48 Hour pH test 3 tests are used to measure reflux of material, particularly acid, from your stomach into your esophagus: What is the 48-hour esophageal pH monitoring test? An esophageal pH test measures how often and for how long
Abdominal CT Scan What is an abdominal/pelvic CT scan? The abdominal and pelvic CT scan is used to assist in the detection of (amongst other diagnoses): Cause of fever, abdominal pain or swelling Hernias Masses and tumors, including cancer Infections
Abdominal MRI What is an abdominal MRI? A magnetic resonance imaging scan that uses powerful magnets and radio waves to create pictures of the inside of the belly area. It does not use radiation- x-rays. Why is the abdominal MRI performed? An
Abdominal X-ray What is an abdominal x-ray?A test to look at the organs in the belly area, like the spleen, stomach and intestines. Why is the abdominal x-ray performed?This test is used to diagnose pain in the abdomen or unexplained nausea. It
Anorectal Manometry What is anorectal manometry? Anorectal manometry is a test to evaluate rectum and the anal canal. It is one of the tests used for evaluation of constipation and fecal incontinence. This test measures the pressures of the anal
Band Ligation What is band ligation of esophageal varices? Endoscopy band ligation is used to treat enlarged veins in the esophagus, the tube connecting the throat to the stomach. If left untreated esophageal veins (varices) can spontaneously rupture and cause
Barium Enema What is a Barium enema? Barium enema is an x-ray of the large intestine that includes the colon and rectum. It was used more commonly before colonoscopies became available. This test is occasionally used to help the doctor
Capsule Endoscopy (PillCam™) What is a capsule endoscopy?Capsule endoscopy is a procedure with a camera that sits inside vitamin-sized capsule. The capsule is swallowed and travels through your digestive tract taking pictures that are transmitted to a recorder that you
Colonoscopy What is colonoscopy?Colonoscopy is a procedure used to see inside the colon and rectum, used to detect inflamed tissue, ulcers and abnormal growths. A colonoscopy also looks for early signs of colorectal cancer and can be used to diagnose
Spyglass What is SpyGlass®? The SpyGlass® system is a recently developed, well-validated method for performing cholangioscopy, the direct visual examination of the bile ducts. It is used in conjunction with Endoscopic Retrograde Cholangiopancreatography (ERCP). While ERCP provides diagnostic imaging of
Endoscopic Retrograde Cholangiopancreatography (ERCP) What is endoscopic retrograde cholangiopancreatography (ERCP)? ERCP is an endoscopic procedure used to take radiographic pictures of the Bile duct, pancreas and gall bladder. Treatment can also be done at the same time. When is the
Endoscopic Ultrasound What is Endoscopic ultrasound (EUS)?EUS is a minimally invasive endoscopic procedure that allows the doctor to see detailed images of the esophagus, stomach, pancreas, bile ducts or rectum to provide additional information obtained from CT or MRI. An
Balloon dilation Narrowed (strictured) parts in the GI tract may benefit from getting stretched and re-opened. Strictures may occur for many reasons and anywhere in the digestive system, such as the esophagus (food pipe) from excessive acid reflux. During an
Transoral Incisionless Fundoplication (TIF) What is Transoral Incisionless Fundoplication (TIF)? Transoral Incisionless Fundoplication is an endoscopic treatment designed to relieve symptoms of acid reflux (heartburn) and gastroesophageal reflux disease (GERD). TIF is one way to relieve GERD without the need
FilmArray The FilmArray is a PCR test that detects gastrointestinal pathogens including viruses, bacteria and parasites that cause infectious diarrhea. (PCR stands for polymerase chain reaction, which detects genetic material from a specific organism – such as a virus.) This
Flexible Sigmoidoscopy What is flexible sigmoidoscopy?Flexible sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum. It is used to look for cancer, changes in bowel habits, abdominal pain or bleeding, inflamed tissue, abnormal growths and ulcers.
Liver Biopsy What is a liver biopsy?A small piece of the liver (vital organ that fights infection and helps digest food) is removed and examined for signs of damage or disease. When is a liver biopsy performed?When a liver problem
Endoscopic Sleeve Gastroplasty What is Endoscopic Sleeve Gastroplasty? Endoscopic Sleeve Gastroplasty is a weight loss procedure that uses a suturing device to make the stomach smaller and shorter, helping the patient lose weight by limiting how much they can eat.
