of the population experience problems related to the digestive system. These include difficulty in swallowing food or fluids,
reflux, heartburn and chest pain.
Constipation, diarrhoea and abdominal pain that persist may require more indepth investigations into the causes.
One of the Mayo Day Clinic's newest additions is the introduction of a specialised gastro-intestinal enterology unit.
- Upper endoscopy
Colonoscopy - Examining the lining of your colon
ERCP - Examining the ducts of the gallbladder, pancreas and liver
Oesophageal manometry - Oesophageal motility disorders
A gastroscopy lets your doctor examine the lining of the upper part of your gastrointestinal tract, which includes the oesophagus, stomach and duodenum (first portion of the small intestine). Your doctor will use a thin, flexible tube called a gastroscope, which has its own lens and light source, and will view the images on a video monitor. You might hear your doctor or other medical staff refer to a gastroscopy as an upper GI endoscopy.
Why are gastroscopies done?
Your doctor might use upper endoscopy to obtain a biopsy. A biopsy helps your doctor distinguish between benign and malignant tissues. Your doctor might use a biopsy to test for Helicobacter pylori, the bacterium that causes ulcers. He may introduce a small brush to collect cells to perform a cytology test.
Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract. Your doctor can pass instruments through the endoscope to directly treat many abnormalities with little or no discomfort. For example, your doctor might stretch a narrowed area, remove polyps or treat bleeding.
How should I prepare for the procedure?
An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately ten hours before the examination.
Tell your doctor in advance about any medications you take; you might need to adjust your usual dose for the examination. Discuss any allergies to medications as well as medical conditions, such as heart or lung disease.
What can I expect during a gastroscopy?
If you received sedatives, you won't be allowed to drive after the procedure even though you might not feel sleepy. You should arrange for someone to accompany you home because the sedatives affect your judgment and reflexes for the rest of the day. You should also apply for a day's leave of absence from work.
What are the possible complications of gastroscopy procedures?
A colonoscopy enables your doctor to examine the lining of your colon for abnormalities by inserting a flexible tube (as thick as your finger) into your anus and slowly advancing it into the rectum and colon. This allows the doctor to see the lining of your large bowel. Sometimes a sample of the lining of the bowel (a biopsy) may be taken and sent to pathology for analysis. This is painless. If polyps (an overgrowth of bowel tissue) are found, they can be removed during the procedure.
What preparation is required?
Here is an example of a typical preparation procedure prior to going for a
Can I take my current medications?
What happens during the colonoscopy examination?
What if the colonoscopy shows something abnormal?
What are polyps and why are they removed?
How are polyps removed?
What happens after a colonoscopy?
You must arrange for someone to drive you home and stay with you. You must not drink alcohol, operate machinery or sign important documents for at least 24 hours following the sedative. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You may have some cramping or bloating because of the air introduced into the colon during the examination. You should also apply for a day's leave of absence from work.
You should be able to eat after the examination, but your doctor might restrict your diet and activities, especially after a polypectomy. You may find that your bowels do not immediatly return to normal
What are the possible complications of colonoscopy?
One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but it's usually minor. Bleeding can stop on its own or be controlled through the colonoscope; it rarely requires follow-up treatment. Some patients might have a reaction to the sedatives or complications from heart or lung disease.
Although complications after a colonoscopy procedure are uncommon, it's important to recognise early signs of possible complications.
If any of the follwoing occur within 48 hours after a colonoscopy consult a doctor immediately:
Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialised technique used to study the ducts of the gallbladder, pancreas and liver. Ducts are drainage routes and the drainage channels from the liver are called bile or biliary ducts.
During an ERCP, your doctor will pass an endoscope through your mouth, oesophagus and stomach into the duodenum. 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, he will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a dye into the pancreatic or biliary ducts and will take X-rays.
What preparation is required?
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 may need to remove stones which have collected in the biliary or pancreatic ducts. He will do this at the same time as the ERCP using either a stone extraction basket, or by dilating the duct to enable the stones to pass through naturally.
What are possible complications of ERCP?
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 a therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing a diagnostic ERCP. Your doctor will discuss your likelihood of complications before you undergo the test.
What can I expect after an ERCP?
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.
Please contact your doctor promptly if you have any follow-up questions or if you are experiencing any complications due to the procedure.
This was introduced at the Mayo Day Clinic as an important extension to our endoscopy theatre as an aid to the effective diagnosis and treatment of oesophageal motility disorders.
After patients have had a gastroscopic evaluation performed by a physician in the Mayo Day Clinic's endoscopy theatre, abnormalities may indicate that further tests are required. This is when an oesophageal manometry investigation and pH study is recommended in our gastro-intestinal unit.
Oesophageal manometry is the recording of muscle pressures within the oesophagus, including the evaluation of muscle waves in the main section of the oesophagus, as well as the valve at the end of it. The 24 hour pH monitoring is very important in the diagnosis of acid exposure caused by reflux.
The procedure is very simple. After a local anaesthetic is sprayed into your throat, a thin, soft tube is gently passed through the nose into the throat. With swallowing, the tip of the tube enters the oesophagus and the technician then quickly passes it down to the desired position. Swallow tests are recorded and the tube is then removed. A second, smaller tube is then inserted and passed into the stomach. The catheter is attached to a pH recorder, a small instrument which hangs from a strap around your shoulder, and the you are then sent home. The following day you return and the catheter is removed. The technician downloads the information from the recorder onto a computer for analysis and interpretation. Notes that you have made during the 24 hour period detailing when you had heartburn or chest pain, when you ate and when you slept are correlated with the computer data.
These test will indicate to the physician what the best treatment will be for your condition, be it conservative or surgical.
The above graph is an ambulatory pH study on a patient where the electrode was placed 5cm above the lower oesophageal sphincter. Acid reflux was defined as a drop in pH below 4.0 (indicated by the red line).
The total length of the study was 21 hours 33 minutes. During this period the patient experienced 243 acid refluxes with seven of them lasting more than five minutes. The study revealed a deMeester score of 55.5, where normal is less than 14.72, indicating signs of pathological acid reflux. The lower oesophageal sphincter is defined as incompetent with the function of the oesophagus revealing occasional dropped swallows as well as low amplitude peristaltic contractions.