Home › Areas of Practice

Gastrointestinal Medicine

Areas of Practice – Gastroenterology, Colonoscopy, Endoscopy, Flexible Sigmoidoscopy, ERCP, EUS

  • Gastroenterology
  • Colonoscopy
  • Endoscopy
  • Flex. Sigmoidoscopy
  • ERCP
  • EUS
  • Capsule
  • Hepatology

What is Gastroenterology?

Gastroenterology monitorsGastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. It involves a detailed understanding of the normal action (physiology) of the gastrointestinal organs including the movement of material through the stomach and intestine (motility), the digestion and absorption of nutrients into the body, removal of waste from the system, and the function of the liver as a digestive organ. It includes common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs is part of the study of Gastroenterology.

What is a Gastroenterologist?

A Gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver.

Training

A Gastroenterologist must first complete a three-year Internal Medicine residency and is then eligible for additional specialized training (fellowship) in Gastroenterology. This fellowship is generally 2-3 years long so by the time Gastroenterologists have completed their training, they have had 5-6 years of additional specialized education following medical school. Gastroenterology fellowship training is an intense, rigorous program where future Gastroenterologists learn directly from nationally recognized experts in the field and develop a detailed understanding of gastrointestinal diseases. They learn how to evaluate patients with gastrointestinal complaints, treat a broad range of conditions, and provide recommendations to maintain health and prevent disease. They learn to care for patients in the office as well as in the hospital.

Gastroenterologists also receive dedicated training in endoscopy (upper endoscopy, sigmoidoscopy, and colonoscopy) by expert instructors. Endoscopy is the use of narrow, flexible lighted tubes with built-in video cameras, to visualize the inside of the intestinal tract. This specialized training includes detailed and intensive study of how and when to perform endoscopy, optimal methods to complete these tests safely and effectively, and the use of sedating medications to ensure the comfort and safety of patients. Gastroenterology trainees also learn how to perform advanced endoscopic procedures such as polypectomy (removal of colon polyps), esophageal and intestinal dilation (stretching of narrowed areas), and hemostasis (injection or cautery to stop bleeding). Importantly, Gastroenterologists learn how to properly interpret the findings and biopsy results of these studies in order to make appropriate recommendations to treat conditions and/or prevent cancer.

Some Gastroenterologists also receive directed training in advanced procedures using endoscopes such as endoscopic biliary examination (endoscopic retrograde cholangiopancreatography or ERCP), removal of tumors without surgery (endoscopic mucosal resection or EMR), placement of internal drainage tubes (stents) and endoscopic ultrasound (EUS). This provides them with the training necessary to non-surgically remove stones in the bile ducts, evaluate and treat tumors of the gastrointestinal tract and liver, and provide minimally invasive alternatives to surgery for some patients. The most critical emphasis during the training period is attention to detail and incorporation of their comprehensive knowledge of the entire gastrointestinal tract to provide the highest quality endoscopy and consultative services. The final product is a highly trained specialist with a unique combination of broad scientific knowledge, general Internal Medicine training, superior endoscopic skills and experience, and the ability to integrate these elements to provide optimal health care for patients.

This advanced fellowship training is overseen by national societies committed to ensuring high quality and uniform education. These groups include the American Board of Internal Medicine, the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. These groups carefully scrutinize the educational experience of each program to ensure that every Gastroenterology trainee receives the highest quality training. Once fellows successfully complete their training they are considered “Board Eligible.” They are then qualified to take the Gastroenterology board certification test administered by the American Board of Internal Medicine. Once they have successfully completed this examination they are “Board Certified.”

What Is a Colonoscopy?

Colonoscopy drawing

Colonoscopy is a procedure that enables the physician to perform a careful, thorough examination of the large intestine. A thin flexible tube is inserted into the rectum and advanced through the entire five to six foot length of colon. The examination can detect an abnormality present within the inner lining of the colon, such as a tumor or polyp, or an area of inflammation or infection.

Screening for colon cancer and rectal cancer is an important function of colonoscopy. Cancer of the large bowel, also referred to as colorectal cancer, usually develops from a benign precursor, a polyp. The detection and removal of colon polyps will reduce the chances of an individual developing colorectal cancer by 87-93%. In order to achieve this level of success in cancer prevention, colonoscopy should be performed in healthy individuals before the symptoms of bowel cancer are present.

