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What is Upper gastrointestinal endoscopy?
This is a very useful way to examine your oesophagus, stomach and upper duodenum. A narrow flexible tube (an endoscope) is
gently passed down your throat while you are sedated. This tube contains a very small camera which transmits light and images back
to the doctor.
Sometimes this is used to diagnose a digestive problem you may be having, to remove a foreign object, or a polyp, to stop any
bleeding, or to stretch a narrow area (a stricture). The doctor will look for any signs of unhealthy digestive tissue (redness,
inflammation, a lump or an ulcer) or may take a biopsy to reveal any underlying problems that may not be apparent during the
procedure, (e.g. Lactose intolerance, Coeliac Disease).
The procedure itself takes between 15-30 minutes, after which you will rest to allow the sedation to wear off.
What is a Colonoscopy?
A colonoscopy is a procedure which enables the Doctor to have a thorough look at the lining of your large bowel. this procedure is performed following extensive preparation of your bowel. The instrument used is a thin flexible tube containing fibre optic filaments which transfer the image from the tip of the instrument to the video screen. You are given a Neurolept anaesthetic (heavy sedation) and NOT a general anaesthetic used for surgery such as an appendectomy. The tube is inserted in the rectum and is gently manoeuvred around the large bowel to the junction of the small intestine. The instrument (a colonoscope) has the ability to blow air into your bowel and remove excess fluid, as well as being able to pass smaller instruments used to take small pieces of tissue for testing or to remove any polyps found. Following completion of your test (between 15-45 minutes) you are taken to the recovery area and may sleep for 15-30 minutes. The nursing staff will then sit you in a chair while you enjoy a light snack until they feel yourco-ordination is suitable for discharge home.
Why is Colonoscopy necessary?
Colonoscopy is a valuable tool for the diagnosis and treatment of many diseases of the large bowel. Abnormalities suspected by x-rays are negative, the cause of symptoms such as rectal bleeding or change in bowel habit may be found by colonoscopy. It is useful for the diagnosis and follow-up of patients with inflammatory bowel disease as well. Colonoscopy's greatest impact is probably in its contribution to the control of colon cancer by polyp removal. Before colonoscopy became available major abdominal surgery was the only way to remove colonic polyps to determine if they were benign or malignant. Now, most polyps can be removed easily and safely without surgery. Periodic colonoscopy is a valuable tool for follow-up which is well tolerated. The decision to perform this procedure was based upon your referring Doctor's assessment of your individual problem.
What are the risks of Colonoscopy?
Colonoscopy is a low risk and safe procedure when performed by a trained and experienced Endoscopist. Minor bleeding may occur after a biopsy or removal of a polyp. Some abdominal distension from air trapped in the bowel may occur but is usually passed naturally. You should feel well, though tired on the day of the procedure. There should be no adverse feeling the following day. rarely damage to the bowel wall occurs and this could require urgent surgical repair (an operation). Serious complications from the anaesthetic are very uncommon.
What is a Polyp?
During the course of the examination polyp may be found. Polyps are abnormal growths of tissue on the bowel wall which vary in size. In most cases polyps can be removed at the time of the colonoscopy. Polyps are usually removed because they may cause bleeding or can become a cancer. Although the majority of polyps are benign (not cancerous), a small percentage may contain an area of cancer or develop into cancer if not removed. Removal of polyps is an important means in the prevention and cure of bowel cancer. Most patients have little or no recollection of discussions in the procedure room following sedation, therefore it is important to understand polypectomy and the risks involved prior to the procedure, should this treatment be required. Removal of a polyp involves passing a snare wire through the colonoscope and over the polyp and then cutting through the stem using an electrical current. You should not experience any pain during the removal. The risks involved are rare and far less risky than an operation or leaving the polyp to perhaps form a cancer. These risks range from continued severe bleeding to perforating the colon. In most cases this is apparent at the time of the procedure and can require surgical repair. The Doctor performing your procedure is very experienced and has performed thousands of these procedures. Should a polyp be removed, this will be sent to a pathologist where possible (sometimes polyps may be too small or unable to be retrieved from the colon) for examination. The results of the pathology are usually available 3-4 days after the test and a copy will be sent to your referring Doctor. The Doctor referring you for colonoscopy will be notified regarding the expected interval before having a follow-up procedure to check that no further polyps have grown. The Preparation. For a successful colonoscopy, it is important that the bowel be thoroughly cleansed so that the lining is clearly seen. Poor preparation may result in the doctor being unable to examine the bowel properly.