Percutaneous Endoscopic Gastrostomy What is percutaneous endoscopic gastrostomy (PEG)? Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure used to help those who are unable to take food in via the mouth. A feeding tube is placed in the abdomen. A
Peroral Endoscopic Myotomy (POEM) What is POEM? POEM (Peroral Endoscopic Myotomy) is an endoscopic procedure used to treat swallowing disorders, most commonly Achalasia, a rare disorder that makes it difficult for liquid and food to pass into the stomach. POEM
Upper Gastrointestinal Endoscopy What is upper gastrointestinal (GI) endoscopy?Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract that includes the esophagus, stomach, and duodenum—the first part of the small intestine.
The abdominal and pelvic CT scan is used to assist in the detection of (amongst other diagnoses):
No eating or drinking 4 to 6 hours before the test. A special dye, called contrast, helps certain areas show up better on the x-rays. The contrast is given through a vein (IV) in your hand or forearm. You may feel a slight burning sensation, a metallic taste in the mouth and a warm flushing of the body, all which are normal and usually go away within a few seconds. Additional contrast is given by mouth so the radiologist can tell the bowel from other structures.
Make sure to tell your doctor if you have ever had a reaction to contrast or shellfish, or if you are taking diabetes medications, or if you have kidney problems, as the technique of the scan may need to be changed to prevent adverse reactions and complications.
You will lie on a table in the center of the CT scanner with your arms raised above your head. The machine’s x-ray beam will rotate around you. You may be asked to hold your breath for short periods of time while images of your belly area are taken. The scan usually takes 30 minutes.
A magnetic resonance imaging scan that uses powerful magnets and radio waves to create pictures of the inside of the belly area. It does not use radiation- x-rays.
An MRI can determine normal tissue versus tumors and is also used to verify results from previous x-rays for the following:
The test will take 30-60 minutes and is not painful. A special dye may be given before the test through a vein (IV) in your hand or forearm so the radiologist can see areas more clearly. Some tests do not require dye.
No eating or drinking 4 to 6 hours before the scan. Because the MRI contains strong magnets, metal objects are not allowed into the room with the MRI scanner so you must tell your doctor prior to the test if you have:
A test to look at the organs in the belly area, like the spleen, stomach and intestines.
This test is used to diagnose pain in the abdomen or unexplained nausea. It can also identify urinary tract problems like kidney stones or blockages in the intestine.
In a radiology department or where x-rays are taken while lying on your back, side or standing up.
Inform your doctor if you are pregnant, have an IUD inserted, have had a barium x-ray or taken medications like Pepto Bismol in the last 4 days.
There is low radiation exposure so the risks are low compared to the benefits.
Anorectal manometry is a test to evaluate rectum and the anal canal. It is one of the tests used for evaluation of constipation and fecal incontinence. This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal evacuation of bowel movements.
You will need to fast for at least two hours before the test and give yourself an enema.
It takes about 30 minutes. You will lie on your side while a small, flexible tube with a balloon attached is inserted into the rectum. The small balloon is inflated in the rectum to assess the normal reflex pathways.
Anorectal manometry is a safe, low risk procedure and is unlikely to cause any pain. Complications are rare but in some cases perforation (tearing) or bleeding of the rectum could occur.
Endoscopy band ligation is used to treat enlarged veins in the esophagus, the tube connecting the throat to the stomach. If left untreated esophageal veins (varices) can spontaneously rupture and cause severe bleeding.
The procedure is performed during an upper gastrointestinal endoscopy. A local anesthetic is given to numb the throat and sedation medication will also be given through IV to help you relax/sleep through the procedure.
A scope is placed in the mouth down to the esophagus. When varices are found, tiny elastic bands are placed around the enlarged veins in the esophagus to tie them off so they can’t bleed. The banded varices are then eventually sloughed after a few days and the esophagus is much less likely to bleed after it’s healed.
Barium enema is an x-ray of the large intestine that includes the colon and rectum. It was used more commonly before colonoscopies became available. This test is occasionally used to help the doctor diagnose certain problems of the large intestine.
The colon must be completely empty (your doctor will give you instructions prior to the test) and the test is performed at a radiology department.
During the test the patient lies flat on their back and on their sides for x-rays to be taken.
