Procedures
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A flexible endoscope with a diameter of 12 mm is inserted into the food pipe (esophagus), stomach and upper part of the small bowel (duodenum). The procedure allows to visualize all tissues in high definition quality and take small tissue samples with a biopsy forceps which is a non painful. Other interventions are hemostasis of bleeding gastric or duodenal ulcers, dilatation of strictures of the esophagus, stent insertion in complicated strictures of esophagus and duodenum and others.
You must be nil by mouth for solids for at least 6 hours prior to the procedure.
A specialist anaesthetist will look after you throughout the procedure ensuring that you do not suffer any pain and you are well sedated. The duration of a endoscopy is between 10 – 15 minutes. After the procedure you will be looked after for about 1 hour in recovery until completely awake and free of any discomfort.
Please be aware that you are not allowed to drive a car , operate any dangerous machinery or sign any documents in the 24 hours following the procedure. A next of kin or friend has to look after you overnight to ensure you are well and comfortable.
If any tissue samples have been taken your GP will obtain a copy of the results and my recommendations about 2 working days post procedure. If required, I will see you in my rooms to discuss the results or initiate any treatments.
You might forget that I have explained my findings to you after the procedure as some of the medication you get for sedation might cause post procedural forgetfulness for some time. As a consequence I will give you a brief explanation of your findings in written form.
A flexible endoscope is inserted from the anus into the large bowel. All parts of the large bowel can usually be visualized and if needed the lower part of the small bowel (terminal ileum) can be seen as well. Indications for a colonoscopy include chronic diarrhea, rectal bleeding, removal of colonic polyps (small tissue growths which can turn cancerous), recurrent abdominal pain and others.
Small biopsies can be obtained without pain to allow tissue diagnostics under the microscope.
A colonoscopy is a low risk procedure. Major complications are rare but possible. They include bleeding from a polypectomy site (site where growths have been removed), damage of adjacent organs and perforation. The statistical risk of perforation of the bowel in a healthy patient is 1:3500. In case of a perforation surgery may be required to avoid further complications.
Thorough bowel preparation prior to the procedure is absolutely crucial to ensure that we do have optimal views of the tissues in order to minimize the risk of missing any pathology. A dedicated nurse will explain in a meeting how the bowel preparation is performed. We hand out a booklet which explains step by step how to ensure the optimal outcome of the bowel preparation.
On the day of the procedure, I will discuss any questions prior to the procedure with you. A specialist anaesthetist is looking after you throughout the procedure ensuring that you do not suffer any pain and you are well sedated. The duration of a colonoscopy is between 20 – 30 minutes. After the procedure you will be looked after for 1 – 2 hours in recovery until completely awake and free of any discomfort.
Please be aware that you are not allowed to drive a car , operate any dangerous machinery or sign any documents in the 24 hours following the procedure. A next of kin or friend has to look after you overnight to ensure you are well and comfortable.
If any tissue samples have been taken your GP will obtain a copy of the results and my recommendations about 2 working days post procedure. If required, I will see you in my rooms to discuss the results or initiate any treatments.
You might forget that I have explained my findings to you after the procedure as some of the medication you get for sedation might cause post procedural forgetfulness for some time. As a consequence I will give you a brief explanation of your findings in written form.
What is a PEG?
PEG stands for percutaneous endoscopic gastrostomy. It is an endoscopic medical procedure in which a flexible feeding tube is placed through the abdominal wall into the stomach.
It provides a mean of feeding when oral intake is inadequate allowing nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus.
How is the PEG performed?
This procedure is generally performed with a mild sedation. The doctor will use a lighted flexible tube called an endoscope to guide the creation of a small opening through the skin of the upper abdomen directly into the stomach. This procedure allows the doctor to place and secure a feeding tube into the stomach. Patients can usually go home the day of the procedure or the next day.
Who can benefit from a PEG?
May be indicated in numerous situations, usually those in which normal nutrition (or nasogastric) feeding is impossible. The causes for these situations may be neurological (e.g. stroke), anatomical (e.g. cleft lip and palate) or other (e.g. radiation therapy for tumors in head & neck region, lack of appetite).
This is a procedure that allows your doctor to dilate/stretch a narrowed area (=stricture) of your esophagus. Your doctor will perform the procedure as part of an upper gastrointestinal (GI) endoscopy under sedation. o The most common cause for a narrowing of the esophagus is the result of years of reflux of acidic stomach contents into the esophagus. I will use a special catheter with a balloon at its tip to treat the stricture. This catheter is inserted into the narrowing under vision. The balloon at the tip of the catheter can be insufflated with air and is used to stretch the narrowing.
An esophageal dilatation is generally a safe procedure but some patients might have an increased risk of a tear. Potential risks and complications will be discussed thoroughly on a case by case basis.
A stent is made out of plastic or from an expandable metal mesh tube. It can be used to bridge a narrowing or obstruction of the gastrointestinal tract. They can be inserted into the esophagus, duodenum, bile duct or large bowel. Stents are placed via an endoscope. Stenting is a minimally invasive procedure and can often help avoid or delay the need for surgery. It can improve a patient’s well-being and overall quality of life.
Capsule endoscopy helps doctors see inside your small intestine, an area of your gastrointestinal tract (GI) not reached with conventional endoscopy.
The procedure uses a tiny wireless camera that sits inside a small capsule that you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist or over your shoulder. Following the procedure, the colour video taken from the capsule will be reviewed. The pillcam is single use only.
The procedure is usually started in a doctor’s office and does not require sedation.
A capsule endoscopy is performed to investigate conditions such as:
- Chronic blood loss (iron deficiency anaemia)
- Crohn’s Disease*
- Coeliac Disease*
- Small Bowel tumours*
* No medicare rebate available for this indication
A faecal calprotectin test can now be performed in the practice within 20 minutes.
This test measures the level of calprotectin protein in your faeces. Calprotectin is predominantly found in neutrophils (a type of white blood cell) responsible for inflammation in the intestine. The higher the concentration of calprotectin, the more inflammation present. The result of this test can accurately indicate if inflammation is present in the bowel, which could indicate Inflammatory Bowel Disease (IBD). A colonoscopy would then be required to differentiate between Ulcerative Colitis and Crohns Disease.
The test is also useful for monitoring treatment in IBD — it can identify anyone who appears to be in remission or who is at an increased risk of early relapse. Even in cases of successful treatment, a low level of inflammation can persist, increasing the chance of a relapse.
What is a Hydrogen Breath Test (HBT)?
A hydrogen breath test (HBT)* is a diagnostic tool for small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption, such as lactose, fructose, and sorbitol malabsorption.How is it performed?
The test is very safe, even for people with diabetes, pregnant women and children > 5 yrs. of age. It is non-invasive and simple, taking between 2-3 hours to perform. To ensure accurate and reliable results the test is performed following a 24-hour restrictive diet and short period of fasting (typically 8–12 hours).Who should have a Hydrogen Breath Test?
It should be considered in people having unexplained abdominal symptoms particularly after eating, like bloating, pain or diarrhoea.Contraindications
Contraindicated in people with hereditary fructose intolerance, post-prandial hypolycaemia, and ileostomies.Studies have shown that some patients do not produce hydrogen, but are methane producers. In these people the test will not predict malabsorption or SIBO, hence the need for the Lactulose control test to determine hydrogen production.
* This is not a medicare rebated procedure.