Digestive Health Center

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General Stats:

  • Description: Angiography of the abdomen is performed by injecting contrast dye into the blood vessels that supply the organs of the abdomen. By filling the vessels with dye, they can be identified and abnormalities can be detected. A Radiologist and x-ray technicians perform the test in a hospital x-ray facility. The results are interpreted by the Radiologist. The test takes 30-90 minutes to perform.
  • Discomfort - There is moderate discomfort associated with this test (having an artery punctured, lying on the x-ray table, some have burning with injection of the dye).
  • Results - 1-2 days, within 1 hour in emergency situations.
  • Risks of Procedure - Exposure to radiation, particularly during pregnancy; reaction to the contrast dye, including kidney damage; bleeding; perforation of the artery; injury to the nerves; and blood clots that may form on the catheter and travel through the bloodstream.
  • Other Names - Celiac and mesenteric arteriography.

Indications for the Test

  • Diagnose diseases of the blood vessels in the small and large intestines such as a narrowing that could limit blood flow.
  • To identify when a tumor has invaded a blood vessel which would preclude resection of the tumor.
  • To identify the site of bleeding in the abdomen and possibly stop the bleeding by injecting a plug or chemical.

Preparation

  • Consume only clear liquids for six to eight hours before the procedure.
  • Remove all clothing and wear a hospital gown.

Procedure

  • About 30 minutes before the procedure, patient is given a sedative.
  • Your heart rate and blood pressure are monitored during the test.
  • An intravenous line is placed into your arm to provide fluids and medications necessary for the test.
  • Anesthetic is injected at the catheter insertion site and a small incision is made in the groin.
  • A catheter is inserted into the major artery in the abdomen and guided to the area to be examined with the help of an x-ray machine.
  • Contrast dye is injected through the catheter and the Radiologist views the arteries while x-ray pictures are made for later interpretation.

After the Procedure

  • The catheter is removed and a pressure dressing is applied until bleeding stops.
  • You will be instructed to lie with your legs straight for about four hours. A small sandbag is usually placed over the incision for a few hours to prevent bleeding.
  • You are monitored for at least four hours, and the puncture site will be examined for signs of bleeding or swelling.
  • If there is no bleeding after 4 hours, outpatients can leave but must be driven home.
  • Before you go home, you are taught how to apply pressure to stop any bleeding that may occur later. Any bleeding that lasts more than a few minutes requires emergency medical attention.
  • Activity should be limited for several days, particularly in the leg in which the test was performed.
  • After the test, you should drink extra fluid to aid in flushing the dye out of the body by the kidneys.

Factors Affecting Results

  • Movement during the X-rays may cause blurred images.
  • Obesity and failure to fast before the procedure may obscure the X-rays.
  • Sometimes it is impossible to place the catheter into a specific artery that needs to be examined.

Advantages

This is the best test for providing an excellent view of the arteries in the abdomen.

Disadvantages

  • It's invasive.
  • It entails risks of bleeding or abnormal clotting.
  • It also entails exposure to radiation.
  • Potential for allergic reactions to the dye.

General Stats:

  • Description: A transmitter is pressed gently against the abdominal wall. Sound waves are emitted from the transmitter and then bounce off of the internal organs. Information can be obtained about the internal organs by studying the appearance of the sound waves as they bound off of the organs. A radiology technician or doctor at an office or x-ray facility performs the test. A doctor interprets the results. The test takes 30-60 minutes to complete.
  • Discomfort - None.
  • Results - Usually within 2 days, within 1 hour in emergency situations.
  • Results - 48 Hours. One hour in emergency situations.
  • Risks/Complications - None.
  • Variations - Endoscopic ultrasound combines endoscopy and ultrasound. A small ultrasound probe attached to an endoscope (see the description of esophagogastroduodenoscopy) is inserted into the digestive tract via the mouth. This makes it possible to examine organs with minimal interference of other tissues or gas. This method is helpful at identifying abnormalities in the esophagus, stomach, bile duct and pancreas.
  • Other Names - Sono or sonography

Indications for the Test

  • Examine the organs of the abdomen. Sono can examine the liver, bile ducts, gall bladder, pancreas, spleen, appendix, and female organs.
  • Ascites (collection of fluid in the abdomen) can be detected.

Preparation

  • You might be asked to fast overnight or for at least six hours prior to the test.
  • You might be asked to wear a hospital gown.

Procedure

While lying flat, a clear jelly is applied to the abdomen. Then the probe is rubbed over the abdominal wall. A computer in the ultrasound machine produces the images.

After the Test

You may dress and leave.

Factors Affecting Results

Several factors may affect the images: movement, obesity, and the presence of gas in the bowel that may overlie the organ of interest.

Advantages

  • The test is quick and painless.
  • The test is noninvasive.
  • The test is particularly good at evaluating the solid organs of the abdomen.
  • The test is easier and less expensive than a CT.

Disadvantages

  • The cause of an abnormality may not be apparent from the test.
  • Bowel gas can interfere with obtaining good images.
  • The test is generally less effective at locating small abnormalities in the abdomen.
  • The test is not good at examining the intestines.

General Stats:

  • Description: X-rays are projected through the body onto x-ray film. The different densities and location of the organs, fluid and gases of the abdomen are revealed. Different conditions such as bowel perforation or bowel blockage have characteristic appearances that can be recognized. The test is performed in a doctor's office or x-ray facility by a radiology technician and takes minutes to perform. A doctor interprets the film.
  • Discomfort - None.
  • Results - 1-2 days; within 1 hour in an emergency.
  • Risks of Procedure - Risks related to radiation exposure, although the dose is small.
  • Other Names - KUB, abdominal film.

Indications for the Test

  • Evaluate abdominal pain or distention.
  • Look for evidence of bowel perforation, bowel blockage or a swallowed foreign object.

Preparation

Remove your clothing and wear a hospital gown.