A small, well-lubricated enema tube is inserted into the rectum. The tube is connected to a bag that holds a liquid containing barium sulfate. The liquid helps highlight specific areas in the body under x-ray. The barium flows into your colon, x-ray pictures are taken, and the barium fluid then eventually passes out of your body with your stools.
The doctor will monitor the flow of the barium inside your colon via monitor on an x-ray fluoroscope screen. There are two types of barium enemas:
After the pictures have been taken you will be given a bedpan or helped to the toilet to empty your bowels and remove the barium.
You must completely empty your bowels before the exam by enema or laxatives combined with a clear liquid diet
When barium enters your colon, you may feel like you need to have a bowel movement. A feeling of fullness, moderate to severe cramping and general discomfort is normal. Take deep breaths during the procedure to help you relax.
The test involves low radiation exposure so the risks are low compared to the benefits, however a few of the very rare risks include possible perforation and abdominal gas and bloating.
Capsule endoscopy is a procedure with a camera that sits inside vitamin-sized capsule. The capsule is swallowed and travels through your digestive tract taking pictures that are transmitted to a recorder that you wear on your belt or waist.
If other imaging tests were unuseful or unclear your doctor may recommend a capsule endoscopy as a follow up to test for:
No eating at least 12 hours before your capsule endoscopy and stop taking certain medications. Discuss all preparations for the procedure with your doctor or nursing staff. Be sure your doctor knows if you have a pacemaker, swallowing disorder, or stricture of the small bowel as these may be relative contraindications to routine capsule testing.
The test involves low radiation exposure so the risks are low compared to the benefits, however a few of the very rare risks include possible perforation and abdominal gas and bloating.
Colonoscopy is a procedure used to see inside the colon and rectum, used to detect inflamed tissue, ulcers and abnormal growths. A colonoscopy also looks for early signs of colorectal cancer and can be used to diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus and weight loss. It is most often used to find and remove precancerous tissue (polyps) in order to prevent colon cancer.
The colon and rectum are the two parts of the large intestine; the two terms are often used interchangeably. The large intestine is also sometimes called the large bowel. Digestive waste enters the colon from the small intestine as a semisolid or liquid. As waste moves toward the anus, the colon removes moisture and forms solid stool. The rectum is about 6 inches long and connects the colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus control bowel movements.
All solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Acceptable liquids include: fat-free bouillon or broth, strained fruit juice, water, plain coffee, plain tea, sports drinks, such as Gatorade or gelatin.
A laxative or an enema may be required the night before colonoscopy to ensure your gastrointestinal tract is emptied. Your physician will order a variety of bowel preparations designed to completely empty your colon of waste before the colonoscopy.
During colonoscopy, patients are sedated. While lying on your left side on an examination table a long, flexible, lighted tube called a colonoscope, is inserted into the anus and slowly guided through the rectum and into the colon. The scope inflates the large intestine with air to give the doctor a better view. Images are transmitted from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The lower small bowel is frequently seen as well.
During a colonoscopy the doctor removes abnormal looking tissues and also removes polyps to test for signs of pre-cancer or cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.
It usually takes 30 minutes or less and cramping or bloating may occur during the first hour after the procedure. The sedative rapidly wears off. Patients may need to remain at the facility for 30 minutes after the procedure for recovery.
Routine colonoscopy should begin at age 50 for most people (45 for African Americans), earlier if there is a family history of colorectal cancer, personal history of inflammatory bowel disease, obesity, smoking or certain higher risk groups such as African Americans.
ERCP is an endoscopic procedure used to take radiographic pictures of the Bile duct, pancreas and gall bladder. Treatment can also be done at the same time.
Usually an ERCP is given for one of these reasons:
Fasting is required, do not eat or drink after midnight prior to the test. Make sure to let your physician know all the medications you are taking especially blood thinners. Antibiotics may be required at the time of the procedure.
This procedure is done in a hospital setting. Patients are given sedation through IV so there is no discomfort during the procedure. While lying on your abdomen, a small tube is passed through your mouth into the small bowel. Using a small catheter, dye is injected into the bile duct or the pancreatic duct and X rays are taken. During the procedure your physician may decide to obtain biopsies/brushings / remove gallstones or place a stent to drain the bile duct or pancreas.