Requirements: You must organise a driver and someone to look after you post procedure. The sedatives used for this procedure will mean that you are LEGALLY under the infuence of a mind altering drug for a period of 12 hours. It is best not to work on the day of the examination.
E.R.C.P. (Endoscopic Retrograde Cholangiopancreatography)
Why do I need an E.R.C.P.?
After careful medical assessment, your doctor will decide whether an E.R.C.P. (Endoscopic Retrograde Cholangiopancreatography) is necessary for further evaluation and treatment of your condition. E.R.C.P. is a highly sophisticated technique requiring special endoscopic training, and can be accomplished successfully in a high percentage of patients. This leaflet has been prepared to help you understand this procedure.
What is E.R.C.P?
A long flexible tube, slightly thinner than a pen is passed through the mouth and back of the throat, into the duodenum (the first portion of the small intestine). The opening from the bile duct and pancreatic duct into the duodenum is identified. A small plastic tube (cannula) is then passed through the endoscope into this opening and directed into the bile duct and/or pancreatic duct. Contrast material (dye) is then injected and x-rays are taken to study these ducts.
What preparation is required?
For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, from 11pm the evening before the examination or for at least 8 hours before its performance. Your doctor will be more specific about the time to begin fasting, depending on the time of day your E.R.C.P. is scheduled.Be sure to let your doctor know if you are allergic to any drugs or have had an allergic reaction to iodine dyes.A companion must accompany you to the examination because you will be given an anaesthetic sedation to help you relax. It will make you drowsy, so you will need someone to take you home. Legally, you are considered to be under the influence of mind-altering drugs and therefore you will not be allowed to drive after the procedure. Even though you may not feel tired, your judgment and reflexes will have been affected by the sedation. Most patients are kept in hospital overnight for observation.
It is important to let your doctor know if you have had any barium x-rays within the past week, as barium may interfere with this test. Please bring your x-rays with you, as they may be important.
What to expect during the procedure?
You will be given an anaesthetic sedation through a vein to make you relaxed and sleepy, and your throat may be sprayed with local anaesthetic. While you are lying in a comfortable position on an x-ray table, the E.R.C.P. Endoscope will be inserted through the mouth and into the duodenum. During the procedure, while x-rays are being taken, you may be asked to change your position.
The tube will not interfere with your breathing, and any gagging is usually prevented by the sedation. During the procedure, you may feel bloated due to the air used to inflate the intestine. As x-ray contrast material is injected into the ducts, you may also feel some discomfort.
What happens after E.R.C.P?
You will be observed in the endoscopic area until most of the effects of the sedation have worn off. You may feel bloated and might have a soft bowel movement because of the air and contrast material that were introduced during the examination.
You will be able to resume your normal diet after the procedure unless you are instructed otherwise.
Are there any complications from E.R.C.P?
E.R.C.P. is safe, and is associated with very low risk when performed by physicians who have been specially trained and are experienced in this highly specialised procedure. Complications can occur but are uncommon.One possible complication is pancreatitis due to irritation of the pancreatic ducts by the x-ray contrast material. Another possible complication is infection. Localised irritation of the vein where your sedation is injected may also occur. A tender lump develops which may remain for several weeks to several months but does eventually go away.Other less common risks include perforation (tear) of the bowel, drug reactions, and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare, but still remains a remote possibility.
What are the reasons for performing E.R.C.P?
E.R.C.P. is a valuable tool for the diagnosis of many diseases of the pancreas, bile ducts, liver and gallbladder. An abnormality suspected by clinical history, blood tests or x-ray can be confirmed and studied in detail. The cause of an obstruction to the flow of bile may be found in a patient who is jaundiced. The diagnosis may be made in a patient who is not jaundiced when symptoms suggest disease of the bile ducts or gallbladder. If a blocked duct is found, surgery may be required without delay. In patients with suspected or known pancreatic disease, E.R.C.P. will help to determine the need for surgery and the best type of surgical procedure to be performed.
