Gastroenterology Consultants,SC: Procedures Performed By Our Staff Colonoscopy: Colonoscopy is the examination of the entire colon (or large intestine) by the insertion of a flexible light tipped tube (colonoscope) into the rectum and hence into the colon which allows the direct visualization of the lining of the colon. This is used to diagnose cancer, polyps, inflammation (for example colitis), causes of bleeding, and abnormal or questionable x-rays. Colonoscopy is both diagnostic and therapeutic by removing the precancerous polyps and by obtaining biopsies from them. Current recommendation by American Cancer Society, US Preventive Health Task Force, American College Of Gastroenterology, and AGA recommend Colonoscopy for all over 50 years. If they are in high-risk group (Eg: Family history of Colon Cancer) they may need Colonoscopy at an earlier age and require more frequent screening. Most of the cancers can be detected at an early stage but may not be preventable. On the other hand Colon Cancer can be preventable by early and effective screening procedures. Colonoscopy is used as screening procedure to prevent colon cancer. back to top Sigmoidoscopy: Sigmoidoscopy is the visual examination of the inside of the rectum and sigmoid (lower) colon,using a flexible tube called a sigmoidoscope. The colon, or large intestine is 5 to 6 feet long. During the sigmoidoscopy, only the last 1 to 2 feet of the colon is examined. During the test, your physician will inspect the lining of the bowel to look for growth and other abnormalities back to top Esophagogastroduodenoscopy (EGD): This is an examination of the upper digestive tract by a flexible tube called an endoscope. The endoscope will allow for direct visualization of the lining of your esophagus, stomach and duodenal portion of the small intestine. EGD can diagnosis ulcers, gastritis, tumors and causes of bleeding and pain. It is also used for taking biopsy specimens, removing foreign objects (coins swallowed by children), polyps to control bleeding and to open strictures (narrow areas) that cause difficulty swallowing with the aid of fluoroscopy (x-ray) back to top Esophageal Manometry and 24-Hour PH Testing: The esophagus is the food pipe that carries food and liquids from the throat to the stomach. Although it seems like a simple organ, the esophagus is not a rigid tube. the wall of the esophagus contains muscle that automatically contracts whenever a person swallows. The contraction occurs as a sweeping wave(peristalsis) down the esophagus. It literally strips the food or liquid from the throat to the stomach. Another important part of the esophagus is the lower valve muscle(lower esophageal sphincter,or LES ). this is a specialized muscle that remains closed most of the time, only opening when swallowed food is moved down the esophagus or when a person burps or vomits. This muscle protects the lower esophagus from caustic stomach acid and bile. These substances of course cause the discomfort of heartburn and in time can lead to damage in the esophagus. Everyone has heartburn at times, especially after a large or fatty meal. Manometry is the recording of muscle pressures within an organ. Esophageal manometry measures the pressure within the esophagus. It can evaluate the action of the stripping muscle waves in the main portion of the esophagus as well as the muscle valve at the end of it. This test will record acidity as it refluxes from the stomach back up into the esophagus. back to top Laparoscopy (Peritoneoscopy): Laparoscopy, or Peritoneoscopy is a procedure in which the physician introduces a small laparoscope through the abdominal wall where the liver and abdominal cavity can be evaluated for evidence of tumors, inflammation, infection, or scarring . Instruments can be passed through the laparoscope or guided from another site under direct vision to take a sample (biopsy) of tissue. back to top Endoscopic Retrograde Cholangiopancreatography (ERCP): This is an examination of the bile and pancreatic ducts using a flexible tube called an endoscope. The endoscope is passed through the mouth, esophagus, stomach, and into the duodenum (first portion of the small intestine). The opening from the bile duct and pancreatic duct is identified. A small plastic tube (cannula) is then passed through the endoscope into the opening and directed into the bile duct and/or pancreatic duct. Contrast material (x- ray dye) is then injected through the cannula into the ducts and x-rays are taken. ERCP can diagnose many diseases of the pancreas, bile ducts, liver and gall bladder including the presence of stones. An abnormality suspected by clinical history, blood tests or x-ray can be confirmed and studied in detail with ERCP. back to top Liver Biopsy: Liver biopsy is a diagnostic procedure in which a special needle is introduced