After the procedure it will take about 60 minutes for sedation medication to wear off. Sore throat and bloating are normal right after the procedure. You may be observed for 3-4hrs after the procedure before you are discharged home.
Risks and benefits have to be evaluated prior to the procedure. Risks include bleeding, infection, pancreatitis (inflammation of pancreas) and rarely perforation (hole in the bowel).
EUS is a minimally invasive endoscopic procedure that allows the doctor to see detailed images of the esophagus, stomach, pancreas, bile ducts or rectum to provide additional information obtained from CT or MRI. An EUS can also be used for taking samples of abnormal tissue using a fine needle.
A thin, flexible tube (endoscope) is passed through the mouth and into the stomach and duodenum or through the rectum. The endoscopes ultrasound probe emits sound waves that pass through the lining of the GI tract, creating an image of the bowel or adjacent organs.
EUS is performed on an outpatient basis; you will be sedated and not allowed to drive after the procedure. It takes about 30 to 45 minutes and recovery time is another 40 minutes.
EUS is a very safe procedure and although complications occur, they are rare when doctors with specialized training and experience perform the EUS examination. You may have a sore throat, which usually resolves within a day or two.
Consult your doctor for all the risks associated with the EUS procedure.
Narrowed (strictured) parts in the GI tract may benefit from getting stretched and re-opened. Strictures may occur for many reasons and anywhere in the digestive system, such as the esophagus (food pipe) from excessive acid reflux. During an endoscopy, your doctor will pass a catheter across the narrowing to increase it to the desired size. Patients with a disease called achalasia, a disorder that makes it difficult for food and liquid from the esophagus into your stomach, may need more aggressive dilation called pneumatic dilation.
Stents are cylinder-shaped metal tubes that are placed across a blockage in the GI tract. The stents come in different sizes and lengths, and allows your digestive system to resume normal transit of food and liquids. These stents can be placed anywhere in the digestive tract (esophagus, stomach, small intestine, and large intestine). Reasons why these stents might be placed is for: Esophageal cancer patients who cannot swallow, lung cancer that is compressing the esophagus, post-operative leaks, pancreatic cancer that blocks the small intestine and colon obstruction from cancer).
When liver enzymes are abnormal and blood tests may are not conclusive, your doctor may want to obtain a piece of liver tissue to analyze under the microscope. This typically helps pinpoint the cause o the problem. This is typically done with the patient awake; a needle is inserted through the skin and into your liver (percutaneous liver biopsy). With advanced training, this can now be done through endoscopy while the patient is fully sedated and asleep. Tissue obtained has been shown to be equal to a percutaneous liver biopsy. This is a great option for patients who already need an upper endoscopy to assess other digestive structures. Patients may return to work the day after the procedure.
In reflux disease (for example, GERD), the bottom of the esophagus is too loose and allows too much food and fluid to reflux into the esophagus causing heartburn, regurgitation, damage, ulcers and even precancerous changes in the esophagus. An ARMS procedure removes the mucosa at the junction between the bottom of the esophagus and top of the stomach. Patients may return to work the day after the procedure.
The esophagus is a complex organ that requires specialized tests. The 24-hour pH impedance tests to see if the patient has reflux disease (GERD). This involves a flexible and small catheter inserted into your nose to reach the stomach. The 48-hour Bravo pH testing involves endoscopically placing a capsule into the lower esophagus to measure if reflux and the degree of acidity.
Patients with difficulty or pain swallowing or chest pain not related to the heart be referred for a “motility study.” Esophageal manometry is a test that allows us to measure how the patient’s esophagus is contracting, how much, and how often. Patients must be awake for this procedure.
EndoFLIP is a new technique that measures the area across the lower esophagus and the pressure inside of it. The ratio is measured and called distensibility (or stiffness). During an upper endoscopy, the patient is sedated and the endoscopist will place the catheter across the lower esophagus and into the stomach. The balloon is inflated with water and pressure measurements are taken. The procedure is typically 10-15 minutes long. This is a great alternative when patients need an esophageal manometry test but cannot tolerate it or decline to do it from discomfort.
Flexible sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum. It is used to look for cancer, changes in bowel habits, abdominal pain or bleeding, inflamed tissue, abnormal growths and ulcers.
The sigmoid colon is the last one-third of the colon. The colon absorbs nutrients and water and forms solid stool.
