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Procedure FAQs

Abdominal Ultrasound

About Abdominal Ultrasound

An abdominal ultrasound is a non-invasive imaging test that uses sound waves to create images of organs within the abdomen. The test is performed by placing a handheld device, also called a transducer, onto the skin over the organ(s) of interest. The transducer sends and receives sound waves through the body, then converts the waves into images on a monitor.

Normal and abnormal tissues and organs contain different acoustic properties which are recorded by the sound waves during an ultrasound. For example, an ultrasound would be able to show the presence of a gallstone or cyst, as well as the swelling of the liver. An abdominal ultrasound can be used to evaluate the gallbladder, liver, bile ducts, pancreas, spleen, and kidneys.

Frequently Asked Questions about Abdominal Ultrasound
Q. Why is an abdominal ultrasound used?
A.  It depends on your symptoms. A gastroenterologist may order this test to determine the cause of abdominal pain, detect gallbladder or kidney stones, identify the cause of abnormal blood tests, or monitor tumors. Among many other reasons, your doctor may use an abdominal ultrasound to look for damage after an injury or the cause of a fever, fluid retention or swelling of an abdominal organ.

Q. Is there any preparation for this procedure?
A. Usually patients are asked to not to eat or drink for 6 to 8 hours before the procedure; however, preparation for the procedure depends on your age and the nature of your examination. Your health care provider will advise you of your preparation instructions based on your specific needs.

Q. What should I expect during the ultrasound?
A. Depending on which area is being examined, you may need to take off any jewelry or clothing that will interfere with the ultrasound images. You will be given a cloth or paper covering to wear during the test.

While lying down, a clear, water-based conducting gel is applied to the skin on your abdomen to help transmit the sound waves. The transducer is then pressed against your abdomen and moved back and forth over the organ(s) of interest. You will feel light pressure as it passes over your abdomen. Typically, an ultrasound is not uncomfortable, but if the test is being done to check for damage from a recent injury, the slight pressure of the transducer may be painful. You will not hear or feel the sound waves as they pass through your abdomen; however, a picture of the organs and blood vessels can be seen on a video monitor.

During the ultrasound, it is important that you remain very still. You may be asked to hold your breath for short periods of time during the examination in order to get the clearest images possible of your abdomen. You may be asked to change position so that different areas can be examined (for example, you may be asked to lie on your stomach for a kidney ultrasound). The procedure usually takes less than 30 minutes, but could take up to 60 minutes depending on why the procedure is being performed and which areas are being viewed.

Q. Are there any risks?
A. There are no documented risks to having an ultrasound regardless of age or health.

Q. What happens if a mass is found?
A. Using abdominal ultrasound, the physician can usually distinguish among a simple fluid-filled cyst, a solid tumor, or another type of mass that needs further evaluation. If a solid tumor is found, an abdominal ultrasound cannot determine whether it is cancerous or noncancerous, and a biopsy may be needed. In that case, an ultrasound may be used during the biopsy to help guide the placement of a needle. The biopsied specimen will then be sent to a pathology lab for testing.

Q. What is a Doppler ultrasound?
A. A continuous sound wave commonly known as "Doppler" may be used during the ultrasound procedure to evaluate blood flow to and from the intestinal tract or other organs. It can help diagnose many conditions including blood clots, decreased blood circulation or blocked arteries. A mesenteric Doppler ultrasound looks for any narrowing of the three main arteries that carry blood to the intestinal tract. Similarly, a Doppler ultrasound of the liver determines if the veins to and from the liver are narrowed or obstructed.
 
This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or procedure.

Capsule Endoscopy

About Capsule Endoscopy
Capsule endoscopy – commonly referred to as “pill cam”  – is a diagnostic procedure that enables your gastroenterologist to examine three portions of your small intestine using a tiny camera the size of a large vitamin pill. The video capsule is swallowed and as it travels through the body, images are sent to a data recorder worn on a waist belt.

