Procedure Preparation
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Investigations & Procedures

Terms:

Endoscope – small, flexible tube with a light that is used to examine the interior of a hollow organ or cavity of the body. 

Gastroscope - small, flexible tube with a light that is inserted through the esophagus and used to examine the upper gastrointestinal tract, instruments can be inserted through the hollow gastroscope to perform other procedures or obtain biopsies. 

Procedures:

Colonoscopy

What is it? A colonoscopy is the examination of the large intestinal lining with an endoscope.

Why is it done? A colonoscopy is used to examine bleeding, changes in bowel movements, and abdominal pain. It is used to identify colon cancer, remove polyps and to check on IBD treatment success.

What are the risks? Surgical complications are rare but some patients may experience side effects to drugs, perforations, and bleeding. Overall, colonoscopies are very safe procedures.

Downloads: http://www.cdhf.ca/bank/document_en/48understanding-colonoscopy.pdf#zoom=100

Videos: http://www.cdhf.ca/en/videos/video/5, http://www.mayoclinic.org/tests-procedures/colonoscopy/multimedia/colonoscopy/vid-20084716

Upper GI Endoscopy or Gastroscopy

What is it? A minimally invasive medical procedure in which an endoscope is inserted into the mouth through the esophagus, into the stomach and up to the first portion of the small bowel (duodenum). 

Why is it done? The procedure diagnoses and investigates diseases and problems in the upper gastrointestinal tract. The list includes but is not limited to: anemia, upper GI bleeding, nausea, abdominal pain, problems swallowing, unexplained weight loss, digestive tract obstruction, GERD, abnormal growths, cancer/ precancerous cells, hiatial hernia, inflammation and ulcers. The procedure may be used to remove the obstruction, obtain a biopsy, remove polyps, and can even be used to treat certain conditions.

What are the risks? Upper GI endoscopies are painless and can be completed using only light sedatives. Despite being very rare, there are a few risks associated with the procedure including perforation, medication side effects, and bleeding.

Video: http://www.cdhf.ca/en/videos/video/4

Capsule Endoscopy

What is it? Capsule endoscopy is a painless procedure that involves swallowing a tiny, wireless video camera (the size of a small pill) in order to visualize areas of the digestive tract that are not easily visible with conventional endoscopy.

Why is it done? Capsule endoscopy investigates recurrent bleeding in the small intestine, celiac disease, inflammatory bowel disease, polyps, cancer and other digestive problems that cannot be found by more conventional techniques. Although the procedure may reveal new information, diagnosis should be confirmed with a follow up procedure such as a colonoscopy.

What are the risks? Generally, capsule endoscopy is risk free. However if the capsule gets embedded in the digestive tract and does not exit the body with a bowel movement it may need to be surgically removed. This occurs in 1.5% of patients (higher in patients with Crohn’s disease or intestinal blockage).

Downloads: http://www.cdhf.ca/bank/document_en/47capsule-endoscopy.pdf#zoom=100

Endoscopic Mucosal Resection (EMR) and difficult Polypectomy

What is it? A minimally invasive medical procedure where a device is attached to the end of a gastroscope to remove precancerous or early cancerous tissue within the lining of the esophagus. It is performed with a gastroscope and the necessary instruments are easily inserted within the channels of the scope.

Why is it done? EMR is primarily used for the treatment of cancer by removing any abnormal growths. It can also be used for diagnosis and staging of cancer by collecting tissue for examination.

What are the risks? The most common risk is bleeding, however this can be detected and fixed during the procedure. Other risks include perforation, and narrowing of the esophagus (if the lesion is in the esophagus).

Video: http://www.mayoclinic.org/tests-procedures/endoscopic-mucosal-resection/multimedia/endoscopic-mucosal-resection/vid-20084651

Other Resources: http://www.mayoclinic.org/tests-procedures/endoscopic-mucosal-resection/basics/definition/prc-20014197

Deep Enteroscopy (Double-Balloon Enteroscopy or DBE)

What is it? In DBE, the endoscope is inserted through the throat with the assistance of balloons, which are inflated to help anchor the endoscope in the small bowel. This allows deeper access into the small bowel than conventional endoscopic methods. It may also be used to access difficult to reach areas for people with altered digestive tract anatomy from previous surgeries.

