Procedures performed in the GI Lab

Esophagogastroduodenoscopy (EGD)
Colonoscopy
Flexible Sigmoidoscopy
Enteroscopy
BRAVO pH Monitoring
Esophageal Manometry
Barrett’s Esophagus
Esophageal Ablation
Capsule Endoscopy
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Bronchoscopy
Gastrostomy Tube Placement
Transrectal Ultrasound

Esophagogastroduodenoscopy (EGD)

An EGD, also referred to as an upper endoscopy, is used to check for problems in the upper digestive tract. This includes the esophagus, stomach and small intestine.

Before the Procedure:
To allow adequate gastric emptying, the patient should have nothing by mouth for 6 hours before the procedure.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the EGD.

The patient will be instructed to lie on his or her left side on the examination table. A numbing medication will be administered orally prior to insertion of the endoscope. Conscious sedation or MAC (Monitored Anesthesia Care) Anesthesia is also used. A bite block will be placed in the mouth to protect the endoscope. Nausea or gagging may occur during the passing of the tube.

An endoscope (flexible tube that acts as a camera) is placed through the mouth and into the pharynx, esophagus, stomach, and duodenum. It is used to find any growths or foreign bodies. If anything unusual is found, the endoscope can also be used for treatment.

Throughout the EGD, the doctor can take photographs, a biopsy (a sample of tissue) or cytology (a brushing of cells). Other procedures may be performed including the stretching of narrowed areas of the esophagus, stomach, or duodenum and removing polyps and swallowed objects. Bleeding vessels and ulcers may also be treated during the procedure.

The EGD usually takes about 15-20 minutes.

After the Procedure:
Patients are monitored in a recovery area for at least 15-30 minutes. Once the patient is alert, he or she will be allowed to leave with a responsible driver and will be given post-procedure instructions.

Driving is not permitted for 24 hours after a procedure requiring sedation.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777.

Colonoscopy

A colonoscopy is used to see inside the rectum and colon. It can detect abnormal growth, ulcers as well as screen for early signs of colorectal cancer. Colonoscopies are also administered to help diagnose unexplained abdominal pain, weight loss and bleeding from the anus.

Before the Procedure:
Your physician will decide which colon prep is best for you and will give you specific instructions to ensure your colon is clean for the procedure. It will be some sort of a laxative preparation and large quantities of liquid or an enema.

Liquids containing red or purple dye should not be ingested prior to the colonoscopy.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the colonoscopy.

Patients are instructed to lie on their left side on the examination table and moderate sedation or MAC anesthesia is administered to help with relaxation. A long, flexible lighted tube called a colonoscope or scope is inserted into the anus and lead through the rectum and into the colon.

The large intestine is then inflated with air or carbon dioxide gas to provide the doctor with a better view. A video is transmitted from inside the large intestine by the scope onto a screen which the doctor examines.

Polyps can be removed during the procedure and tissue samples can be taken as well.

The procedure usually takes 30-40 minutes.

After the Procedure:
Patients are monitored in a recovery area for at least 15-30 minutes. Cramping and bloating may occur and patients will be passing air that was put into the colon for the procedure. A full recovery is likely by the next day.

Once the patient is alert, he or she will be allowed to leave with a responsible driver and will be given post-procedure instructions.

Driving is not permitted for 24 hours after receiving sedation.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Flexible Sigmoidoscopy

A flexible sigmoidoscopy is used to see inside the rectum and (sigmoid) colon. The sigmoid colon is the last one-third of the colon and is where water and nutrients are absorbed. It is also where stool is formed.

This procedure can detect abnormal growth, ulcers as well as screen for early signs of colorectal cancer.  Flexible sigmoidoscopies are also administered to help diagnose unexplained abdominal pain, weight loss and bleeding from the anus.

Although it is very similar to a colonoscopy, a flexible sigmoidoscopy is used only to see the sigmoid colon where as a colonoscopy enables the doctor to examine the entire colon.

Before the Procedure:
One or two enemas are performed two hours before the sigmoidoscopy to remove all solids from the colon. An enema is performed by flushing water, laxative or a mild soap solution into the anus using a special bottle

Patients should not drink liquids containing red or purple dye prior to the sigmoidoscopy.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the flexible sigmoidoscopy.

The patient will be instructed to lie on his or her left side on the examination table. A long, flexible, lighted tube called a sigmoidoscope or scope is inserted into the anus and lead through the rectum and into the sigmoid colon.

The physician may or may not used sedation or MAC anesthesia.

