ServicesDetailed Description of Our Services and Procedures
Colonoscopy lets the physician look inside your entire large intestine, from the rectum all the way up through the colon to the lower end of the small intestine. The procedure is used to look for early signs of cancer in the colon and rectum. It is also used to diagnose the causes of unexplained changes in bowel habits. Colonoscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, and bleeding.
For the procedure, you will lie on your left side on the examining table. Under the supervision of your physician, a Certified Registered Nurse Anesthetist (CRNA) will place you under sedation. The physician will then insert a long, flexible, lighted tube, a colonoscope, into your rectum and slowly guide it into your colon. The scope bends, so the physician can move it around the curves of your colon. The scope transmits an image of the inside of the colon, so the physician can carefully examine the lining of the colon. The scope also blows air into your colon, which inflates the colon and helps the physician see more clearly.
If anything abnormal is seen in your colon, like a polyp or inflamed tissue, the physician can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the physician can pass a heated probe or electrical probe through the colonoscope to stop the bleed, or the physician can inject medicines as well as attach a clip through the scope which can stop the bleeding. Bleeding and puncture of the colon are possible complications of colonoscopy. However, such complications are uncommon.
Colonoscopy takes 30 to 60 minutes. The sedative you receive from the CRNA will keep you from feeling much discomfort during the exam. You should plan to be at our facility for 1-2 hours for your procedure, and you will need to bring a driver with you due to the use of sedation during your procedure. You will not be permitted to leave without a driver.
Upper Endoscopy (EGD)
Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). This procedure can be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).
For the procedure you will swallow a thin, flexible, lighted tube called an endoscope. Under the supervision of your physician, a Certified Registered Nurse Anesthetist (CRNA) will place you under sedation. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.
The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don’t show up well on x-rays. The physician can also insert instruments into the scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further tests.
Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.
The procedure takes 20 to 30 minutes. Because you will be sedated, you should plan to be at our facility for 1-2 hours for your procedure, and you will need to bring a driver with you due to the use of sedation during your procedure. You will not be permitted to leave without a driver.
FibroScan is a non-invasive, pain-free test to measure the “stiffness” of the liver. It is a faster, easier, and less expensive alternative to painful biopsies and is a similar procedure to an ultrasound. A technician will place a probe on your side, near where the liver is located. The probe sends a painless vibration through your body into your liver. The probe measures how long it takes the vibration to travel through the liver. The faster the vibration travels through the liver, the stiffer the liver is. The liver’s stiffness helps your physician determine the best course of treatment for you. The stiffer the liver, the more likely you have scarring, and the more rigorous treatment required.
The test will only take 10-15 minutes in most instances, and you will not be permitted to have anything to eat or drink for 3 hours prior to the test.
We offer several different infusions at North Shore: REMICADE® (infliximab), Entyvio, and iron. You are welcome to bring books or portable electronic devices to your infusion appointments since you will be here for several hours. All three of these infusions are offered at our conveniently located Westlake on an out-patient basis.
REMICADE® is a medication used to treat Crohn’s disease, ulcerative colitis, and rheumatoid arthritis. REMICADE® helps decrease inflammation associated with inflammatory bowel disease (IBD) and rheumatoid arthritis. For Crohn’s disease, REMICADE® can help in decreasing symptoms and achieving remission in patients who have not adequately responded to other medical therapies.
Prior to your infusion, please be sure to disclose to your physician all medications you are currently taking, and be sure to notify your doctor if you have had any of the following (from REMICADE® website):
- Infections (like TB, blood infections, pneumonia)—fever, tiredness, cough, flu, or warm, red or painful skin or any open sores. REMICADE® can make you more likely to get an infection or make any infection that you have worse.
- Lymphoma, or any other cancers in adults and children.
- Skin cancer—any changes in or growths on your skin.
- Heart failure—new or worsening symptoms, such as shortness of breath, swelling of your ankles or feet, or sudden weight gain.
