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SCOPE OUT CANCER









































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COLONOSCOPY

What is a colonoscopy?

Colonoscopy enables your doctor to examine the lining of your colon (large intestine), "scoping out cancer"™ for abnormalities by inserting a flexible tube as thick as your finger into your anus and slowly advancing it into the rectum and colon, so we can "Scope out Cancer" ™. The Colonoscopy procedure is performed at our surgery center in Beverly Hills.

What preparations are required?

Your doctor will tell you what dietary restrictions to follow and what cleansing routine to use.  In general, the preparation consists of either consuming a large volume of a special cleansing solution or clear liquids and special oral laxatives.  The colon must be completely clean for the procedure to be accurate and complete, so be sure to follow your doctor’s instructions carefully.

Can I take my current medications?

Most medications can be continued as usual, but some medications can interfere with the preparation or the examination.  Inform your doctor about medications you’re taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners), insulin or iron products.  Also, be sure to mention allergies you have to medications.

Alert your doctor if you require antibiotics prior to dental procedures because you might need antibiotics before a colonoscopy as well.

What happens during colonoscopy?

Colonoscopy is well tolerated and rarely causes much pain.  You might feel pressure, bloating or cramping during the procedure.  Your doctor might give you a sedative to help you relax band better tolerate any discomfort.

You will lie on your side or back while your doctor slowly advances a colonoscope through your large intestine to examine the lining.  Your doctor will examine the lining again as he or she slowly withdraws the colonoscope.  The procedure itself usually takes 15 to 60 minutes, although you should plan on two to three hours for waiting, preparation and recovery.

In some cases, the doctor cannot pass the colonoscopy through the entire colon to where it meets the small intestine.  Although another examination might be needed, your doctor might decide that the limited examination is sufficient.

What if the colonoscopy shows something abnormal?

If you doctor thinks an area needs further evaluation, he or she will pass an instrument through the colonoscope to obtain a biopsy (a sample of the colon lining) to be analyzed.  Biopsies are used to identify many conditions, and your doctor might order one even if he or she doesn’t suspect cancer.  If colonoscopy is being performed to identify sites of bleeding, your doctor might control the bleeding through the colonoscope by injecting medications or by coagulation (sealing off bleeding vessels with heat treatment).  Your doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination.  These procedures don’t usually cause any pain.

What are polyps and why are they removed?

Polyps are abnormal growths in the colon lining that are usually benign (noncancerous).  They vary in size from a tiny dot to several inches.  Your doctor can’t always tell a benign polyp from a malignant (cancerous) polyp by its outer appearance, so he or she will send removed polyps for analysis.  Because cancer begins in polyps, removing them is an important means of prevention of colorectal cancer.

How are polyps removed?

Your doctor will destroy tiny polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments.  Your doctor will use a technique called “snare polypectomy” to remove larger polyps.  Your doctor will pass a wire loop through the colonoscope and will remove the polyp from the intestinal wall using an electrical current.  You should feel no pain during the polypectomy.

What happens after a colonoscopy?

Your physician will explain the results of the examination to you, although you’ll probably have to wait for the results of any biopsies performed.  If you were given sedatives during the procedure, someone must drive you home and stay with you.  Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day.  You might have some cramping or bloating because of the air introduced into the colon during the examination.  This should disappear quickly when you pass gas. You should be able to eat after the examination, but your doctor might restrict your diet and activities, especially after polypectomy.

What are the possible complications of colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by doctors who have been specially trained and are experienced in these procedures. One possible complication is a perforation, or tear, through the bowel wall that could require surgery.  Bleeding might occur at the site of biopsy or polypectomy, but it’s usually minor.  Bleeding can stop on its own or be controlled through the colonoscope; it rarely requires follow-up treatment.  Some patients might have a reaction to the sedatives or complications from heart or lung disease. Although complications after colonoscopy are uncommon, it’s important to recognize early signs of possible complications.  Contact your doctor if you notice severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup.  Note that the bleeding can occur several days after polypectomy.

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COLON POLYPS AND THEIR TREATMENT

What is a colon polyp?

Polyps are benign growths involving the lining of the bowel (noncancerous tumors or neoplasms).  They can occur in several locations in the gastrointestinal tract, but are most common in the colon.  They vary in size from less than a quarter of an inch to several inches in diameter.  Hey look like small bumps growing from the lining of the bowel and protruding into the lumen (bowel cavity). They sometimes grow on a “stalk” and look like mushrooms.  Many patients have several polyps scattered in different parts of the colon.