Frequently Asked Questions about Capsule Endoscopy
Q. Why is capsule endoscopy performed?
A. When other diagnostic procedures have failed to determine the cause of recurrent or persistent symptoms like abdominal pain, diarrhea, anemia or bleeding, capsule endoscopy helps your physician actually see what the reason may be for those symptoms. For some chronic gastrointestinal diseases, the pill cam can help evaluate the extent to which your small intestine is involved or to monitor the effect of therapeutics. Capsule endoscopy also can be used to obtain motility data, such as gastric or small bowel passage time.

Q. Is any preparation necessary before the procedure?
A. Yes. In general, for approximately 10 hours before the procedure, you cannot have anything to eat or drink. An empty stomach is essential so your physician has optimal viewing conditions. You will get specific instructions about when to start fasting and whether you need any medication, such as a mild laxative, prior to the procedure.

In addition, because the waist belt that records the video images has small sensors that attach to your skin, men must shave their chest and stomach area and all patients should shave their upper pelvic area.

Q. What happens the day of the procedure?
A. The morning of the procedure, you cannot have anything to eat or drink, and you should go to your appointment dressed in loose, two-piece clothing. First the sensors will be applied to your abdomen with adhesive pads and connected to the data recorder – the belt you will wear around your waist. Then you will swallow the pill cam capsule with a cup of water.

Q. What happens during the procedure?
A. The procedure lasts about right (8) hours and you do not have to stay at the physician’s office during that time. The data recorder, which is actually a small computer, will capture the images from the pill cam. You will be responsible for making sure the recorder is continuously working by checking a small blinking light and you will not be able to do anything strenuous, like bending over or lifting anything.

Q. Do I have to fast while I’m wearing the data recorder?
A. No. Approximately two hours after you swallow the pill cam, you can have clear liquids and after four hours, you can usually have a light snack unless your physician instructs you otherwise. After the eight-hour period is completed, most patients can return to their normal diet.

Q. What happens after the eight-hour period?
A. At the end of the eight-hour procedure, you will return to the physician’s office and the data recorder will be removed. The physician will then review the video images and compile the results. Results are generally ready in two to three weeks.

Q. Should I expect complications or side effects?
A. As a rule, most patients consider the test comfortable. Complications may occur, but they are rare when physicians who are specially trained and experienced perform the procedure. A potential risk could be retention of the capsule. Early signs of possible complications might include fever after the test, severe constipation, difficulty swallowing, increasing chest pain or abdominal pain. In any of these cases, the physician should be notified immediately.

Q. What happens to the capsule?
A. The capsule should pass through your body naturally in a bowel movement. If you can’t verify that the capsule has been excreted, it is common to have an abdominal X-ray to make sure. You should not undergo an MRI or get an MRI unless you are certain the capsule has passed.

Colonoscopy

About Colonoscopy
Nearly one in every 20 adult Americans will develop colon cancer in his or her lifetime. Research has confirmed that the single best prevention for colon cancer is the early detection and removal of all colon polyps. And the best method for detection and removal is a colonoscopy.

Colonoscopy is a valuable tool for the diagnosis and treatment of many diseases of the large intestine.  As a result of the progress made in the field of fiber optics, colonoscopies are now considered a safe, relatively simple and highly effective diagnostic technique. Increased awareness of the value of early diagnosis has made the procedure part of many people’s comprehensive physical examination.

Through the use of colonoscopy, a physician can detect and remove polyps without abdominal surgery, and perform biopsies, which may reveal early signs of cancer.  In addition, periodic colonoscopy is critical in monitoring patients who have had polyps, colitis or colon cancer, or who have a family history of colon cancer.

Frequently Asked Questions about Colonoscopy
Q.  What is a colonoscopy?
A.  The colon, which is shaped like a very large question mark with many twists and turns, begins in the right lower abdomen and ends in the rectum. A colonoscopy is a safe, effective method of visually examining the colon using a very narrow lighted, flexible fiber optic tube called a colonoscope.  At the end of the tube is a miniature camera with a wide-angle lens that helps your doctor examine the lining of your digestive tract on a video monitor. More accurate than a barium enema X-ray and much simpler than exploratory abdominal surgery, colonoscopy is safe and generally well-tolerated by patients.