into the liver to obtain a tissue specimen for pathological examination. The procedure is performed under a local anesthetic. back to top Hemorrhoid Coagulation: Hemorrhoids are swelling in the rectum or anal area that may protrude through the anus on straining. They usually contain enlarged veins and are most common in people over the age of 50. Three out of four people will develop hemorrhoids at some time in their lives. Infrared Coagulation(IRC) is the most widely used office treatment for hemorrhoids and is preferred over other methods because it is fast, well tolerated by patients, and virtually problem-free. A small probe contacts the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid causing it to shrink and recede. Another office treatment is the banding of hemorrhoids. With the use of a sigmoidoscope, a small amount of suction is applied to elevate the hemorrhoid so that a small rubber band can be placed at the base of the hemorrhoid. The rubber band cuts off circulation to the hemorrhoid and the tissue will eventually slough off. back to top PY Test: The urea breath test (i.e., the PYtest) is the only diagnostic test that can determine the presence of H. pylori without the use of a scope. It is safe, accurate and easy to perform and also is much less expensive than a scope and biopsy for diagnosis. The PYtest capsule contains sugar beads coated with small amounts of chemical called urea. Urea is naturally found in the human body, and the amount in the capsule is much smaller than the head of a pin. The urea in the PYtest had been labeled with a naturally occurring radioactive tracer called carbon-14, so it can be detected after it is taken into the body. After the capsule is swallowed, it takes about three minutes to dissolve in the stomach. If the C-urea comes into contact with H. pylori, it is immediately broken down into C-carbon dioxide ammonia. The carbon dioxide enters the bloodstream and is exhaled by the patient. Ten minutes after ingesting the capsule, a breath sample is collected in a balloon. The breath sample is then analyzed; if enough of the C is present, the patient has H.pylori. If H. pylori is not present, the C urea simply washes through the stomach and is passed in the urine. back to top H2 Breath Test (for Lactose Intolerance): Lactose intolerance develops when the body has difficulty digesting whole and skim milk and other dairy products. Lactose is a milk sugar and like most sugars, it is broken down by enzymes in the intestinal tract so it can be absorbed as an energy source. The enzyme that breaks down lactose is called lactase. When the intestine does not contain lactase, then lactose intolerance can occur. It is a troublesome and annoying problem, but it is never a serious one. As commonly expected, infants and small children have the enzyme lactase so they can digest mothers' milk. However, during childhood, lactase begins to disappear in many people. Some ethnic groups are more likely to develop lactose intolerance. By adolescence, it is gone in about 75% of African Americans, Jews, Native Americans, Mexicans, and in 90% of Asians. so the condition is very common. · Hydrogen Breath Test - When lactose is broken down by the colon's bacteria, hydrogen is released, which then passes out through the lungs. The amount of hydrogen released after a lactose meal can indicate a problem. This test detects a lactose intolerance (not being able to digest sugar lactose in various food items) by showing a high amount of hydrogen in the air you breath out. This is done by drinking a lactose solution (a sugar water ) and having breath samples taken by the blowing into a mask. This test takes approximately 3 1/2 hours in our office. back to top Ultrasound Endoscope: Under IV conscious sedation, a specialized endoscope is inserted into the mouth, esophagus and stomach. This type of scope is connected to an ultrasound machine. By using sound waves, it provides visualization of the wall and all layers of GI tract as well as outside organs namely lymph nodes and other growths. This is the best modality available to evaluate tumors in the wall of the GI tract as well as tissue sampling of these tumors. This method is used for adequate cancer staging to evaluate the need for surgical intervention. In many cases it will prevent unnecessary surgical intervention. It has greater accuracy for local staging compared to CT Scan and MRI. This is highly useful in staging of Esophageal Cancer Pancreatic Cancer Lung Cancer Rectal Cancer Evaluation of sub mucosal tumors in GI tract This method may help in relief of severe cancer pain by injecting anesthetic agent and by blocking nerves (Celiac Block). Although this is highly useful in cancer staging because of steep learning curve only few experienced physicians are able to perform this technique. We