Patient FAQ

This page has been prepared to help you understand the procedure. It includes answers to questions patients ask most frequently. Please read it carefully. If you have any additional questions, please feel free to discuss them with the endoscopy nurse or your physician before the examination begins.

You may also view the patient preparation information:
Patient Procedure Instructions

Understanding Flexible Sigmoidoscopy

What is flexible sigmoidoscopy?

Flexible sigmoidoscopy is a procedure that enables your physician to examine the lining of the rectum and a portion of the colon (large bowel) by inserting a flexible tube that is about the  thickness of your finger into the anus and advancing it slowly into the rectum and lower part of the colon.

What preparation is required?

The rectum and lower colon must be completely empty of waste material for the procedure to be accurate and complete.  Your physician will give you detailed instructions regarding the cleansing routine to be used.  In general, preparation consists of one or two enemas prior to the procedure but may include laxatives or dietary modifications.  In some circumstances, for example, if you have acute diarrhea or colitis, your physician may advise you to forgo any special preparation before the examination.

What about my current medications?

Most medications can be continued as usual.  You should inform your physician of all current medications as well as any allergies to medications several days prior to the examination.  However, drugs such as aspirin or anticoagulants (blood thinners) are examples of medications whose use should be discussed with your physician.  You should alert your doctor if you require antibiotics prior to undergoing dental procedures, since you may need antibiotics prior to sigmoidoscopy as well.

What can be expected during flexible sigmoidoscopy?

Flexible sigmoidoscopy is usually well tolerated and rarely causes much pain.  There is often a feeling of pressure, bloating, or cramping at various times during the procedure.  You will be lying on your side while the sigmoidoscope is advanced through the rectum and colon.  As the instrument is withdrawn, the lining of the intestine will be examined.  The procedure usually takes anywhere from 5 to 15 minutes.

What if the flexible sigmoidoscopy shows something abnormal?

If the doctor sees an area that needs evaluation in greater detail, a biopsy (sample of the colon lining) may be obtained and submitted to a laboratory for greater analysis.  If polyps (growths from the lining of the colon which vary in size) are found, they can be biopsied, but usually are not removed at the time of the  sigmoidoscopy.  Polyps area of varying types; certain benign polyps, known as "adenomas," are potentially precancerous.  Certain other  polyps ("hyperplastic" by biopsy analysis) may not require removal. Your doctor will likely request that you have a colonoscopy (a complete examination of the colon) to remove any large polyps found, or any small polyp that is adenomatous after biopsy analysis.

What happens after flexible sigmoidoscopy?

After sigmoidoscopy, the physician will explain the results to you.  You may have some mild cramping or bloating sensation because of the air that has been passed into the colon during the examination.  This will disappear quickly with the passage of gas. You should be able to eat and resume your normal activities after leaving your doctor's office or the hospital.

What are possible complications of flexible sigmoidoscopy?

Flexible sigmoidoscopy and biopsy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.  Possible complications include a perforation (tear through the bowel wall) and bleeding from the site of the biopsy.

Although the complications after flexible sigmoidoscopy are rare, it is important for you to recognize early signs of any possible complication.  Contact your physician if you notice any of the following symptoms:  severe abdominal pain, fevers and chills, or rectal bleeding of more than one-half a cup.  It is important to note that rectal bleeding can occur several days after a biopsy.

To the patient

Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure.  If you have any questions about your need for flexible sigmoidoscopy, alternative tests, the cost of the procedure, methods of billing, or insurance coverage, do not hesitate to speak to your doctor or doctor's office staff about it. most endoscopists are highly trained specialists and welcome your questions regarding their credentials and training.  If you have questions that have not been answered, please discuss them with the endoscopy nurse or your physician before the examination begins.

Understanding ERCP (Endoscopic Retrograde Cholangiopancreatography)

What is ERCP?

ERCP is a specialized technique used to study the ducts (drainage routes) of the gallbladder, pancreas, and liver.  An endoscope (flexible thin tube that allows the physician to see inside the bowel) is passed through the mouth, esophagus, and and stomach into the duodenum (first part of the small intestine). After the common opening to ducts from the liver and pancreas is visually identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts.  Contrast material ("dye") is then injected gently into the ducts and x-ray films are taken.

Why is ERCP done?

