Our Procedures
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The following information is intended to provide patients with information about some of then medical procedures performed by Gastroenterology Group of Rochester.
To learn more about our Endoscopy Suite procedures, simple click on the links below.
| Colonoscopy / Polyp Removal | Flexible Sigmoidoscopy | | Moderate (conscious) sedation
View our In-Office Endoscopy Suite
Capsule Endoscopy
Capsule Endoscopy allows your doctor to examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). You will swallow a pill sized capsule camera. You might hear your doctor or other medical staff refer to capsule endoscopy as capsule enteroscopy, or wireless capsule endoscopy.
Why is Capsule Endoscopy Done?
Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn's disease), ulcers, and tumors of the small intestine.
As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.
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 twelve hours before the examination. Your doctor will tell you when to start fasting.
Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other "over-the-counter" medications. You might need to adjust your usual dose prior to the examination.
Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease. Tell your doctor of the presence of a pacemaker, previous abdominal surgery, or previous history of obstructions in the bowel, inflammatory bowel disease, or adhesions.
What Can I Expect During Capsule Endoscopy?
Our staff will prepare you for the examination by applying several adhesive electrodes to your chest and abdomen. The capsule camera (pill cam) is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the study you will return to the office where the data recorder is removed so that images of your small bowel can be downloaded to a computer for your doctor to review at a later date.
What Happens After Capsule Endoscopy?
You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within a few weeks following the study; however, the results of some tests might take longer.
What are the Possible Complications of Capsule Endoscopy?
Although complications can occur, they are rare when doctors who are specially trained and experienced order a capsule endoscopy. Potential risks include complications from obstruction. This usually relates to a stricture (narrowing) of the intestine from inflammation, prior surgery, or tumor. It's important to recognize early signs of possible complications. If you have symptoms such as unusual bloating, pain, and/or vomiting, call your doctor immediately. Also, if you develop a fever after the test, have trouble swallowing or experience increasing chest pain, tell your doctor immediately. Do not disconnect the system as this may result in loss of image acquisition.
Patient instructions for capsule endoscopy
Day before the study::
1. Start a liquid diet at 10 a.m., and do not eat or drink, except with necessary medications taken with a sip of water after 6 p.m.
2. Do not take any medications for 2 hours before examination.
3. No smoking for 24 hours before examination.
4. Male patients need to shave from the nipple line to 6 inches below the navel.
Day of study:
1. Arrive at the office dressed in loose fitting, two piece clothing at 8:30 a.m..
2. You will have a pre-study interview with the medical assistant or nurse where you will be given the chance to ask questions.
3. You will be required to sign an informed consent.
4. Adhesive sensor pads will be applied to your abdomen and chest, and you will wear a belt with a data recorder around your waist.
5. You will be instructed to swallow the capsule (pill cam)..
After ingesting the capsule::
1. Do not eat or drink for at least 2 hours. After 4 hours you may have a light snack (1/2 sandwich, soup, salad)..
2. Do not go near any powerful electromagnetic fields (i.e. MRI, or amateur (ham) radio.
3. Do not disconnect or remove the belt during the study.
4. Avoid sudden movement or banging data recorder, treat it with the utmost care.
5. Verify every 15 minutes that the blue light is blinking twice per second. If not, contact the office.
6. Record the time and nature of events such as eating, drinking, or activity.
7. Avoid any strenuous physical activity, especially if sweating is involved. Do not bend or stoop during examination.
8. Do not shower until the sensor pads and data recorded have been removed by GGR staff.
Return to the office in 8 hours for removal of sensor pads, data recorder and return event sheet. It may take several days for the capsule to pass. If you don't visibly see the capsule pass, you may need an x-ray.
DO NOT HAVE AN MRI IF YOU HAVE NOT SEEN THE CAPSULE PASS.
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Colonoscopy Patient Education Colonoscopy Video
What is Colonoscopy?
