Austin Gastroenterology

 

 Colonoscopy

The Colonoscopy procedure is used to evaluate the lining of the colon in order to check for several medical conditions. It is the method of choice for screening patients at risk for colon cancer.

Using a colonoscope, a long, thin, flexible, tube-like instrument, your physician can visually inspect the lining of the colon. The scope bends, so the physician can move it around the curves of your colon. You may be asked to change position occasionally to help the physician move the scope. The scope also blows air into your colon, which inflates the colon and helps the physician see better. Color images are sometimes taken using video capture technology and polyps can be removed with a plastic covered wire snare that cuts, cauterizes and removes the polyp.

For the procedure, you will lie on your left side on the examining table. You will be given pain medication and sedation to keep you comfortable and sleepy during the exam. The physician will insert the colonoscope into the rectum and slowly guide it all the way up through the colon to the lower end of the small intestine. Colonoscopy is a relatively simple and painless procedure and usually lasts less than one half hour.

 

Flexible Sigmoidoscopy

Flexible sigmoidoscopy enables the physician to look at the inside of the large intestine from the rectum through the last part of the colon . Because it does not extend up through colon, flexible sigmoidoscopy is not sufficient to detect polyps or cancer in this area. Physicians use it to look for the presence of several conditions including early signs of cancer in the descending colon and rectum. Color images are sometimes taken using video capture technology. Therapy can be administered directly through the sigmoidoscope.

For the procedure, you will lie on the examining table, while the physician inserts a short, flexible, lighted tube into your rectum and slowly guides it into your lower colon. The scope transmits an image of the inside of the rectum and colon, so the physician can carefully examine the lining of these organs. The scope also blows air into these organs, which inflates them and helps the physician see better. Flexible sigmoidoscopy is a relatively simple and painless procedure and usually lasts less than fifteen minutes.

 

Esophagogastroduodenoscopy (EGD)

Upper GI endoscopy, sometimes called EGD (esophagogastroduodenoscopy), is a visual examination of the upper intestinal tract using a lighted, flexible fiber optic or video endoscope. EGD is usually performed on an outpatient basis. The throat is anesthetized by a spray or liquid and intravenous sedation is usually given to relax the patient. The endoscope is then inserted into the upper esophagus and a visual examination is conducted. Color images are sometimes taken using video capture technology and therapy can be administered directly through the endoscope. The exam takes 15 to 30 minutes. There is no pain and patients seldom remember much about the procedure. A temporary, mild throat irritation sometimes occurs after the exam. Your doctor can answer any questions you may have regarding the EGD or any other procedure.

Upper GI endoscopy helps in diagnosing and often in treating several conditions including, but not limited to, ulcers, intestinal bleeding, esophagitis and heartburn and gastritis.

 

Esophageal Manometry

Esophageal manometry measures and records esophageal sphincter (a ring like muscle that constricts and relaxes as required to assist with normal body functions) pressure, duration, and sequence of the esophageal contractions. An analysis and interpretation is completed, by your physician, of the muscle functioning of the esophagus.
While you are sitting upright, a small catheter (about the size of a blade of grass) is gently passed through your nostril and eased into your esophagus to the desired area. You will be asked to lie down and then pressure recordings are obtained (this is not painful). The catheter is then removed and you may leave. Your physician will then do the interpretation of those measurements.

 

Esophageal pH Probe

Ambulatory 24-hour pH probe monitoring is a method for recording the amount and severity of acidic stomach contents backing up into the esophagus. It is the most effective method for diagnosing Gastroesophageal Reflux Disease (GERD) and is considered the standard for evaluation.

To properly prepare for the pH probe, do not eat or drink anything 4 to 6 hours prior to the test and discuss with your physician all medications you are currently taking. He or she will tell you which you should or should not take before the test.

The actual test involves placing a small probe or catheter in the nose and down through the esophagus. To make the test more comfortable, the probe will be lubricated. It takes just a few seconds to place the probe. The probe is connected to a small recording device called a Digitrapper and using a microprocessor, this unit is able to record the pH or acid levels in your esophagus over a 24-hour period. Once you are connected to the monitor, you can go home and resume eating and normal daily activities, however showering, swimming and any other activities involving water are not allowed for the entire testing period, as the equipment cannot get wet.

Status switches/buttons and the symptom button on the Digitrapper allow you to record your mealtime, sleep periods and symptoms, such as heartburn. Once the test is completed, your doctor can correlate these events and activities with acid levels in your esophagus and make medical treatment recommendations.

 

Patient Instructions for Undergoing Capsule Endoscopy

Your physician has determined that as part of your medical evaluation you should undergo an examination known as Capsule Endoscopy. This procedure involves ingesting a small (the size of a large vitamin pill) Pillcam Capsule which will pass naturally through your digestive system while taking pictures of the intestine. The images (pictures) are transmitted to small sensors which are placed on your abdomen. The sensors are attached to a walkman-like DataRecorder which saves all the images. It is located on the RecorderBelt, which is worn around your waist. After a few hours, you will remove the RecorderBelt and return it to your physician for processing. The Pillcam Capsule is disposable and will be excreted naturally in your bowel movement. In the rare case that it will not be excreted naturally, it will need to be removed endoscopically or surgically. In order for your physician to get the most accurate information from this examination, you will need to follow the instructions below:

The Day Before Capsule Endoscopy

After lunch on the day before the Capsule Endoscopy examination, start the clear liquid diet your physician prescribed.

