Medical Procedures

In addition to a full range of office and hospital based consultations. we perform a broad range of diagnostic and therapeutic endoscopic procedures including:

Flexible Sigmoidoscopy


A procedure to visualize the inside of the rectum and sigmoid colon using a lighted flexible tube attached to a video screen for viewing.  The colon (large intestine) is 5 to 6 feet long.  A sigmoidoscopy allows visualization of the distal 1 to 2 feet of the colon.  The exam usually takes 5 to 15 minutes.  It is usually performed in the office and sedation is generally not required.

Indications for exam:

  • Bleeding – Rectal bleeding is very common.  It can be caused by conditions as benign as hemorrhoids or tears at the anus (fissure).  However, it can also be a warning sign for a more serious underlying problem, such as cancerous lesions, and advanced polyps, or various forms of inflammation of the colon (colitis).
  • Diarrhea – Persistent diarrhea should be evaluated, and during sigmoidoscopy, sampling of the lining (biopsy) can often help in elucidating the cause and provide appropriate therapy.
  • Pain – Among causes for rectal pain include hemorrhoids, fissures, diverticulosis (pockets in the colon), and tumors.  These can be evaluated appropriately during the exam.
  • Follow-up abnormal X-ray studies – Abnormal findings on barium studies, CAT scans or other radiographic methods need to be evaluated directly with sigmoidoscopy or colonoscopy.

Side Effects and Risks:

  • Overall well tolerated and low-risk examination
  • Bloating and discomfort related to air insufflated into the bowel are the most common side effects but usually resolve within an 30 to 60 minutes.  If biopsies obtained, some small amount of spotting may be observed.

Colonoscopy


A procedure performed to visualize the large intestine (colon) using a lighted, flexible fiberoptic video endoscope. The colonoscope is inserted into the rectum, advanced through the left colon ending in the right colon, or often times, advanced into the distal part of the small intestine (terminal ileum). The colon is approximately 5 to 6 feet long.

Indications for exam include:

  • Colon cancer screening and diagnoses
  • Polyps - small benign tumors in the colon that are usually precursors to colon cancer if left undetected over years
  • Coliris (including Crohn's disease and ulcerative colitis) - inflammation of the lining of the colon, usually presenting as abdominal pain, bleeding, or diarrhea.
  • Diverticulosis - pockets along the intestinal wall of the colon that can often times get infected (diverticulitis) or bleed
  • Bleeding - can be caused by various sources within the large intestines
  • Abdominal pain, especially if associated with weight loss or changes in bowel habits
  • Follow-up on abnormal X-ray studies
  • Evaluate diarrhea, constipation or bowel irregularities
  • Anemia workup

Esophagogastroduodenoscopy (EGD) or Upper Endoscopy


Upper GI endoscopy, somtimes called EGD (esophagogastroduodenoscopy), is performed to examine the upper intestinal tract using a lighted, flexible fiberoptic endoscope. The endoscope is inserted into the mouth, advanced through the esophagus (food pipe), enters the J-shaped stomach and ends in the duodenum (the first part of the small intestines).

The procedure hel;s in the diagnosis and treatment of various upper GI disorders including:

  • Ulcers of the esophagus, stomach, and duodenum
  • Tumors of the upper intestinal tract
  • Difficulty swallowing
  • Abdominal pain or indigestion
  • Gastroesophagheal reflux disease (GERD), heartburn and related complications including esophagitis (inflamation of the esophagus due to acid) and Barrett's esophagus (precancerious condition of the lining of the esophagus)

Endoscopic Retrograde Cholangiopancreatography (ERCP)


An ERCP (Endoscopic Retrograde CholangioPancreatography) test is an examination of the bile and pancreatic ducts coming for your gallblader and pancreas.

The ERCP is done with an instrument called an endoscope. This is a narrow, flexible tube that goes through the mouth into the upper digestive tract (esophagus, stomach, and duodenum). It lets the doctor look into your esophagus, stomach, and small intestine. Dye is then put into your common bile duct and pancreatic duct and x-rays are taken. This test helps your doctor diagnose your illness and plan specific treatment.

For further details regarding ERCP, visit the American Gastroenterological Society (AGA) Patient Center website (www.gastro.org)

Endoscopic Ultrasound (EUS)


Endoscopic Ultrasound (EUS) combines endoscopy and ultrasound in order to obtain images and information about the digestive tract and the surrounding tissue and organs. EUS involves passing a thin, flexible tube (endoscope) through the patient's mouth or anus. A small ultrasound transducer in the endoscope produces sound waves that create a viewable image of surrounding tissue. This technology allows the physician to examine the lining and walls of the upper and lower gastrointestinal tract and nearby organs such as the pancreas, liver, and gallbladder. EUS can provide detailed, cost-effective nonsurgical assessment of certain diseases. The procedure is performed by gastroenterologists who have had extensive advanced training.

Indications for EUS include:

  • Diagnosing and staging of tumors of the gastrointestinal tract including pancreatic, esophageal, and gastric cancer, as well as benign tumors of the intestinal tract
  • Evaluating bile duct stones and gall bladder - related disease in a less invasive manner than traditional methods
  • Evaluating conditions of the pancreas including pancreatitis, pancreatic cysts and tumors
  • Assessing enlarged lymph nodes
  • Lymph nodes or suspicious tumors (fine needle aspiration or FNA).

Infrared Coagulation of Internal Hemorrhoids (IRC)


IRC is the most widely used office treatment for internal hemorrhoids and is preferred over other methods because it is fast, well-tolerated by patients, and virtually problem-free. A small prove contacts the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulated the veins above the hemorrhoid causing it to shrink and recede. The patient may feel a sensation of heat very briefly, but it is generally not painful. Therefore, anesthetic is usually not required.

The procedure is perfromed in the office and takes less than ten minutes. Patients can return to normal lifestyle and work that same day. Usually several sessions are required two weeks to amonth apart.

Wireless Capsule Endoscopy


A procedure that examines the middle part of the gastrointestinal tract (small intestines) and includes the duodenum, jejunum, and ileum. This part of the bowel cannot be reached by traditional upper endoscopy or colonoscopy. The patient will be asked to swallow a pill sized video capsule (about size of a dime), which has its own lens and light source. The capsule naturally passes through the digestive tract while transmitting video images to a video monitor, that will then be sent to a computer screen to be reviewed by the physician.

Indications for wireless capsule endoscopy include:

  • Search causes of bleeding from the small intestine
  • Diagnosing Crohn's disease
  • Evaluate possible celic disease
  • Evaluate for polyps, ulcers, tumors and other conditions of the small bowel.