Colonoscopy is also recommended for a number of other reasons. Rectal bleeding, iron-deficiency anemia, a recent change of bowel habits, abdominal pain, or persistent diarrhea are several of the more common symptons requiring colonoscopic examination. Individuals with an extended history ofulcerative colitis or Crohn's disease, a personal history of colon polyps or cancer, or a family history of either polyps or cancer of the colon require periodic examination of the colon.

What are the colon and rectum?

The colon and rectum are the two main parts of the large intestine. Although the colon is only one part of the large intestine, because most of the large intestine consists of colon, the two terms are often used interchangeably. The large intestine is also sometimes called the large bowel.

Digestive waste enters the colon from the small intestine as a semisolid. As waste moves toward the anus, the colon removes moisture and forms stool. The rectum is about 6 inches long and connects the colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus control bowel movements.

 

How to Prepare for Colonoscopy

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called a bowel prep. Generally, all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Acceptable liquids include

  • fat-free bouillon or broth
  • strained fruit juice
  • water
  • plain coffee
  • plain tea
  • sports drinks, such as Gatorade
  • gelatin

A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water. An enema is performed by flushing water, or sometimes a mild soap solution, into the anus using a special wash bottle.

Patients should inform the doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including

  • aspirin
  • arthritis medications
  • blood thinners
  • diabetes medications
  • vitamins that contain iron
Driving is not permitted for 12 hours after colonoscopy to allow the sedative time to wear off. Before the appointment, patients should make plans for a ride home.

 

How is colonoscopy performed?

Examination of the Large Intestine

During colonoscopy, patients lie on their left side on an examination table. In most cases, a light sedative, and possibly pain medication, helps keep patients relaxed. Deeper sedation may be required in some cases. The doctor and medical staff monitor vital signs and attempt to make patients as comfortable as possible.

The doctor inserts a long, flexible, lighted tube called a colonoscope, or scope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.

Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Bleeding and puncture of the large intestine are possible but uncommon complications of colonoscopy.

Removal of Polyps and Biopsy

A doctor can remove growths, called polyps, during colonoscopy and later test them in a laboratory for signs of cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.

The doctor can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.

The doctor removes polyps and takes biopsy tissue using tiny tools passed through the scope. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.

Recovery

Colonoscopy usually takes 30 to 60 minutes. Cramping or bloating may occur during the first hour after the procedure. The sedative takes time to completely wear off. Patients may need to remain at the clinic for 1 to 2 hours after the procedure. Full recovery is expected by the next day. Discharge instructions should be carefully read and followed.

Patients who develop any of these rare side effects should contact their doctor immediately:

  • severe abdominal pain
  • fever
  • bloody bowel movements
  • dizziness
  • weakness

At what age should routine colonoscopy begin?

Routine colonoscopy to look for early signs of cancer should begin at age 50 for most people—earlier if there is a family history of colorectal cancer, a personal history of inflammatory bowel disease, or other risk factors. The doctor can advise patients about how often to get a colonoscopy.

 

Colonoscopy for Dummies

What Is An Endoscopy?

Enhanced Endoscopy and Colonoscopy

Endoscopy drawing

 During conventional endoscopy and colonoscopy, we directly inspect the lining of the gut. In most instances, this provides a highly accurate evaluation. However, in some instances, potentially important growths are too subtle to be seen by the human eye.

At MGC, we are using new techniques to help us detect small cancerous or pre-cancerous abnormalities of the intestinal tract before they are visible with conventional methods. Once these growths are detected, we can eliminate them before they cause you serious health issues.



Magnification colonoscopy utilizes a tiny magnifying lens attached to a standard colonoscope to enlarge images of the intestine.

Chromoendoscopy utilizes brightly-colored natural stains to discern subtle abnormalities of the surface of the intestine. If abnormal cells are detected by either method, we can remove them before they can turn into lifethreatening growths.

Upper Endoscopy

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the first part of the small intestine.

What problems can upper GI endoscopy detect?

Upper GI endoscopy can detect

  • ulcers
  • abnormal growths
  • precancerous conditions
  • bowel obstruction
  • inflammation
  • hiatal hernia
  • When is upper GI endoscopy used?