Q.  How do I know if I need a colonoscopy?
A.  Your physician may recommend a colonoscopy if you have changes in bowel habits, blood in your stool, an unusual abdominal pain, a history of colon polyps or a history of colon cancer in your family, or if you suffer from inflammatory bowel disease (colitis) or Crohn’s disease.  Colonoscopies also can verify findings of polyps or tumors located with a barium enema exam, as well as evaluate intestinal inflammation, ulcerations and diverticulitis.

Q.  What should I do before the procedure?
A.  Always tell your doctor if you are taking any medications – particularly those that may affect blood clotting — or if you have any special medical conditions, including diabetes, pregnancy, lung or heart conditions.  Also let your doctor know if you are allergic to any medications. If you have ever been told to take antibiotics before a dental or surgical procedure, you may need to take antibiotics before a colonoscopy.  Your physician can answer all your questions.

Q.  Is any preparation necessary before the procedure?
A.  Yes. Your colon must be completely empty for the colonoscopy to be thorough and safe. There are a variety of preparations your doctor can choose from to flush the colon, including tablets or a liquid solution that you drink. In addition, you will be asked to drink only clear liquids for one or two days before the procedure and you will be given advice on taking regular medications during that time. A list of detailed instructions will be provided by your physician.

Q.  What happens during the procedure?
A.  On the day of the procedure you will be given a mild sedative to help you relax. During the procedure, you will lie on your left side on an examining table and the physician will insert the colonoscope into the rectum and gently move it through your colon. There are several tiny instruments in the scope that help the physician during the procedure: one to blow air into your colon, which inflates it to help the physician see better; one to remove polyps or take biopsies; and one to stop any bleeding.  After the procedure, you may experience a little discomfort, like the feeling of having gas, but that soon subsides. The entire procedure usually takes less than 30 minutes and most people can resume their regular diet later that day.

Q.  What happens after the examination?
A.  Your physician will explain the findings to you. If a biopsy was performed or a polyp removed, you should get the results in about a week. Your physician may give you other special instructions as well. Even though you should feel fine, you must have someone else drive you home after the procedure because of the sedatives. You should not drive, operate heavy machinery or make important decisions for up to six hours after your procedure.
 
If you’ve had prolonged effects from the sedative, you may need to make a follow-up appointment.  If you have excessive or prolonged rectal bleeding or severe abdominal pain, fever or chills, call your doctor right away.

Q.  Are there any risks associated with having a colonoscopy?
A.  Serious complications from this procedure are very rare. Of course, as with any medical procedure, they can occur. Complications might include excessive bleeding, especially if a large polyp was removed, or, in rare cases, a tear in the lining of the colon, which might require hospitalization or surgery.  Again, these complications are rare.
This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

CT Scan

About CT Scan
A computed tomography scan, or CT scan, is a non-invasive, diagnostic procedure that uses a large, doughnut-shaped X-ray machine to create multiple, high-resolution cross-sectional pictures of the abdomen and pelvic areas and the thorax, the area between the head and abdomen. With the aid of a computer, the machine can combine these images to create three-dimensional views of internal organs and body structure.

Frequently Asked Questions about CT Scan
Q. Why is a CT scan used?
A. CT scans are used to verify the presence or absence of tumors, infection, abnormal anatomy, or to examine changes in the body as a result of trauma. Gastroenterologists may order this scan to evaluate abdominal pain or to examine organs such as the stomach, small intestine, liver, pancreas, gall bladder, and colon. An abdominal CT scan also can be extremely helpful in the diagnosis of conditions like Crohn’s disease, appendicitis or colon cancer.

Q. Is there any preparation for this procedure?
A. Yes. To prepare for a CT scan, patients are often asked to avoid food and adhere to a clear liquid diet for 6 hours prior to the scan. Your physician may also ask you to temporarily stop certain medications.

The exam is usually done with an oral contrast (barium is most common), which you drink a few hours before the procedure. Additionally, the procedure may require another type of contrast, such as iodine, which is given by injection at the time of the procedure.

Q.  What should I expect during an abdominal CT scan?
A. The actual scan will take only a few minutes; however, plan on being at the scanning facility for two and a half hours due to the preparations before and observation time after the procedure. You will be asked to remove all metallic materials and certain articles of clothing that could interfere with the clarity of the images.