ERCP is a valuable tool that is used for diagnosing many diseases of the pancreas, bile ducts, liver, and gallbladder. Structural abnormalities suggested by symptoms, physical examination, laboratory tests, or x-ray films can be shown in detail, and biopsies of abnormal tissue can be obtained if necessary. ERCP can make the important distinction between whether  jaundice (yellow discoloration of the eyes and skin) is caused by diseases such as hepatitis, which are treated medically, or by structural diseases, such as gallstones, tumors, or strictures (obstructing scar tissue), which are treated surgically or endoscopically.  For patients who are not jaundiced but have pain or laboratory abnormalities suggesting biliary or pancreatic disease, ERCP may also provide important diagnostic information. ERCP can be used to determine whether or not surgery is necessary and is helpful in providing the anatomic detail the surgeon needs to plan an operation when surgery is necessary.  Because x-ray films or scans may be taken, it is important that women of childbearing age tell their physician if they are pregnant.  The the information provided by an ERCP is far more detailed than that provided by standard x-ray films or scans.

Diagnostic ERCP is the necessary first step for therapeutic ERCP.  Several conditions of the biliary or pancreatic ducts can be treated (cured or improved) by therapeutic ERCP techniques that can open the end of the bile duct, extract stones, and place stents (plastic drainage tubes) across obstructed ducts to improve their drainage.

What preparation is required?

It is necessary to have a completely empty stomach for the best possible examination.  You should, therefore fast for at least 6 hours (and preferably overnight) before the procedure.  An allergy to iodine-containing drugs (contrast material or "dye") is not a contraindication to ERCP, but it should be discussed with your physician prior to the procedure.  The physician performing the procedure should be informed of any medications that you take regularly, any heart or lung conditions (or any other major diseases), and whether you have any drug allergies.

Someone must accompany you home from the procedure because of the sedation used during the examination.  Even if you feel alert after the procedure, your judgment and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery,  if a complication occurs, you may need to be hospitalized until it resolves.

What can be expected during ERCP?

Your physician will discuss why ERCP is being performed, potential complications from ERCP, and alternative diagnostic or or therapeutic tests that are available.  A local anesthetic may be applied to your throat and an intravenous sedative may be given to make you more comfortable during the test.  Some patients also receive antibiotics before the procedure.  The test begins with you lying on you left side on an x-ray table.  The endoscope is passed through the mouth, esophagus, and stomach into the duodenum.  The instrument does not interfere with breathing.  Air is introduced through the instrument and may cause temporary bloating during and after the procedure.  The injection of contrast material into the ducts rarely causes discomfort.

What are possible complications of ERCP?

ERCP is generally a well-tolerated procedure when performed by physicians who have had special training and experience in this technique.  Localized irritation of the vein into which medications were given may rarely cause a tender lump that may last several weeks.  The application of heat packs or hot moist towels to the area may ease the discomfort.

Major complications requiring hospitalization can occur bur are uncommon during diagnostic ERCP.  They include serious pancreatitis and even more rarely infections, bowel perforation, and bleeding.  Another potential risk of ERCP is an adverse reaction to the sedative used.  The risks of the procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, eg, heart or lung diseases.  Your physician will tell you what is your likelihood of complications before undergoing the test.

If therapeutic ERCP is performed (cutting an opening in the bile duct, stone removal, dilation of a stricture, stent or drain replacement, etc), the possibility of complications is higher than with diagnostic ERCP; complications include pancreatitis, bleeding, and bowel perforation.  These risks must be balanced against the potential benefits of the procedure and the risks of alternative surgical treatment of the condition.  Often these complications can be managed without surgery, but occasionally they do require corrective surgery.

What can be expected following ERCP?

If you are having ERCP as an outpatient, you will be kept under observation until most of the effects of the medications have worn off.  Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation is necessary.  You may experience bloating or pass gas because of the air introduced during the examination.  You may resume your usual diet unless you are instructed otherwise.

To the patient

Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure. If you have any questions about your need for ERCP, alternative approaches to your problem, the cost of the procedure, methods of billing, or insurance coverage, do not hesitate to speak to your doctor or doctor's office staff about it. Most endoscopists are highly trained specialists and welcome your questions regarding their credentials and training. If you have questions that have not been answered, please discuss them with the endoscopy nurse or your physician before the examination begins.

Understanding Colonoscopy

What is a Colonoscopy?

Colonoscopy is a procedure that enables your physician to examine the lining of the colon (larger bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it slowly into the rectum and colon.

What preparation is required?

The colon must be completely clean for the procedure to be accurate and complete. Your physician will give you detailed instructions regarding the dietary restrictions to be followed and the cleansing routine to be used. In general, preparation consists of either consumption of a large volume of a special cleansing solution or several days of clear liquids, laxatives, and enemas prior to the examination. Follow your doctor's instructions carefully. If you do not, the procedure may have to be canceled and repeated later.

What about my current medications?