Upper GI endoscopy can be used to determine the cause of

  • abdominal pain
  • nausea
  • vomiting
  • swallowing difficulties
  • gastric reflux
  • unexplained weight loss
  • anemia
  • bleeding in the upper GI tract

Upper GI endoscopy can be used to remove stuck objects, including food, and to treat conditions such as bleeding ulcers. It can also be used to biopsy tissue in the upper GI tract. During a biopsy, a small piece of tissue is removed for later examination with a microscope.

How to Prepare for Upper GI Endoscopy

The upper GI tract must be empty before upper GI endoscopy. Generally, no eating or drinking is allowed for 4 to 8 hours before the procedure. Smoking and chewing gum are also prohibited during this time.

Patients should tell their doctor about all health conditions they have—especially heart and lung problems, diabetes, and allergies— and all medications they are taking. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are often given during upper GI endoscopy.

Medications and vitamins that may be restricted before and after upper GI endoscopy include:

  • nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil), and naproxen (Aleve)
  • blood thinners
  • blood pressure medications
  • diabetes medications
  • antidepressants
  • dietary supplements

Driving is not permitted for 12 to 24 hours after upper GI endoscopy to allow sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home.

How is upper GI endoscopy performed?

Patients may receive a local, liquid anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex. An intravenous (IV) needle is placed in a vein in the arm if a sedative will be given. Sedatives help patients stay relaxed and comfortable. While patients are sedated, the doctor and medical staff monitor vital signs.

During the procedure, patients lie on their back or side on an examination table. An endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a video monitor, allowing close examination of the intestinal lining. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier to see. Special tools that slide through the endoscope allow the doctor to perform biopsies, stop bleeding, and remove abnormal growths.

Recovery from Upper GI Endoscopy

After upper GI endoscopy, patients are moved to a recovery room where they wait about an hour for the sedative to wear off. During this time, patients may feel bloated or nauseated. They may also have a sore throat, which can stay for a day or two. Patients will likely feel tired and should plan to rest for the remainder of the day. Unless otherwise directed, patients may immediately resume their normal diet and medications.

Some results from upper GI endoscopy are available immediately after the procedure. The doctor will often share results with the patient after the sedative has worn off. Biopsy results are usually ready in a few days.

What is Flexible Sigmoidoscopy?

Flexible Sigmoidoscopy

Flexible sigmoidoscopy lets your doctor examine the lining of the rectum and a portion of the colon (large intestine) by inserting a flexible tube about the thickness of your finger into the anus and slowly advancing it into the rectum and lower part of the colon. If your doctor has recommended a flexible sigmoidoscopy, this brochure will give you a basic understanding of the procedure - how it is performed, how it can help, and what side effects you might experience. It can't answer all of your questions, since a lot depends of the individual patient and the doctor. Please ask your doctor about anything you don't understand.

What Preparation is Required?

Your doctor will tell you what cleansing routine to use. In general, preparation consists of one or two enemas prior to the procedure but could include laxatives or dietary modifications as well. However, in some circumstances your doctor might advise you to forgo any special preparation. Because the rectum and lower colon must be completely empty for the procedure to be accurate, it's important to follow your doctor's instructions carefully.

Should I continue my current medications? 

Most medications can be continued as usual. Inform your doctor about medications that you're taking - particularly aspirin products or anticoagulants (blood thinners) -- as well as any allergies you have to medications. Also, tell your doctor if you require antibiotics prior to dental procedures, because you might need antibiotics prior to sigmoidoscopy as well.

What can I expect during flexible sigmoidoscopy? 

Flexible sigmoidoscopy is usually well-tolerated. You might experience a feeling of pressure, bloating or cramping during the procedure. You will lie on your side while your doctor advances the sigmoidoscope through the rectum and colon. As your doctor withdraws the instrument, your doctor will carefully examine the lining of the intestine.

What if the flexible sigmoidoscopy finds something abnormal? 

If your doctor sees an area that needs further evaluation, your doctor might take a biopsy (sample of the colon lining) to be analyzed. Biopsies are used to identify many conditions, and your doctor might order one even if he or she doesn't suspect cancer. 