During the procedure, you are placed on a table that slips into the center of the large, doughnut-shaped X-ray machine. Once the procedure begins, you must remain very still while the images are taken. The technician will tell you when to hold your breath and when to exhale during the scan. This helps ensure the clearest images for your physician.

Q. What happens after the scan?
A.  Typically after a CT scan, you can resume your normal diet. If you received contrast material, you may be given special instructions. For example, you may be told to drink plenty of water in order to flush your kidneys.  After the images are reviewed by the radiologist and the reports are provided to your physician, you will be notified of the results.

Q. Are there risks in obtaining a CT scan?
A.  A CT scan is a very low-risk procedure. Some people experience a feeling of warmth throughout their body or the urge to urinate after receiving intravenous contrast material. These are temporary reactions and go away once the scan is complete and the contrast material has passed through your system. If you experience hives, itchiness of the skin or a scratchy throat, notify the technician during the scan. Although rare, there is a risk of allergic reaction to contrast materials.

The amount of radiation a person receives during a CT scan is minimal and has not been shown to produce any adverse effects. However, if a woman is pregnant, the risk to the fetus is unknown. It is critical that female patients inform the staff of pregnancy and discuss alternative methods of imaging.

Toxicity to the kidney is an extremely rare complication of the intravenous contrast material. Patients who are dehydrated, have diabetes or already have impaired kidney function are most vulnerable to this reaction. However, by following pre- and post-procedure instructions, patients can typically avoid any adverse reactions.

Q. Why do I need a CT scan instead of a traditional X-ray?
A. While traditional X-rays are an excellent method of identifying solid objects in the body, like bones and kidney stones, they cannot show physicians the detail and depth of soft tissue organs such as the stomach, intestines and liver.

Q. What is CT Angiography?
A. CT angiography is a procedure that produces detailed images of major blood vessels throughout the body. CT angiography is sometimes used to diagnose and precisely locate acute gastrointestinal bleeding.

Q. What is CT Enterography?
A. CT enterography is a procedure specifically used to generate images of the small and large intestines. CT enterography is used to detect the presence and extent of Crohn's disease and/or inflammatory bowel disease (IBD). If an abnormality is discovered, important information such as the type of abnormality, location and severity can be further evaluated.

ERCP

About ERCP (endoscopic retrograde cholangiopancreatography)
ERCP, or endoscopic retrograde cholangiopancreatography, is an outpatient procedure performed primarily to identify a problem in the bile ducts or pancreas.  Disorders found in the bile ducts, gallbladder and pancreas often result from diet, the environment and heredity.  They can develop into a variety of symptoms or diseases.

ERCP can be used to check for:

  • gallstones, which are trapped in the main bile duct;
  • blockage of the bile duct;
  • yellow jaundice, which turns the skin yellow and the urine dark;
  • undiagnosed upper-abdominal pain;
  • cancer of the bile ducts or pancreas; and
  • pancreatitis (inflammation of the pancreas)

If a gallstone is found during the exam, it can often be removed, eliminating the need for major surgery.  If a blockage in the bile duct causes yellow jaundice or pain, it can be relieved using ERCP.

Frequently Asked Questions about ERCP
Q. Why are bile and the pancreas important?
A.  The liver produces bile, which flows through the ducts, passes or fills the gallbladder and then enters the intestine (duodenum) just beyond the stomach.  The pancreas, which is six to eight inches long, sits behind the stomach.  This organ secretes digestive enzymes that flow into the intestine through the same opening as the bile.  Both bile and enzymes are needed to digest food, so it is important to diagnose any problems as quickly as possible.

Q.  What happens during the ERCP procedure?
A.  The actual exam is fairly simple and usually takes 20 to 40 minutes. The doctor will numb your throat with a spray or solution and usually give you a mild sedative.  The endoscope is then gently inserted into the upper esophagus. A thin tube is inserted through the endoscope to the main bile duct entering the duodenum.  Dye is then injected into this bile duct and/or the pancreatic duct and X-rays are taken.  The physician will ask you to lie on your left side and then turn onto your stomach to allow for complete visualization of the ducts.   You will be taken to the recovery area following the procedure.

