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Frequently Asked Questions
Why will you ask to take my picture?
We are now taking patient photos to include in our new Electronic Medical Record system. Having patient photos will assist the staff and physicians in putting a face with a name when looking at your chart in preparation for your visit or after test results come in. We can retake your photo at your next visit if you like.
Gastroenterology ("GI") is the medical subspecialty involving the evaluation and management of disorders of the digestive system; this includes disorders of the esophagus, stomach, small intestine, colon, liver, pancreas, and biliary system, including the gall bladder. Swallowing difficulties, indigestion, heartburn, ulcer disease, abdominal pain, inflammatory bowel diseases, Hepatitis, polyps and cancers are some of the GI problems treated. Gastroenterologists work closely with primary care physicians and other special consultants to provide the best medical care and recommendations for every patient.
Many problems of the digestive tract cannot be diagnosed by an x-ray. Scopes allow us to thoroughly examine the inside of your digestive tract to detect abnormal tissue that may be causing you problems.
EGD (Esophagogastroduodenoscopy) is the examination of your upper digestive tract. It is more accurate than an x-ray. Sometimes, an EGD is used for treatment, such as the stretching of a narrowed esophagus, removal of polyps or swallowed foreign objects.
Colonoscopy is the examination of your lower intestinal tract or colon. It is a major advancement in the diagnosis, prevention and treatment of colon cancer. It is the most effective way to detect and remove polyps that can develop into cancer. Before Colonoscopy, major surgery was necessary to remove colon polyps to determine if they were benign or malignant. Now, most can be removed easily and safely without surgery. In addition, many other conditions can be diagnosed such as diverticulosis, colitis, inflammatory diseases and infections.
An endoscope is a small fiberoptic instrument that the doctor uses to examine your digestive tract. He sees all of your tissues by manipulating the scope with the aid of a light source.
During the EGD we use a gastroscope. This is a long flexible tube about the thickness of your finger, which is passed through your mouth into your esophagus, stomach and duodenum.
A colonoscope is longer and is passed during the Colonoscopy through the rectum to examine the entire colon lining.
For an EGD your stomach must be empty. This means for a morning appointment you should not eat or drink after midnight the evening before your exam.
If you are scheduled an afternoon exam, you can have clear liquids (broth, apple juice, cranberry juice, soda pop, coffee, tea, lemon or pineapple jello) in the morning but nothing for 6 hours prior to your appointment. (Unless you are a patient of Dr. Brock or Dr. Landers - they prefer you have nothing after midnight the evening before the exam.)
For a Colonoscopy your colon needs to be empty of waste material. You will achieve this by using a bowel cleansing preparation, as specified by your physician. Complete instructions accompany the preparation. You may have only clear liquids once you start the preparation and no solid food until after your exam. Please select the prep name you were given when you scheduled your procedure to view the instructions your physician will want you to follow (if you have trouble with the suggested prep there may be an alternate available):
The procedure will cause you little or no discomfort. Your doctor will give you enough medication both before and during the procedure through a vein to make you relaxed and sleepy. The procedure will be performed while you are lying in a comfortable position.
After the exam is over, you will be watched until most of the effects of the medication have worn off. You may feel bloated after the procedure from air that was introduced into your system during the exam. You should be able to eat normally afterwards unless we instruct you otherwise.
As you will be groggy afterwards, it is necessary to have someone available to drive you home.
If the doctor finds a suspicious area, he can take a biopsy with small forceps through the scope. This will cause no additional discomfort.
Sometimes the doctor finds a polyp. A polyp is a benign growth that can become malignant in time, if it is not removed. It can vary in size from a tiny dot to several inches. It the doctor feels it's necessary he may remove the polyp during the exam using a hot wire loop or hot forceps. Again, this is done through the scope and causes you no additional pain.
EGD, Colonoscopy and polypectomy are safe and are associated with very low risk when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.
One possible complication is perforation in which a tear through the wall of the bowel may allow leakage of intestinal fluids. This complication usually requires surgery but may be managed with antibiotics and intravenous fluids in selected cases.
Bleeding may occur from the site of the biopsy or polyps removal. It is usually minor and stops on its own or can be controlled by cauterization (application of electrical current) through the colonoscopy. Rarely, transfusion s or surgery may be required.
Localized irritation of the vein may occur at the site of the medication injection. A tender lump develops which may remain for several weeks to several months but goes away eventually. Other risks include drug reactions and complication from unrelated diseases such as heart attack or stroke.