How common are colon polyps?  What causes them?

Polyps are very common in adults, who have an increased chance of acquiring them as they age.  While quite rare in 20-year-olds, it’s estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp. We don’t know what causes polyps. Some experts believe a high-fat, low-fiber diet can be a predisposition to polyp formation. There may be a genetic risk to develop polyps as well.

What are known risks 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, patients with a personal history of polyps or colon cancer are at risk of developing new polyps.  In addition, there are some rare polyp or cancer syndromes that run in families and increase the risk of polyps occurring at younger ages.

Are there different types of polyps?

There are two common types:  hyperplastic polyp and adenoma.  The hyperplastic polyp is not at risk for cancer and, therefore, is not as significant.  The adenoma, however, is thought to be the precursor (origin) for almost all colon cancers, although most adenomas never become cancers.  A biopsy (or small piece of removed tissue) is the only way to differentiate between hyperplastic and adenomatous polyps.  Although it’s impossible to tell which adenomatous polyps will become cancers, larger polyps are more likely to become cancers and some of the largest ones (those larger than 1 inch) can already contain small areas of cancer.  Because your doctor cannot be certain of the tissue type by the polyp’s appearance, doctors general recommend removing all but the smallest polyps.

How are polyps found?

Most polyps cause no symptoms.  Larger ones can cause blood in the stools, but even they are usually asymptomatic.  Therefore, the best way to detect polyps is by screening individuals with no symptoms.  Several other screening techniques are available:  testing stool specimens for traces of blood, performing sigmoidoscopy to look into the lower third of the colon, or using a radiology test such as a barium enema.  If one of these tests finds or suspects polyps, your doctor will generally recommend colonoscopy to remove them.  Because colonoscopy is the most accurate 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?

Most polyps found during colonoscopy can be completely removed during the procedure.  Various removal techniques are available; most involved severing them with a wire loop and/or burning the polyp base with an electric current.  This is called polyp resection.  Because the bowel’s lining isn’t sensitive to cutting or burning, polyp resection doesn’t cause discomfort.  Resected polyps are then examined under a microscope to determine the tissue type and to detect any cancer.

What are the risks of polyp removal?

Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure.  Possible complications, which are uncommon, include bleeding from the polypectomy site and perforation (a hole) of the colon.  Bleeding from the polypectomy site can be immediate or delayed for several days; persistent bleeding can almost always be stopped by treatment during colonoscopy.  Perforations usually require surgery to repair.

How often do I need colonoscopy if I have polyps removed?

Your doctor will decide when your next colonoscopy is necessary.  The timing depends on several factors, including the number and size of polyps removed, the polyps’ tissue type and the quality of the colon cleansing for your previous procedure.  The quality of cleansing affects your doctor’s ability to see the surface of the colon.  If the polyps were small and the entire colon was well seen during your colonoscopy, doctors generally recommend a repeat colonoscopy in three years.  If your repeat colonoscopy doesn’t show any indication of polyps, you might not need another procedure for an additional five years. However, if the polyps were large and flat, your doctor might recommend an interval of only months before a repeat colonoscopy to assure complete polyp removal.  Your doctor will discuss those options with you.

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COLON CANCER SCREENING

Six Questions That Could Save Your Life (or the Life of Someone You Love):

What You Need to Know about Colon Cancer Screening

March is National Colorectal Cancer Awareness Month and the American Society for Gastrointestinal Endoscopy (ASGE) encourages everyone over 50, or those under 50 with a family history of other risk factors, to be screened for colorectal cancer.

Test Your Knowledge about Colorectal Cancer (CRC) Screening.

If you think the answer is true or mostly true, answer true.  If you think the answer is false or mostly false, answer false. Answers appear below.

Colorectal cancer is predominantly a “man’s disease,” affecting many more men than women annually.

FALSE – Colorectal cancer affects an equal number of men and women.  Many women however, think of CRC as a disease only affecting men and might be unaware of important information about screening and preventing colorectal cancer (CRC) that could save their lives, says the American Society for Gastrointestinal Endoscopy.

Only women over the age of 50 who are currently experiencing some symptoms or problems should be screened for colorectal cancer or polyps.

FALSE – Beginning at age 50, all men and women should be screened for colorectal cancer EVEN IF THEY ARE EXPERIENCING NO PROBLEMS OR SYMPTOMS.

