How often should you get a colonoscopy?
Colon cancer screening should begin at age 50 for most people. If a colonoscopy doesn't find adenomas or cancer and you don't have risk factors, the next test should be in ten years. If one or two small, low-risk adenomas are removed, the exam should be repeated in five to ten years.
What age should you get a colonoscopy?
If you are at an increased or high risk of colorectal cancer, you should begin colorectal cancer screening before age 50 and/or be screened more often. The following conditions make your risk higher than average: A personal history of colorectal cancer or adenomatous polyps.
When should you get a colonoscopy with family history?
People who have one first-degree relative (parent, brother, sister, or child) with colorectal cancer or adenomatous polyps at a young age (before the age of 60 years), or two first-degree relatives diagnosed at any age, should begin screening for colon cancer earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first. Screening usually involves colonoscopy every five years.
What is a colonoscopy?
Colonoscopy is a procedure that enables your physician to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it slowly into the rectum and colon.
What preparation is required?
The colon must be completely clean for the procedure to be accurate and complete. Your physician will give you detailed instructions regarding the dietary restrictions to be followed and the cleansing routine to be used. In general, preparation consist of consumptions of a large volume of a special cleansing solution. Follow your doctor’s instructions carefully. If you do not, the procedure may have to be canceled and repeated later.
What about my current medications?
Most medications may be continued as usual, but some medications can interfere with the preparation or the examination. It is therefore best to inform your physician of your current medications as well as any allergies to medications several days prior to the examination. Aspirin products, arthritis medications, anticoagulants (blood thinners), insulin, and iron products are examples of medications whose use should be discussed with your physician prior to examination.
What can be expected during a colonoscopy?
Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at times during the procedure. Your doctor will give you medication through a vein to help you relax and better tolerate any discomfort from the procedure. You will be lying on your side or on your back while the colonoscope is advanced slowly through the large intestine. As the colonoscope is slowly withdrawn, the lining is again carefully examined. The procedure usually takes 15 to 60 minutes. In some cases, passage of the colonoscope through the entire colon to its junction with the small intestine cannot be achieved. The physician will decide if the limited examination is sufficient or if other examinations are necessary.
What if the colonoscopy shows something abnormal?
If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If a colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.
What are polyps and why are they removed?
Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to several inches. The majority of polyps are benign (noncancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer.
How are polyps removed?
Tiny polyps may be totally destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. The doctor passes a wire loop (snare) through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which could require emergency surgery.
What happens after the colonoscopy?
After colonoscopy, your physician will explain the result to you. If you have been given medications during the procedure, someone must accompany you home from the procedure because of the sedation used during examination. Even if you feel alert after the procedure, your judgement and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery.
You may have some cramping or bloating because the air introduced into the colon during the examination. This should disappear quickly with passage of flatus (gas). Generally, you should be able to eat after leaving the endoscopy, but your doctor may restrict your diet and activities, especially after polypectomy.
What are the possible complications of colonoscopy?
Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One possible complication is a perforation of tear through the bowel wall that could require surgery. Bleeding may occur from the site of biopsy and polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely, blood transfusions or surgery may be required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may rarely cause a tender lump lasting for several weeks, but this will go away eventually. Applying hot packs or hot moist towels may help relieve discomfort. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup. Bleeding can occur several days after polypectomy.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
What is ERCP?
ERCP is a specialized technique used to study the ducts (drainage routes) of the gallbladder, pancreas, and liver ( the drainage channels from the liver are called bile ducts or biliary ducts). An endoscope (flexible thin tube that allows the physician to see inside the bowel) is passed through the mouth, esophagus, and stomach into the duodenum (first part of the small intestine). After the common opening to ducts from the liver and pancreas is visually identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts (pancreatic of biliary) and x-ray films are taken.
What preparation is required?
It is necessary to have a completely empty stomach for the best possible examination. You should therefore fast for at least 6 hours (and preferably overnight) before the procedure. An allergy to iodine containing drugs (contrast material or “dye”) is not a contraindication to ERCP, but it should be discussed with your physician prior to the procedure. The physician performing the procedure should be informed of any medications that you take regularly, any heart or lung conditions (or and other major diseases), and whether you have any drug allergies.
