Endoscopy

Diagnostic colonoscopy

In addition to performing screening colonoscopies for the early detection of colon polyps and colon cancer, clinicians at LVHN Gastroenterology perform colonoscopies to help diagnose common gastrointestinal diseases.

If you’re experiencing gastrointestinal symptoms such as abdominal pain, rectal bleeding, diarrhea, blood in your stool, constipation or unexplained weight loss, among other symptoms, you may be a candidate for a diagnostic colonoscopy.

Screening colonoscopy

We are dedicated to the prevention and early detection of colon cancer and perform screening colonoscopies every day. Our highly trained clinicians and staff are available to answer any questions and walk you through the screening process. Your convenience and comfort are our priorities.

Adults ages 50 and older without any risk factors, and those with a family history of colon cancer, colon polyps or inflammatory bowel disease, should be screened every 10 years for colon cancer. Colon cancer, the second leading cause of cancer deaths, can be prevented and is most easily treated when detected early.

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Colonoscopy preparation: Please review our colonoscopy preparation guide here. [ADD LINK]

Flexible sigmoidoscopy enables clinicians to look at the inside of your large intestine from the rectum through the last part of the colon, called the sigmoid or descending colon. Clinicians may use the procedure to find the cause of diarrhea, abdominal pain or constipation. They also use it to look for bleeding, inflammation, abnormal growths, ulcers and early signs of cancer. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon).

During the procedure, the clinician inserts a short, flexible, lighted tube (the sigmoidoscope) into your rectum and slowly guides it into your 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. If a polyp or inflamed tissue is found, the clinician can remove a piece of it using instruments inserted into the scope. That sample can then be sent to a lab for testing.

Flexible sigmoidoscopy takes 10 to 20 minutes. There is no sedation required, so you should be able to drive to and from your office visit on the day of your procedure.

Preparation

The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe. The night before the procedure, administer an enema at least one hour before bedtime. Administer a second enema at least one hour before leaving for your procedure. Speak to your clinician about recommendations or special instructions.

PEG stands for percutaneous endoscopic gastrostomy and is a procedure that allows nutrition, fluids and medications to be put into the stomach, bypassing the mouth and the esophagus.

The clinician uses an endoscope to guide the creation of a small opening through the skin of your abdomen and directly into your stomach. Then, a feeding tube is placed and secured into your stomach. You will receive a mild sedative and local anesthesia and will most likely go home the same day or the next day.

If you have difficulty swallowing, problems with your appetite or inability to take enough nutrition though your mouth, you can benefit from this procedure. Your clinician will review care the PEG tube, feeding and potential complications along with complete instructions.

The first few feet of the small intestine ‒ the duodenum and first portion of the jejunum ‒ can be examined by using a longer endoscope called an enteroscope. Used by clinicians to diagnose certain gastrointestinal conditions, the instrument is introduced through the mouth and slowly advanced through the stomach, duodenum and into the jejunum by a gentle pushing action.

Your gastroenterologist may recommend push enteroscopy if there is an abnormality suspected in the upper portion of your small bowel that may be causing recurrent or persistent symptoms. These may include abdominal pain, diarrhea, bleeding or anemia.

This advanced procedure is often used as a follow-up to other diagnostic testing such as upper endoscopy, colonoscopy, capsule endoscopy or radiology imaging tests.

Upper endoscopy, or esophagogastroduodenoscopy (EGD), enables clinicians to look inside the esophagus, stomach and duodenum (first part of the small intestine). The procedure can be used to evaluate the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, or abdominal or chest pain.

Your clinician can see abnormalities, such as inflammation or bleeding, through the endoscope that don’t show up well on X-rays. Instruments can also be inserted into the scope to remove samples of tissue (biopsy) for further tests or treat bleeding abnormalities.

Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.

The procedure takes 15 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 30 to 45 minutes until the medication wears off. You will need someone to drive you home after your procedure.

A capsule endoscopy uses a tiny wireless camera to take pictures of the digestive tract. The endoscopy camera sits inside a vitamin-sized capsule that you swallow. As the capsule travels through your digestive organs and structures, the camera takes pictures that are sent to a recorder.