A colonoscopy screening exam typically requires an overnight stay in a hospital.

FALSE – Colonoscopy is almost always done on an outpatient basis.  A mild sedative typically given before the procedure and then a flexible slender tube is inserted into the rectum to look inside the colon.  The test is safe and the procedure itself typically takes less than 30 minutes.

Colorectal cancer is the third leading causing of cancer deaths in women in the United States.

TRUE – After lung cancer and breast cancer, colorectal cancer is the third leading cause of cancer deaths in women in the United States.  Annually, approximately 130,000 new cases of colorectal cancer are diagnosed in the United States and 56,000 people die from the disease.  It has been estimated that increased awareness and screening could save 30,000 lives each year.

Tests used for screening for colon cancer include digital rectal exam, stool blood test, barium enema, flexible sigmoidoscopy, and colonoscopy.

TRUE – These are the five different tests used for screening for colorectal cancer even before there are symptoms.  Talk to your healthcare provider about which test is best for you.  Current recommendations for screening include:

Beginning at age 50, men and women should have, at a minimum:

-An annual stool occult blood test;

-Flexible sigmoidoscopy every three to five years, or a colonoscopy every ten years;

-A digital rectal exam at the time of the each screening sigmoidoscopy, colonoscopy, or barium enema

IMPORTANT:  You should begin screening earlier if you have a personal or family history of colorectal cancer, polyps, rectal bleeding, or long-standing inflammatory bowel disease such as ulcerative colitis disease. Colon cancer is often preventable.

TRUE – Colorectal cancer is highly preventable.  Screening tests such as colonoscopy and flexible sigmoidoscopy may detect polyps (small, grapelike growths on the lining of the colon).  Removal of these polyps can prevent colorectal cancer from developing.

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UPPER ENDOSCOPY

What is upper endoscopy?

Upper endoscopy lets your doctor examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine).  Your doctor will use a thin, flexible tube called an endoscope, which has its own lens and light source and we will view the images on a video monitor.  You might hear your doctor or other medical staff refer to upper endoscopy as upper GI endoscopy, esophagogastroduodenoscopy (EGD) or panendoscopy.

Why is upper endoscopy done?

Upper endoscopy helps your doctor evaluation symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing.  It’s the best test for finding the cause of bleeding from the upper gastrointestinal tract.  It’s also more accurate than x-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum. Your doctor might use upper endoscopy to obtain a biopsy (small tissue samples).  A biopsy helps your doctor distinguish between benign and malignant (cancerous) tissues.  Remember, biopsies are taken for many reasons, and your doctor might order one even if he or she does not suspect cancer. For example, your doctor might use a biopsy to test for Helicobacter pylori, bacteria that cause ulcers. Your doctor might also use upper endoscopy to perform a cytology test, where he or she will introduce a small brush to collect cells for analysis. Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract.  Your doctor can pass instruments through the endoscopy to directly treat many abnormalities with little or no discomfort.  For example, your doctor might stretch a narrow area, remove polyps (usually benign growths) or treat bleeding.

How should I prepare for the procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination.  Your doctor will tell you when to start fasting. Tell your doctor in advance about any medications you take; you might need to adjust your usual dose for the examination.  Discuss any allergies to medications as well as medical conditions, such as heart or lung disease. Also, alert your doctor if you require antibiotics prior to undergoing dental procedures, because you might need antibiotics prior to upper endoscopy as well.

What can I expect during upper endoscopy?

Your doctor might start by spraying your throat with a local anesthetic or by giving you a sedative to help you relax.  You’ll then lie on your side, and your doctor will pass the endoscope through your mouth and into the esophagus, stomach and duodenum.  The endoscope doesn’t interfere with your breathing.  Most patients consider the test only slightly uncomfortable, and many patients fall asleep during the procedure.

What happens after upper endoscopy?

You will be monitored until most of the effects of the medication have worn off.  Your throat might be a bit sore, and you might feel bloated because of the air introduced into your stomach during the test.  You will be able to eat after you leave unless your doctor instructs you otherwise. Your doctor generally can tell you your test results on the day of the procedure; however, the results of some tests might also take several days. If you received sedatives, you won’t be allowed to drive after the procedure even though you might not feel tired.  You should arrange for someone to accompany you home because the sedatives might affect your judgment and reflexes for the rest of the day.

What are the possible complications of upper endoscopy?