The colon is inflated with air to provide the doctor with a better view. A video is transmitted from inside the colon by the scope onto a screen which the doctor examines.

Polyps can be removed during the procedure and tissue samples can be taken as well.

The procedure usually lasts around 20 minutes.

After the Procedure:
If sedation was used the patient will be monitored in the recovery area for at least 15-30 minutes. Cramping and bloating may occur.

Driving is not permitted for 24 hours after receiving sedation.

The patient will be given post-procedure instructions.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Enteroscopy

An enteroscopy is used to examine the first part of the small intestine.

Before the Procedure:
No solid food or dairy products should be ingested after midnight on the day of the procedure. The patient can drink clear liquids up to 6 hours before the exam.

For best results, the stomach should be completely empty.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the enteroscopy.

The patient will be instructed to lie on his or her left side on the examination table. A sedative or MAC anesthesia will be administered through an IV to help with relaxation.

An endoscope (flexible tube that acts as a camera) is placed through the mouth and into the pharynx, esophagus, stomach, and duodenum. The doctor will them examine the small intestine.

Polyps can be removed during the procedure and tissue samples can be taken. Any sites of bleeding can be treated as well.

The procedure usually lasts around 20-25 minutes.

After the Procedure:
The patient is monitored in the recovery area for at least 15-30 minutes.

Driving is not permitted within 24 hours after receiving sedation.

The patient will be given post-procedure instructions.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

BRAVO pH Monitoring

BRAVO is a catheter free pH monitoring device that helps doctors in determining the regularity and rigorousness of gastroesophageal reflux disease (GERD). GERD occurs when the lower esophageal sphincter of the esophagus does not close correctly causing the stomach acid and food in the stomach to reflux, or back up, into the esophagus.

Before the Procedure:
Ten days prior the exam, patients should stop using all acid-blocking medication including but not limited to the following:   

  • Aciphex
  • Nexium
  • Pepcid
  • Prevacid
  • Prilosec
  • Protonix
  • Tagamet
  • Zantac

Short acting antacids are permitted for use until the day before the procedure. These include but are not limited to:

  • Maalox
  • Mylanta
  • Rolaids
  • Tums

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

For an AM procedure, patients should not eat or drink anything after midnight.

For a PM (afternoon) procedure time a clear liquid breakfast may be ingested before 8 am. Your doctor may also allow you to have a light solid breakfast.

Do not take any antacids on the day of the test.

During Capsule Placement in Conjunction with an Endoscopy:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the procedure.

The patient will be instructed to lie on his or her left side on the examination table. A sedative or Mac Anesthesia will be administered through an IV to help with relaxation.

An endoscope (flexible tube that acts as a camera) is placed through the mouth and into the pharynx, esophagus, stomach, and duodenum. A biopsy may be taken during the procedure.

At the end of the endoscopy the doctor will pass a small catheter to deliver the BRAVO capsule to the desired location.

The capsule is about the size of a gel cap and contains a radio transmitter that sends pH information to a pager-sized receiver worn on the waist or carried in a pocket.

The procedure usually takes 20-30 minutes.

After the Procedure:
The patient is monitored in the recovery area for at least 15-30 minutes. Once the patient has recovered from the sedation or MAC anesthesia patients are discharged to a responsible driver.

Driving is not permitted for 24 hours after receiving sedation.
Normal diet is to be resumed immediately. Patients should try to eat 3 well-portioned meals per day. Liquids should be ingested mainly at mealtime because prolonged exposure to water will rinse the stomach acid off of the BRAVO capsule. Meal times and liquid ingested separately from a meal should be logged in a journal. GERD symptoms should also be recorded. The journal should be returned to the location of the procedure within 48 hours of the capsules insertion.
Patients will be given a receiver after the procedure. It should be within 3 feet of the patient at all times to ensure accurate reading.

The BRAVO capsule will pass naturally through your digestive system within 5-7 days.

Patients should not take any antacids during the study unless instructed by a physician.

The patient will be given post-procedure instructions.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Esophageal Manometry

Esophageal manometry measures the muscle pressures within the esophagus and can be used to determined unexplained heartburn, chest pain or difficulty swallowing.

Before the Procedure:
No food or liquid should be ingested within 8 hours of the exam.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the esophageal manometry.

The patient will be instructed to lie on his or her left side on the examination table. A small tube will be guided into the nose, through the esophagus and into the stomach
A topical anesthetic will be applied to the nose to ease discomfort during insertion of the tube.