For the procedure you will be lying on your left side on a stretcher. Your do
ctor will insert a thin flexible tube into your rectum and slowly guide it into your colon (the tube is called a colonoscope). The scope transmits an image of the inside of the colon onto a monitor. The colonoscope is capable of introducing air, which opens the bowel lumen, allowing your doctor to thoroughly evaluate the mucosa.
Why is Colonoscopy done?
Colonoscopy enables your doctor to look at the inside of the large intestine from the rectum through the last part of the colon, called the cecum. Colonoscopy is performed to evaluate abdominal pain, diarrhea, constipation, bleeding, and other symptoms. In addition, colonoscopy is deemed the "gold standard" for screening for early signs of colon cancer.
If anything unusual is in your colon, like a polyp or inflamed tissue, your doctor can remove a piece of it using various equipment inserted into the scope. Your doctor will send tissue samples (biopies) to the lab for testing.
How should I prepare for the Colonoscopy?
How do I prepare for the colonoscopy?
Answer: Exact instructions will be given to you when you set up your appointment; the colon must be completely clean for the procedure to be accurate.
What about my current medications?
Answer: Alert the nurse or medical assistant of your current list of prescriptions, over-the-counter drugs, herbal remedies, or sensitivities when setting up the appointment.
Can I have my coffee?
Answer: Yes, you can have black coffee with sugar. No dairy, liquid or dry milk.
What are clear liquids?
Answer: Water, coffee, or tea, strained fruit juices with no pulp (apple juice, white grape juice), soft drinks, sports drinks (ginger ale, cola, Sprite, 7-Up, Gatorade). Chicken or beef bouillon/ broth low sodium, fat free. Lemon or lime Jello with no fruit or toppings. You can have hard candies. Nothing with red or purple coloring.
Why can't I have red or purple coloring?
Answer: It can leave a residue in the bowel that resembles blood or can obscure the doctor's view.
Why do I need a driver?
Answer: Because moderate sedation is utilized, which impairs judgement and reflexes; arrangements for transportation to and from our facility need to be made in advance.
Can my driver leave the office during the procedure?
Answer: The driver must stay on the premises. Our comfortable waiting room has cable TV, magazines, newspapers, as well as free Wi-Fi.
How soon after the procedure will I return to full activity?
Most people can expect to return to full activities the next day including driving. Your doctor will inform you if there are activity restrictions.
What happens after the procedure?
Colonoscopy takes approximately 15 to 30 minutes. You will be monitored by nursing staff for approximately 30 to 45 minutes post procedure. Due to the air introduced during the procedure, you may notice some cramping or bloating which generally resolves once you pass the air. Patients typically resume their usual diet, unless the doctor instructs otherwise.
Your doctor can give you a summary of her/his findings on the day of your procedure, however, the results of some tests might take several days to be finalized.
Since you will receive sedatives, you will not be allowed to drive after the procedure even though you might not feel tired. You must arrange for someone to accompany you home, because the sedatives impair judgement and reflexes for the rest of the day. Driving is restricted until the following day.
Moderate (Conscious) Sedation
We use a form of IV sedation/anesthesia called moderate (conscious) sedation. Moderate sedation is a drug-induced depression of consciousness, which also minimizes the stress and and anxiety almost always associated with any medical procedure. iAlthough these drugs do not produce deep unconsciousness, they often leave the patient with little or no memory of the procedure (short-term amnesia). In fact, at the conclusion of most tests, patients usually ask, "When are you going to start?"
Monitoring
If you have a procedure in the GGR Endoscopy unit, monitoring devices will be placed on your body prior to your procedure. These sophisticated devices are more precise extensions of our own senses. Safety during your procedure is of the utmost importance to our Endoscopy team.
These devices are:
- Blood pressure cuff - measures your blood pressure at frequent intervals during your procedure. This may be tight on your arm for a few seconds, and will cycle approximately every 5 minutes. The first time is usually the tightest as the machine senses your normal blood pressure range.