Although complications can occur, they are rare when doctors who are specially training and experienced in this procedure perform the test.  Bleeding can occur at a biopsy site or where a polyp was removed, but it’s usually minimal and rarely requires follow up.  Other potential risks include a reaction to the sedative used, complications from heart or lung diseases, and perforation (a tear in the gastrointestinal tract lining).  It’s important to recognize early signs of possible complications.  If you have a fever after the test, trouble swallowing, or increasing throat, chest or abdominal pain, tell your doctor immediately.

 

 

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ESOPHAGEAL DILATATION

What is esophageal dilatation?

Esophageal dilatation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus (swallowing tube).  Doctor can use various techniques for this procedure.  Your doctor might perform the procedure as part of a sedated endoscopy.  Alternatively, your doctor might apply a local anesthetic spray to the back of your throat and then pass a weighted dilator through your mouth and into your esophagus.

Why is it done?

The most common cause of narrowing of the esophagus, or stricture, is scarring of the esophagus from reflux of acid occurring in patients with heartburn.  Patients with a narrowed portion of the esophagus often have trouble swallowing; food feels like it is “stuck” in the chest region, causing discomfort or pain.  Less common causes of esophageal narrowing are webs or rings (which are thin layers of excess tissue), cancer of the esophagus, scarring after radiation treatment or a disorder of the way the esophagus moves (motility disorder).

How should I prepare for the procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to drink, including water, for at least six hours before the examination.  Your doctor will tell you when to start fasting. Tell your doctor in advance about any medications you take, particularly aspirin products or anticoagulants (blood thinners).  Most medications can be continued as usual, but you might need to adjust your usual dose before the examination.  Your doctor will give you specific guidance.  Tell your doctor if you have any allergies to medications or if you have medical conditions such as heart or lung disease.  Also, tell your doctor if you require antibiotics prior to dental procedures because you might need antibiotics prior to esophageal dilatation as well.

What can I expect during esophageal dilatation?

Your doctor might perform esophageal dilatation with sedation along with an upper endoscopy.  Your doctor may spray your throat with a local anesthetic spray, and then give you sedatives to help you relax.  Your doctor will then pass the endoscope through your mouth and into the esophagus, stomach and duodenum.  The endoscope does not interfere with your breathing.  As this point your doctor will determine whether to use dilating balloon or plastic dilators over a guiding wire to stretch your esophagus.  You might experience mild pressure in the back of your throat or in your chest during the procedure.  Alternatively, your doctor might start by spraying your throat with a local anesthetic.  Your doctor will then pass a tapered dilating instrument through your mouth and guide it into the esophagus.

What can I expect after esophageal dilatation?

After the dilatation is done, you will probably be observed for a short period of time and then allowed to return to your normal activities.  You may resume drinking when the anesthetic no longer causes numbness to your throat, unless your doctor instructs you otherwise.  Most patients experience no symptoms after this procedure and can resume eating the next day, but you might experience a mild sore throat for the remainder of the day.  If you received sedatives, you probably will be monitored in a recovery area until you are ready to leave.  You will not be allowed to drive after the procedure even though you might not feel tired.  You should arrange for someone to accompany you home, because the sedatives might affect your judgment and reflexes for the rest of the day.

What are the potential complications of esophageal dilatation?

Although complications can occur even when the procedure is performed correctly, they are rare when performed by doctors are specially training.  A perforation, or hole, of the esophagus lining occurs in a small percentage of cases and may require surgery.  A tear of the esophagus lining may occur and bleeding may result.  Complications from heart or lung diseases are potential risks if sedatives are used. It is important to recognize early signs of possible complications.  If you have chest pain, fever, difficulty swallowing, bleeding or black bowel movements after the test, tell your doctor immediately.

Will repeat dilatations be necessary?

Depending on the degree and cause of narrowing of your esophagus, it is common to require repeat dilatations.  This allows the dilatation to be performed gradually and decreases the risks of the procedure.  Once the stricture, or narrowed esophagus, is completely dilated, repeat dilatations may not be required.  If the stricture was due to acid reflux, acid-suppressing medicines can decrease the risk of stricture recurrence.

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ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

What is ERCP?

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the ducts of the gallbladder, pancreas and liver.  Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. During ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine).  An endoscope is a thin, flexible tube that lets your doctor see inside your bowels.  After your doctor sees the common opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts.  Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take x-rays.

What preparation is required?

