Procedures

EGD

EGD

During this procedure an endoscope (a thin flexible tube with a camera and a light on the end) is guided down the esophagus under sedation and used to examine the esophagus, stomach, and the duodenum (the first part of the small intestine). Disorders that would be found by an EGD include: problems of the esophagus such as esophagitis from acid reflux, strictures, eosinophilic esophagitis, Barrett’s esophagus, and esophageal varices; problems of the stomach such as ulcers and hiatal hernias; and problems of the small intestine such as duodenal ulcers or celiac disease. Esophageal strictures can be dilated to alleviate problems swallowing and esophageal varices can be band ligated. To perform an upper endoscopy the patient must not have eaten solid foods for 8 hrs beforehand, but it doesn’t require a clean-out like a colonoscopy.

Colonoscopy

During this procedure a colonoscope (a thin flexible tube with a camera and light on the end) is guided up the rectum and the colon under sedation. This is used to perform a thorough examination of the inside of the entire colon. We can remove colon polyps and/or take biopsies to diagnose any abnormalities. Of any form of colorectal cancer screening, colonoscopy has the best sensitivity for finding colon polyps and is able to prevent colon cancer by removing those precancerous polyps during the procedure. To get a good exam, the colon must be cleaned out with a colon prep prior to the procedure. In addition to colorectal cancer screening, we use colonoscopy to diagnose colonic disorders such as ulcerative colitis, Crohn’s disease, and microscopic colitis and to look for causes of rectal bleeding.

ERCP

Under sedation, a side viewing endoscope (a flexible tube with a light and camera) is passed to the duodenum where the bile duct and pancreatic duct exit into the small intestine at the major papilla. Using fluoroscopy (X-ray guidance) we are able to pass a catheter into the bile duct where it can be used to remove stones from the bile duct (usually that have fallen down from the gallbladder), take samples, perform dilations of strictures, or place stents (thin plastic tubes that are temporarily left in place to hold the bile duct open). This procedure is done in a hospital setting (as an inpatient or outpatient) with deep sedation.

BARRX

This is a procedure that can be done during an EGD where special catheters are used to apply a very superficial burn (using radiofrequency) to areas of Barrett’s mucosa in the lower esophagus. Over the next several weeks the area heals over with normal mucosa. With repeated treatments we can get rid of the Barrett’s mucosa and reduce a person’s risk of developing esophageal cancer.

Hemorrhoidal Banding

Capsule Endoscopy

A pill-like capsule with a camera inside is swallowed, and over the next 8 hours takes thousands of pictures, which are transmitted wirelessly to a recording device that is worn around the waist like a fanny pack. After returning the fanny pack recording device to the office, these 8 hours of images are then uploaded to the computer and reviewed by the physician. This is used to examine the middle part of the small intestine that cannot be examined through an EGD or colonoscopy. It is typically used to look for obscure sources of bleeding or to look for Crohn’s disease or other abnormalities of the small intestine. To exclude the possibility of a stricture behind which the capsule could get stuck, a CT enterography or small bowel follow through is always performed before a capsule endoscopy. The capsule is passed in the stool and flushed down the toilet (they are not reused).

Bravo Capsule

During an EGD, a small capsule may be temporarily affixed to the lining of the lower esophagus where is stays in place for the next 48hours to wirelessly transmit the pH (level of acidity) of the lower esophagus to a recording device that is worn on the outside of the body. The recording device is returned to our office to upload the data onto a computer to be analyzed. The BRAVO capsule detaches from the lower esophagus and passes through the GI tract and into the toilet. BRAVO capsule is used to quantitate the severity of GERD.

24hr pH Monitoring

A thin flexible tube (about the diameter of a spaghetti noodle) is directed through the nose and down the esophagus where it is positioned in the esophagus (it’s not as bad as it sounds). The outside of the tube is taped to the nose and worn around for the next 24hours where it records the pH (level of acidity) and impedence (whether there is liquid present) in the lower esophagus. The person is able to eat and drink normally with it in place. The tube is then removed after 24hours and the data is analyzed. We use this to quantitate the severity of GERD. It has the advantage over the BRAVO capsule that it can record both acidic and non-acidic reflux, but the disadvantage that the person has to endure having a small tube down their nose for a day.

Esophageal Manometry

a thin flexible tube is directed through the nose and down the esophagus where it is positioned to record pressure at various points down the esophagus. The person is then given different consistencies of liquids to drink while measuring the contractility and peristalsis of the esophagus. This is used to evaluate neuromuscular causes of dysphagia (problems swallowing) and to diagnose achalasia (a disorder where the valve at the bottom end of the esophagus doesn’t want to relax).