Procedure

  • You stand in front of or lie on an x-ray machine.
  • You hold your breath while the film is taken.
  • Films may be taken from different angles.

After the Test

After dressing, you may leave.

Factors Affecting Results

Movement during the x-ray can affect the image.

Advantages

  • The test is quick.
  • The test is noninvasive.
  • The test is inexpensive.

Disadvantages

Usually the cause of any abnormality is not determined by the test.

{slider=Angiography}

General Stats:

  • Description: Angiography of the abdomen is performed by injecting contrast dye into the blood vessels that supply the organs of the abdomen. By filling the vessels with dye, they can be identified and abnormalities can be detected. A Radiologist and x-ray technicians perform the test in a hospital x-ray facility. The results are interpreted by the Radiologist. The test takes 30-90 minutes to perform.
  • Discomfort - There is moderate discomfort associated with this test (having an artery punctured, lying on the x-ray table, some have burning with injection of the dye).
  • Results - 1-2 days, within 1 hour in emergency situations.
  • Risks of Procedure - Exposure to radiation, particularly during pregnancy; reaction to the contrast dye, including kidney damage; bleeding; perforation of the artery; injury to the nerves; and blood clots that may form on the catheter and travel through the bloodstream.
  • Other Names - Celiac and mesenteric arteriography.

Indications for the Test

  • Diagnose diseases of the blood vessels in the small and large intestines such as a narrowing that could limit blood flow.
  • To identify when a tumor has invaded a blood vessel which would preclude resection of the tumor.
  • To identify the site of bleeding in the abdomen and possibly stop the bleeding by injecting a plug or chemical.

Preparation

  • Consume only clear liquids for six to eight hours before the procedure.
  • Remove all clothing and wear a hospital gown.

Procedure

  • About 30 minutes before the procedure, patient is given a sedative.
  • Your heart rate and blood pressure are monitored during the test.
  • An intravenous line is placed into your arm to provide fluids and medications necessary for the test.
  • Anesthetic is injected at the catheter insertion site and a small incision is made in the groin.
  • A catheter is inserted into the major artery in the abdomen and guided to the area to be examined with the help of an x-ray machine.
  • Contrast dye is injected through the catheter and the Radiologist views the arteries while x-ray pictures are made for later interpretation.

After the Procedure

  • The catheter is removed and a pressure dressing is applied until bleeding stops.
  • You will be instructed to lie with your legs straight for about four hours. A small sandbag is usually placed over the incision for a few hours to prevent bleeding.
  • You are monitored for at least four hours, and the puncture site will be examined for signs of bleeding or swelling.
  • If there is no bleeding after 4 hours, outpatients can leave but must be driven home.
  • Before you go home, you are taught how to apply pressure to stop any bleeding that may occur later. Any bleeding that lasts more than a few minutes requires emergency medical attention.
  • Activity should be limited for several days, particularly in the leg in which the test was performed.
  • After the test, you should drink extra fluid to aid in flushing the dye out of the body by the kidneys.

Factors Affecting Results

  • Movement during the X-rays may cause blurred images.
  • Obesity and failure to fast before the procedure may obscure the X-rays.
  • Sometimes it is impossible to place the catheter into a specific artery that needs to be examined.

Advantages

This is the best test for providing an excellent view of the arteries in the abdomen.

Disadvantages

  • It's invasive.
  • It entails risks of bleeding or abnormal clotting.
  • It also entails exposure to radiation.
  • Potential for allergic reactions to the dye.

VIDEO: BRAVO ph Monitoring

General Stats:

  • Gastroesophageal reflux disease (GERD) is a common condition in which gastric contents, including acid, reflux up into the esophagus from the stomach. In some situations, a pH study is needed to identify the presence of this disease. In this test, a small catheter is placed in the esophagus that can detect the presence of acid within the esophagus. The catheter is attached to a small computer that records the pH (acid content) over a period of time (12-24 hours). A nurse or doctor at a doctor's office, endoscopy center, or hospital places the catheter. A Gastroenterologist interprets the results. The test takes 12-24 hours to complete.
  • Discomfort - Minimal discomfort associated with placement of the catheter via the nose.
  • Results - 24-36 hours.
  • Risks of Procedure - Minimal. Risk of causing bleeding from the nose.
  • Other Names: Ambulatory pH test.

Indications for the Test

  • To determine if acid reflux is present to account for symptoms of chest pain or heartburn.
  • To determine the adequacy of acid suppressing medications in a person with known GERD.

Preparation

  • You may be advised to avoid certain medications before or during the test (antacids, acid blocking medications).
  • You may be advised that nothing should be consumed for 8 hours before the test, except medications as directed by your doctor.

Procedure

  • Your throat may be anesthetized prior to placement of the catheter.
  • While sitting in an upright position, the catheter is guided down the esophagus and secured into position.
  • Once the catheter is positioned, you are free to return to normal activities.
  • You are asked to record when you are in an upright position or reclined position, when you eat, or when you sense the occurrence of heartburn/reflux.
  • After completion of the test period 12-24 hours), you return to have the catheter removed.
  • The information recorded by the computer is then downloaded into another computer for analysis.

After the Procedure

Once the catheter is removed, you are free to return to normal activities.

Factors Affecting Results

  • It is important to avoid any medications, as advised, during the test in order to get accurate results.
  • Some diseases may interfere with the proper uptake of the nucleotide, limiting the test.

Advantages

  • The test is the gold standard for determining the presence of GERD.
  • The test can identify the cause of heartburn or chest pain if other tests are non-conclusive.

Disadvantages

  • It is unpleasant to wear the catheter for 12-24 hours.
  • The test takes hours to perform.