You should fast for at least six hours (and preferably overnight) before the procedure to make sure you have an empty stomach, which is necessary for the best examination. You should talk to your doctor about medications you take regularly and any allergies you have to medications. Tell your doctor if you have an allergy to iodine-containing drugs, which include contrast material.  Although an allergy doesn’t prevent you from having ERCP, it’s important to discuss it with your doctor prior to the procedure. Also, but sure to tell your doctor if you have heart or lung conditions, or other major diseases.

What can I expect during ERCP?

Your doctor might apply a local anesthetic to your throat or give you a sedative to make you more comfortable.  Some patients also receive antibiotics before the procedure.  You will lie on your left side on an x-ray table. Your doctor will pass the endoscope through your mouth, esophagus, stomach, and into the duodenum.  The instrument does not interfere with breathings, but you might feel a bloating sensation because of the air introduced through the instrument.

What are possible complications of ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially training and experienced in the technique.  Although complications requiring hospitalization can occur, they are uncommon.  Complications can include pancreatitis (an inflammation or infection of the pancreas), infections, bowel perforation and bleeding.  Some patients can have an adverse reaction to the sedative used.  Complications are often managed without surgery. Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems.  Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP.  Your doctor will discuss your likelihood of complications before you undergo the test.

What can I expect after ERCP?

If you have ERCP as an outpatient, you will be observed for complications until most of the effects of the medication have worn off.  You might experience bloating or pass gas because of the air introduced during the examination.  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.

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THERAPEUTIC ERCP

What is a therapeutic ERCP?

Endoscopic retrograde cholangiopancreatography, or ERCP, is a study of the ducts that drain the liver and pancreas.  Ducts are drainage routes in the bowel.  The ones that drain the liver and gallbladder are called bile or biliary ducts.  The one that drains the pancreas is called the pancreatic duct.  The pancreatic and bile ducts join together before they drain into the upper bowel, about 3 inches from the stomach.  The drainage opening is called the papilla.  The papilla is surrounded by a circular muscle, called the sphincter of Oddi. Diagnostic ERCP is when x-ray contrast dye is injected into the bile duct, the pancreatic duct, or both.  This contrast dye is squirted through a small tube called a catheter that fits through the ERCP endoscope.  X-rays are taken during ERCP to get pictures of these ducts.  That is called diagnostic ERCP.  However, most ERCP’s are actually done for treatment and not just picture taking.  When an ERCP is done to allow treatment, it is called therapeutic ERCP. 

What treatments can be done through an ERCP scope?

Sphincterotomy

Sphincterotomy is cutting the muscle that surrounds the opening of the ducts, or the papilla.  This cut is made to enlarge the opening.  The cut is made while your doctor looks through the ERCP scope at the papilla, or duct opening.  A small wire on a specialized catheter uses electric current to cut the tissue.  A sphincterotomy does not cause discomfort, you do not have nerve endings there.  The actual cut is quite small, usually less than ½ inch.  This small cut, or sphincterotomy, allows various treatments in the ducts.  Most commonly the cut is directed toward the bile duct and is called a biliary sphincterotomy.  Occasionally, the cutting is directed towards the pancreatic duct, depending on the type of treatment you need.

Stone Removal

The most treatment through an ERCP scope is removal of bile duct stones.  These stones may have formed in the gallbladder and traveled into the bile duct or may form in the duct itself years later after your gallbladder has been removed.  After a sphincterotomy is performed to enlarge the opening of the bile duct, stones can be pulled from the duct into the bowel.  A variety of balloons and baskets attached to specialized catheters can be passed through the ERCP scope into the ducts allowing stone removal.  Very large stones may require crushing in the duct with a specialized basket so the fragments can be pulled out through the sphincterotomy.

Stent Placement

Stents are placed into the bile or pancreatic ducts to bypass strictures, or narrowed parts of the duct.  These narrowed areas of the bile or pancreatic duct are due to scar tissue or tumors that cause blockage of normal duct drainage.  There are two types of stents that are commonly used.  The first is made of plastic and looks like a small straw.  A plastic stent can be pushed through the ERCP scope into a blocked duct to allow normal drainage.  The second type of stent is made of metal wires that locks like the cross wires of a fence.  The metal stent is flexible and springs open to a larger diameter than plastic stents.  Both plastic and metal stents tend to clog up after several months and you may require another ERCP to place a new stent.  Metal stents are permanent while plastic stents are easily removed at a repeat procedure.  Your doctor will choose the best type of stent for your problem.