Someone must accompany you home from the procedure because the sedation used during the examination. Even if you feel alert after the procedure, your judgement and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery. If a complication occurs, you may need to be hospitalized until it resolves.
What can be expected during ERCP?
Your physician will discuss why ERCP is being performed, potential complications from ERCP, and alternative diagnostic or therapeutic tests that are available. A local anesthetic may be applied to you throat and an intravenous sedative may be given to make you more comfortable during the test. Some patients also receive antibiotics before the procedure. The test begins with you lying on your abdomen on an x-ray table. The endoscope is passed through the mouth, esophagus, and stomach into the duodenum. The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. The injection of contrast material into the ducts rarely causes discomfort.
What are possible complications of ERCP?
ERCP is generally a well-tolerated procedure when performed by physicians who have had special training and experience in this technique. Localized irritation of the vein into which medications were given may rarely cause a tender lump that may last several weeks. The application of heat packs or hot moist towels to the area may ease the discomfort.
Major complications requiring hospitalization can occur but are uncommon during diagnostic ERCP. They include serious pancreatitis and even more rarely infections, bowel perforation, and bleeding. Another potential risk of ERCP is an adverse reaction to the sedative used. The risks of the procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, eg, heart or lung diseases. Your physician will tell you what is your likelihood of complications before undergoing the test.
If therapeutic ERCP is performed (cutting an opening in the bile duct, stone removal, dilation of the stricture, stent or drain replacement, etc), the possibility of complications is higher than with diagnostic ERCP; complications include pancreatitis, bleeding, and bowel perforation. These risks must be balanced against the potential benefits of the procedure and the risks of alternative surgical treatment of the condition. Often these complications can be managed without surgery, but occasionally they do require corrective surgery.
What can be expected following ERCP?
If you are having ERCP as an outpatient, you will be kept under observation until most of the effects of the medications have worn off. Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation is necessary. You may experience bloating or pass gas because of the air introduced during the examination. You may resume your usual diet unless you are instructed otherwise.
To the patient:
Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure. If you have any questions about your need for ERCP, alternative approached 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. Most endoscopists are highly trained specialists and welcome your questions regarding their credentials and training. If you have questions that have not been answered, please discuss them with the endoscopy nurse or your physician before the examination begins.
Flexible Sigmoidoscopy enables the physician to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid or descending colon with the use of and endosope. This examination is typically used to evaluate complaints of rectal bleeding, constipation, diarrhea and pain in the left lower quadrant or pelvis. It is important for your doctor to have a clear view of your colon during the examination, you will be given instructions from your physician as to the preparation to use prior to the examination.
The examination is a quick procedure with minimal complications. Usually, patients are not sedated for this procedure. During the procedure you may experience the sensations you feel prior to a bowel movement. You will be asked to lie on your left side on the examination table. The physician will insert a short, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a sigmoidoscope. The scope has a camera on the distal tip which enables the physician to carefully examine the lining of your colon. If anything unusual is in your rectum or sigmoid colon, such as a polyp or inflamed tissue, the physician can remove a sample using an instrument inserted into the scope. The tissue can then be sent to the lab and for evaluation.
Flexible sigmoidoscopy takes 10 to 12 minutes. Flexible sigmoidoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at various times during the procedure and for a short period after the procedure.
Bleeding and puncture of the colon are possible complications of flexible sigmoidoscopy. However, such complications are uncommon.
Most medications can be continued as usual. You should inform your physician if you are taking blood thinners or if you require antibiotics prior to undergoing dental procedures.
What is a Liver Biopsy?
A liver biopsy is done using a long needle inserted between two of the right lower ribs to remove a sample of liver tissue. The tissue sample is sent to a laboratory and looked at under a microscope to see if there are any liver problems.
Why is it done?
A liver biopsy may be done to:
Find the cause of jaundice. A liver biopsy can find certain liver disease (such as cirrhosis), infections (such as hepatitis), and liver tumors.
Find the cause of abnormal liver blood test results. These include aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Both ALT and AST levels show liver damage and can help confirm liver disease.
See how much the liver is inflamed or scarred by hepatitis or other liver disease.
See whether other liver conditions, such as hemochromatosis and Wilson’s disease, are present.