VIDEO: Colonoscopy: What Patients Can Expect Before, During and After a Procedure

General Stats:

  • Description: A long, flexible tube with a camera mounted on the end (colonoscope) is inserted into the rectum and guided to the end of the colon (large intestines). This allows for viewing of the internal lining of colon directly. A Gastroenterologist performs the test with assistance from a nurse in a hospital, endoscopy suite or doctor's office. The Gastroenterologist interprets the results. If specimens are obtained, a Pathologist interprets the results. The test takes 15-60 minutes to complete.
  • Discomfort - An intravenous line has to be placed. Depending on the level of sedation, there may be some Discomfort as the scope is passed through the colon and as air is instilled into the intestines.
  • Results - The Gastroenterologist's interpretation is available immediately; 2-3 days for results from tissue samples obtained.
  • Risks of Procedure - Colon perforation is the major risk and occurs in 0.01% to 0.5% of cases. Other risks include bleeding, infection, and adverse reaction to the medication used for sedation.
  • Other Names - Lower Endoscopy.

Indications for the Test

  • Colon cancer and colon polyp screening.
  • To further evaluate abnormalities identified in the colon by other tests.
  • To identify a source of diarrhea, bleeding, or anemia (low blood count).

Preparation

  • Only clear liquids are consumed on the day before the test. After midnight on the morning of the test, nothing should be consumed, except medications as directed by your doctor.
  • A special medication (laxative) will be given the day before the test with instructions on how to take it. An enema may be prescribed on the morning of the test. It is important that the laxative be taken as prescribed in order for the colon to be cleaned adequately.
  • Aspirin, non-steroidal anti-inflammatory drugs (aspirin substitutes), blood thinners, anticoagulants, and iron supplements should not be taken for five days before the test to reduce the risk of bleeding.
  • If the procedure is performed on an outpatient basis, patient must arrange in advance to have someone drive them home afterward.
  • Patient will be asked to remove all clothing and wear a hospital gown.
  • If patient is at a high risk of certain types of heart disease, they may be given antibiotics to prevent infection, since there is a small risk that infectious organisms from the bowels may penetrate the bloodstream as a result of this procedure and may travel to the heart.

Procedure

  • After changing into a hospital gown, you will have an intravenous line placed for the sedative to be given.
  • Monitors are attached to observe the blood pressure, pulse rate, and oxygen level of the blood. Supplemental oxygen is given via the nose.
  • While lying on your left side, you are sedated. The doctor examines the colonic lining as it is projected to a TV monitor as the scope is guided into the colon. Air is instilled into the colon to aid in visualization of the lining.
  • If indicated by the findings, the doctor can take tissue samples, treat sites that are bleeding, place stents, or remove polyps (growths).
  • During the test, you may have discomfort related to a feeling of distention. Breathing slowly and deeply usually relieves this discomfort.

After the Procedure

  • You are monitored in the recovery area until the sedation wears off.
  • Once the sedation wears off, you may have someone drive you home.
  • You pass large amounts of gas for several hours after the test.
  • You may be advised not to take aspirin or aspirin substitutes for up to 2 weeks after the test.
  • Notify your doctor immediately if you experience bleeding, severe pain, or fever after the test.

Factors Affecting Results

An incomplete bowel preparation will obscure the lining of the colon limiting the doctor's ability to examine the colon.

Advantages

  • The lining of the colon can be viewed directly.
  • Abnormalities identified can be biopsied and polyps can be removed during the test.

Disadvantages

  • The preparation for the test is unpleasant.
  • There may be some discomfort during the test.
  • The test is invasive.

Frequently Asked Questions

  • Do I take my blood pressure medicine before the test? Yes.
  • I take blood thinners. What do I do? Do not take blood thinners for four days prior to the test.
  • I'm on dialysis. Are there any special instructions? Drink Colyte prep instead of Fleets the night before the test.
  • My test is scheduled for late afternoon. Can I eat something prior to the test? No, just clear liquids up until 4 hours prior to the test.
  • I'm a diabetic. Do I take my normal amount of insulin? Take ½ of your normal dosage the night before the test. Do not take insulin the morning of the test. If you take oral medication for your diabetes, do not take your medication the morning of the test.
  • Can I take aspirin prior to the test? Do not take aspirin 4 days prior to the test.
  • Can I take iron? Do not take iron 4 days prior to the test.
  • Can I take my heart medicine? Yes, take as normal.

General Stats:

  • Description: Contrast dye (Barium) is used to fill the intestines. X-rays cannot penetrate the contrast dye. With the intestines filled with the dye, abnormalities in the lining can be detected. A Radiologist and a technician at an x-ray facility perform the test. The results are interpreted by the Radiologist. The test takes 30 minutes - 3 hours to perform, depending on which segment is being examined.
  • Discomfort - Minimal discomfort associated with lying on the x-ray table.
  • Results - Within 1-2 days; within 1 hour in emergency situations.
  • Risks of Procedure - Exposure to radiation, particularly during pregnancy. Some types of contrast dye may block the intestines if not passed in 1 to 2 days.
  • Special Equipment - Contrast material (barium), X-ray machine, and Fluoroscope.
  • Risks/Complications - Risks associated with radiation, particularly during pregnancy. The barium may accumulate and block the intestines if it is not removed within a day or two.
  • Other Names - Other Names of contrast x-rays of the intestines depend on the segment of the intestines to be examined. Barium swallow or esophagogram (examines the esophagus and swallowing); upper gastrointestinal (GI) series (examines the esophagus, stomach and the first part of the small intestines); small bowel series, enteroclysis or small bowel enema (examines the small intestines); barium enema (examines the large intestines or colon).

Indications for the Test

  • To evaluate swallowing problems and identify abnormalities in the esophagus (barium swallow or esophagogram).
  • To detect cancers, ulcers and other inflammatory conditions in the lining of the esophagus, stomach, or duodenum (upper GI series).
  • To identify abnormalities of the small intestines such as blockages, tumors and Crohn's disease (enteroclysis or small bowel series).
  • To identify cancer, polyps, inflammation, and diverticula of the colon and rectum (barium enema or air contrast barium enema).