- Pulse oximeter - a device placed on your finger, toe, or earlobe that measures the amount of oxygen in your body at all times and in addition displays your pulse rate.
- EKG (electrocardiogram) - If you are connected to the electrodes, a constant picture of your heart tracing is displayed on a monitor screen. These small electrodes may be placed on your chest or back to gather this information.
In summary, these monitoring devices improve the safety of the administration of your sedation, allowing you to feel more comfortable and less anxious about your procedure.
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Flexible Sigmoidoscopy
The digestive system
Flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) enables the physician to look at the inside of the large intestine from the rectum through approximately one-third of the colon. This procedure can be performed in an exam room or in the endoscopy suite. Physicians may use the procedure to find the cause of diarrhea, abdominal pain, bleeding, or constipation. With flexible sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers in the lower one-third of the colon. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the upper two-thirds of the colon. Colonoscopy is the gold standard for screening for early signs of colon cancer. note to sandy, link colonoscopy - look for flex sig picture remove picture to right
For the procedure, you will lie on your left side on the stretcher or office exam table. The physician will insert a flexible tube into your lower colon. The scope transmits an image of the inside of the colon, onto a monitor. The scope introduces air, which opens the bowel lumen, allowing your doctor to thoroughly evaluate the mucosa.
If anything unusual is in your colon, like a polyp or inflamed tissue, the physician can remove a piece of it using various equipment.. The physician will send tissue samples (biopsy) to the lab for testing.
Flexible sigmoidoscopy takes approximately 5 to10 minutes. You may notice some cramping or bloating following the procedure, which generally resolves once you pass the air.
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Polyp Removal
What Is a Colon Polyp?
Polyps are benign growths involving the lining of the bowel (noncancerous tumors or neoplasms). They can occur in several locations in the gastrointestinal tract but are most common in the colon. They vary in size from several millimeters (mm) to several centimeters (cm) in diameter. They look like small bumps growing from the lining of the bowel and protruding into the lumen (bowel cavity). Occasionaly, they grow on a "stalk" and look like mushrooms. Many patients have several polyps scattered in different parts of the colon.
How Common Are Colon Polyps? What Causes Them?
Polyps are very common in adults, who have an increased chance of acquiring them as they age. While quite rare in 20-year-olds, it's estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp. We don't know what causes polyps. Some experts believe a high-fat, low-fiber diet can be a predisposition to polyp formation. There may be a genetic risk to develop polyps as well.
What Are Known Risks for Developing Polyps?
The biggest risk factor for developing polyps is being older than 50. A family history of colon polyps or colon cancer increases the risk of polyps. Also, patients with a personal history of polyps or colon cancer are at risk of developing new polyps. In addition, there are some rare polyp or cancer syndromes that run in families and increase the risk of polyps occurring at younger ages.
Are There Different Types of Polyps?
There are two common types: hyperplastic polyp and adenoma. The hyperplastic polyp is not at risk for cancer and, therefore, is not as significant. The adenoma, however, is thought to be the precursor (origin) for almost all colon cancers, although most adenomas never become cancers, an evaluation under a microscope by a pathologist is the only way to differentiate between hyperplastic and adenomatous polyps. Because your doctor cannot be certain of the tissue type by the polyp's appearance, doctors generally recommend removing all polyps whenever possible.
How Are Polyps Found?
Most polyps cause no symptoms. Larger ones can cause blood in the stools, but even they are usually asymptomatic. Therefore, the best way to detect polyps is by screening individuals with no symptoms. Several other screening techniques are available: testing stool specimens for traces of blood, performing sigmoidoscopy to look into the lower third of the colon, or using a radiology test such as a barium enema. If one of these tests finds or suspects polyps, your doctor will generally recommend colonoscopy to remove them. Because colonoscopy is the most accurate way to detect polyps, many experts now recommend colonoscopy as a screening method so that any polyps found or suspected can be removed during the same procedure.
