Surgical Correction of Reflux Disease

Surgical Correction of Reflux Disease

What is GERD?

Gastroesophageal reflux disease (GERD) is very common in the United States, with up to 40% of Americans having symptoms monthly.  Gastroesophageal reflux is defined as the movement of contents within the stomach, mainly acid, upwards into the esophagus.  This causes heartburn, regurgitation and other problems.

The majority of patients with GERD are placed on acid-suppression medication.  The medications are safe and effective in eliminating symptoms in most people.  In a few, however, medication alone does not control symptoms.  It is these people who are usually considered for antireflux surgery.

Do I need surgery?

Normal anatomy has the esophagus and stomach merging where the chest and abdomen meet.  Their meeting point is a muscular ring called a sphincter.  The sphincter’s normal job is to maintain pressure so that stomach contents cannot pass upwards into the esophagus.  In some people, their sphincter has become loosened and no longer acts as a protective barrier between stomach and esophagus.  Antireflux surgery acts to retighten the sphincter between esophagus and stomach and reclaim the protective pressure barrier.

Your GI physician will help you to choose an experienced general surgeon, who performs the surgery.  The procedure is called a laparoscopic fundoplication.  Laparoscopic refers to making 4 small incisions on the abdomen surface through which the surgeon passes equipment.  Fundoplication refers to the internal repair work performed by your surgeon.  The upper portion of the stomach, called the fundus, is tightly wrapped around the bottom of the esophagus (wrapping is referred to as plicating) to recreate pressure in the same location the sphincter used to be.  Thus, fundoplication, or stomach wrapping, is performed.

Recovery is usually rapid, as the small skin incisions heal quickly and most patients return to work within two weeks.  Most patients are able to stop using their acid-suppression medication and remain symptom-free.

What are the possible complications of the surgery?

Complications of the procedure include an excessively tight stomach wrap that makes swallowing difficult.  This can usually be solved with a gentle stretch of the newly wrapped area during upper GI endoscopy.  Most patients lose the ability to vomit after a stomach wrap.

What other tests are necessary prior to surgery?

Prior to consideration for fundoplication, patients must undergo esophageal manometry, which is a test to measure esophageal pressures.  The esophagus uses squeezing pressure to move swallowed materials downwards.  If squeezing pressures prior to fundoplication are not adequate, tightening of the esophageal-stomach connection may make swallowing more difficult or impossible.

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Liver Biopsy

Liver Biopsy

The liver is a large, football-shaped organ located in the right upper abdomen behind the lower rib cage. There are a variety of problems that can affect the liver such as viruses, alcohol, fat, medications, genetic disorders, liver tumors and autoimmune diseases. Some of these may lead to permanent liver damage. The liver can be evaluated by performing blood tests or imaging via ultrasound, CT or MRI. Sometimes a liver biopsy is needed to obtain additional information about the cause or amount of liver injury.

What is a liver biopsy?

A liver biopsy is a procedure in which a small sample of liver tissue is obtained. The tissue is then processed in the laboratory where it is analyzed under the microscope. Even though it is a small sample of the liver (about a one inch thin strand), the biopsy can provide information about the whole liver.

What should I expect the day of my procedure?

Before a liver biopsy is done, blood tests are obtained to check a patient’s clotting factors. Adequate clotting of the blood is important to minimize the risk of bleeding after the biopsy. A patient is instructed to completely avoid aspirin or arthritis-type medications that may thin the blood such as Aleve, Motrin, Ibuprofen and Advil for at least 5 days prior to the procedure. If a patient is on other blood thinners such as Coumadin or Plavix additional instructions may be needed after consulting with the patient’s physicians.  Physicians have different preferences in terms of fasting or not fasting prior to the biopsy. Please check with your physician prior to having a liver biopsy for specific instructions.   If you are unclear as to your instructions, please call our office.

A liver biopsy is usually performed as an outpatient in a hospital by either a gastroenterologist or radiologist. The procedure is generally done in the radiology department. The patient lies on a stretcher, ultrasound is used to find an appropriate place for the biopsy, the skin is cleaned and then local numbing medication is used.  Following this a tiny incision is made in the skin so that the small needle can pass easily into the liver.  The liver biopsy is done by passing a small needle quickly into and out of the liver for approximately one second while the patient holds their breath. Infrequently the biopsy needle needs to be passed again in order to obtain an adequate sample. Stitches are not necessary and a bandage is placed over the biopsy site. Patients are generally monitored for about 4 hours after the biopsy with frequent vital signs. For the first two hours of recovery patients generally lie on their right side to apply pressure to the biopsy site. For the remainder of the monitoring period patients generally lie in bed with the head of the bed raised. During this time a patient may eat.