Preparation

  • A light meal should be eaten the evening before the test and nothing by mouth after midnight. Children should have nothing by mouth 4 hours before the test.
  • A laxative or enema is given on the day before the test to clear the colon for a small bowel series.
  • Clear liquids and an intestinal purgative are given the day before the test for a barium enema.
  • Prior to the procedure, remove all clothing and wear a hospital gown.

Procedure

  • For an upper GI or a small bowel series, you drink the contrast. For an enteroclysis, barium is pumped through a tube that is passed down the nose, through the stomach, and into the small bowel. For a barium enema, the contrast is given via an enema.
  • You are placed on an x-ray table for the images to be taken.
  • The Radiologist examines the intestines with a fluoroscope. The Radiologist may push on your abdomen to better view different segments of the intestines.
  • Air may be introduced into the colon during the barium enema to perform an air contrasted barium enema. This makes it possible to see small abnormalities of the lining of the colon.

After the Procedure

  • You may dress and leave.
  • You may be given a mild laxative to assist in passage of the contrast dye.
  • Your stools will be light-colored and chalky after the test till all of the contrast is passed.

Factors Affecting Results

  • An incomplete bowel preparation (presence of food) may affect the x-ray films.
  • Movement during the test and obesity may affect the x-ray films.

Advantages

  • The test gives a better image of the intestines than a regular (un-contrasted) x-ray.
  • The test is minimally invasive.
  • The test is less expensive than endoscopy or a CT scan.

Disadvantages

  • Radiation exposure.
  • Further testing might be needed to clarify the cause of any abnormality identified.

General Stats:

  • Description: A CT scan involves taking X-ray pictures of the body and using computers to combine these pictures into a high-resolution image, making small abnormalities detectable. A radiology technician performs the test at an x-ray facility. The results are interpreted by a Radiologist. A CT scan takes about an hour to complete.
  • Discomfort - Minimal. An intravenous line has to be placed. The x-ray table can be uncomfortable to some people, the contrast dye can cause a hot flush and some people may experience anxiety during the test.
  • Results - Usually within 1-2 days. Results can be available within 1 hour in emergency situations.
  • Risks of Procedure - Adverse reactions to contrast dye, risks associated with radiation during pregnancy.
  • Other Names - CT scan, CAT scan and computed axial tomography of the abdomen.

Indications for the Test

  • To evaluate abdominal pain.
  • To evaluate the organs of the abdomen including the stomach, small bowel, large bowel (colon), appendix, liver, gall bladder, pancreas, kidneys, spleen, lymph nodes and female organs.
  • To detect cysts, abscesses and cancer.

Preparation

  • A blood test of kidney function might be performed first to determine if the dye could be used safely.
  • Avoid eating for four hours before the test.
  • Some patients may require a sedative before the test.
  • You remove all clothing and wear a hospital gown.

Procedure

  • About one hour prior to the test you may be asked to drink a solution of barium to provide an outline of the digestive tract. Contrast dye may be injected into your vein to highlight blood vessels.
  • The CT table, with the patient lying flat, is slowly moved through the center of the CT scanner.
  • You are instructed to remain still and to hold your breath when each picture is taken.

After the Test

After dressing, you may leave.

Factors Affecting Results

Body movement affects image quality.

Advantages

Allows for identification of small abnormalities (as little as .5 inches in size) in and around the organs of the abdomen.

Disadvantages

  • Main disadvantage is the expense of the procedure.
  • Although abnormalities can be located, the exact cause of the abnormality may not be apparent.

 

General Stats:

  • Description: While performing endoscopy, a contrast material is injected via the endoscope into the pancreas and bile ducts. X-ray pictures are obtained allowing for abnormalities to be identified and sometimes treated. A Gastroenterologist performs the test in a hospital or endoscopy center with the assistance of nurses and technicians. The Gastroenterologist and a Radiologist interpret the results. If specimens are obtained, a Pathologist interprets the results. The test takes 30 to 60 minutes to complete.
  • Discomfort - An intravenous line has to be placed. Depending on the level of sedation, there may be discomfort associated with swallowing the endoscope. After the procedure, there may be discomfort related to a sore throat and air that has been placed into the intestines.
  • Results - The Gastroenterologist's results are generally available at the end of the study. The results from the x-rays may take 1-2 days. Results of tissue samples in 2-3 days.
  • Risks of Procedure - Complications occur in 1-5% of cases and include inflammation of the pancreas (pancreatitis), bleeding, infection, perforation of the intestines, and adverse reaction to the medications used in the procedure.
  • Other Names - ERCP

Indications for the Test

  • To identify the cause of obstruction of the bile ducts (gallstones, tumors, and strictures), that may cause abnormal liver tests, pain and/or jaundice.
  • To evaluate tumors of the pancreas when identified by CT or sonogram.
  • To identify the cause of inflammation of the pancreas (pancreatitis). To evaluate the pancreas before surgery is performed.
  • To treat blockages of the bile ducts or pancreas.

Preparation

  • Nothing should be consumed for 8 hours before the test, except medications as directed by your doctor.
  • Aspirin, non-steroidal anti-inflammatory drugs (aspirin substitutes), blood thinners, anticoagulants, and iron supplements should not be taken for five days before the test to reduce the risk of bleeding.
  • Arrangements should be made for someone to drive you home after the test.
  • Some patients may receive antibiotics prior to the test.
  • You wear a hospital gown and lie on an x-ray table.