Q.  What exactly is an endoscope?
A. An endoscope is a lighted, flexible tube with a tiny, optically sensitive computer chip at the end. As the physician moves it through the upper gastrointestinal tract, electronic signals are transmitted from the scope to a computer that displays the image on a video screen.  An open channel in the scope allows other instruments to be passed through it to perform biopsies, inject solutions, or place stents.

Q.  Is any preparation necessary before the procedure?
A.  Before an ERCP, you cannot eat or drink anything for eight hours. Your physician may ask you to stop taking certain medications, such as aspirin, before the procedure. Also, you should have someone drive you to and from the test.

Q.  What happens after the procedure?
A.  After the procedure, your physician will explain the results.  If the effects of the sedatives are prolonged, the physician may suggest a follow-up appointment to review the results.

Q.  Should I expect complications or side effects?
A.  You may experience a temporary, mild sore throat. The most common complication of ERCP is called pancreatitis, an inflammation of the pancreas, but that only occurs in three to five percent of cases.  Pancreatitis results in abdominal pain and, occasionally, the need for hospitalization.  Another risk is excessive bleeding, especially when electrocautery is used to open a blocked duct.  In rare instances, a perforation or tear in the intestinal wall can occur.  These complications may require hospitalization and, rarely, surgery.

EUS

About EUS (endoscopic ultrasound)
An EUS, or endoscopic ultrasound, is an outpatient procedure used to closely examine the tissues in the digestive tract. The procedure is done using a standard endoscope and a tiny ultrasound device. The ultrasound sensor sends back visual images of the digestive tract to a screen, allowing the physician to see deeper into the tissues and the organs beneath the surface of the intestines. An EUS allows the physician to get a much clearer view of an area, making this a very reliable test and preferable to more invasive procedures.

EUS can be used to evaluate:

  • blood vessels
  • gallstones inside the gallbladder and bile duct
  • pancreas;
  • rectum abnormalities
  • tumors and lymph nodes underneath the intestinal wall
  • existing tumor growth; and
  • tumors that appear benign

The procedure can also be used to take biopsies of tumors.

Frequently Asked Questions about EUS
Q.  What exactly is an endoscope?
A. An endoscope is a lighted, flexible tube with a tiny, optically sensitive computer chip at the end. As the physician moves it through the gastrointestinal tract, electronic signals are transmitted from the scope to a computer that displays the image on a video screen.  An open channel in the scope allows other instruments, like the ultrasound device, to be passed through it.

Q.  Why does the physician need to see into the tissues of the digestive tract?
A.  When patients have symptoms of more common problems in the gastrointestinal system, like stomach ulcers or intestinal polyps, physicians use standard endoscopic procedures.  Sometimes, the physician needs to get a better look at the area of concern. In those cases, the ultrasound is recommended because it helps provide a more life-like picture of your condition and allows the physicians to make a much more accurate diagnosis.

Q.  What happens during the EUS procedure?
A.  The actual exam is fairly simple and usually takes 20 to 40 minutes. You will be given a mild sedative and the physician will ask you to lie on your left side. For this procedure, the endoscope can be inserted either into the mouth or the rectum. If the endoscope is being inserted in the mouth, an anesthetic spray will be used to numb the back of your throat.  Once the endoscope has been gently guided into position, the ultrasound device will begin sending images to a video screen.  Once the procedure is completed, you will be taken to the recovery area.

Q.  Is any preparation necessary before the procedure?
A.  When an EUS is done on the upper digestive tract, you cannot eat or drink anything for eight hours before the procedure.  If it is being done on the lower intestine, the colon must be clean. In this case, your physician will provide you with instructions for a liquid diet and laxatives or an enema to cleanse the lower bowel. Your physician may ask you to stop taking certain medications, such as aspirin, before the procedure. Also, you should have someone drive you to and from the test.

Q. What happens after the procedure?
A. After the examination, your physician will explain the results. If the effects of the sedatives are prolonged or a biopsy was taken, the physician may suggest a follow-up appointment to review the results.