are fortunate in providing this service in our center on out patient basis. back to top Rectal Motility And Rectal Suction Biopsy: These tests are done by a pediatric gastroenterologist. The motility study is done with a balloon catheter, connected to a computer. It indicates the strength of the anal sphincter and is usually done on children with constipation problems. The rectal suction biopsy is done with a small instrument that is inserted a short distance into the rectum and a small piece of tissue is taken. This test is specific for Hirschsprung's disease - diminished peristalsis of the colon. back to top Abdominal Paracentesis: Fluid is accumulated in the abdomen, caused by various diseases. A short needle is inserted into the abdomen, under local sedation, to drain excess fluid from the abdomen. back to top Video Capsule Endoscopy: Gastroenterology Consultants, S.C. is now among the first in the nation to use a clinically proven medical technology that allows physicians to see what no one has ever been able to fully capture before - the entire 21 feet of the human small intestine. The PillCam Capsule Endoscope, or camera in a pill, was pioneered by Given Imaging Corporation (Nasdaq: GIVN) to give patients a non-invasive option for diagnosis of certain small intestine disorders. Approximately 70 million Americans currently suffer from gastrointestinal troubles, including disorders such as obscure bleeding, Crohn's Disease, malabsorption or Celiac Disease, and intestinal tumors. However, many of these conditions go undiagnosed, or are treated with trial and error, due to the limited diagnostic options available for this region of the body. Given Imaging's PillCam Capsule Endoscope significantly improves the chances of accurate diagnosis for many previously undiagnosed small intestine disorders. The capsule, which is taken with a sip of water, just like a vitamin, passes naturally through the digestive tract, recording video images that are transmitted to and then stored on a recorder belt worn throughout the day. Eight hours after swallowing the capsule, the patient returns the belt to the physician's office. The physician then views the images using the Given Imaging workstation and RAPID software, and later reports his or her findings back to the patient. About Given Imaging Corporation Given Imaging produces and markets the Given® Diagnostic System featuring its PillCam Capsule Endoscope, a fundamentally new approach to examining the gastrointestinal tract. The system uses a disposable miniature video camera contained in a capsule that is ingested by a patient and delivers high quality color images in a painless and noninvasive manner. The test can be conducted while a patient continues normal daily activities. The system received clearance from the FDA in August 2001. Many patients suffering from diseases of the small intestine such as obscure bleeding, Crohn's Disease, malabsorption (Celiac disease), and intestinal tumors have already benefited from this innovative technology. back to top Sedation: There are two types of sedation administered at our facility: conscious sedation and monitored anesthesia care (MAC). The type of sedation administered to each patient depends upon the patient's medical history and the preference of the physician performing the endoscopy. Conscious sedation is administered by registered nurses (RN) under the supervision of a physician. The goal of conscious sedation is to decrease anxiety and pain during the patient's procedure. Patient response and degree of sedation are variable during conscious sedation. Level of sedation and vital signs are monitored by the RN throughout the procedure. Most patients receiving conscious sedation tolerate their procedure well. MAC is a safe and effective option for patients undergoing procedures such as endoscopy. Patients that receive MAC are typically more deeply sedated than patients receiving conscious sedation. MAC allows most patients to recover more quickly than conscious sedation and resume their normal daily activities in a shorter period of time after their endoscopy. Medication is injected into the bloodstream through an IV producing a semi-conscious state. Anxiety level will be reduced along with partial/total amnesia. Proper monitoring is essential and includes breathing, heart rate/rhythm, blood pressure and oxygen monitors. A Certified Registered Nurse Anesthetist (CRNA) administers MAC. CRNA's are advance practice nurses that work in collaboration with other qualified healthcare professionals. CRNA's provide 65% of all anesthetics given to patients each year in the United States. President George W. Bush received MAC anesthesia during his recent colonoscopy. back to top   Office hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Call (309)762-5560 to make an appointment.