Procedure

  • Your blood pressure and oxygen levels are monitored during the procedure.
  • An intravenous line is placed for a sedative to be given. A local anesthetic may be sprayed into the throat to suppress the gag reflex. Supplemental oxygen is given via the nose.
  • A mouthpiece is placed between your teeth to prevent you from accidentally biting the endoscope.
  • After you are sedated, an endoscope is passed through your mouth and guided down into the duodenum (the first part of the small intestines just beyond the stomach). The image from the endoscope is displayed on a TV monitor and the image from the x-ray machine is displayed on the fluoroscope monitor.
  • Air is instilled into the intestines via the endoscope to aid in viewing the inside lining of the intestines. Additional medications may be given to suppress contractions in the intestines and to remove gas bubbles.
  • After the endoscope is positioned correctly in the duodenum, a smaller tube (cannula) is passed through the endoscope and into the opening of the ampulla of vater in the duodenum. Contrast dye can then be injected through the cannula into the common bile duct and into the pancreatic duct.
  • X-rays of the ducts filled with the contrast are then taken.
  • If needed, the opening of the ampulla of vater may be enlarged, gallstones may be removed, tissue samples may be obtained or a stent (a small tubular structure that supports opening of the duct) may be placed to allow drainage of a duct.

After the Procedure

  • Same as for EGD. After the gag reflex returns, consume only light foods for 24 hours.
  • There may be some cramping of the abdomen as the air instilled during the test passes through the intestines.
  • Pancreatitis (inflammation of the pancreas) can be induced by the test. If severe abdominal pain or nausea/vomiting should develop, contact your doctor.

Factors Affecting Results

  • Same as for EGD.
  • The pancreatic or bile duct may be impossible to fill with contrast dye, particularly if there is significant disease present.

Advantages

  • The bile ducts and pancreas can be viewed in great detail allowing for the identification of abnormalities.
  • Tissue samples can be obtained if needed.
  • Some diseases such as gallstones in the ducts or blockages of the ducts can be treated thus avoiding the need for surgery.

Disadvantages

  • It may cause discomfort.
  • Risk of pancreatitis.
  • There is a small amount of radiation exposure.

General Stats:

  • Description: Food is carried down the esophagus into the stomach by waves of muscle contractions in the esophagus called paristaltic contractions. There are diseases of the esophagus in which these contractions are absent or are distorted. Esophageal manometry involves placing a small, pressure-sensing tube into the esophagus and measuring the paristaltic contractions. A nurse and possibly a Gastroenterologist perform the test at a hospital, endoscopy center, or doctor's office. A Gastroenterologist interprets the results. The test takes 30-90 minutes to perform.
  • Discomfort - There is some discomfort associated with the passage of the catheter through the nose.
  • Results - 1-3 days.
  • Risks of Procedure - Minimal. The catheter can cause nose bleeding.
  • Other Names - Motility Study.

Indications for the Test

  • To evaluate swallowing problems, particularly when a problem with the muscle contractions of the esophagus is suspected.
  • To identify the cause of chest pain when heart problems have been ruled out.
  • To evaluate the strength of contractions in the esophagus prior to surgery on the esophagus.

Preparation

Nothing should be consumed for 8 hours before the test, except medications as directed by your doctor.

Procedure

  • A local anesthetic is sprayed into the throat to aid in passage of the catheter.
  • You sit in an upright position with your chin down.
  • The catheter (a thin, flexible tube) is passed through one of your nostrils and guided down the esophagus into the stomach.
  • After the catheter is passed into the stomach, the recording of pressures in the esophagus begins. You drink small sips of water as the catheter is withdrawn.
  • If chest pain is being evaluated, certain medications may be administered in an attempt to reproduce the pain.

After the Procedure

  • If your throat was sprayed with oral sedation, you should not eat or drink until it wears off (up to 2 hours after the test).
  • You are free to resume normal activities.

Factors Affecting Results

Passage of the catheter may be difficult to tolerate for some.

Advantages

  • This is the best test to evaluate the muscle contractions of the esophagus.
  • Some causes of chest pain can be identified when other tests have been non-conclusive.

Disadvantages

Passage of the catheter may be difficult to tolerate for some.

VIDEO: Upper Endoscopy

General Stats:

  • Description: A long, flexible tube with a camera mounted on the end (endoscope) is inserted into the mouth. The scope is then guided through the esophagus, stomach, and into the duodenum (first part of the small intestines). This allows for viewing of the internal lining of the upper intestines directly. A Gastroenterologist performs the test with assistance from a nurse in a hospital, endoscopy suite or doctor's office. The Gastroenterologist interprets the results. If specimens are obtained, a Pathologist interprets the results. The test takes 5-15 minutes to complete.
  • Discomfort - An intravenous line has to be placed. Depending on the level of sedation, there may be some discomfort as the scope is passed and as air is instilled into the intestines.
  • Results - The Gastroenterologist's interpretation is available immediately; 2-3 days for results from tissue samples obtained.
  • Risks of Procedure - Perforation of the intestines, bleeding, aspiration of gastric juices into lungs.
  • Other Names - Endo, Upper Gastrointestinal (GI) Endoscopy

Indications for the Test

  • To examine and take tissue samples of abnormalities identified by other tests (UGI X-ray or CT) of the esophagus, stomach, and duodenum.
  • To search for the cause of symptoms thought to come from the UGI tract such as swallowing problems, chest pain, nausea or vomiting, heartburn, loss of appetite and weight loss, diarrhea, or GI bleeding.
  • To stop bleeding from the upper GI tract, stretch open the esophagus, or remove foreign bodies.
  • Some persons may be given an antibiotic before the test if there is a risk of infection associated with the test.

Preparation

  • Nothing should be consumed for 8 hours before the test, except medications as directed by your doctor.
  • Aspirin, non-steroidal anti-inflammatory drugs (aspirin substitutes), blood thinners, and anticoagulants should not be taken for five days before the test to reduce the risk of bleeding.
  • Arrangements should be made for someone to drive you home after the test.
  • You wear a hospital gown. Dentures are removed before the test.