What are the possible complications of a liver biopsy?

Overall a liver biopsy is a safe procedure. Infrequently patients may experience brief discomfort or pain at the biopsy site or the right shoulder. Internal bleeding is a rare complication that can occur in less than 1% of patients. If this happens patients may require blood transfusions or surgery. An infrequent complication is accidentally puncturing organs adjacent to the liver such as the gallbladder, lungs, kidney and intestine. Also bile can rarely leak from the liver biopsy site or gallbladder and cause peritonitis.

Are there any restrictions after the biopsy?

Generally patients should plan to take it easy the day of the biopsy. Patients cannot drive the day of the biopsy particularly if any sedating medications were used for the procedure. Aspirin or other arthritis-type medications that may thin the blood need to be avoided for an additional 5 days after the biopsy to allow the site to heal. Lifting objects heavier than 20 pounds should be avoided for 5 days following the biopsy.

When are the biopsy results available?

The liver tissue is processed in the laboratory where slides are made and evaluated under the microscope by the pathologist. The results are usually available within one week of the procedure. Results are discussed with the patient by phone or during a follow-up clinic visit, depending on your physician’s preference.

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Esophageal Manometry

Esophageal Manometry

What is esophageal manometry?

The esophagus is the tube that conducts food from your mouth to stomach.  Food propulsion is accomplished by muscles in the wall of the esophagus squeezing in a coordinated fashion.  In some people, the muscles do not function properly, or may squeeze too hard.  Patients often complain of difficulty swallowing.  Manometry is a method by which muscle contraction can be measured.  Esophageal manometry allows the muscles of the esophagus to be examined for coordination of contractions and pressure of squeeze.

The second important feature of esophageal manometry involves the connection between the esophagus and stomach.  A small ring of muscle at the connection site called the lower esophageal sphincter can be too tight or too loose, contributing to heartburn, pain and other symptoms.  Esophageal manometry allows measurement of this muscular ring.

Why have this test?

Your doctor may request this examination if you have swallowing problems, heartburn, regurgitation, chest pain, lump in your throat, or are planning to have anti-reflux surgery.  There are other tests to evaluate the esophagus, such as gastroscopy and upper GI, but only manometry allows for pressure measurements.  Many times manometry will be used in combination with these other tests to define your medical problem.

How do I prepare for the test?

Preparation is simple, and requires that you have nothing to eat or drink for 6-8 hours prior to the exam.  Your physician will provide these details.  You may also be asked to stop certain medications on the day of the test, or several days prior.  Again, your doctor will give you instruction.

Procedure

A thin tube smaller than a straw is passed through the nose into your esophagus.  While lying flat, you are asked to swallow multiple times, both dry (saliva only) and wet (sips of water).  Pressure measurements are taken during the swallows.  The tube is then removed, and you can return to normal daily functions.  The computer will generate a graphic representation of your swallows.  Your doctor will analyze the graphs and provide you an interpretation of your swallowing function.

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BRAVO pH study

BRAVO pH study

pH is a measure of acidity or alkalinity.  Most people are familiar with pH tests done on soil or swimming pools.  As esophageal pH test measures how often stomach acid flows into the lower esophagus and the degree of acidity during a 12-24 hour period

What is Bravo pH monitoring?

Bravo pH monitoring is a test for identifying the cause of heartburn. This test allows your doctor to evaluate if you reflux acid into your esophagus, and for how long and how frequently. It also helps to see if acid reflux is the cause for symptoms such as heartburn, cough, or chest pain.
The test involves a miniature pH capsule, approximately the size of a gel cap that is attached to your esophagus. Throughout the test period, the Bravo pH capsule measures the pH in the esophagus and transmits this information to a small receiver worn on your belt or waistband.

What to expect during the procedure?

The capsule takes only moments to place in the esophagus. Then the test period lasts 48 hours or more, depending on what your doctor requests. A thin tube is used to pass the capsule over the tongue into the esophagus. A small amount of tissue is suctioned into the capsule and a small pin secures it. The catheter is then removed leaving the capsule inside.  The majority of patients tolerate this with very little discomfort. You will then be asked to keep a symptom diary and keep the receiver box close to you for the duration of the test. The usual test period lasts 48 hours.