The rectum is about 6 inches long and connects the sigmoid colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus help control bowel movements.
A colonoscopy shows the entire colon where the flexible sigmoidoscopy only shows the last third of the colon at best.
Before the test a clear liquid diet 1 to 3 days before the procedure must be followed so that the entire gastrointestinal tract is emptied. A laxative or an enema may also be required the night before a flexible sigmoidoscopy to ensure all solids are removed.
During the examination you will lie on your left side while a long, flexible, lighted tube called a sigmoidoscope is inserted into the anus. The procedure normally takes about 20 minutes. Cramping and bloating are normal and may occur during the first hour after the procedure.
A small piece of the liver (vital organ that fights infection and helps digest food) is removed and examined for signs of damage or disease.
When a liver problem is difficult to diagnose with blood tests or imaging, a liver biopsy is performed.
There are three main types of liver biopsies used at outpatient facilities and hospitals.
Most patients fully recover from a liver biopsy in 1 to 2 days. Patients should avoid intense activity, exercise, or heavy lifting during this time.
Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure used to help those who are unable to take food in via the mouth. A feeding tube is placed in the abdomen. A gastrostomy is the surgical opening in the stomach where the endoscope is passed to help with placing and securing the tube.
The purpose of a percutaneous endoscopic gastronomy is to help feed those that can’t swallow food. The percutaneous endoscopic gastronomy provides fluids, nutrition and medications directly into the stomach.
Local anesthesia is given to anesthetize the throat then an endoscope is passed through the mouth, throat and esophagus into the stomach.
A small incision is made in the abdomen and a needle is pushed through the skin and into the stomach. The tube for feeding is then pushed through the needle and into the stomach. Lastly, the tube is secured with a bumper against the skin.
Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract that includes the esophagus, stomach, and duodenum—the first part of the small intestine.
An upper GI endoscopy is used to biopsy the tissue in the upper GI tract by removing a small piece of tissue to examine with a microscope. This procedure helps determine the cause of symptoms like abdominal pain, nausea or vomiting, reflux, weight loss and bleeding. It is frequently used to diagnose the cause of swallowing difficulties.
Upper GI endoscopy can also be used to remove objects like food, and to treat conditions such as bleeding ulcers.
No eating or drinking 8 hours before the procedure. Also avoid smoking and gum chewing. Some medications and vitamins may be prohibited so tell your doctor about all of your health conditions before your upper GI endoscopy. You will be sedated for this procedure so driving is not permitted for 12 to 24 hours after an upper GI endoscopy.
Patients are sedated to numb the throat and calm the gag reflux. Then an endoscope with a small camera is fed down the esophagus into the stomach and duodenum. A video image is transmitted to a monitor to view the intestinal lining. During the upper GI endoscopy air is pumped through the endoscope to inflate the stomach making it easier to see. The doctor can also use special tools during the procedure to perform biopsies, stop bleeding and to remove abnormal growths.
An esophageal pH test measures how often and for how long stomach acid enters the esophagus (tube from mouth to stomach). The test is used to determine if you have gastroesophageal reflux disease (GERD), which is when stomach contents (particularly acid) backs up into your esophagus. A thin tube with a monitor is inserted through your nose or mouth into your stomach. You will wear this monitor on a strap for two days to track the acidity level, and you will be asked to write down symptoms you experience over that 48-hour period. These will be matched with reflux events detected by the monitor.
This test also measures acid reflux into the esophagus but instead of a tube placed through your nose into the stomach a small sensor is clipped to your esophagus under sedation using endoscopy and measures acidity in a wireless fashion for 48 hours. You will also be asked to keep a diary of your symptoms.
Some reflux is not due to acid and this test, which also involves placing a small catheter through your nose into the esophagus, measures this unusual type of reflux.
Based on your symptoms your gastroenterologist will decide which test will provide the answers he/she needs to decide what treatment you should receive for your reflux symptoms. To prepare for the test you will be asked to avoid eating, drinking or smoking after midnight before the test. It is very important to alert your physician if you have a pacemaker or heart defibrillator or a history of bleeding problems or if you are on blood thinners. Because certain drugs may affect test results, you may be asked to stop taking some medications such as acid suppressants, certain blood pressure medications, alcohol, antacids and corticosteroids.