Understanding EUS (Endoscopic Ultrasonography)
You've been referred to have an endoscopic ultrasonography, or EUS, which will help your doctor, evaluate or treat your condition. This brochure will give you a basic understanding of the procedure - how it is performed, how it can help, and what side effects you might experience. It can’t answer all of your questions, since a lot depends on the individual patient and the doctor. Please ask your doctor about anything you don't understand. Endoscopists are highly trained specialists who welcome your questions regarding their credentials, training and experience.
What is EUS? EUS allows your doctor to examine the lining and the walls of your upper and lower gastrointestinal tract. The upper tract is the esophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the gall bladder and pancreas.
Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will turn on the ultrasound component to produce sound waves that create visual images of the digestive tract.
Why is EUS done? EUS provides your doctor more detailed pictures of your digestive tract anatomy and some organs outside of but located anatomically close to your digestive tract. Your doctor can use EUS to diagnose the cause of conditions such as abdominal pain or abnormal weight loss. Or, if your doctor has ruled out certain conditions, EUS can confirm your diagnosis and give you a clean bill of health.
EUS is also used to evaluate an abnormality, such as a growth, that was detected at a prior endoscopy or by x-ray. EUS provides a detailed picture of the growth, which can help your doctor determine its nature and decide upon the best treatment. In addition, EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive.
How should I prepare for EUS? Please carefully read through the preparation instructions in a separate letter. If you did not get one, please call our office immediately.
For your safety, the procedure might have to be rescheduled if you don't follow the instructions as requested.
What about my current medications or allergies? Tell your doctor in advance of the procedure about all medications that you're taking and about any allergies you have to medication. He or she will tell you whether or not you can continue to take your medication as usual before the EUS examination. In general, you can safely take aspirin before an EUS examination. But nonsteroidal anti-inflammatories (Motrin, Advil, Aleve, etc.), and other medications that affect the clotting of your blood (warfarin and plavix) may need to be held for 5 days prior to the exam. It's always best to discuss their use with your doctor. Check with your doctor about which medications you should take the morning of the EUS examination, and take essential medication with only a small cup of water.
If you have an allergy to latex you should inform your doctor prior to your test. Patients with latex allergies often require special equipment.
Do I need to take antibiotics? Antibiotics generally are required before or after only very specific EUS examinations. But tell your doctor if you take antibiotics before dental procedures. If your doctor feels you need antibiotics, then the antibiotics might be ordered during the EUS examination or after the procedure to help prevent an infection.
Should I arrange for help after the examination? If you received sedatives, you won't be allowed to drive after the procedure, even if you don't feel tired. You should arrange for a ride home. You should also plan to have someone stay with you at home after the examination, because the sedatives could affect your judgment and reflexes for the rest of the day.
What can I expect during EUS? For an EUS examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. You will begin by lying on your left side, then you will receive sedatives intravenously to help you relax. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breath. For EUS examination of the lower gastrointestinal tract, you will start by lying on your left side with your back toward the doctor. The actual EUS examination generally takes between 30 to 60 minutes, but make take longer if your doctor needs to obtain tissue biopsies. Most patients consider the procedure only slightly uncomfortable, and many fall asleep during it.
What happens after EUS? If you received sedatives, you will be monitored in the recovery area until most of the sedative medication's effects have worn off. If you had an upper EUS, your throat might be sore. You might feel bloated because of the air and water that were introduced during the examination. You'll be able to eat after you leave the procedure area, unless you're instructed otherwise. Your doctor will discuss with you some of the findings of the test before you leave the hospital, but the results of certain tests (such as tissue biopsy results, if any is obtained) may take longer.
What are the possible complications of EUS? Although complications can occur, they are rare when doctors with specialized training and experience perform the EUS examination. Bleeding might occur at a biopsy site, but it's usually minimal and resolve on their own. You might have a sore throat for a day or more. Nonprescription anesthetic-type throat lozenges and painkillers help relieve the sore throat. Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; backwash of stomach contents into your lungs; infection; inflammation of the pancreas and complications from heart or lung diseases. One major, but very uncommon, complication of EUS is perforation. This is a tear through the lining of the intestine that might require surgery to repair.
The possibility of complications increases slightly if a deep needle aspiration is performed during the EUS examination. These risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.
Additional Questions? If you have any questions about your need for EUS, alternative approaches to your problem, the cost of the procedure, methods of billing or insurance coverage, do not hesitate to speak to your doctor or doctor's office staff about it.
IMPORTANT REMINDER: The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.