Procedure

  • Monitors are attached to observe the blood pressure, pulse rate, and oxygen level of the blood. Supplemental oxygen is given via the nose.
  • An intravenous line is placed for a sedative to be given. A local anesthetic may be sprayed into the throat to suppress the gag reflex.
  • A mouthpiece is placed between your teeth to prevent you from accidentally biting the endoscope.
  • Your throat may be sprayed with a medication to suppress the gag reflex. You receive a sedative intravenously. Depending on the level of sedation, you may drift off to sleep during the procedure.
  • After you are sedated, an endoscope is passed through your mouth and guided down into the duodenum (the first part of the small intestines just beyond the stomach). The image from the endoscope is displayed on a TV monitor.
  • Air is instilled into the intestines via the endoscope to aid in viewing the inside lining of the intestines.
  • Tissue samples can be taken via the endoscope. If a narrowed area is found, it can be dilated via the endoscope.

After the Procedure

  • You are monitored in the recovery area until the sedation wears off.
  • Once the sedation wears off, you may have someone drive you home.
  • If your throat was sprayed with oral sedation, you should not eat or drink until it wears off (up to 2 hours after the test).
  • You will belch and pass flatulence until the air instilled during the study has been passed. A mild sore throat is to be expected after the test for several days.
  • If you have severe abdominal pain or pass blood, notify your doctor immediately.

Factors Affecting Results

The presence of food or blood in the stomach can limit the ability to examine the gastric lining.

Advantages

  • The lining of the esophagus, stomach, and duodenum can be visualized directly.
  • If an abnormality is identified, tissue can be obtained for analysis, bleeding can sometimes be stopped, and narrowed areas can sometimes be dilated.

Disadvantages

  • The test is an invasive procedure.
  • Depending on the level of sedation, there may be discomfort associated with the test.

Frequently Asked Questions

  • Do I take my blood pressure medicine before the test? Yes.
  • I take blood thinners. What do I do? Do not take blood thinners for four days prior to the test.
  • I'm on dialysis. Are there any special instructions? Drink Colyte prep instead of Fleets the night before the test.
  • My test is scheduled for late afternoon. Can I eat something prior to the test? No, just clear liquids up until 4 hours prior to the test.
  • I'm a diabetic. Do I take my normal amount of insulin? Take ½ of your normal dosage the night before the test. Do not take insulin the morning of the test. If you take oral medication for your diabetes, do not take your medication the morning of the test.
  • Can I take aspirin prior to the test? Do not take aspirin 4 days prior to the test.
  • Can I take iron? Do not take iron 4 days prior to the test.
  • Can I take my heart medicine? Yes, take as normal.

General Stats:

  • Description: A video is taken as contrast is swallowed. The video can then be played back at a slower speed to detect minor abnormalities in the swallowing mechanism. An Otolaryngologist or Radiologist and speech therapist perform the test at an x-ray facility. The doctor then interprets the results. The test takes 1 hour to perform.
  • Discomfort - Minimal. The contrast is unpleasant to swallow to some.
  • Duration - About 30 minutes to 1 hour depending on findings.
  • Results - Within 1-2 days.
  • Risks of Procedure - Exposure to radiation, particularly during pregnancy.
  • Other Names - Video swallow or cookie swallow.

Indication for the Test

To examine the swallowing mechanism in persons who are having problems swallowing.

Preparation

  • Nothing by mouth for several hours before the test.
  • You wear a hospital gown.
  • You are placed on an x-ray table.
  • A video monitor attached to an x-ray machine is used to take pictures and videos as you swallow various foods.

Procedure

  • While on the x-ray table, you swallow barium of varying consistencies (thin liquid, thick liquid, paste, and barium-coated cookie/marshmallow/pill).
  • By varying the amounts and consistency of the contrast material that is swallowed, the doctor is able to identify the cause of the swallowing problem.
  • With a speech pathologist present, techniques to aid in improving the swallowing problem can be identified.

After the Procedure

Patient is free to leave and resume normal activities.

Factors Affecting Results

Movement affects the quality of the images obtained.

Advantages

The test can identify the cause of the swallowing problem and, in some cases, identify techniques to improve swallowing.

Disadvantages

  • Detailed images of the damaged organs are not obtained.
  • There is a small amount of radiation exposure.
  • Some diseases that can cause swallowing problems can be missed if they occur in the mid or lower esophagus.

General Stats:

  • Description: Infection, inflammation, and tumors can affect any organ within the abdomen. Sometimes an abnormality is identified to involve the liver, pancreas, lymph nodes, or kidneys and the exact cause may not be apparent. In these situations a biopsy of the affected organ can be helpful in leading to the cause and treatment of the disease process. A Radiologist or Gastroenterologist performs the test in a hospital. Sometimes CT scan or ultrasound guides the biopsy needle. A Pathologist interprets the results. The test takes 15-60 minutes to perform.
  • Discomfort - Moderate discomfort during needle insertion.
  • Results - 2-3 days.
  • Risks of Procedure - Main risk of test is bleeding. Other risks include injury to the organs of the abdomen and infection.
  • Other Names - Liver biopsy, pancreatic biopsy, or fine needle biopsy.

Indications of the Test

  • To identify the cause of an abnormality (infection, inflammation, or tumor/cancer) involving the liver, pancreas, lymph nodes, or kidney when other tests have been non-conclusive.
  • To identify cirrhosis or hepatitis in the liver.

Preparation

  • Nothing should be consumed for 8 hours before the test, except medications as directed by your doctor.
  • Aspirin, non-steroidal anti-inflammatory drugs (aspirin substitutes), blood thinners, and anticoagulants should not be taken for five days before the test to reduce the risk of bleeding.
  • You will be asked to empty your bladder before the test.
  • You wear a hospital gown.

Procedure

  • You are placed on a table or x-ray table.
  • After the site to be biopsied is sterilized, a local anesthetic is injected.
  • You may be asked to exhale completely and hold your breath to reduce the risk of a puncturing the lung.
  • A needle is inserted into the organ to be biopsied. A CT scan or ultrasound may be used to guide placement of the needle.
  • The needle is inserted quickly and then withdrawn. The tissue inside the needle is removed for analysis.
  • Sometimes several insertions of the needle are performed to ensure that adequate tissue is obtained or to sample different areas.