Sensors at various locations on the tube sense the strength of the lower esophageal sphincter and the muscles of the esophagus during the test. The sensors measure the strength and coordination of the contractions in the esophagus during swallowing as well. Patients may be asked to swallow a small amount of water to evaluate how well the sphincter and muscles are working.

The procedure usually lasts about 20-30 minutes.

After the Procedure:
There is no recovery time since no sedation is used.

Patients do not receive sedation for this procedure.

The patient will be given post-procedure instructions.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Barrett’s Esophagus

Barrett’s Esophagus affects the lining of the esophagus. It is a pre-cancerous condition requiring frequent follow up for changes in the cells of the esophagus.

Injury to the lining of the esophagus is caused from acid and enzymes refluxing from the stomach (Gastroesophageal Reflux Disease—GERD). It causes symptoms like heartburn, regurgitation and chest pain. This damage, over time, can result in changes that cause the cells to take on an abnormal appearance and actually become intestinal tissue. “Intestinal Metaplasia” or Barrett’s Esophagus is the result.

If you are suffering heartburn symptoms more than 3 times per week or have been on long term medication for symptoms, you should consult you physician.

Someone with Barrett’s Esophagus is at a higher risk to develop esophageal adenocarcinoma. Follow up is based on the “grade” of Barrett’s Esophagus that is diagnosed. Upper Endoscopy could be needed as often as every 3-6 months or up to every 3 years. Top

Esophageal Ablation


Ablation is a technique used to kill tissue through exposure to heat energy delivered in a precise and highly-controlled manner. Esophageal ablation is used to treat a condition called Barrett’s esophagus which is a pre-cancerous condition affecting the lining of the esophagus. Barrett’s tissue can be completely eliminated through ablation technology in 98.4% of patients

Esophageal ablation is performed in conjunction with an upper Endoscopy.

Before the Procedure:
To allow adequate gastric emptying, the patient should have nothing by mouth for 6 hours before the procedure.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the procedure.

The patient will be instructed to lie on his or her left side on the examination table. A numbing medication will be administered orally. MAC (Monitored Anesthesia Care) anesthesia is used for sedation. A bite block will be placed in the mouth to protect the endoscope. Nausea or gagging may occur during the placement of the endoscope.

An endoscope (flexible tube that acts as a camera) is placed through the mouth and into the pharynx, esophagus, stomach, and duodenum. It is used to find any growths or foreign bodies. If anything unusual is found, the endoscope can also be used for treatment.

Throughout the Upper Endoscopy, the doctor can take photographs, a biopsy (a sample of tissue) or cytology (a brushing of cells). If the ablation is done, biopsies are not typically done.

In the procedure, the physician can ablate, or zap, abnormal tissue within the esophagus. Called the HALO ablation system, two components are used to remove diseased tissue — one treats large, circumferential areas of the esophagus, and the other component targets focal, non-circumferential disease.
The procedure usually lasts about 40-60 minutes.

After the Procedure:
The patient is monitored in the recovery area for at least 15-30 minutes.

Patients may experience chest pain or discomfort and difficulty swallowing for several days after the procedure, all of which can be controlled with medications supplied by the physician. In clinical trials, these symptoms were typically resolved within 3 to 4 days.

The patient will be given post-procedure instructions and prescriptions for medications.

Driving is not permitted for 24 hours after receiving sedation.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Capsule Endoscopy

A capsule endoscopy is used to examine the gastrointestinal tract, specifically the small bowel using a Pillcam. The Pillcam allows for doctors to detect illnesses such as Crohn’s disease, celiac disease and ulcerative colitis by taking photographs of the inside of the small intestine.

Before the Procedure:
Patients should not eat or drink anything after midnight the night before the procedure.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients should wear loose, comfortable clothing that is easily removed and avoid tight fitting garments the day of the capsule endoscopy. Patients should wear a t-shirt under clothing.

To swallow the Pillcam which is hidden inside a capsule, patients drink a glass of water. A nurse will then attach sensors or a sensor belt to the patient’s stomach to help the doctor identify the location of pictures taken by the Pillcam.

Patients will be given a small recording device to be worn around the waist during the procedure.

The Pillcam is moved throughout the esophagus and small intestine by natural digestive contractions.

The patient is in the Endoscopy Department the morning of the procedure approximately 30-45 minutes.

After the Procedure:
The entire capsule endoscopy lasts around 7 1/2 hours. The patient is allowed to leave the department for this time and can resume normal activities. They will be allowed to eat a light lunch 2-3 hours after ingestion of the capsule. The patient must return to the Endoscopy Department 7 ½ hours after the capsule is ingested. At that time, the recorder will be removed and downloaded. Results are usually read by the physician within 24-48 hours.