Check the response to treatment for liver disease.
Measure whether the medicine, such as methotrexate, is causing a toxic effect on the liver.
Check the function of a transplanted liver.
Find the cause of an unexplained and ongoing fever.
Check a liver mass found on an X-ray, ultrasound, or CT scan.
How to Prepare
If you take insulin, check with you doctor about what you need to take on the day of your test.
During the Test
Before the test, you may be given a sedative through vein (IV) in your arm. The sedative will help you relax and remain still. During the test, you will lie on your back with your right arm resting under or above your head and your head turned to your left. Your doctor may tap on your chest and belly to find your liver or he or she may use ultrasound.
Your doctor will mark a spot between two of your right lower ribs where the biopsy needle will be inserted. The site will be cleaned with a special soap and draped with sterile towels. The doctor will give you a medicine (local anesthetic) to numb the area where the biopsy needle will be inserted.
You may be asked to take a deep breath, blow all the air out, and then hold your breath while the biopsy needle is being inserted and withdrawn. This will take only a few seconds. Holding your breath lowers the chance that the needle will go in your lung since the lungs are very close to the liver. It is important to remain still during the few seconds it takes for the doctor to collect the tissue sample. The doctor may take another tissue sample from the same spot, but from a different angle.
As soon as the doctor removes the needle, you can breathe normally. A bandage will be put on the puncture site. The test generally takes 15 to 30 minutes.
Barrett’s esophagus is a metaplastic change of the epithelium of the esophagus, caused by injury and inflammation related to gastroesophageal reflux disease. Metaplasia is defined as the transformation from one cell type to another cell type. In the case of Barrett’s esophagus, the normal squamous epithelium is replaced by a columnar epithelium-containing goblet cells, deemed intestinal metaplasia (IM). Owing to a significantly elevated risk for the development of esophageal adenocarcinoma associated with the presence of IM, patients with this diagnosis undergo surveillance endoscopy with multiple biopsies of the diseased tissue every 2-3 years, in order to detect adenocarcinoma at the earliest possible tumor stage. Development of dysplastic cellular changes within the Barrett’s epithelium often preceded the development of cancer. In cases of IM containing dysplasia, surveillance endoscopy is performed more frequently (every 3-12 months). For many patients with high-grade dysplasia, the esophagus may be surgically in order to preempt the development of cancer.
Small Bowel Capsule Endoscopy
What is Small Bowel Capsule Endoscopy?
Your physician may determine that a capsule endoscopy of the small bowel is necessary to further evaluate you condition. Capsule Endoscopy will provide your physician with pictures of you small intestine.
What is Capsule Endoscopy?
The capsule endoscope, utilizes a wireless video camera, small enough to swallow, to perform painless endoscopic imaging of the small intestine. The capsule contains a camera, light source, radio transmitter, and battery. Patients can simply swallow the capsule and the camera takes and transmits about two images per second as it travels the entire length of the gastrointestinal tract. Thousands of video images are transmitted by the sensors attached to the patient’s abdomen. These images are stored on a data recorder worn by the patient and later downloaded onto a computer for viewing by the physician.
Why is Capsule Endoscopy of the Small Bowel performed?
Capsule endoscopy assists in diagnosing gastrointestinal conditions such as bleeding, malabsorption, abdominal pain, tumors, Crohn’s Disease, infectious enteritis, celiac sprue and drug-induced ulceration. Capsule endoscopy can help your physician determine the cause for recurrent or persistent symptoms such as diarrhea, bleeding or anemia. In certain chronic gastrointestinal diseases, this method can also help to evaluate the extent to which your small intestine is involved or monitor the effect of therapy. The physician can also use capsule endoscopy to obtain motility data such as gastric or small bowel passage time.
Preparing for the Procedure
You will receive preparation instructions from our office before your procedure date. You must follow these instructions in order to obtain maximum results. You should start a clear liquid diet after lunch the day before the procedure and have nothing to eat or drink after midnight. At noon you would take 2 Dulcolax tablets and at 6:00 pm drink one bottle of Magnesium Citrate. You need to inform our office in advance about any medications you take, if you have a pacemaker or other implanted electromedical devices, previous abdominal surgeries, swallowing difficulties or previous history of bowel obstruction.