Balloon Dilatation

There are ERCP catheters fitted with dilating balloons that can be placed across a narrowed area or stricture.  The balloon is then inflated to stretch out the narrowing.  Dilatation with balloons is often performed when the cause of the narrowing is benign (not a cancer).  After the balloon dilatation, a temporary stent may be placed for a few months to help maintain the dilatation.

Tissue Sampling

The procedure that is commonly performed through the ERCP scope is to take samples of tissue from the papilla or from the bile or pancreatic ducts.  There are several different sampling techniques, although the most common is to brush the area with subsequent examination of the cells obtained.  Tissue samples can help decide if a stricture, or narrowing, is due to a cancer.  If the sample is positive for cancer, it is very accurate.  Unfortunately, a tissue sampling that does not show cancer may not be accurate.

What can you expect before, during and after a therapeutic ERCP?

You should not eat for at least 6 hours before the procedure.  You should tell your doctor about medications that you take regularly and whether you have allergies to medications or contrast material such as dye.  You will have an intravenous needle placed in your arm so you can receive medicine during the procedure.  You will be given sedatives that will make you comfort during the ERCP.  Some patients require antibiotics before the procedure.  The procedure is performed on an x-ray table.  After the ERCP is complete, you will go to a recovery area until the sedation effects subside.  Some patients are admitted to the hospital for a day, but many go home from the recovery unit.  You should not drive a car for the rest of the day, although most patients can return to full activity the next day.

What are possible complications of therapeutic ERCP?

The overall ERCP complication rate requiring hospitalization is 6 to 10%.  Depending on your age, your other medical problems, what therapy is performed, and the indication for your procedure, your complication rate may be higher or lower than the average.  Your doctor will discuss your likelihood of complications before you undergo the test.  The most common complication is pancreatitis, or inflammation of the pancreas.  Other complications include bleeding, infection, and adverse reaction to the sedative medication, or bowel perforation.  Most complications are managed without surgery but may require you to stay in the hospital for treatment.

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CAPSULE ENDOSCOPY (PILL CAMERA)

What is Capsule Endoscopy?

Capsule endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract; which includes the three portions of the small intestine (duodenum, jejunum, ileum).  Your doctor will use a pill sized video capsule called an endoscope, which has its own lens and light source and will view the images on a video monitor.  You might hear your doctor or other medical staff refer to capsule endoscopy as small bowel endoscopy, capsule enteroscopy, or wireless endoscopy.

Why is capsule endoscopy done?

Capsule endoscopy helps your doctor evaluate the small intestine.  This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy.  The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine.  It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine. As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure.  You may need to check with your own insurance company to ensure that this is a covered benefit. 

How should I prepare for the procedure?

You will receive preparation instructions before the examination.  An empty stomach allows optimal viewing condition, so you should start a liquid diet after lunch the day prior to the examination and have nothing to eat or drink, including water, for approximately 10 hours before a small bowel examination.  Your doctor will tell you when to start fasting.  Tell your doctor in advance about any medications you take as you might to adjust your usual dose for the examination.  Tell your doctor of the presence of a pacemaker or other implanted electromedical devices, previous abdominal surgery, swallowing problem or previous history of obstruction in the bowel.

What can I expect during capsule endoscopy?

Your doctor will prepare you for the examination by applying a sensory device to your abdomen with adhesive sleeves (similar to tape).  The capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours.  At the end of the procedure, you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review. Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill.  After ingesting the capsule and until it is excreted, you should not be near an MRI device or schedule an MRI examination.

What happens after capsule endoscopy?

You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise.  You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within the week following the procedure, however, the results of some tests might take longer.

What are the possible complications of capsule endoscopy?

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test.  Potential risks include complications from obstruction.  This usually relates to a stricture (narrowing) of the intestine from inflammation, prior surgery, or tumor.  It’s important to recognize early signs of possible complications.  If you have evidence of obstruction, such as unusual bloating, pain, and/or vomiting, call your doctor immediately.  Also, if you develop a fever after the test, have trouble swallowing or experience increasing chest pain, tell your doctor immediately.  Be careful not to prematurely disconnect the system as this may results in loss of image acquisition.

How will I know the results of the capsule endoscopy?

After you return the equipment, your doctor will process the information from the data recorder and will view a color video of the pictures taken from the capsule.  After the doctor has looked at this video, you will be contacted with the results.

How does the capsule get eliminated, and will I feel it come out?