If your doctor finds polyps, he or she might take a biopsy of them as well. Polyps, which are growths from the lining of the colon, vary in size and types. Polyps known as "hyperplastic" might not require removal, but benign polyps known as "adenomas" are potentially precancerous. Your doctor might ask you to have a colonoscopy (a complete examination of the colon) to remove any large polyps or any small adenomas.

What happens after a flexible sigmoidoscopy?

Your doctor will explain the results to you when the procedure is done. You might feel bloating or some mild cramping because of the air that was passed into the colon during the examination. This will disappear quickly when you pass gas. You should be able to eat and resume your normal activities after leaving your doctor's office or the hospital, assuming you did not receive any sedative medication.

What are possible complications of flexible sigmoidoscopy?

Flexible sigmoidoscopy and biopsy are safe when performed by doctors who are specially trained and experienced in these endoscopic procedures. Complications are rare, but it's important for you to recognize early signs of possible complications. Contact your doctor if you notice severe abdominal pain, fevers and chills, or rectal bleeding of more than one-half cup. Note that rectal bleeding can occur several days after the biopsy.

What is ERCP? 

ERCP

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the ducts of the gallbladder, pancreas and liver. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. If your doctor has recommended an ERCP, this brochure will give you a basic understanding of the procedure - how it's performed, how it can help, and what side effects you might experience. It can't answer all of your questions, since a lot depends on the individual patient and the doctor. Please ask you doctor about anything you don't understand. 

During ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the common opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays.

What preparation is required?

You should fast for at least six hours (and preferably overnight) before the procedure to make sure you have an empty stomach, which is necessary for the best examination. Your doctor will give you precise instructions about how to prepare. 

You should talk to your doctor about medications you take regularly and any allergies you have to medications, or intravenous contrast material. Although an allergy doesn't prevent you from having ERCP, it's important to discuss it with your doctor prior to the procedure. 

Also, be sure to tell your doctor if you have heart or lung conditions, or other major diseases.

What can I expect during ERCP?

Your doctor might apply a local anesthetic to your throat or give you a sedative to make you more comfortable. Some patients also receive antibiotics before the procedure. You will lie on your left side on an X-ray table. Your doctor will pass the endoscope through your mouth, esophagus, stomach and into the duodenum. The instrument does not interfere with breathing, but you might feel a bloating sensation because of the air introduced through the instrument.

What are possible complications of ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (an inflammation or infection of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. Sometimes the procedure cannot be completed for technical reasons

Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. Your doctor will discuss your likelihood of complications before you undergo the test.

What can I expect after ERCP?

If you have ERCP as an outpatient, you will be observed for complications until most of the effects of the medications have worn off. You might experience bloating or pass gas because of the air introduced during the examination. You can resume your usual diet unless you are instructed otherwise. 

Someone must accompany you home from the procedure because of the sedatives used during the examination. Even if you feel alert after the procedure, the sedatives can affect your judgment and reflexes for the rest of the day.

Understanding EUS (Endoscopic Ultrasonography)

Endoscopic Ultrasonography

What is EUS?

EUS allows your doctor to examine the lining and the walls of your upper and lower gastrointestinal tract. The upper tract is the esophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the gall bladder and pancreas. 

Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will turn on the ultrasound component to produce sound waves that create visual images of the digestive tract.

Why is EUS done? 

EUS provides your doctor more detailed pictures of your digestive tract anatomy. Your doctor can use EUS to diagnose the cause of conditions such as abdominal pain or abnormal weight loss. Or, if your doctor has ruled out certain conditions, EUS can confirm your diagnosis and give you a clean bill of health. 

EUS is also used to evaluate an abnormality, such as a growth, that was detected at a prior endoscopy or by x-ray. EUS provides a detailed picture of the growth, which can help your doctor determine its nature and decide upon the best treatment. 

In addition, EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive.

Why is EUS used for patients with cancer? 

EUS helps your doctor determine the extent of certain cancers of the digestive and respiratory systems. EUS allows your doctor to accurately assess the cancer's depth and whether it has spread to adjacent lymph glands or nearby vital structures such as major blood vessels. In some patients, EUS can be used to obtain tissue samples to help your doctor determine the proper treatment.