Q. Should I expect complications or side effects?
A.  In general, an EUS is a very safe procedure. If your procedure is being done on the upper GI tract, you may have a sore throat for a few days.  As a result of the sedation, you should not drive, operate heavy machinery or make any important decisions for up to six hours following the procedure.  There is a slight risk of the endoscope tearing the intestinal tract, which would require surgery. Rarely, bleeding does occur if a biopsy is taken. Serious complications are extremely uncommon.

Flexible Sigmoidoscopy

About Flexible Sigmoidoscopy
Sigmoidoscopy is the visual examination of the inside of the rectum and lower part of the colon, called the sigmoid colon.  The examination is done using an endoscopy which is a lighted, flexible tube connected to a video screen. During a sigmoidoscopy only the last one to two feet of the five to six-foot-long colon (large intestine) is examined.

Frequently Asked Questions about Flexible Sigmoidoscopy
Q.  What exactly is an endoscope?
A.  An endoscope is a flexible tube with a tiny, optically sensitive computer chip at the end that can easily be moved around the bends in the lower colon and rectum.  As the physician moves the endoscope through the bowel, the image is transmitted to a video screen.  An open channel in the scope allows other instruments to be passed through it to take tissue samples (biopsies) or to remove polyps.

Q.  What can a sigmoidoscopy diagnose?
A.  Sigmoidoscopy is performed to diagnose the cause of certain symptoms, including:


  • Bleeding: Rectal bleeding is very common. It often is caused by hemorrhoids or by a small tear at the anus, called a fissure. However, more serious problems can also cause bleeding, including benign polyps.  It is important to identify and remove polyps at an early stage before they can become cancerous.  Rectal and colon cancers bleed and require immediate diagnosis and treatment. Various forms of colitis and inflammation also can cause bleeding.
  • Diarrhea: Persistent diarrhea should always be evaluated. There are many causes of diarrhea, and this procedure is effective in tracking down the specific cause.
  • Pain: Hemorrhoids and fissures can cause pain around the anus or in the rectum. Discomfort in the lower abdomen can be caused by tumors.  Also, diverticulosis can cause pain in the lower bowel. 
  • X-ray findings: A barium enema X-ray exam may show abnormalities that need to be confirmed or treated by sigmoidoscopy.

Q.  Does a sigmoidoscopy help monitor and prevent disease?
A.  Yes.  With a sigmoidoscopy, conditions such as colitis and diverticulosis can be monitored to determine the effectiveness of treatment. Sigmoidoscopy is also used as a preventive measure to detect problems at an early stage, such as polyps and tumors, even before you have symptoms. It can also help detect colon cancer, although a colonoscopy is considered the best way to examine the entire colon.

Q.  Is any preparation necessary before the procedure?
A.  Yes.  To obtain the full benefit of the exam and allow a thorough inspection, the rectum and sigmoid colon must be clean.  Preparation usually involves drinking clear liquids the day before the procedure, along with taking enemas and/or laxatives.  Your physician will give you specific instructions.

Q.  What happens during the procedure?
A.  Flexible sigmoidoscopy is usually performed on an outpatient basis.  Your physician will ask you to lie on your left side with your legs drawn up, and will place a sheet over your lower body.  He or she will begin by performing a digital exam of the anus and rectum.  Next, the endoscope is gently inserted. The bowel is inflated with air to expand it and allow for careful examination.  You may feel a slight discomfort similar to strong gas cramps. The endoscope is advanced and moved as far as possible without causing you discomfort around the various bends in the lower bowel.  Certain conditions, such as diverticulosis, irritable bowel syndrome or prior pelvic surgery may produce discomfort when the sigmoid colon is entered by the endoscope.  Your physician will stop the exam if this occurs.  The exam usually takes 5 to 15 minutes.  Normally, sedation is not required.

Q.  Are there any side effects?
A.  Bloating and bowel distension are common.  This usually lasts only 30 to 60 minutes.  If biopsies are done or if a polyp is removed, there may be some spotting of blood.  However, this is rarely serious.  Uncommon risks include a diagnostic error or oversight or a tear of the wall of the colon, which might require surgery.