Most medications may be continued as usual, but some medications can interfere with the preparation or the examination. It is therefore best to inform your physician of your current medications as well as any allergies to medications several days prior to the examination. Aspirin products, arthritis medications, anticoagulants (blood thinners), insulin, and iron products are examples of medications whose use should be discussed with your physician prior to the examination. You should alert your doctor if you require antibiotics prior to undergoing dental procedures, since you may need antibiotics prior to colonoscopy as well.

What can be expected during colonoscopy?

Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at times during the procedure. Your doctor may give you medication through a vein to help you relax and better tolerate any discomfort from the procedure. You will be lying on your side or on your back while the colonoscope is advanced slowly through the large intestine. As the colonoscope is slowly withdrawn, the lining is again carefully examined. The procedure usually takes 15 to 60 minutes. In some cases, passage of the colonoscope through the entire colon to its junction with the small intestine cannot be achieved. The physician will decide if the limited examination is sufficient or if other examinations are necessary.

What if the colonoscopy shows something abnormal?

If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or be coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

What are polyps and why are they removed?

Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to several inches. The majority of polyps are benign (noncancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer.

How are polyps removed?

Tiny polyps may be totally destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. The doctor passes a wire loop (snare) through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which could require emergency surgery.

What happens after colonoscopy?

After colonoscopy, your physician will explain the results to you.  If you have been given medications during the procedure, someone must accompany you home from the procedure because of the sedation used during the examination.  Even if you feel alert after the procedure, your judgment and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery.

You may have some cramping or bloating because of the air introduced into the colon during the examination.  This should disappear quickly with passage of flatus (gas).  Generally, you should  able to eat after leaving the endoscopy, but your doctor may restrict your diet and activities after polypectomy.

What are the possible complications of colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.

One possible complication is a perforation or tear through the wall that could require surgery.  Bleeding may occur from the site of biopsy or polypectomy.  It is usually minor and stops on its own or can be controlled through the colonoscope.  Rarely, blood transfusions or surgery may be required.  Other potential risks include a reaction to the sedative used and complications from heart or lung disease.  Localized irritation of the vein where medications were injected may rarely cause a tender lump for several weeks, but this will go away eventually.  Applying hot packs or hot moist towels may help relieve discomfort.

Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication.  Contact your physician who performed the colonoscopy if you notice any of the following symptoms:  severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup.  Bleeding can occur several days after polypectomy.

To the patient

Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure. If you have questions about your need for colonoscopy, alternative tests, the cost of the procedure, methods of billing, or insurance coverage, do not hesitate to speak to your doctor or your doctor's office staff. Most endoscopists are highly trained specialists and welcome your questions regarding their credentials and training. If you have questions that have not been answered, please discuss them with the endoscopy nurse or your physician before the examination begins.

Understanding Upper GI Endoscopy

What is upper endoscopy?

Upper endoscopy (also known as an upper GI endoscopy [EGD], or panendoscopy) is a procedure that enables your physician to examine the lining of the upper part of your gastrointestinal tract, ie, the esophagus (swallowing tube), stomach, and duodenum (first portion of the small intestine) using a thin flexible tube with its own lens and light source.

Why is upper endoscopy done?

Upper endoscopy is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract. Upper endoscopy is more accurate than x-ray films for detecting inflammation, ulcers, or tumors of the esophagus, stomach, and duodenum. Upper endoscopy can detect early cancer and can distinguish between benign and malignant (cancerous) conditions when biopsies (small tissue samples) of suspicious areas are obtained. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. A cytology test (introduction of a small brush to collect cells) may also be performed. Upper endoscopy is also used to treat conditions present in the upper gastrointestinal tract. A variety of instruments can be passed through the endoscope that allow many abnormalities to be treated with little or no discomfort, for example, stretching narrowed areas, removing polyps (usually benign growths) or swallowed objects, or treating upper gastrointestinal bleeding. Safe and effective endoscopic control of bleeding has reduced the need for transfusions and surgery in many patients.

What preparation is required?

For the best (and safest) examination, the stomach must be completely empty. You should have nothing to eat or drink, including water, for approximately 6 hours before the examination. Your doctor will be more specific about the time to begin fasting, depending on the time of day that your test is scheduled. It is best to inform your doctor of your current medications as well as any allergies several days prior to the examination. You should alert your doctor if you require antibiotics prior to undergoing dental procedures, since you may need antibiotics prior to upper endoscopy as well.

Possible medication adjustments?

Before the test, be sure to discuss with the doctor whether you should adjust any of your usual medications before the procedure, any drug allergies you may have, and whether you have any other major diseases such as a heart or lung condition that might require special attention during the procedure.

Arrangements to get home after the test?

If you are sedated, you will need to arrange to have someone accompany you home from the examination because sedatives may affect your judgment and reflexes for the rest of the day. If you received sedation, you will not be allowed to drive after the procedure even though you may not feel tired.