From 10 p.m. the evening before Capsule Endoscopy, do not eat or drink except for necessary medication with a sip of water.

Do not take any medication beginning 2 hours before undergoing Capsule Endoscopy.

Abstain from smoking 24 hours prior to undergoing Capsule Endoscopy.

Male patient should shave their abdomen 6 inches (15cm) above and below the navel on the day of the examination. If it is difficult for you to shave your abdomen, please contact your physician’s office to arrange to have this done in advance.

Day of Capsule Endoscopy

Arrive at the annex office located at: 8015 Shoal Creek Blvd., Suite 300 early for your Capsule Endoscopy dressed in loose fitting, two-piece clothing.

At the annex office, you will have a pre-procedure interview the morning of your procedure by the Pillcam Nurse. During this interview you will be informed that Capsule Endoscopy is associated with a small chance of intestinal obstruction. You will be checked-in and asked to give your informed consent.

The sensors will be applied to your abdomen with adhesive pads and will be connected to the DataRecorder which you will wear in a belt around your waist. After that you will be instructed to ingest the Pillcam Capsule and drink 1-2 glasses of water.

After ingesting the Pillcam Capsule

After ingesting the Pillcam Capsule, do not eat or drink for at least 2 hours. At the end of the 2nd hour, you may take your morning medications with a small amount of water.

1. After 4 hours you may have a light snack. After the examination is completed, you may return to your normal diet. The above instructions related to eating apply, unless your physician specifies otherwise. Contact your physician immediately if you suffer from any abdominal pain, nausea or vomiting during Capsule Endoscopy.
2. After ingesting the Pillcam Capsule and until it is excreted, you should not be near any source of powerful electromagnetic fields such as one created near an MRI device or amateur (ham) radio.
3. Occasionally, some images may be lost due to radio interference (e.g. from amateur radio transmitter, MRI, etc.). On rare occasions this may result in the need to repeat the Capsule Endoscopy examination. In this case, the physician will advise you to stay within the premises of the clinic during the Capsule Endoscopy to prevent this problem from recurring.
4. Capsule Endoscopy may last anywhere from 4-6 hours and is considered complete according to your physician’s instructions. Do not disconnect the equipment or remove the belt at any time during this period. Since the DataRecorder is actually a small computer, it should be treated with utmost care and protection. Avoid sudden movements and banging of the DataRecorder.
5. During Capsule Endoscopy, you will need to verify every 15 minutes that the small light on top of the DataRecorder is blinking twice per second. If, for some reason it stops blinking at this rate, record the time and contact your physician. You should also record the time and nature of any event such as eating, drinking, your activity and unusual sensations. Return the Event Form with these notes to your physician at the time you return the equipment.
6. Avoid any strenuous physical activity, especially if it involves sweating and do not bend over or stoop during Capsule Endoscopy.

After completing Capsule Endoscopy

You will be instructed by the Pillcam Nurse on how to return the equipment at the end of Capsule Endoscopy.

Do not pull the leads of the sensors or try to remove the sensors yourself.

The DataRecorder stores the images of your examination. (Handle the DataRecorder, RecorderBelt, sensors, and Battery Pack carefully). Do not expose them to shock, vibration or direct sunlight, which may result in loss of information. Return all of the equipment to the office as directed.

If you did not positively verify the excretion of the Pillcam Capsule from your body, and you develop unexplained post procedure nausea, abdominal pain or vomiting, contact your physician at 458-1121 (Medical Exchange) for evaluation and possible abdominal X-ray examination.

Undergoing an MRI while the capsule is inside your body may result in serious damage to your intestinal tract or abdominal cavity. If you did not positively verify the excretion of the Pillcam Capsule from your body, you should contact your physician for evaluation and possible abdominal X-ray before undergoing an MRI examination.

 

48 hour Bravo pH Capsule Procedure

The Bravo pH Capsule contains a radio telemetry pH sensor and is a little larger than a “gel cap.” It is introduced orally into the esophagus, via a delivery system, that accurately inserts it above the lower esophageal sphincter.

After the capsule is positioned suction is applied drawing a small amount of the esophageal mucosa into the well of the capsule. A tiny locking pin within the capsule is advanced, penetrating the mucosa, thus attaching the capsule. Then the delivery system is withdrawn. There is no sensation or pain or discomfort when the capsule is deployed. Capsule placement takes less than 60 seconds.

The capsule is left in place to begin pH recording. Esophageal pH levels are transmitted, via radio frequency telemetry, to an external pager-size receiver for up to 48 hours. Data from the recorder is uploaded to a computer for analysis by your physician and a report is generated.

Following the study, normal functions such as swallowing and passage of food will cause the disposable capsule to slough off and pass through the patient’s digestive tract to be excreted.

Restrictions for using the Bravo pH capsule include patients with pacemakers, defibrillators or neuro-stimulators. Patients who have a history of bleeding disorders, strictures, severe esophagitis, esophageal varices and esophageal or intestinal obstructions are not candidates for the Bravo system.