Q.  Are there alternatives to the flexible sigmoidoscopy?
A.  Alternative testing includes a barium enema X-ray. In addition, stools can be examined in a variety of ways to uncover or study certain bowel conditions.  However, a direct look at the lower rectum and lower bowel by sigmoidoscopy is the best method of examining this area.

Hemorrhoid Banding

About Hemorrhoid Banding
Hemorrhoids are swollen vessels in the lower rectum and anus caused by increased pressure or straining. They are common in both men and women – especially pregnant women. After age 30, the incidence of hemorrhoids increases, and by age 50, about half of the population will have experienced them. While not life threatening, hemorrhoids can cause bleeding, burning or discomfort.

For decades, chronic hemorroid sufferers resorted to surgery for relief.  Today, a procedure called the CRH-O’Regan Disposable Hemorrhoid Banding System has all but eliminated the need for surgery and allows patients to be treated quickly and resume normal activity with very little discomfort. Most patients with office jobs find they can return to work the same day.

Frequently Asked Questions about Hemorrhoid Banding
Q. How does the banding work?
A. The O’Regan method uses a small rubber band to strangle the base of the swollen vein, which cuts off the blood supply to the hemorrhoid. This causes the banded tissue to shrink and fall off along with the rubber band. Typically, this happens within a few days after your appointment during a routine trip to the toilet, and you may not even notice when this happens. The treatment itself takes less than five minutes and can be performed in one of our offices or endoscopy centers.

Q. Is more than one visit necessary?
A. The physicians trained in this procedure tend to avoid doing more than one treatment per visit. Subsequently, some patients who have multiple hemorrhoids may require two or three treatments which are scheduled a few weeks apart.

Q. Is the procedure really pain-free?
A. The band placement is relatively painless due to this refined technique and it does not require anesthesia or other numbing agents. You may experience a dull ache or sense of fullness in the rectum within the first 24 hours, but this can generally be relieved by over-the-counter pain medication.

Q. How common is hemorrhoid banding?
A. AGA’s physicians have performed thousands of rubber band ligations on patients just like you. It is the most frequently used non-surgical treatment for hemorrhoids in the world.

Q. Should I expect complications?
A. The CRH O’Regan method – unlike traditional banding techniques – uses a gentle suction device that reduces the risk of pain and bleeding. Some patients may have a little bleeding, discomfort and urine hesitancy, but these are considered minor complications. It’s important that you refrain from rigorous activity immediately following your treatment to reduce the risk of any complications.

Liver Biopsy

About Liver Biopsy
A liver biopsy is a quick and simple method of obtaining a sample of liver for analysis.

Because so many different problems can occur in the liver, some causing permanent damage, a biopsy provides important information for evaluating and treating liver disorders. Biopsies also can help identify the cause of the problem and the severity of the condition, which could include virus infections, reactions to drugs or alcohol, tumors, hereditary conditions and problems with the body’s immune system.  Finding the cause is important because there are effective treatments for many liver disorders.  Early, specific and effective therapy often can prevent irreversible liver damage.

Frequently Asked Questions about Liver Biopsy
Q.  What is a liver biopsy?
A.  A biopsy is a tiny sample of body tissue – in this case, liver tissue – that is removed by the physician.  The tissue is prepared and stained in a laboratory so the physician can view it under a microscope.  This usually helps the physician make a specific diagnosis and determine the extent and seriousness of the condition, which is vital in determining treatment.

Q.  When is a liver biopsy recommended?   
A.  Your physician will always take a medical history and perform a physical exam.  Blood studies, known as liver function tests (LFT), give an overview of the health of the liver.  If LFT results are persistently abnormal, the physician will then perform additional medical tests, including a biopsy, to determine the exact cause of the problem.

Q.  What do I need to know about having a biopsy?
A.  The liver biopsy is usually performed on an outpatient basis.  Your physician may give you a mild sedative prior to the procedure. The entire procedure usually lasts only 15 to 20 minutes.  You will be asked to lie on your back or slightly to the left side.  The area of the skin where the biopsy will be done is carefully cleaned.  Then a local anesthetic is used to numb the skin and tissue and a specially designed thin needle is inserted through the skin.  At this point, your physician will tell you how to breathe.  The needle is advanced into and out of the liver.  This takes only one or two seconds.  A slender core of tissue is removed with the needle and is then sent to a laboratory for analysis.