What Can I Expect During Capsule Endoscopy?
When the patient arrives, the procedure will be fully explained, a consent form signed and instructions for the day’s activities will be given. The patient will then have the sensor leads attached to the abdomen and a halter belt will be put om which holds the data recorder. The capsule is swallowed with a glass of water and the patient is then free to leave and pursue their regular activity. The patient is then instructed on dietary guidelines for the day and what time to return the same afternoon. Upon completion of the allotted time the patient will return and the halter and the sensors will be removed and the patient is free to go. Results of the capsule endoscopy will be available within seven to ten days.
Upper GI Endoscopy
What is Upper Endoscopy?
Upper endoscopy is a procedure to enable your physician to examine the lining of the upper part of your gastrointestinal tract. The upper part of your gastrointestinal tract includes your esophagus, stomach, and duodenum. The upped endoscopy is performed to diagnose and, in some cases, treat problems of the upper digestive system. The procedure is performed using a flexible endoscope. The flexible endoscope is a long, thin, flexible tube with a tiny camera and light on the end. The endoscope projects high quality pictures on a monitor which enables the physician to carefully examine the inside lining of the upper digestive system.
Why is upper endoscopy done?
The upper endoscopy is performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding cause of bleeding from the upper gastrointestinal tract.
What preparation is required?
You should have nothing to eat or drink, including water, after midnight the day before your procedure. Your physician will be more specific about the time to begin fasting, depending on the time of day your test is scheduled.
You will need to inform your physician of your current medications as well as any allergies several days prior to your procedure. You need to inform your physician if you have a pacemaker or defibrillator or any major disease that might require special attention during the procedure.
Arrangements to get home after the test
If you are sedated, you will need to arrange to have someone to drive you home after the examination. The sedatives may affect your judgement and reflexes the rest of the day, you should not drive, operate any machinery, or make any important decisions.
What can be expected during the upper endoscopy?
Your physician will review with you why this test is being performed, whether any alternative tests are available and possible complications from the procedure. You will have medications given through an IV to sedate you, a latex free mouthpiece will be placed between your teeth to protect your teeth and instrument. The endoscope will be passed through the mouthpiece, then the esophagus, stomach and duodenum. The endoscope does not interfere with your breathing during the test. Your blood pressure, heart rhythm, and oxygen saturation will be carefully monitored throughout the procedure.
What happens after endoscopy?
After the test you will be monitored in the recovery area until most of the effects of the medication have worn off. You will be given instructions regarding how soon you can eat and drink, and guidelines for resuming normal activities.
Occasionally, minor problems may persist, such as a mild sore throat, bloating, or cramping; these should disappear within 24 hours of less.
In most cases, your physician can inform you of your test results on the day of the procedure; however, the results of any biopsies or cytology samples taken will take two to three days.
What are the possible complications of upper endoscopy?
Endoscopy is generally safe. Complications can occur but are rare. Bleeding may occur from a biopsy site to where a polyp was removed. Localized irritation of the vein where the medication was injected may rarely cause a tender lump lasting for several weeks. Applying heat packs of hot moist towels may help relieve the discomfort. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Perforation (a tear that might require surgery) could possible occur but is very uncommon.
It is important to recognize early signs of any possible complications. If you begin to run a temperature after your procedure, begin to have trouble swallowing, or have increasing throat, chest, or abdominal pain, let your physician know immediately.
What is a Fibroscan?
A pain free diagnostic test that requires no sedation of any kind to patients in order to provide early detection and to maintain a healthy liver.
What happens during the procedure?
You will lie on your back with your right arm raised behind your head and your right abdominal area exposed. A nurse will apply a water-based gel to your skin and then place a non-invasive probe over your liver. During the exam, you may feel a slight vibration on the skin at the tip of the probe as it delivers ultrasound waves to the area for measuring purposes.
What are the risks?
There are no risks involved. It is painless and not invasive (meaning it's not carried out inside your body and does not break the skin.)
What are the benefits?
The results of the scan can help your doctor find out about the level of damage that affects your liver, and provide recommendations for a healthier liver.
1105 Eagletree Lane SE
Huntsville, AL 35801
Phone: (256) 261-2826
Fax: (256) 429-9246