How Are Polyps Removed?
Most polyps found during colonoscopy can be completely removed during the procedure. Various removal techniques are available; most involve using a wire loop or a biopsy forcep. Sometimes the doctor burns the base of the polyp with an electric current. This is called a polypectomy. Because the bowel does not have pain receptors, a polypectomy doesn't cause discomfort. All polyps are sent to the lab to evaluate tissue type and to detect any cancer.
What Are the Risks of Polyp Removal?
Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure. Possible complications, which are uncommon, include bleeding, infection, an d perforation (a hole) of the colon. Your doctor will discuss any questions you may have regarding polypectomy.
How Often Do I Need Colonoscopy if I Have Polyps Removed?
Your doctor will recommentd when your next colonoscopy is necessary. The timing depends on several factors, including the number and size of polyps removed, the polyps' tissue type and the quality of the colon cleansing of your previous procedure. (The quality of cleansing affects your doctor's ability to examine the lining of your colon.)
If the polyps were small and the entire colon was well seen during your colonoscopy, doctors generally recommend a repeat colonoscopy in three years. If your repeat colonoscopy doesn't show any indication of polyps, you might not need another procedure for an additional five years. However, if the polyps were large and flat, your doctor might recommend an interval of only months before a repeat colonoscopy to assure complete polyp removal. Your individual status, family history, and the quality of your bowel preparation will determine when your next colonoscopy is recommended. Your doctor will discuss these situations with you, so you can understand the reason she/he recommended a particular interval.
Gastroscopy/EGD (Upper Endoscopy)
What is upper endoscopy?
Upper endoscopy allows your doctor to examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). Your doctor will guide a thin, flexible tube called an endoscope, which transmits an image of the inside of the esophagus, stomach and duodenum. You might hear your doctor or other medical staff refer to upper endoscopy as upper GI endoscopy, esophagogastroduodenoscopy (EGD) or gastroscopy.
Why is upper endoscopy done?
Upper endoscopy helps your doctor evaluate symptoms of persistent abdominal pain, nausea, vomiting, difficulty swallowing, and other symptoms. It's an excellent test for finding the cause of bleeding from the upper gastrointestinal tract. It's also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.
Your doctor might use upper endoscopy to obtain a biopsy (small tissue sample). A biopsy helps your doctor distinguish between benign and malignant (cancerous) tissues. Remember, biopsies are taken for many reasons, and your doctor might order one even if he or she does not suspect cancer. For example, your doctor might use a biopsy to test for helicobacter pylori, a bacteria that can cause ulcers. An EGD can be used to perform a cytology test, where a small brush is introduced to collect cells for analysis. In addition, your doctor can pass instruments to directly treat some abnormalities including stretching a narrowed area, removing polyps (usually benign growths), or cauterizing bleeding areas.
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 4-6 hours before the examination. Follow your gastroenterologist's instructions for when to start fastiing.
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 upper endoscopy?
Your doctor typically starts by spraying your throat with a local anesthetic followed by administering a sedative to help you relax. For the procedure, you will be lying on your left side; once sedated, your doctor will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope will not interfere with your breathing and the procedure is generally well-tolerated.
What happens after upper-endoscopy?
You will be monitored by the nursing staff for approximately 30-45 minutes. You may feel bloated due to the air introduced during the test. Occasionally, there may be soreness in the throat, which resolves quickly after the procedure. Generally, patients are able to resume their usual diet, unless your doctor instructs you otherwise.
Your doctor can give you a summary of her/his findings on the day of the procedure; however, the results of some tests might take several days.
Since you will receive sedatives, you will not be allowed to drive after the procedure even though you might not feel tired. You must arrange for someone to accompany you home because the sedatives impair judgment and reflexes for the rest of the day. Driving is restricted until the following day.