How is the capsule placed?

The capsule can be placed during an endoscopy or at a later date to be determined by your physician. If the procedure is done at a later date you will not be sedated for the capsule placement. Your throat will be sprayed to assist you in swallowing the capsule. The capsule is small so you may eat normally and go about your daily routine.

Who should not undergo BRAVO testing?

The Bravo pH test is not for everyone. If you have a severe bleeding condition, blockages or narrowing of the esophagus, severe esophageal inflammation, varices, a pacemaker, or an implantable cardiac defibrillator, you should not undergo a Bravo pH test. Additionally, because the capsule contains a small magnet, you should not have an MRI study within 30 days of undergoing the Bravo pH test.

What are the potential risks of the test?

  • Premature detachment of the pH capsule
  • Failure of the pH capsule to detach from the esophagus within several days  or discomfort associated with the pH capsule, requiring another procedure to remove the capsule
  • Tears in the mucosal and sub mucosal layers of the esophagus, causing bleeding and requiring possible medical intervention
  • Perforation
  • Minor complications associated with capsule placement also include: sore throat, discomfort, and tissue damage resulting in bleeding.

 

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24-hour pH Study

24-hour pH Study

pH is a measure of acidity or alkalinity.  Most people are familiar with pH tests done on soil or swimming pools.  As esophageal pH test measures how often stomach acid flows into the lower esophagus and the degree of acidity during a 12-24 hour period.

Why do I need a 24-hour pH test?

A measurement of esophageal pH is of great importance in evaluating heartburn and non-cardiac chest pain.  It can also be useful in determining the success of treatment for acid reflux.  Some patients with acid reflux do not have typical heartburn.  pH testing is particularly helpful in making the correct diagnosis.

What should I expect the day of the procedure?

To prepare for the test, you should take no food or liquid for 8 hours prior to the exam.  In most cases, you should not take any medicine that can affect the function of the esophagus or control of stomach acid.  Your physician will give you specific instructions about which medications you should or should not take.

The test is initiated at the hospital and takes about 30 minutes to start.  A small, thin tube is gently inserted through the nose, down to the end of the esophagus.  Sometimes a separate test, called esophageal manometry, is performed at the same time to assure proper placement of the pH tubing within your esophagus.  The pH tubing is attached to a portable recorder that you carry at your waist.  You can then leave the hospital and go about your usual daily business.  It is important that you carry out all of your usual activities in order to assess the presence or absence of esophageal acid under real life situations.  The acid content in the lower esophagus is recorded throughout the day and night.  When you experience reflux or other symptoms, you press a button on the recorder.  This marks the time so it can be determined if acid was present in the esophagus at the time of the symptom.  When your study time is complete, you will return the recorder to the hospital and have the tube removed.

When will I receive results?

Generally, the esophageal pH test will show a small amount of acid seeping into the esophagus at various times during the day and night.  This is normal for almost everyone.  However, if protective actions of the esophagus do not function properly, the test will show a greater degree and duration of stomach acid in the esophagus.  Your physician will read the pattern of pH changes recorded during your test and provide you with results and interpretation.  You and your physician will decide on treatment plans and changes based on the results of the 24-hour pH study.

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Capsule Endoscopy

Capsule Endoscopy

What is capsule endoscopy?

Capsule endoscopy is a fairly new method used to evaluate the lining of the small bowel.  It is otherwise known as the “pill cam.”  The bowels are divided into three portions – the upper portion includes your stomach and can be easily reached by gastroscopy.  The lower portion is your colon, which can be thoroughly seen via colonoscopy.  The middle section, the small bowel, is too long and winding to be reached effectively with an endoscope.  Capsule endoscopy is a means by which the small bowel lining can be seen.  Capsule endoscopy involves swallowing a small capsule with a battery and camera inside.  As the capsule meanders through your small bowel, images are taken of the small bowel lining.

What can I expect the day of the procedure?

The capsule is about the size of a vitamin pill.  Once it is swallowed, images of your bowel are obtained continuously for eight hours.  You will wear a sensor device to store the images.  At the end of the day you will return to the office, the sensor will be removed, and the images will be downloaded to a computer, so that your physician can review the images.  The capsule will spontaneously pass through your system and be eliminated within a bowel movement.  Passage of the capsule does not hurt and you may not realize when the capsule passes. Most patients consider the test comfortable.  You should not be near MRI equipment while wearing the sensor.