How should I prepare for EUS?

For EUS of the upper gastrointestinal tract, you should have nothing to eat or drink, not even water, usually six hours before the examination. Your doctor will tell you when to start this fasting. 

For EUS of the rectum or colon, your doctor will instruct you to either consume a large volume of a special cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. The procedure might have to be rescheduled if you don't follow your doctor's instructions carefully.

What about my current medications or allergies? 

Tell your doctor in advance of the procedure about all medications that you're taking and about any allergies you have to medication. He or she will tell you whether or not you can continue to take your medication as usual before the EUS examination. In general, you can safely take aspirin and nonsteroidal anti-inflammatories (Motrin, Advil, Aleve, etc.) before an EUS examination, but it's always best to discuss their use with your doctor. Check with your doctor about which medications you should take the morning of the EUS examination, and take essential medication with only a small cup of water. 

If you have an allergy to latex you should inform your doctor prior to your test. Patients with latex allergies often require special equipment and may not be able to have an EUS examination.

Do I need to take antibiotics? 

Antibiotics aren't generally required before or after EUS examinations. But tell your doctor if you take antibiotics before dental procedures. If your doctor feels you need antibiotics, antibiotics might be ordered during the EUS examination or after the procedure to help prevent an infection. Your doctor might prescribe antibiotics if you're having specialized EUS procedures, such as to drain a fluid collection or a cyst using EUS guidance. Again, tell your doctor about any allergies to medications.

Should I arrange for help after the examination?

If you received sedatives, you won't be allowed to drive after the procedure, even if you don't feel tired. You should arrange for a ride home. You should also plan to have someone stay with you at home after the examination, because the sedatives could affect your judgment and reflexes for the rest of the day.

What can I expect during EUS?

Practices vary among doctors, but for an EUS examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes between 15 to 45 minutes. Most patients consider it only slightly uncomfortable, and many fall asleep during it. 

An EUS examination of the lower gastrointestinal tract can often be performed safely and comfortably without medications, but you will probably receive a sedative if the examination will be prolonged or if the doctor will examine a significant distance into the colon. You will start by lying on your left side with your back toward the doctor. Most EUS examinations of the lower gastrointestinal tract last from 10 to 30 minutes.

What happens after EUS?

If you received sedatives, you will be monitored in the recovery area until most of the sedative medication's effects have worn off. If you had an upper EUS, your throat might be sore. You might feel bloated because of the air and water that were introduced during the examination. You'll be able to eat after you leave the procedure area, unless you're instructed otherwise. 

Your doctor generally can inform you of the results of the procedure that day, but the results of some tests will take longer.

What are the possible complications of EUS? 

Although complications can occur, they are rare when doctors with specialized training and experience perform the EUS examination. Bleeding might occur at a biopsy site, but it's usually minimal and rarely requires follow-up. You might have a sore throat for a day or more. Nonprescription anesthetic-type throat lozenges and painkillers help relieve the sore throat. Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; backwash of stomach contents into your lungs; infection; and complications from heart or lung diseases. One major, but very uncommon, complication of EUS is perforation. This is a tear through the lining of the intestine that might require surgery to repair. 

The possibility of complications increases slightly if a deep needle aspiration is performed during the EUS examination. These risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

What is Capsule Endoscopy?

Pill Cam

Capsule Endoscopy is a term used to describe a miniature capsule used to record images through the digestive tract for use in medicine. The capsule contains an imaging system, often a camera, with the size and shape of a pill used to visualize the gastrointestinal tract. The procedure was approved by the U.S. Food and Drug Administration (FDA) in 2001. It is an imaging device used to diagnose diseases and disorders of the gastrointestinal tract.

You can see our brochure for more information.