What can be expected during the upper endoscopy?

Your doctor will review with you why upper endoscopy is being performed, whether any alternative tests are available, and possible complications from the procedure. Practices may vary among doctors, but you may have your throat sprayed with a local anesthetic before the test begins and may be given medication through a vein to help you relax during the test. While you are in a comfortable position on your side, the endoscope is passed through the mouth and then in turn through the esophagus, stomach, and duodenum. The endoscope does not interfere with your breathing during the test. Most patients consider the test to be only slightly uncomfortable and many patients fall asleep during the procedure.

What happens after upper endoscopy?

After the test, you will be monitored in the endoscopy area until most of the effects of the medication have worn off. Your throat may be a little sore for a while, and you may feel bloated right after the procedure because of the air introduced into your stomach during the test. You will be able to resume your diet after you leave the procedure area unless you are instructed otherwise. In most circumstances, your doctor can inform you of you test results on the day of the procedure; however, the results of any biopsies or cytology samples taken will take several days.

What are the possible complications of upper endoscopy?

Endoscopy is generally safe. Complications can occur but are rare when the test is performed by physicians with specialized training and experience in this procedure. Bleeding may occur from a biopsy site or where a polyp was removed. It is usually minimal and rarely requires blood transfusions or surgery. Localized irritation of the vein where the medication was injected may rarely cause a tender lump lasting for several weeks, but this will go away eventually. Applying heat packs or hot moist towels may help relieve discomfort. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Major complications, eg, perforation (a tear that might require surgery for repair) are very uncommon. It is important for you to recognize early signs of any possible complication. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest, or abdominal pain, let your doctor know about it promptly.

To the patient

Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure. If you have any questions about your need for upper endoscopy, alternative tests, the cost of the procedure, methods of billing, or insurance coverage, do not hesitate to speak to your doctor or doctor's office staff about it. Most endoscopists are highly trained specialists and welcome your questions regarding their credentials and training. If you have questions that have not been answered, please discuss them with the endoscopy nurse or you physician before the examination begins.

Understanding Liver Biopsy

What is a liver biopsy?

A liver biopsy is a procedure to remove a small piece of the liver so it can be examined for signs of damage or disease. A thin, hollow needle is inserted through the abdomen into the liver to remove the small piece of tissue. To help find the liver and avoid sticking other organs with the biopsy needle, doctors often use ultrasound to find the best spot on the abdomen for inserting the biopsy needle and then mark the spot with ink. In other cases, ultrasound is used during a biopsy to safely guide the needle through the abdomen and into the liver.

When is a liver biopsy performed?

A liver biopsy is performed when a liver problem is difficult to diagnose with blood tests or imaging techniques, such as an ultrasound. More often, a liver biopsy is performed to estimate the degree of liver damage - a process called staging. Staging helps guide further treatment.

What preparation is required?

At least 3-5 days before your liver biopsy is to be performed, all aspirin, blood thinners and nonsteroidal anti-inflammatory drugs should be discontinued. Depending on your situation, your doctor may have you discontinue these medications for a longer or shorter duration. You will be given detailed instructions by your doctor’s assistant on exactly how to prepare yourself for this procedure.

How long does it take to recover from a liver biopsy?

After the biopsy, patients must lie on their right side for up to 2 hours to reduce the risk of bleeding. Patients are then monitored up to an additional 2 hours after the biopsy before being sent home. Most patients fully recover from a liver biopsy within 1 to 2 days. Patients should avoid intense activity or heavy lifting during this time. Acetominophen (Tylenol) that your doctor approved and does not interfere with blood clotting may help. Always check with your doctor before taking any pain medications after this procedure.

How soon do results come back from a liver biopsy?

Results from a liver biopsy take one week to come back. The liver sample goes to a pathology laboratory where the tissue is stained. Staining highlights important details within the liver tissue and helps the pathologist identify signs of liver disease. The pathologist looks at the tissue with a microscope and sends a report to the patient’s doctor.

What are the risks of a liver biopsy?

Pain at the biopsy site is the most frequent risk, and typically resolves on it’s own within a few days. Your doctor will discuss any other and all risks of having a liver biopsy performed before the procedure.

To the patient

Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure. If you have any questions about your need for a liver biopsy, alternative tests, the cost of the procedure, billing or insurance coverage, do not hesitate to speak to your doctor or the doctor’s office staff about it. Gastroenterologists and Radiologists are highly trained specialists and welcome your questions regarding their credentials and training. If you have questions that have not been answered, please discuss them with the assisting nurse or your doctor before the examination begins.

 

Designed by: