sideway position, the physician insert the endoscope into your mouth and advance it through the esophagus, stomach and duodenum, which will not affect your respiration. Most of the patients define this procedure as mildly discomforting process and some of them fall asleep during the procedure.
What Comes Next After The Upper GIS Endoscopy?
You will be monitored until effects of the sedation go down. After the procedure, you may experience sore throat and mild distention due to air inflated in your stomach during the endoscopy. Unless your physician recommends anything, you can consume solid foods 30 to 45 minutes after the procedure. Results mostly come out on the same day and you will be informed by your physician; however, it may take a few days to get the results of additional tests and biopsy analysis. If a sedative medication is administered during the procedure, you will be prohibited to drive, even if you feel good. Since sedatives can affect your decision-making abilities and reflexes all day after the endoscopy, it is preferable to have someone accompany you during the procedure.
What Are Complications of Upper GIS Endoscopy?
When performed by a well-trained and experienced physician, it is very rare for patients to have complications after the endoscopy. Although there is a possibility of bleeding in the area where a biopsy sample or polyp is taken, it is usually minimal and does not require a follow-up process. Following removal of large polyps or bleeding treatment, bleeding may persist from time to time. Other likely risks include reaction to sedatives, cardiac and pulmonary distress and gastric perforation. It is important to detect early signs of potential complications. If you experience fever, dysphagia or gradually worsening sore throat, chest or abdominal pain, defecating black and malodorous stool, low blood pressure and palpitation, you should immediately call your physician. For a healthy life, it will be the safest way for you to have the examinations requested by your physicians carried out on time at centers under appropriate conditions by well-trained physicians.
Percutaneous Endoscopic Gastrostomy (PEG)
What Does PEG Mean?
The PEG refers to percutaneous endoscopic gastrostomy, which is defined as accessing the stomach with an endoscope and placing a flexible feeding tube in the stomach through anterior abdominal wall for nourishment. With the use of this tube, foods and fluids can be directly delivered to stomach by bypassing the mouth and esophagus. This leaflet will provide information with you in detail about the procedure; for instance, how it's performed, how it can help, and what side effects you might experience. Of course, you may not find answers for some of your questions, as each patient has a different medical needs and attention. In this case, we advise you to ask your unanswered questions to your physician.
How Is PEG Procedure Performed?
Using a flexible device with light and camera on the tip, called the endoscope, your physician creates an opening that will connect your stomach and skin of anterior abdominal wall. Afterwards, a tube is placed in stomach and secured at this site. Patients generally receive an intravenous sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Depending overall condition, consciousness and additional diseases of patients, the procedure can be performed under operating room conditions and general anesthesia. Patients can usually go home the day of the procedure or the next day.
Who Can Benefit from The PEG Procedure?
This procedure is recommended for those who suffer dysphagia (swallowing difficulty), loss of appetite and malnutrition. Some severe complications may arise in the long-term intravenous nutrition or the nutrition with tubes inserted through the nose into the stomach. In cases when GI tract is functional, the healthiest long-term nutritional method is to put the foods directly into stomach of small intestines. However, PEG is not recommended if oral intake is possible after a short period of time or life expectancy is quite short.
What Kind of Care Does the PEG Tube Require?
A medical dressing is placed on the PEG site following the procedure. This dressing is usually removed after one or two days. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed.
How are feedings given? Can I still eat and drink?
Specialized liquid nutrition, as well as fluids, are given through the PEG tube using a large syringe, plastic tube bags functioning by gravity or tube systems connected with a mechanical pump. You will be provided with hands-on training by your physician or a healthcare professional. Although the PEG procedure does not prevent you from eating or drinking, this is a very important issue to discuss with your physician.
Are There Complications from PEG Placement?
Complications can occur with the PEG placement. Possible complications include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube as well as infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). If the PEG is unintentionally dislodged at the early period following placement, leakage of the gastric contents in the abdomen may occur. Your doctor will describe the symptoms that could indicate a possible complication.
How Long Do These Tubes Last? How Are They Removed?
PEG tubes can last for months or years. However, it should be noted that they might need to be replaced, because they can break down or become clogged with residual formula over extended periods of time. Your physician can easily remove or replace the tube without sedatives or anesthesia, but your doctor might prefer use sedation and endoscopy in some cases. When a replacement or removal is needed, your physician removes the tube using firm traction and either inserts a new tube or let the opening close spontaneously if no replacement is planned. Once the tube is involuntarily removed, PEG sites close quickly. Therefore, it is very important for you to immediately consult your physician or apply to a hospital if an accidental dislodgment occurs. Otherwise, endoscopy-guided PEG placement may be considered.
COLONOSCOPY
Colonoscopy allows your physician to examine the mucosa of rectum and large intestine (colon). A colonoscope, a thin flexible tube, as thick as your finger, is inserted into your anus and slowly advanced into the rectum and colon.
How should I prepare for the colonoscopy?
Your doctor will tell you how you should prepared and provide necessary recommendations that generally consists of limiting your diet, consuming oral laxatives or, if needed, applying enema. It is important for you to follow your physician’s instructions carefully, as colon cleansing may affect the colonoscopy results.
Should I continue to take my current medications?
Most medications can be continued as usual. Please let your physician know about medications you are taking, particularly aspirin products, anticoagulants/antiaggregants (blood thinners) products. Also, remember to mention allergies you have to medications. Inform your physician if you have a vital health problem or antibiotic prophylaxis prior to a dental treatment.
What should I expect from colonoscopy?
As the colonoscopy is performed after you are given a sedative at our clinic, you will feel or remember nothing about the procedure. You will lie on your left side during the colonoscopy. After waking up, you might feel mild bloating, which is normal and temporary.
What happens if something abnormal is detected during the colonoscopy?
If your physician sees a finding in mucosa of the large intestines that requires further evaluation, obtaining a sample of biopsy may be necessary. Biopsy is performed not only for cancer or tumor, but also benign formations.
When a benign formation such as polyp is detected, your physician naturally decide to take a biopsy sample for further analysis. Polyps are the formations originating from mucosa and tending to grow in terms of size and type. Known as hyperplastic, the polyps generally do not require an intervention; however, the adenomas that are mostly benign have a potential to become malignant. Possibility of biopsy or more comprehensive interventions should be discussed prior to the procedure.
What happens after the colonoscopy?
Your physician will explain the results of the examination to you. It is natural for you to feel mild bloating and cramp-like abdominal pain after the procedure due to gas inflated into intestines during the colonoscopy. These kinds of complaints are expected to occur less as carbon dioxide is preferred to be used during all your endoscopic procedures. Unless your physician provides additional recommendations with you, you are free to eat and return to your daily routines.
What are the possible complications of the colonoscopy?
This procedure is quite safe when performed by well-trained physicians who are specially experienced in endoscopy. Although complications after colonoscopy are uncommon, it’s important to recognize early signs of possible complications. Contact your physician if you notice severe abdominal pain, fever and chills, or rectal bleeding (at least in amount of half teacup). Note that bleeding can occur even several days after the procedure.
Large intestine (colon) polyps and treatment
What is a colonic polyp?
Polyps are formations tending to grow in the colon lining that are usually benign (noncancerous tumors or neoplasms). They may develop in several areas of GI tract as well as are mostly seen in colon. They vary in size from 1-2 millimeters to above 10 centimeters. They seem like small swellings originating from colonic mucosa and grow into the intestinal lumen (intestinal space). They can sometimes be of fungal structure (with pedicles) whereas several polyps are detected in different colon parts in some patients.
How common are colonic polyps? What causes them?
Polyps are common in adults and their frequency increases with age. While uncommon in individuals aged 20, this pathology can be seen with a ratio of 25% in individuals aged 60, according to predictions based on various researches. The cause of polyps is not known for sure. However, based on general predictions, polyp growth may be caused by fatty and low-fiber diets. There are genetic risk factors for developing polyps as well.
What are known risk factors for developing polyps?
The biggest risk factor for developing polyps is being older than 50. A family history of colon polyps or colon cancer increases the risk of polyps. Also, people with a personal history of polyps or colon cancer are at higher risk of developing new polyps in the future. In addition, there are some rare “syndromes” that run in families which increase the risk of forming polyps and cancers, even at younger ages.
What are the types of polyps?
There are two common types: hyperplastic and adenomatous polyps. The hyperplastic polyp is not at risk for cancer. The adenoma, however, is thought to be the origin for almost all colon cancers, although most adenomas never become cancers. Taking a biopsy samples for analysis is the best way to differentiate between hyperplastic and adenomatous polyps. Although it is impossible to tell which adenomatous polyps will become cancers, larger polyps are more likely to become cancers and they are removed. Moreover, some of the largest ones (those larger than 2.5-3 cm) might already contain small areas of cancer. Because your doctor cannot be certain of the tissue type by the polyp’s appearance, your physician generally recommends removing all polyps found during a colonoscopy.
How are polyps found?
Most polyps cause no symptoms. Larger ones can cause blood in the stools, but even they may be usually asymptomatic. Therefore, the best way to detect polyps is by screening individuals with no symptoms. Several other screening techniques can be used such as testing stool specimens for traces of blood, performing a sigmoidoscopy or a barium enema (radiology test). If one of these tests suspects polyps, your physician can recommend colonoscopy to remove them. Because colonoscopy is the most accurate way to detect polyps, many experts now recommend colonoscopy as a screening method so that any polyps found or suspected can be removed during the same procedure.
How are polyps removed?
Almost all polyps found during colonoscopy can be completely removed during the procedure. Various removal techniques are available; however, most involve removing them with a special device (wire loop or biopsy forceps) cauterizing the base using electric current. This is called polyp resection. Because the colon mucosa is not sensitive to cutting or burning, polyp resection does not cause discomfort. The obtained tissue samples are analyzed under the microscope and the tissue type is determined as well as whether there is cancer or not.
What are the risks of polyp removal?
Polyp removal or polypectomy during the colonoscopy is a routine outpatient procedure. Possible complications, which are uncommon, include bleeding from the polypectomy site and perforation (a hole or tear) of the colon. Bleeding from the polypectomy site might initiate immediately or later (after several days). Persistent bleeding can almost always be stopped by treatment during a repeat colonoscopy. Perforations, on the other hand, require surgery to repair.
How often do I need to undergo colonoscopy if I have polyps removed?
Time of your next colonoscopy is planned and decided by your physician. The timing depends on several factors, including number and size of polyps removed, the type and the quality of bowel cleansing. Bowel cleansing is very important since it affects the evaluation of mucosa. If the polyps are small and entire colon is evaluated, your physician is most likely recommend you to have the next colonoscopy 3 years later. If the next colonoscopy does not detected an additional polyp, so the following colonoscopy is scheduled for 5 years later.
On the other hand, if the polyps are large and flat, a follow-up colonoscopy may be recommended in order to see whether polypectomy was successfully performed. Your physician will discuss all the options with you.
Note: The information presented above is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about treatment and follow-up recommendations.
What Is ERCP?
Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to visualize gallbladder, intrahepatic and extrahepatic bile ducts, pancreatic ducts.
During the ERCP, your physician will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin and flexible tube with light and camera on the tip. After your physician sees the common opening to the ducts from the liver and pancreas, a narrow plastic tube, called a catheter, is passed through the endoscope and into the ducts. A contrast agent (dye) is injected through the catheter and images of the examined areas are taken with an x-ray device.
How should I Prepare for the ERCP?
You should fast for at least 6 hours preferably overnight before the procedure. It is important that you have an empty stomach during the procedure, which is necessary for the best examination.
You should inform your physician about medications you take regularly and any allergies you have to medications. Remember to let your physician know about any allergies you have to medications containing iodine including contrast agents. Although an allergy doesn’t prevent you from having ERCP, it’s important to discuss it with your physician prior to the procedure. Also, be sure to tell your physician if you have heart or lung conditions.
What should I expect from the ERCP?
A local anesthetic may be applied to your throat or a sedative may be administered to make you more comfortable during the procedure. Some patients also receive antibiotics before the procedure. You will lie on your left side on a table compatible with x-ray device. Then, the endoscope is passed through your esophagus and stomach by your physician to reach duodenum. The instrument does not interfere with breathing, but you might feel mild bloating sensation because of the air inflated in the stomach.
What are possible complications of ERCP?
ERCP is a well-tolerated procedure when performed by well-trained physicians who are specially experienced in the technique. Although complications requiring hospitalization can occur, they are quite uncommon. The most common complications can include pancreatitis (inflammation of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. The complications are mostly manageable without requiring a surgical intervention.
Risks vary, depending on why the ERCP is performed, what is found during the procedure, and whether a patient has major medical problems. Patients undergoing therapeutic ERCP (removing stones from bile ducts) face a higher risk of complications than patients undergoing diagnostic ERCP. Your physician will discuss your likelihood of complications before you undergo the procedure.
What should I expect after the ERCP?
If you undergo the ERCP as an outpatient, you will be observed for complications until most of the effects of the medications have worn off before being sent home. You might experience bloating or burping. 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.