Why is it done? In conventional endoscopic procedures, only diagnostic images of the small bowel can be taken. With DBE, therapeutic interventions, such as biopsies, and foreign object removal can be applied.

What are the risks? The most common complications are ileus, pancreatitis, and perforation.

Video: http://www.mayoclinic.org/diseases-conditions/small-bowel-cancer/multimedia/vid-20078533

Endoscopic Ultrasound

What is it? Endoscopic ultrasound refers to the insertion of an ultrasound probe attached to a long, flexible endoscope via the mouth or rectum to visualize and examine the digestive tract. The ultrasound uses high frequency sound waves to take images of the digestive tract. When combined with fine need aspiration, the procedure can also obtain biopsies.

Why is it done? Most commonly, endoscopic ultrasound is used to detect pancreatic disorders, bile duct disorders, fecal incontinence, for cancer staging, or to investigate an abnormal x-ray.  

What are the risks? Complication rate is very low (1 in 2,000). Some patients may experience drug side effects such as skin rash or nausea, whereas others may have a perforation of the intestinal wall. If fine needle aspiration is used, the risk is higher but still small, as bleeding, infection or pancreatitis may occur.

Downloads: http://www.cdhf.ca/bank/document_en/51endoscopic-ultrasound.pdf#zoom=100

Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is it? ERCP is a test that combines endoscopy with x-ray pictures to view the duodenum, gall bladder, and bile and pancreatic ducts. Dye is passed through the small intestine so the digestive tract (usually the ducts) and any blockage can be seen on an x-ray. The hollow endoscope allows other instruments to be filed through it in order to perform biopsies, incisions and remove obstructions.

Why is it done? ERCP can diagnose and treat blockage of the bile duct (by cancer, gallstones, scarring or compression), jaundice, upper abdominal pain, unexplained appetite and weight loss, and can confirm the presence of bile and pancreatic duct cancer.

What are the risks? Complications occur in 1-5% of patients, dependent on the underlying condition and skill of physician. The most common complication is pancreatitis, but bleeding, infection, perforation, and drug side effects may also occur.

Other Resources: http://www.medicinenet.com/ercp/article.htm

Luminal Stenting

What is it? A stent is a mesh tube inserted into organs to prevent constriction and help maintain the proper shape. In the gastrointestinal tract, stents are inserted via endoscopy to open up the esophagus, duodenum, bile duct or colon after an obstruction normally from cancer. Stents allow for the passage of digestive fluids such as food, chyme, and stool. 

Why is it done? Luminal stenting helps palliate the effects of cancer and other disorders obstructing the digestive tract.

What are the risks? Possible complications include side effects from sedation, perforation, and compression of neighboring organs from stent expansion.  

Radiofrequency Ablation (RFA)

What is it? A minimally invasive medical procedure where the abnormal esophageal tissue is destroyed using high frequency electrical energy. The heat ablates the diseased tissue, allowing new, healthy tissue to grown and replace it. The electrode and catheter used for treatment are inserted in the esophagus with the assistance of a gastroscope.

Why is it done? RFA can treat Barrett’s Esophagus and stop the progression of cancer and dysplasia.

What are the risks? About 20% of patients will feel chest pain after the procedure, and about 5% will experience stricture of the esophagus. Less than 1% may experience perforation or bleeding.

Video: http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/multimedia/radiofrequency-ablation/vid-20084711

Additional Resources:

https://myhealth.alberta.ca/health/tests-treatments/Pages/default.aspx

http://www.cdhf.ca/en/tests-i-might-need

http://www.gastro.org/patient-center/procedures

http://www.mayoclinic.org/tests-procedures


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