After the Procedure

  • A pressure dressing is applied to the puncture site to control bleeding.
  • You are monitored in a recovery area until it is certain you have no complications. You may be monitored for up to 4 hours if a liver biopsy was performed.
  • You may be instructed to have limited activity for 1 day.
  • Pain is to be expected at the puncture site for 1-2 days. Sometimes the pain may be in the shoulder.

Factors Affecting Results

Small areas of abnormality can be difficult to sample adequately.

Advantages

  • Tissue is obtained for analysis when the cause of an abnormality is not apparent from other tests.
  • The test can sometimes avoid the need for surgery.

Disadvantages

  • The test is painful and invasive.
  • Only small tissue samples are obtained.

General Stats:

  • Description: Some diseases of the intestines can result in the passage of blood in the stool. Small amounts of blood are not visible in the stool. Special chemicals can be applied to stool samples in order to allow for detection of small amounts of blood (occult blood). The stool sample can be obtained by a doctor, nurse, or the patient at a hospital, doctor's office, or at home. The results are interpreted by a doctor, lab technician, or nurse. The test takes minutes to perform, both in collecting the stool and applying the chemical.
  • Discomfort - Minimal or no discomfort; although, obtaining the stool specimen is unpleasant.
  • Results - Immediately, or 1-2 days if the results are interpreted at a lab.
  • Risks of Procedure - None.
  • Other Names - Hemoccult, fecal occult blood test (FOBT).

Indications for the Test

  • To identify blood in the stool as a manifestation of disease in the intestines.
  • To screen for colorectal cancer.

Preparation

The test can be made to show a false positive result by various compounds. You may be advised to avoid aspirin or aspirin substitutes, iron supplements, alcohol, or foods such as red meats, citrus fruits, bean sprouts, turnips, radishes, mushrooms or artichokes.

Procedure

  • Stool samples are collected by digital rectal exam in the hospital or doctor's office.
  • Stool samples are collected at the patient's home by the patient. A sample is obtained with the use of an applicator stick and applied to the cards as directed.
  • The stool cards are then developed at a doctor's office or lab.

After the Procedure

You are free to resume normal activities.

Factors Affecting Results

Hemorrhoids, menstrual bleeding, or one of the compounds listed above may cause false-positive results.

Advantages

  • The test can detect minute amounts of blood in the stool.
  • The test is inexpensive.
  • The test can be performed at home.

Disadvantages

  • The cause of the blood in the stool is not made apparent from the test.
  • False positive results are common.
  • Collecting stool specimens is unpleasant.

 

General Stats:

  • Description: The collection of fluid within the abdomen is a sign of significant disease. This fluid can be drawn out of the abdomen and analyzed to determine the cause of its accumulation. Possible causes of ascites include liver disease, infection and cancer. At times, the amount of fluid collected may cause problems (discomfort or problems breathing). A large amount of the fluid can be removed in such situations to provide patient relief. A paracentesis is performed by a doctor in an office, at an x-ray facility or at a hospital. The fluid as aspirated via a needle inserted into the abdominal cavity. The fluid is analyzed in a lab to determine its composition. The test can take from 5-45 minutes.
  • Discomfort - Pain at puncture site.
  • Results - 1-3 days.
  • Risks of Procedure - Infection, bleeding, puncture of internal organs by the needle. Blood pressure may fall if too much fluid is removed too rapidly.
  • Other Names - Fluid tap.

Indications for the Test

  • Identify the source or cause of fluid collection within the abdomen.
  • To provide relief of discomfort or shortness of breath related to ascites.

Preparation

  • Limit food intake for 4 hours before the test.
  • Empty bladder before the test.
  • You might be asked to wear a hospital gown.

Procedure

  • While lying on your back local anesthesia is given and a needle is inserted into the abdomen. Fluid is then withdrawn and sent to the lab.
  • A CT scan or abdominal ultrasound may be used to guide the needle into the abdomen.

After the Test

  • Dressing is placed over the puncture site.
  • The site is observed for leakage.

Factors Affecting Results

Small amounts of fluid may be difficult to sample.

Advantages

  • The test is simple.
  • The test is relatively safe.
  • The test can provide for relief of discomfort or shortness of breath related to the fluid.

Disadvantages

Can cause infection of the fluid.

VIDEO: PillCam Small Bowel Capsule Endoscopy

Description: PillCam SB is the most widely used, patient-friendly tool for directly visualizing the small bowel to detect and monitor abnormalities. This procedure is the standard of care for small bowel evaluation, helping healthcare practitioners detect the presence of lesions and what may be the source of obscure GI bleeding, Crohn’s disease and iron deficiency anemia.

With PillCam SB, physicians can visualize the entire small bowel without putting their patients through a lengthy, uncomfortable procedure or having them undergo sedation.   By simply swallowing a vitamin-sized capsule, physicians may detect and monitor lesions, ulcers, tumors, and bleeding within the small bowel.

The benefits of direct visualization

  • Capsule endoscopy is a sensitive tool to detect mucosal abnormalities in the small bowel.
  • Direct visualization of the small bowel mucosa is necessary to accurately and fully assess early disease activity and progression.
  • Ileocolonoscopy combined with small bowel direct visualization are the fundamental tools for diagnosing and managing disease over time.

Influencing a change in therapy

  • 62% of patients had their Crohn’s therapy changed within 3 months of using PillCam SB.
  • Change of therapy was defined as the initiation or discontinuation of an IBD medication.
  • 40% were initiated on a new medication.

Low risk of retention

  • Capsule retention has been reported in less than 3 percent of patients with Crohn’s disease.
  • The PillCam patency capsule provides a simple and convenient means to verify functional patency of the GI tract in patients with known or suspected strictures.