- Reactivation of HBV—feeling unwell, poor appetite, tiredness, fever, skin rash and/or joint pain.
- Liver injury—jaundice (yellow skin and eyes), dark brown urine, right-sided abdominal pain, fever, or severe tiredness.
- Blood disorders—fever that doesn’t go away, bruising, bleeding or severe paleness.
- Nervous system disorders—numbness, weakness, tingling, changes in your vision or seizures.
- Allergic reactions during or after the infusion—hives, difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, and fever or chills.
- Lupus-like syndrome—chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that gets worse in the sun.
- Psoriasis—new or worsening psoriasis such as red scaly patches or raised bumps on the skin that are filled with pus.
Any of these conditions can lead to complications if you receive REMICADE® infusions.
During the infusion, one of our nurses will set you up with an IV drip which contains your proper dosage of REMICADE®. As with all medications, allergic reactions, while rare, may occur during administration of your infusion. At North Shore, we are equipped to deal with these reactions should they occur.
REMICADE® infusions generally last 3 hours.
For more information, please visit https://www.remicade.com/
Entyvio is a new option that works to block important contributors to the chronic inflammation that is a well-known symptom of ulcerative colitis and Crohn’s disease. To ensure Entyvio is safe for you, tell your physician if you have:
- an active or recent infection
- tuberculosis (or if you have close contact with someone who has tuberculosis)
- signs of infection such as fever, cough, or flu symptoms
- open sores or skin wounds
- weak immune system (caused by disease or by using certain medicine)
- received any recent vaccines or are scheduled to receive a vaccine.
Entyvio is given intravenously, and requires approximately 2 hours. Your physician will determine how often your infusions are required, but typically after beginning your treatment, regular injections are scheduled every 8 weeks. It is important to keep in mind that it may take several weeks or even several treatments for your symptoms to improve, and you need to communicate any changing symptoms you experience throughout your treatment with your physician.
For more information, please visit https://www.entyvio.com/
IV iron may be necessary to treat iron deficiency (anemia) in patients who do not absorb iron well in the gastrointestinal tract, patients with severe iron deficiency or chronic blood loss, patients who are receiving supplemental erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral iron. Iron deficiency symptoms include:
- difficulty breathing
- fast heartbeat
- feeling cold, mainly in your hands and feet
- infections which are caused by problems with the immune system
IV iron is delivered into your vein through a needle and may take up to several hours. Your doctor may recommend several rounds of infusion based on your iron levels. Side effects are minimal with IV iron, but be sure to report any changes or abnormalities you experience to your doctor.
Hydrogen and H. Pylori Breath Testing
At North Shore Gastroenterology, we offer several breath tests to determine various intolerances and infections. Hydrogen Breath Tests are used to detect Lactose and Fructose Intolerance as well as bacterial overgrowth in the intestine. We also offer a Breath Test for the detection of Helicobacter Pylori (H. Pylori), which is a bacterial infection in the stomach or duodenum (the first part of the small intestine). All of these forms of breath testing are non-invasive, convenient ways to detect these potential digestive issues.
Hydrogen Breath Testing
The Lactose Hydrogen Breath Test is used to detect Lactose Intolerance, the failure to digest lactose, the sugar found in milk. This occurs when the body has a lack of lactase, one of the enzymes produced by the small intestine that is important to the digestion of lactose. Symptoms of Lactose Intolerance include gas, bloating, cramping, or diarrhea after the consumption of dairy products.
The Fructose Hydrogen Breath Test is used to detect Fructose Intolerance. This is caused by the absence of enzymes capable of digesting fructose. It is often diagnosed at a very early age. In addition to digestive issues, some people may also experience symptoms such as fatigue, headaches, brain fog, and mood changes.