Q.  What happens after the biopsy?
A.  You must rest for several hours following the exam and members of the medical staff will monitor your heart rate and blood pressure.  You may experience some discomfort in your chest or shoulder; however, this is usually temporary.  Medication is available for this discomfort if needed.  Before being discharged, your physician will give you instructions about returning to normal activities and about eating.  Activity is usually restricted for a day or so after the biopsy.  

Q.  Should I expect complications?
A.  While some complications can occur, they are unusual.  In most instances, a liver biopsy is obtained quickly and with no problems.  You may experience some fleeting discomfort in the right side or shoulder.  Also, internal bleeding can sometimes occur, or a leak of bile from the liver or gallbladder.  These problems are rare and can usually be handled without surgery.

Upper GI Endoscopy (EGD)

About Upper Gastrointestinal (GI) Endoscopy
The upper gastrointestinal (GI) tract is the site of many disorders, usually related to diet, environment and heredity.  These disorders can develop into a variety of diseases or symptoms, which can be diagnosed with a procedure called an upper gastrointestinal endoscopy or EGD (esophagogastroduodenoscopy).

By visually examining the upper intestinal tract using a lighted, flexible endoscope, gastroenterologists can diagnose:

  • ulcers — which can develop in the esophagus, stomach, or duodenum;
  • tumors of the stomach or esophagus;
  • difficulty in swallowing;
  • upper abdominal pain or indigestion;
  • intestinal bleeding;
  • esophagitis and heartburn —  a chronic inflammation of the esophagus due to reflux of stomach acid and digestive juices; and
  • gastritis — an inflammation of the lining of the stomach.

During an EGD, other instruments can be passed through the endoscope to perform additional procedures if needed. These procedures could include a biopsy, in which a small tissue specimen is obtained for microscopic analysis, or removal of a polyp or tumor using a thin wire snare and electrocautery (electrical heat).

Frequently Asked Questions about Upper GI Endoscopy
Q. Where is the upper gastrointestinal tract and why is it important?
A.  The upper gastrointestinal tract begins with the mouth and continues with the esophagus (food tube) which carries food to the stomach.  The acid in the stomach churns food into small particles. The food particles then enter the duodenum, or small bowel, where bile from the liver and digestive juices from the pancreas mix with it to help the digestive process.  Both bile and enzymes are needed to digest food, so it is important to diagnose any problems as quickly as possible.

Q.  What exactly is an endoscope?
A.  An endoscope is flexible tube with a tiny, optically sensitive computer chip at the end. As the physician moves it through the upper gastrointestinal tract, electronic signals are transmitted from the scope to a computer that displays the image on a video screen.  An open channel in the scope allows other instruments to be passed through it to take tissue samples, remove polyps and perform other exams.

Q.  What happens during the EGD procedure?
A.  First, your physician will anesthetize your throat with a spray or liquid.  The endoscope is then gently inserted into the upper esophagus.  The exam takes from 15 to 30 minutes, then you are taken to the recovery area.  There is no pain with the procedure and patients seldom remember much about it.

Q.  Is any preparation necessary before the procedure?
A.  It is important not to eat or drink anything for at least eight hours before the exam.  Your physician will give you instructions about the use of regular medications, including blood thinners, before the exam.  Because of the mild sedation, you are not allowed to drive, operate heavy machinery or make any important decisions for up to six hours following the exam. It’s important to have someone with you to drive you home.

Q.  What happens after the procedure?
A.  After the exam, the physician will explain the results to you.  If the effects of the sedatives are prolonged, the physician may suggest a follow-up appointment to review your results.  If a biopsy has been performed or a polyp removed, it usually takes several days to get the results.

Q.  Should I expect complications or side effects?
A.  A temporary, mild sore throat sometimes occurs after the exam.  Serious risks with upper gastrointestinal endoscopy, however, are very uncommon.  One such risk is excessive bleeding, especially if a large polyp is removed.  In extremely rare instances, a perforation, or tear, in the esophagus or stomach wall can occur.  These complications may require hospitalization and, rarely, surgery.

 
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