Uses

Capsule endoscopy is used as a less-invasive procedure in placement of an traditional endoscope, which is a long, thin tube inserted into the rectum and transversed through the colon or, alternatively, through the mouth and into the stomach and small intestine as a means of mechanically-assisted visualization of these structures. The technology is used by gastroenterologists to detect diseases such as Crohn's disease, gastric ulcers, and colon cancer. At the present time, the capsule camera is primarily used to visualize the small intestine. Whereas the upper gastrointestinal tract (esophagus, stomach, and duodenum) and the colon (large intestine) can be very adequately visualized with scopes (cameras placed at the ends of thin flexible tubes), the small intestine is very long (average 20-25 feet) and very convoluted. No available scope is able to traverse the entire length of the small intestine. Because the capsule is swallowed and travels through the digestive system, capsule endoscopy takes a longer amount of time than traditional endoscopy. The images are of good quality, comparable to those from scopes. The test carries a high sensitivity and specificity for detecting lesions. Early research has shown that capsule endoscopy can detect evidence of disease in some cases that traditional endoscopy cannot.

Recent developments

Ongoing research is continuing in the United States, Israel, Japan, South Korea, and United Kingdom to improve capsule endoscope technology. Sayaka Capsule by RF System of Japan is an advanced capsule with power supplied wirelessly from an external source. In Japan, capsule endoscopy is now approved for use in the small bowel and in Europe, capsule endoscopy is being used for several areas including colon screening since July 2007. The next major development is to enable the capsule to do other functions that are possible with current traditional endoscopes, besides just imaging with a camera. These include multiple therapeutic and diagnostic operations such as ultrasound, electrocautery, biopsy, laser, and heat with a retractable arm.

Here are the Patient Instructions for undergoing SB Capsule Endoscopy

What is Hepatology?

Hepatology

Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree and pancreas as well as management of their disorders. Etymologically the word Hepatology is formed of ancient Greek hepar(ηπαρ) or hepato-(ηπατο-) meaning ' liver' and suffix -logia(-λογια) meaning 'word' or 'speech'. Although traditionally considered a sub-specialty of gastroenterology, rapid expansion has led in some countries to doctors specialising solely on this area, who are called hepatologists.

Diseases and complications related to viral hepatitis and alcohol are the main reason for seeking specialist advice. More than 2 billion people have been infected with Hepatitis B virus at some point in their life, and approximately 350 million have become persistent carriers. Up to 80% of liver cancers can be attributed to either hepatitis B or Hepatitis C virus. In terms of mortality, the former is second only to smoking among known agents causing cancer. With more widespread implementation of vaccination and strict screening before blood transfusion, lower infection rates are expected in the future. In many countries, though, overall alcohol consumption is increasing, and consequently the number of people with cirrhosis and other related complications is commensurately increasing.

Scope of specialty

As for many medical specialties, patients are most likely to be referred by family physicians ( i.e. GP) or by doctors from different disciplines. The reasons might be:

  • Drug overdose. Paracetamol overdose is common.
  • Gastrointestinal bleeding from portal hypertension related to liver damage
  • Abnormal blood test suggesting liver disease
  • Enzyme defects leading to bigger liver in children commonly named storage disease of liver
  • Jaundice / Hepatitis virus positivity in blood, perhaps discovered on screening blood tests
  • Ascites or swelling of abdomen from fluid accumulation, commonly due to liver disease but can be from other diseases like heart failure
  • All patients with advanced liver disease e.g. cirrhosis should be under specialist care
  • To undergo ERCP for diagnosing diseases of biliary tree or their management
  • Fever with other features suggestive of infection involving mentioned organs. Some exotic tropical diseases like hydatid cyst, kala-azar or schistosomiasis may be suspected. Microbiologists would be involved as well
  • Systemic diseases affecting liver and biliary tree e.g. haemochromatosis
  • Follow up of liver transplant
  • Pancreatitis - commonly due to alcohol or gall stone
  • Cancer of above organs. Usually multi-disciplinary approach is under taken with involvement of oncologist and other experts.

 

Patient Portal

Announcing our new and secure web portal just for our esteemed patients!

Login Now
GI SPECIALISTS
  • Gastroenterology
  • Colonoscopy
  • Balloon Enteroscopy
  • Flexible Sigmoidoscopy
  • ERCP/Choledochoscopy
  • EUS
  • Liver Biopsy
Read More
Contact Us

Miami Office

Address8525 SW 92nd Street, Suite C-10
Miami, FL 33156-7365

Homestead Office

Address975 Baptist Way, Suite 202
Homestead, FL 33033

Contacts for Both Offices

Telephone (305) 274-7800

Fax (305) 270-1246

Email administrationatmiamigastro.org

Contact

Connect with us