Small amounts of bacteria in the intestine are normal. However, significant increases in bacteria can lead to improper absorption of nutrients. Bacterial overgrowth can result from taking certain medications or from slow passage of food through the bowels. Symptoms of bacterial overgrowth can include bloating, gas, diarrhea, and abdominal pain.
After a baseline breath sample has been taken, you may be asked to drink a carbohydrate solution (typically lactulose or glucose). You will be asked to blow into a device designed to measure the levels of hydrogen when you exhale at different time intervals. The test will take approximately three hours.
Pylori Breath Testing
The H. Pylori Breath Test is a safe and easy test used to identify an active H. Pylori infection. If left untreated, H. Pylori can cause gastric ulcers or gastritis (irritation of the stomach lining). Accurate and early detection of H. Pylori can prevent the development of more severe gastrointestinal issues.
After an initial breath sample is taken, you will drink a solution containing Pranactin-Citric. The test will take approximately 20 minutes. Your breath samples will be collected in order to test for urease (an enzyme that breaks urea down into carbon dioxide and ammonia) which is associated with H. Pylori bacteria in the stomach.
Capsule Endoscopy (Pill Cam)
Capsule Endoscopy is a way to record images of the digestive tract without the use of a scope. The capsule is small, comparable to the size of a vitamin, and contains a tiny camera. This device allows your physician to see the parts of your digestive tract that are not reachable in a colonoscopy or EGD (both procedures are described above), mainly the small intestine. The capsule takes thousands of pictures that it transmits to the recorder for the physician to view. It is important that at least 12 hours prior to taking the capsule that you have no food or water, allowing for the clearest possible images to be taken.
The day before your procedure you will be able to eat a light breakfast and lunch. At 12 noon you will start a clear liquid diet. You will have to drink a small amount of laxative that afternoon to help clean the small bowel. The day of your procedure you will report to the office. You will swallow the capsule pill and be given a recorder to carry with you for 8 hours. 2 hours after ingesting the capsule you will be able to have full liquids, and in 4 hours you will be able to eat a light lunch. You will be able to leave the office with your recorder, we recommend that you refrain from strenuous exercise but are able to resume your normal activities. You will return to the office after 8 hours to return the recorder. The capsule passes naturally in your stool in a day or two.
Video capsule endoscopy is generally safe and well tolerated. But it should not be used if you are known to have intestinal obstructions or narrowing (strictures).
Barrx (treatment of Barrett’s Esophagus)
The Barrx treatment offered in our facility is used to treat Barrett’s Esophagus (BE). BE, or intestinal metaplasia (IM), is a change in the tissue lining of the esophagus, causing the tissue to be replaced by a tissue similar to that which is found in the intestinal lining. BE develops as a result of chronic exposure of the esophagus to refluxed stomach acid, enzymes and bile. It is found most often in people having been diagnosed with gastroesophageal reflux disease (GERD); however, only a small percentage of people who have GERD will develop Barrett’s Esophagus. Though the risk is small, people having been diagnosed with BE should be screened regularly for precancerous cells.
In our facility, we offer advanced RF ablation technology for treating Barrett’s Esophagus. Under the supervision of your physician, a Certified Registered Nurse Anesthetist (CRNA) will place you under sedation. Then you physician will use the Barrx™ RF ablation system which is designed to remove the Barrett’s esophagus tissue with a short endoscopic procedure. Your physician will use this tool to remove the layer of diseased tissue while sparing healthy underlying tissue. This allows regrowth of new, healthy tissue within eight weeks.
The procedure takes 20 to 30 minutes. Because you will be sedated, you should plan to be at our facility for 1-2 hours for your procedure, and you will need to bring a driver with you due to the use of sedation during your procedure.
You will not be permitted to leave without a driver.
Bravo (treatment of reflux)
If you suffer from Gastroesophageal Reflux Disease (GERD), your doctor may want to use a Bravo Capsule. Bravo pH monitoring takes place over a 24 or 48 hour period to track what happens in your esophagus as you eat, digest, and go about your daily activities.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays.