Images will be clearer if the bowel is free of waste material, so you will be asked to drink a flushing solution the day prior to swallowing the capsule.  Once you have ingested the pill camera, you can drink clear liquids after two hours and eat a light meal after four hours, unless instructed otherwise by your physician.  You should avoid vigorous activity like running or jumping during the capsule exam.  Results are generally available within one week.

As is the case with all new tests, some insurance companies do not provide benefits for capsule endoscopy.  Please check with your insurer and our office prior to arranging for your capsule endoscopy appointment.

Why perform capsule endoscopy?

As alluded to earlier, evaluating the lining of the small bowel can be difficult.  There are several tests available, such as CT scan, x-rays, or upper GI with small bowel follow-through.  None of these tests, however, provides images of the bowel lining.  Capsule endoscopy is unique in this sense – it allows your physician to see inside of the bowel.  Although any suspected condition of the small bowel can be a reason to have capsule endoscopy, some of the more common causes include Crohn’s disease, gastrointestinal bleeding of unclear source, malignancy, polyps, and ulcers.  Capsule endoscopy is not an adequate test for evaluating the colon and cannot be used in place of colonoscopy.

Risks of the procedure

The most serious complication is entrapment of the capsule within the gastrointestinal tract.  If this occurs, surgery or conventional endoscopy could be necessary to remove the capsule.   Please alert your physician if you have had prior abdominal surgery, bowel obstructions, adhesions, or inflammatory bowel disease.  If you experience abdominal pain, bloating or vomiting during the capsule test, call your doctor immediately.  If you develop chest pain, difficulty swallowing or a fever after the test, please call your physician immediately.  Be careful not to prematurely disconnect the sensor, as data could be lost.

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Esophageal Dilation

Esophageal Dilation

What is the esophagus?

The esophagus is the long narrow tube that carries food from the mouth to the stomach.  When the esophagus does not function properly, patients often complain of difficulty swallowing, also known as dysphagia .  There are many causes of dysphagia, including mechanical obstruction of the esophagus, poor muscular activity within the esophagus, or inflammation.  When mechanical obstruction is present, stretching of the esophagus, called esophageal dilation, can help restore the patient’s ability to swallow normally.

What causes mechanical obstruction of the esophagus?

The most common cause of obstruction is a ring or stricture within the esophagus.  This is usually made up of scar tissue, often caused by repeated reflux of acid contents from the stomach.  Other less common causes of scar tissue occur in the esophagus, such as burns due to lye or acid ingestion.  Tumors and cancers can cause the same symptoms.  Achalasia is a rare condition where the lower esophagus will not relax properly to allow food and fluids to pass.

What is esophageal dilation?

There are several methods by which the esophagus can be stretched or dilated.  Esophageal dilation involves gently opening the closed esophagus.  Most interventions involve upper GI endoscopy, which is passage of a lighted endoscope through the mouth and into the esophagus.  Once inside the esophagus, your doctor has a number of ways to dilate the esophagus, including plastic expanders or fluid filled balloons.  Your physician will determine which method of dilation is most effective and safest for your particular problem.  In rare instances, surgery or even injection of botox into the esophagus can be helpful.

When the esophagus is stretched open, complications are possible.  Bleeding, perforation (tearing a hole in the esophagus), and aspiration (passage of secretions into the lungs) can occur.  If you experience chest pain or difficulty breathing after dilation alert your physician immediately.

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Flexible Sigmoidoscopy

Flexible Sigmoidoscopy

What is flexible sigmoidoscopy?

Sigmoidoscopy is visualization of the sigmoid portion of the colon, which is the lower third of the colon.  A lighted, flexible tube called an endoscopy is inserted via the rectum.  Your physician performs the exam.  Your physician will help you to decide if flexible sigmoidoscopy is right for you.

Why should I have flexible sigmoidoscopy?

Sigmoidoscopy is used to evaluate for problems in the lower portion of the colon.  These problems can include ulcers, polyps, and cancers.  Sigmoidoscopy is also sometimes used to assist in treatment of hemorrhoids.  Other reasons to perform sigmoidoscopy include rectal bleeding, diarrhea, and rectal or anal pain.

Procedure

For the exam to be fully beneficial, it is imperative your colon be clean.  Cleansing preparations may include enemas or oral solutions.  Specific instructions will be issued by our office prior to the exam.