Indications
The PillCam Platform with PillCam SB capsules is intended for visualization of the small bowel mucosa and:

  • May be used in the visualization and monitoring of lesions that may indicate Crohn’s disease not detected by upper and lower endoscopy.
  • May be used in the visualization of lesions that may be a source of obscure bleeding (either overt or occult) not detected by upper and lower endoscopy.
  • May be used in the visualization of lesions that may be potential causes of iron deficiency anemia (IDA) not detected by upper and lower endoscopy.

The PillCam Platform with PillCam SB capsules may be used as a tool in the detection of abnormalities of the small bowel and is intended for use in adults and children from two years of age.

The Suspected Blood Indicator (SBI) feature is intended to mark frames of the video suspected of containing blood or red areas.

Contraindications

  • Patients with known or suspected GI obstructions, strictures, or fistulas based on the clinical picture or pre-procedure testing and profile.
  • Patients with cardiac pacemakers or other implanted electromedical devices.
  • Patients with swallowing disorders.

Procedure Risks
Capsule retention has been reported in less than two percent of all small bowel capsule endoscopy procedures.  Capsule retention is defined as having a capsule that remains in the digestive tract for more than two weeks.  

Causes of retention cited in the literature include: NSAID strictures, Crohn’s disease, small bowel tumors, intestinal adhesions, ulcerations, and radiation enteritis. Summaries in published literature identify the risk of retention for obscure bleeding to be 1.5%; for suspected Crohn’s disease to be 1.4%; for known Crohn’s disease the risk is higher at 5%; and for neoplastic lesions, the rate of retention is 2.1%; as compared to healthy volunteers (Cave et al, 2005; Liao et al, 2010). To verify passage of the capsule from the GI tract, an abdominal X-ray may be obtained at the discretion of the physician.

There is a rare risk of capsule aspiration while patients are attempting to swallow a PillCam capsule.  There is also a low risk of skin irritation from the PillCam sensor array’s sleeve adhesive or silicone exposure.

The PillCam capsule may be administered by using transendoscopic delivery in patients who are either unable to ingest the capsule or who are known to have slow gastric emptying.  If using transendoscopic delivery, potential complications include, but are not limited to: perforation, hemorrhage, aspiration, fever, infection, hypertension, respiratory arrest, and cardiac arrhythmia or arrest.

Medical, endoscopic, or surgical intervention may be necessary to address any of these complications, should they occur.

After ingesting a PillCam capsule and until the capsule is excreted, patients should not be near any source of powerful electromagnetic fields, such as one created by an MRI device.

This information should not be used as a substitute for medical advice concerning specific diagnosis and treatment.

What to Expect from the PillCam SB Procedure

  1. Patients typically begin fasting at midnight the day before the PillCam SB procedure.
  2. The following morning when you arrive at your doctor’s office, a nurse or technician will explain the procedure to you. The nurse or technician will then fit you with the PillCam sensor belt, a comfortable belt worn around your waist and over your clothing.  The PillCam recorder, a small portable recording device that communicates with the PillCam SB capsule as it passes through the small bowel, is attached to the sensor belt.
  3. You will then be asked to swallow the vitamin-sized capsule with a glass of water and you will then be able to resume most daily activities.
  4. You will be scheduled to return to the physician’s office with the sensor belt and the recorder.
  5. Your physician will then download images from the recorder for review.
  6. PillCam SB passes naturally with a bowel movement, usually in 24 to 72 hours.

 

General Stats:

  • Description: Radionuclides are compounds that, when injected into the body, collect in certain organs making them visible by a special type of x-ray machine (gamma scintillation camera). Different radionuclides are used to examine the liver/spleen, gallbladder, stomach, or to locate a site of bleeding in the abdomen. The test is performed in a hospital or outpatient x-ray facility by a radiology technician. The results are interpreted by a Radiologist. Depending on which of the above organs are being examined, the test takes 30-90 minutes.
  • Discomfort - Minimal. The radionuclide has to be injected into a vein and there may be some discomfort associated with the infusion of the drug.
  • Results - 2-3 days; within hours in emergency situations.
  • Risk of Procedure - Minimal risk related to radiation exposure. The test should not be performed if pregnant. Minimal risk of adverse reaction to the medication.
  • Risks of Procedure - None.
  • Other Names - Liver/spleen scan or liver scan Gallbladder scan, HIDA scan, or biliary scan Gastric emptying scan or stomach scan RBC scan or bleeding scan.

Indications for the Test

Liver/Spleen Scan

  • To identify masses in the liver or spleen.
  • To identify cirrhosis of the liver.

Gallbladder Scan

  • To identify cholecystitis (an infected gallbladder).
  • To identify a blockage in the bile ducts draining the liver and gall bladder.
  • To determine how well the gall bladder is functioning.

Gastric Emptying Scan

To determine how well the stomach is emptying solids and liquids after they have been ingested.

Preparation

  • You may be advised that nothing should be consumed for 8 hours before the test, except medications as directed by your doctor.
  • You may be asked to wear a hospital gown.

Procedure

  • An intravenous line is placed to administer the radionuclide.
  • You lay on an x-ray table.
  • The radionuclide is injected into the vein. For a gastric emptying scan, you eat or drink the radionuclide mixed in food or liquid.
  • X-ray images are obtained after the radionuclide collects in the organ of interest.
  • Depending on which organ is being examined, additional medication may be injected via the vein.

After the Procedure

You may dress and return to normal activities.

Factors Affecting Results

  • Movement can blur the images obtained by the x-ray machine.
  • Some diseases may interfere with the proper uptake of the nucleotide, limiting the test.

Advantages

  • The test can determine how well the examined organ is functioning.
  • In a bleeding scan, a site of bleeding can be located when the rate of bleeding is very slow.
  • The tests are easily tolerated with minimal exposure to x-rays.

Disadvantages

Although abnormal functioning or another abnormality may be identified, the exact cause of the abnormality is not determined by these tests.

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