E.R.C.P. is a safe and extremely worthwhile procedure which is well tolerated. The decision to perform this procedure is based upon assessment of your particular problem. If you have any questions about your need for E.R.C.P, do not hesitate to call our rooms for further advice or information.
What is a Liver Biopsy?
Liver Biopsy allows a small sample of liver tissue to be obtained which can be processed and examined under a microscope. It is frequently the only means of precisely diagnosing a variety of liver conditions. Your doctor will usually
recommend a liver biopsy only after a variety of other tests have failed to make a precise diagnosis. Liver biopsy may also be necessary to assess the progress of certain liver disorders.
How are you prepared?
Is it essential that your blood clotting ability has been tested before the biopsy is carried out. You should not take blood thinning tablets e.g. Warfarin, Aspirin or arthritis tablets for one week prior to your procedure.
What happens during a Liver Biopsy?
You will be given an anaesthetic sedation through a vein to make you relaxed and sleepy. The biopsy itself involves preparing the skin over the right lower ribs with an antiseptic solution. A local anaesthetic is then injected into the
area. The skin should become numb in a few minutes. Subsequently, the Liver Biopsy needle is passed quickly in and out of the liver. It is essential that you follow
the instructions of the doctor performing the biopsy regarding holding your breath for a second or two during the actual procedure.
Safety and Risks.
Complications of Liver Biopsy can include bleeding or leakage of bile into the abdominal cavity from the puncture site. Usually, such bleeding will stop without intervention
however, occasionally blood transfusion may be required.In extremely rare cases of severe bleeding, an operation may be necessary to stop the bleeding. Other
complications include damage to other organs, such as the right lung, gall bladder or bowel. Another rare
complication of Liver Biopsy is stimulation of the vagal nerve which can result in fainting. Reactions to the sedation are also a possibility. Death is a remote
possibility, as with any interventional procedure. If you wish to have further details of any of these complications, you should contact your doctor before the
procedure, to allow all possible complications to be discussed in detail.
After the Liver Biopsy.
If you do not stay in hospital overnight following your procedure, you should not stay alone. In the case of severe pain, abdominal distension, faintness or shortness of breath
you should not hesitate in contacting either your doctor or the hospital, for further advice.
Introduction
A 24 hour pH study is performed so that a correlation between symptoms and episodes of oesophagitis (inflammation of the gullet ) can be established. The major indications for pH monitoring are:
* Typical symptoms, without endoscopic signs of inflammation and not responding to reflux medications.i.e. heartburn, indigestion, regurgitation, nausea.
* Atypical symptoms, such as cough, asthma, hoarseness or chest pain in patients without endoscopic confirmation of the reflux symptoms.
A pH probe is a very small soft flexible tube which is inserted down through the nose to the stomach, and is then pulled back about 5cm to sit just above the entrance to the stomach, in the oesophagus. Five days prior to having this procedure you must have ceased any of your medication for your reflux symptoms, such as Losec, Zantac, or Zoton. Your stomach needs to be totally empty for this procedure, so you cannot have anything to eat or drink (including water) for six hours prior to your pH Study.
This procedure is not painful, but may be slightly uncomfortable as it passes down the nasal passage to the back of the throat. Once you feel the probe at the back of your throat, you will be asked to start swallowing a glass of water using a straw, thus aiding the probe's passage into the stomach. Once in your stomach, the probe is pulled back to sit in the oesophagus, where it will record any reflux symptoms over the next 24hours on a small walkman-like computer. You will also be given a diary where you need to record all your meal times, what time you went to bed and what time you woke up, plus any reflux, coughing, or nausea symptoms you may have had. The process itself will take about 15-20 minutes to insert the probe and to go over any computer management and note keeping details. It is advisable to wear a shirt and skirt or trousers for your appointment.
Whilst the probe is in place, you will be able to continue all normal activities, including eating and drinking as per usual. The only restriction with this test is that you are not allowed to shower, bath or swim as the computer is connected to your probe throughout the entire test.
Approximately 24 hours after the insertion of your probe - you will need to come back to our rooms to have your probe removed. This only takes about 5 minutes. All data that was recorded during your test will be uploaded to our main computer, where you results are finalised. These results will either be sent on to your referring doctor or an appointment will be made for you to see Dr McIntyre or Dr White.
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