Through a capsule endoscopy, clinicians can see areas of the small intestine that aren’t easily reached with other endoscopy procedures. They might use this procedure to:

• Find the cause of bleeding in the small intestine
• Diagnose inflammatory bowel, cancer and celiac diseases
• Look at the esophagus
• Screen for polyps
• Do follow-up testing after X-rays or other imaging tests

As many as 20 percent of women and 30 percent of men have polyps detected by screening colonoscopy. Some polyps are too large for standard polypectomy. Our advanced endoscopists can use various advanced EMR techniques to remove these large polyps.

Also known as a push and pull enteroscopy, this technique allows visualization of the small bowel. Using DBE, it is possible to biopsy tissue, dilate strictures, remove polyps and stop bleeding from the small bowel. DBE can be performed in an outpatient or inpatient setting and may require several hours (depending on the therapy required). It is often performed with general anesthesia or moderate sedation and is only performed after careful evaluation by a specialty-trained gastroenterologist.

This specialized endoscopic procedure is used to study the bile and pancreatic ducts and is performed to treat bile duct stones, tumors or narrow areas (strictures) of the bile ducts. ERCP allows for direct visualization of the bile duct (choledochoscopy and pancreatoscopy) as well as stent placement for relief of bile duct and/or pancreatic duct obstruction.

This procedure gives your clinician detailed images of your digestive tract that other procedures or imaging tests cannot provide. It can help diagnose certain conditions that may cause abdominal pain or abnormal weight loss in addition to evaluating previously detected abnormalities including lumps or lesions. EUS also provides access to adjacent organs to detect diseases of the pancreas, bile duct and gallbladder. EUS allows clinicians to diagnose and stage esophageal, gastric, hepatobiliary and pancreatic cancer; screen high-risk individuals for pancreatic cancer; evaluate and risk stratify pancreas cysts; drain pancreatic fluid collections; and biopsy liver lesions and adjacent lymph nodes.

In this minimally invasive procedure, your clinician uses an endoscope to remove precancerous and cancerous areas in the gastrointestinal tract. “Submucosal” means this procedure targets tumors located under the lining of the GI tract. These tumors can be close to muscle tissue and can be difficult to remove completely with other methods.

Your clinician will insert the endoscope through the mouth for upper GI tumors or through the anus for lower GI tumors, depending on where in the GI tract the tumor is located. Our gastroenterologists (doctors specially trained to treat the GI tract) perform this procedure. Only a few centers in the United States perform ESD because the procedure requires a high degree of expertise and precision.

ESD is typically an outpatient procedure, and most people go home the same day.

POEM is used to treat swallowing disorders, especially achalasia. This is when the ring of muscle between the esophagus and the stomach tightens excessively and doesn’t relax. Other esophagus muscles don’t help move down swallowed food and can prevent it from getting to the stomach. This can cause coughing or choking, sore throat, food becoming trapped in the esophagus and even weight loss and nutrient deficiencies.

During the POEM procedures, an endoscope is inserted through the mouth to cut muscles in the esophagus. Cutting the muscles loosens them and prevents them from tightening and interfering with swallowing.

This is a safe, effective treatment of Barrett’s esophagus. During RFA, radio waves are delivered via a catheter to remove diseased tissue of the esophagus while having minimal impact to the healthy tissue. This process is called ablation. Treating Barrett’s esophagus is important because it not only removes diseased tissue, treatment can also prevent development of esophageal cancer.

Gastroesophageal reflux disease, also known as acid reflux or GERD, is a condition in which stomach acid repeatedly flows back up into the esophagus. It’s because this junction has become too relaxed. The TIF procedure may be an option for you if you have mild to moderate GERD and/or hiatal hernias and want a lasting solution, but don’t want or can’t have surgery.

During a TIF procedure, your clinician will operate on your gastroesophageal junction through your mouth, using an endoscope and a special fundoplication device. No incision or surgery is needed. The procedure repairs the lower esophageal sphincter, the valve that allows stomach acid to pass back into the esophagus.

A hiatal hernia is also often involved in GERD. This means that the top of your stomach is emerging through the esophageal hiatus. That’s the opening in your diaphragm that your esophagus passes through to meet your stomach below it. A TIF procedure can also correct a hiatal hernia.

Our endoscopy experts carefully evaluate patients with Barrett’s esophagus with advanced imaging techniques. They are well versed in providing all treatments for Barrett’s esophagus including radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation and endoscopic mucosal resection.