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Procedures

Detailed Description of Our Procedures
Colonoscopy

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.

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.

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.

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

Anorectal manometry is a test that evaluates bowel function in patients with constipation or stool leakage.  It is done on an outpatient basis.

It measures:

  • Strength of the anal sphincter muscles
  • Sensation of stooling in the rectum
  • Reflexes that govern bowel
  • Movements of the rectal and anal muscles
Medtronic Bowel Control Therapy

When  more conservative treatments may not produce the results you want — they don’t target the miscommunication between your bowel and brain. Medtronic Bowel Control Therapy delivered by the InterStim™ system is thought to correct the bowel-brain communication pathway to help control the symptoms of chronic FI.

This therapy:

  • Targets the nerves that control your bowel to help it function normally again
  • Is clinically proven to stop or greatly reduce bowel accidents
  • Delivers significant and lasting improvement to people with chronic FI
  • Only therapy that lets you see if it works before you and your doctor decide