For the procedure, you will lie on your left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected.
If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.
Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.
ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.
Flexible Sigmoidoscopy (Flex Sig)
Flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) 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. Physicians may use the procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use it to look for early signs of cancer in the descending colon and rectum. With flexible sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon).
For the procedure, you will lie on your left side on the examining 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 (sig-MOY-duh-skope). The scope transmits an image of the inside of the rectum and colon, so the physician can carefully examine the lining of these organs. The scope also blows air into these organs, which inflates them and helps the physician see better.
If anything unusual is in your rectum or colon, like a polyp or inflamed tissue, the physician can remove a piece of it using instruments inserted into the scope. The physician will send that piece of tissue (biopsy) to the lab for testing.
Bleeding and puncture of the colon are possible complications of sigmoidoscopy. However, such complications are uncommon.
Flexible sigmoidoscopy takes 10 to 20 minutes. During the procedure, you might feel pressure and slight cramping in your lower abdomen. You should feel better afterward when the air leaves your colon.
Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will use a pill sized video capsule called an endoscope, which has its own lens and light source and will view the images on a video monitor. You might hear your doctor or other medical staff refer to capsule endoscopy as small bowel endoscopy, capsule enteroscopy, or wireless endoscopy.
Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.
As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.
Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves (similar to tape). The capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can put on a computer screen for physician review.
Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill. After ingesting the capsule and until it is excreted, you should not be near a MRI device or schedule a MRI examination.
You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study.
Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.
Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test. Potential risks include complications from obstruction. This usually relates to a stricture (narrowing) of the intestine from inflammation, prior surgery, or tumor. It’s important to recognize early signs of possible complications. If you have evidence of obstruction, such as unusual bloating, pain, and/or vomiting, call your doctor immediately. Also, if you develop a fever after the test, trouble swallowing or increasing chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of image acquisition.
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. Endoscopy refers to the procedure of inserting a long flexible tube via the mouth or the rectum to visualize the digestive tract (for further information, please visit the Colonoscopy and Flexible Sigmoidoscopy articles), whereas ultrasound uses high-frequency sound waves to produce images of the organs and structures inside the body such as ovaries, uterus, liver, gallbladder, pancreas, aorta, etc.
Traditional ultrasound sends sound waves to the organ(s) and back with a transducer placed on the skin overlying the organ(s) of interest. images obtained by traditional ultrasound are not always of high quality. In EUS a small ultrasound transducer is installed on the tip of the endoscope. By inserting the endoscope into the upper or the lower digestive tract one can obtain high quality ultrasound images of the organs inside the body.
Placing the transducer on the tip of an endoscope allows the transducer to get close to the organs inside the body. Because of the proximity of the EUS transducer to the organ(s) of interest, the images obtained are frequently more accurate and more detailed than the ones obtained by traditional ultrasound. The EUS also can obtain information about the layers of the intestinal wall as well as adjacent areas such as lymph nodes and the blood vessels.
Other uses of EUS include studying the flow of blood inside blood vessels using Doppler ultrasound, and to obtain tissue samples by passing a special needle, under ultrasound guidance, into enlarged lymph nodes or suspicious tumors. The tissue or cells obtained by the needle can be examined by a pathologist under a microscope. The process of obtaining tissue with a thin needle is called fine needle aspiration (FNA).
Anorectal manometry is a test that evaluates bowel function in patients with constipation or stool leakage. It is done on an outpatient basis.
- Strength of the anal sphincter muscles
- Sensation of stooling in the rectum
- Reflexes that govern bowel
- Movements of the rectal and anal muscles
Smart Pill (Pressure Cam)
SmartPill is an ingestible capsule that measures pressure, pH and temperature as it travels through the gastrointestinal (GI) tract to assess GI motility. It is used to evaluate motility disorders like gastroparesis (a condition in which the contents of the stomach empty too slowly) and chronic constipation.