Flexible sigmoidoscopy is an outpatient procedure.  You will be asked to lie on your left side for the examination. Your physician will gently place the endoscope into your rectum then guide the endoscope through your lower colon, looking at the colon walls on a video monitor the entire time.  Some patients experience mild cramps due to air being placed into the colon via the endoscope during the exam, but flexible sigmoidoscopy is not generally a painful procedure.  The exam takes between 5-15 minutes and most patients are awake and unsedated for the test.  If you have concerns about pain, discuss these with your physician prior to the beginning of the examination.

Safety and alternatives

Flexible sigmoidoscopy is a very safe procedure with a low risk of complications.  Your physician will discuss the possibility of complications with you before the exam is begun.  Other possible means of colon examination include colonoscopy, barium enema and CT scanning.  Again, your physician will help you to decide which test is appropriate for you.

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ERCP – Endoscopic Retrograde Cholangiopancreatography

ERCP – Endoscopic Retrograde Cholangiopancreatography

What is ERCP?

Endoscopic retrograde cholangiopancreatography, or ERCP, is an endoscopic exam in which dye is injected into the duct systems of the liver and/or pancreas. The exam is similar to a cardiac (heart) catheterization in that x-rays are taken once the dye is injected to show the outline of the ducts.  The bile and pancreatic ducts empty into the early portion of the small bowel (duodenum), which your doctor reaches by passing an endoscope via your mouth and stomach once you are adequately sedated.

Why would I need an ERCP?

The reasons for doing the tests are many, but ERCP is most helpful for diagnosing and treating disorders of the liver, gallbladder and pancreas. The liver produces bile, which flows down the biliary ducts or gets store in the gallbladder. The bile duct empties into the part of the small intestine known as the duodenum. The pancreas is an organ that makes digestive enzymes, which flow from the pancreas through the pancreatic duct. The pancreatic duct also empties into the duodenum, in the same place the bile duct empties into the duodenum. Both bile and pancreatic enzymes are needed for digestion. ERCP is useful in diagnosing or treating diseases causing blockage of either of these duct systems, and diseases affecting the liver and pancreas. Gallstones, inflammation, tumors, or infection can cause these diseases. ERCP can also be helpful in finding causes of upper abdominal pain, yellow jaundice and pancreatitis.

What should I expect on the day of my ERCP?

An ERCP is done in a special hospital procedure room equipped with x-ray machines. In this procedure, a nurse, an endoscopic technician and an x-ray technician assist the physician. The patient’s throat is anesthetized and the patient receives sedation medications intravenously.  An endoscope is then inserted via the patient’s mouth and passed into the duodenum. Special catheters and instruments are passed through the scope and used to inject the dye into the biliary and pancreatic ducts as x-rays are taken. If a gallstone is found in the duct, it may be possible to remove it. A tiny cut may be made inside the duodenum to assist with stone removal.  If a stricture or narrowed area of a duct is encountered, a stent may be placed to open or dilate it. A stent is either plastic or metal and looks like a tiny straw.  If a tumor or mass is seen, biopsies may be taken. The exam usually takes 20-60 minutes, after which the patient is taken to the recovery area.

What are the potential complications?

ERCP is a safe exam when performed by a specially trained endoscopist, however, as with any medical or surgical procedure, there are potential risks or side effects. Serious complications are rare. The most common complication of ERCP is pancreatitis (inflammation of the pancreas). This can occur in 5-15 percent of cases. It results in abdominal pain, and may require hospitalization. Other specific complications, which are much less common can include, bleeding, infection, or perforation. Your doctor can discuss appropriate indications, preparation, and alternative testing before performing an ERCP.

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Colonoscopy

Colonoscopy

Colonoscopy is a visual examination of the colon, otherwise known as the large bowel. A video endoscope is inserted through the rectum and advanced to the end of the colon. The endoscope is a long, flexible black tube with a camera at the end, which projects constant images of the colon onto a video screen for your doctor to watch.

Why have a colonoscopy?

There are many diseases that can occur within the colon. Making a proper diagnosis sometimes involves examining the colon lining with colonoscopy. Although there are many reasons for having a colonoscopy, some of the more common reasons include looking for the following – colon cancer, benign growths called polyps, inflammation or ulcers termed colitis, sources of bleeding, causes of diarrhea, and reasons for anemia.

What is the preparation for the examination?

In order to safely maneuver through the natural curves of the colon and adequately see the lining, the colon must be cleaned and free of stool. Your doctor will prescribe a cleansing method, which usually involves drinking a flushing solution, laxatives, and/or enemas. In most cases, you are asked to consume only clear liquids and eat no solid food the day before your procedure. Your physician will provide advice on which medications are safe to use up until the day of your colonoscopy.