The capsule is disposable and will pass naturally with a bowel movement usually within 24-72 hours of the procedure.

The patient should watch for the capsule to pass and report any abdominal pain to your physician immediately.

The patient will be given post-procedure instructions.

There is no sedation for this procedure.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP allows doctors to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. ERCP combines the use of x rays and an endoscope.
   
Before the Procedure:
Patients should not eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of the procedure.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.
   
During the Procedure:
The patient will be instructed to lie on his or her left side on the examination table. A numbing medication will be administered orally prior to insertion of the endoscope. Conscious sedation, MAC Anesthesia or General Anesthesia is also used.

An endoscope (flexible tube that acts as a camera) is placed through the mouth and into the pharynx, esophagus, stomach, and duodenum until it gets to the spot where the ducts of the biliary tree and pancreas open into the duodenum. The patient will then be turned to lie on his or her stomach. Next, the physician will pass a tiny plastic tube through the endoscope. Using the tube, the doctor will inject a dye into the ducts so they are more visible on an x ray. X rays are taken as soon as the dye is injected.

Any foreign bodies revealed by the dye, such as gall stones, can be removed using the endoscope. Tissue samples can be taken as well. A stent may be placed to assist with evacuation of stones or sludge in the ducts.

After the Procedure:
The entire Endoscopic Retrograde Cholangiopancreatography takes anywhere from 30 minutes to 2 hours. Patients are to remain in the hospital for 1-2 hours after the procedure. Some patients may require overnight observation.

The patient will be given post-procedure instructions.

Driving is not permitted within 24 hours after receiving sedation.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Bronchoscopy

A bronchoscopy allows doctors to examine a patient’s airway using a flexible scope called a bronchoscope. Bronchoscopies are used to diagnose problems in the airway, lungs and lymph nodes as well as to treat such problems.
   
Before the Procedure:
Patients should not eat or drink anything 6-12 hours before the test.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
Patients will be lying on their back. Oxygen will be supplemented through the mouth or the nose. Local anesthesia will be administered to relax the throat muscles. The bronchoscope will be inserted into the lungs.

A saline solution may be sent through the scope in order to wash the lungs and allow the doctor to collect samples of lung cells, fluids, and other materials inside the air sacs.
Small brushes, needles, or forceps may also be passed through the bronchoscope and used to take tissue samples from the lungs.

After the Procedure:
The patient will be given post-procedure instructions.

Driving is not permitted within 24 hours after receiving sedation.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Gastrostomy Tube Placement

Gastrostomy tube placement is usually required when a patient has the inability to take adequate nutrition or liquids by mouth for growth and development. Reasons why the patient is unable to take proper nutrition can be developmental, mechanical, or a result of other health problems.

Before the Procedure:
Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.

During the Procedure:
There are two ways gastrostomy tube placement is done.

The first is usually performed under general anesthesia and is referred to as an open gastrostomy. This procedure is usually performed in conjunction or anticipation of another major operation. This type of procedure occurs in the operating room and not in the GI Lab.

The second is completed under sedation or MAC Anesthesia and a local anesthetic applied to the mouth and abdomen.

An endoscope is used to guide the tube from the stomach to the mouth in both procedures. The endoscope is guided through the esophagus and into the stomach and is used to take pictures of the inside of the stomach and ensure correct positioning of the tube.

The gastrostomy tube is inserted into the stomach through an incision in the abdomen.

After the Procedure:
Patients will be released from the hospital in a timely manner dependant on their condition.

Patients and their caregivers will be given instructions on how to care for their tube.

Driving is not permitted within 24 hours after receiving sedation.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top

Transrectal Ultrasound

Transrectal Ultrasound is an ultrasound that looks at a 3D rendering of the rectum. It is used for tumor staging as well as other examinations of the rectum.

Before the Procedure:
Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly.
Patients may need to do a mild prep for cleaning out the sigmoid portion of the colon.

During the Procedure:
Patients are lying on their left side. The transrectal probe is inserted into the rectum and maneuvered to get a good look at the rectum and any abnormalities noted.

There is no sedation for this procedure.

The entire procedure takes only 10-20 minutes.

After the Procedure:
Patients will be given discharge instructions and follow up instructions.

There is no sedation, so there is no recovery time.

Patients will be able to drive themselves home from the procedure and can return to work upon discharge.

For more information talk with your physician or call the ASK-A-NURSE Resource Center at 913-676-7777. Top