The capsule is disposable and passes naturally with your bowel movement.  You should not feel any pain or discomfort. 

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HELICOBACTER PYLORI

(Stomach pain, peptic ulcers, and H. pylori)

Does your stomach often hurt, but you’re not sure why?  Are stomach aches and nausea a part of your daily life?  You may have a peptic ulcer caused by H. pylori.  This brochure will help you talk to your doctor about your stomach pain, peptic ulcers, and a simple test that can tell you if you have an H. pylori infection.

Look for these symptoms.

Some people ignore or overlook the symptoms of a peptic ulcer because they think that it is just an upset stomach.  Though the signs are similar, peptic ulcers may also cause pain that:

-Is usually in the upper-middle part of the stomach, above the belly button and below the breastbone.

-Feels like burning or gnawing, and it may go through to your back.

-Comes several hours after a meal when the stomach is empty.

-Is often worse at night and in the early morning.

-Lasts anywhere from a few minutes to several hours.

-May be relieved by food, antacids, or vomiting.

Other symptoms of a peptic ulcer include:

-Nausea

-Vomiting

-Burping           

-Bloating

-Weight loss       

-Loss of appetite

What is a peptic ulcer?

A peptic ulcer is an open sore on the lining of your stomach or in the first part of your small intestine.  One out of every 10 Americans – about 25 million people – has a peptic ulcer right now.

What really causes peptic ulcers?

Many people used to think that peptic ulcers were caused by stress or by eating spicy food.  But we now know that three things cause peptic ulcers:

-Infection with bacteria called Helicobacter pylori (H. pylori).  H. pylori causes 80% to 90% of peptic ulcers.

-Overuse of pain relief medicines (like aspirin and ibuprofen).

-In rare cases, other diseases.

H. pylori infection is common

In the United States, about 20% of people under 40 years old and 50% of those over 60 years old have an H. pylori infection.  In other words, 1 out of every 3 people in the U. S. carries this bug.  However, not everyone with an H. pylori infection will show symptoms, and scientists aren’t sure why. H. pylori – a tough bug. Helicobacter pylori (H. pylori) is a type of bacteria that researchers now think causes stomach ulcers.  H. pylori is so tough that it is one of the only bugs that can actually live in your stomach acid.  Unfortunately, H. pylori is not the type of guest that you want to stick around.  That’s because H. pylori breaks down and irritates your stomach lining.  Eventually, this irritation can lead to a painful peptic ulcer. While H. pylori bacteria can survive in stomach acid, it can be killed by antibiotics.  Because you shouldn’t take antibiotics if you don’t need them, your doctor will probably want to make sure your peptic ulcer is caused by H. pylori before treating for it.

You need to know what’s causing your ulcer.

It’s important to learn what has caused your ulcer to better treat the problem.  An ulcer caused by an H. pylori infection could develop into another, more serious problems like stomach cancer.  Plus, treatment for an ulcer caused by an H. pylori infection is different than treatment for an ulcer caused by overuse of pain relief medicine.

Ask about a simple and accurate test

Your doctor can test for H. pylori infection in several different ways.  One of the most convenient, accurate and painless tests for H. pylori infection is a breath test called BreathTek UBT for H. pylori.  This BreathTek BUT test is easier than giving blood, collecting a stool sample, or tissue sampling during an endoscopy.  It can also take as little as 20 minutes in your doctor’s office.

Your family may need to be treated too

Although they are no completely sure, most doctors think that H. pylori bacteria travel by personal contact, in shared food, or in common water sources. So if you have an H. pylori infection, and a member of your family is experiencing similar symptoms, it’s possible that they may be infected too.

H. pylori can be successfully treated

The good news is that peptic ulcers caused by H. pylori infections can be cured with a combination of medicines and without surgery.  Based on your symptoms, your doctor will prescribe a combination of medications.  These include antibiotics needed to kill the H. pylori bacteria that caused your ulcer in the first place, as well as a drug to stop your stomach from making acid while it heals.

Take your medicine as prescribed

The combination of antibiotics and acid-blocking drugs should stop the pain and help your ulcer heal.  But remember, the best medicines in the world can’t work if you don’t take them.  Even if your ulcer pain stops, continue taking your medicines as prescribed.

What happens to your ulcer if you stop taking your medicine?

If you stop taking your medicine too soon, you might not kill all of the H. pylori bacteria or heal your ulcer completely.  The H. pylori bacteria could remain in your stomach and your ulcer could come back.

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