What should I expect the day of the procedure?

Colonoscopy is typically an outpatient procedure. You can expect to spend less than half a day for completion. You may be given sedative medications through an IV that will produce a light sleep or relaxed state of mind. Once you are comfortable, your doctor will maneuver the colonoscope through your bowel. Air is placed into the colon to allow good visualization, and this can create cramping in some people. Turning the colonoscope around corners can also cause discomfort, and these are two of the main reasons patients are given sedation. One of the medications can produce short-term amnesia, so some patients forget or simply sleep through the colonoscopy. Your doctor can discuss the details of these medications with you prior to beginning your colonoscopy. If polyps are found in your colon, your physician will remove them with a heated lasso or biopsy teeth. Polyp removal does not produce pain. Biopsies will also be obtained if any other abnormal tissue is seen. The exam usually lasts 15-45 minutes. You will recover from the medication effects quickly. You should not drive a vehicle the rest of the day. For complete instructions see our website at www.idahogastro.com

When will I get results?

Your doctor will be able to explain what was found on your exam directly after its completion and provide specific recommendations. If biopsies or other specimens were taken during the exam, pathology results usually return within 4-10 working days.

Alternatives to colonoscopy

Other methods to evaluate the colon include flexible sigmoidoscopy, barium enema, virtual colonoscopy, and stool blood testing. Most of these testing methods do not allow for polyp removal, tissue biopsy, or direct visualization of the entire colon. Colonoscopy remains the most comprehensive means for complete evaluation of the colon.

What are the risks and side effects of colonoscopy?

Due to the air placed inside the colon during the exam, some patients feel gassy or bloated after colonoscopy. This usually resolves once you are able to pass gas. Serious risks of the exam include, but are not limited to, bleeding, infection, adverse reaction to the sedative medication, and bowel perforation, which is inadvertently causing a hole in the colon. The chances of these serious side effects are small, but any adverse outcome can result in hospitalization, surgery, or even death.

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Upper GI Endoscopy

Upper GI Endoscopy

What is upper GI endoscopy?

Upper GI endoscopy, otherwise known as esophagogastroduodenoscopy (EGD) is a video examination of the upper third of the GI tract.  Using a flexible scope with a camera and bright light at the end, your physician will guide the instrument through your mouth and into your GI tract.  Images are displayed on a video monitor your doctor watches throughout the exam.  Your physician will be able to evaluate multiple organs including your esophagus (esophago-), stomach (gastro-) and early portion of your small bowel, known as the duodenum (duodeno-).  Tissue biopsies, stretching of tissue narrowings, laser and heat treatments, and medication administration can be accomplished through the scope.  The examination should be performed by a board certified Gastroenterologist, who has extensive training in management of digestive system diseases.

Why should I have upper GI endoscopy?

There are many reasons why your physician may recommend upper GI endoscopy.  The most common reasons include long-standing GERD (acid reflux disease), difficulty swallowing, nausea with or without vomiting, bleeding from the gastrointestinal tract, abdominal pain, chest pain, suspected celiac sprue disease, loss of appetite or weight loss.  Your doctor will help you to determine if upper GI endoscopy is right for you.

What should I expect the day of my upper GI endoscopy?

Most procedures are outpatient, so patients should plan to spend about 2 hours for their examination and plan to return home afterward.  On the day of the procedure, you will be asked not to consume food or beverages for 6 hours prior to your exam.  Discuss routine medication use with your physician or endoscopy staff.  Patients using coumadin and insulin require special instruction.  An IV will be placed to administer sedation medication for the examination.  You must have a driver to assist you home after the procedure and we ask that you avoid alcohol the rest of the day.  For complete preparation instructions visit our Preparation instructions page.

Upper GI endoscopy is a very safe procedure, but risks do exist.  The most common side effect from the procedure is redness at the IV site.  Less common side effects include adverse reactions to the sedation medications, bleeding from a biopsy site, infection, and perforation.  Perforation is a tear in the lining of the digestive tract and can be very dangerous, necessitating hospitalization, antibiotics, and sometimes surgery.

Other options for evaluation of your upper GI tract do exist.  Your physician may requests laboratory testing, barium swallow tests, ultrasound, CT scan, esophageal manometry or 24-hour esophageal pH testing in addition to or in place of upper GI endoscopy.  Discuss these options with your Gastroenterologist.

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