Procedures
If you are experiencing a gastroenterological related problem, we advise you call our office to schedule an appointment with a doctor. Our experienced medical staff will be able to assess, diagnose and then advise you on the best method of treatment. Below is a list of just some of the procedures our medical facility utilizes for treatment and prevention. We also do the procedures at our office.
What is colonoscopy?
Colonoscopy is a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.
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.

Drawing of the digestive tract with labels pointing to the liver, stomach, small intestine, colon, rectum, and anus. The colon is shaded.
The colon and rectum are the two main parts of the large intestine.

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 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.

Drawing of a female colonoscopy patient lying on her left side on an examination table.
During colonoscopy, patients lie on their left side on an examination table.

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

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
What’s a polyp?
A polyp is extra tissue that grows inside your body. Colon polyps grow in the large intestine. The large intestine, also called the colon, is part of your digestive system. It's a long, hollow tube at the end of your digestive tract where your body makes and stores stool.
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

ERCP is a diagnostic test to examine the duodenum (the first portion of the small intestine), the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct), the bile ducts, the gallbladder and the pancreatic duct. The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope is flexible and can be directed and moved around the many bends of the stomach and intestine. Two types of duodenoscopes are currently available. A fiber-optic duodenoscope uses a thin fiber-optic bundle to transmit images to the lens at the viewing end of the instrument. A videoscope uses a thin wire with a chip at the tip of the instrument to transmit images to a TV screen. The duodenoscope is inserted through the mouth, to the back of the throat, down the food pipe, through the stomach and into the first portion of the small intestine (duodenum). Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the duodenoscope into the papilla of Vater, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and x-rays are taken of the bile ducts and the pancreatic duct. The open channel also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal tubing to relieve obstruction of bile ducts caused by cancer or scarring, and to perform incision by using electrocautery (electric heat). For further information on the anatomy and physiology of bile production (by the liver) and circulation, please visit the Gallstones article.

The liver is a large solid organ located beneath the right diaphragm. The liver produces bile, which is stored in the gallbladder (a small sac located beneath the liver). After meals, the gallbladder contracts and empties the bile through the cystic duct, into the bile ducts, through the papilla of Vater, and into the intestine to help with digestion. The pancreas is located behind the stomach. It also produces digestive juice which drains through the pancreatic duct into the papilla of Vater, and into the intestine.

What kind of preparation is required?
For the best possible examination, the stomach must be empty. The patient should not eat anything after midnight on the evening preceding the exam. In case the procedure is performed early in the morning, no liquid should be taken. In case the examination is performed at noon time, a cup of tea, juice, milk, or coffee can be taken 4 hours earlier. Heart and blood pressure medications should always be taken with a small amount of water in the early morning. Since the procedure will require intravenous sedation, the patient needs to have a companion drive him/her home after the procedure.
What can be expected during and after the procedure?

The patient will be given medication through a vein to cause relaxation and sleepiness. The patient will be given some local anesthetic to decrease the gag reflex. Some physicians do not use local anesthetic and prefer to give the patients more intravenous medication for sedation. This also applies to those patients who have a history of allergy to Xylocaine, cannot tolerate the bitter taste of the local anesthetic, or the numbness sensation in the throat. While the patient is lying on the left side on the x-ray table, the intravenous medication is given and then the instrument inserted gently through the mouth into the duodenum. The instrument advances through the food pipe and not the air pipe. It does not interfere with the breathing and gagging is usually prevented or decreased by the medication.

When the patient is in semi-conscious state, he/she can still follow instructions to change the position on the x-rays table. Once the instrument has been advanced into the stomach, there is minimal discomfort except for the foreign body sensation in the throat. The procedure can last any where from fifteen minutes to one hour, depending on the skill of the physician and the anatomy or abnormalities in that area.

After the procedure, the patients should be observed in the recovery area until most of the effects from the medication have worn off. This usually takes one to two hours. The patient may feel bloated or slightly nauseated from the medication or the procedure. Very rarely a patient experiences vomiting and may belch or pass some gas through the rectum. Upon discharge, the patient should be driven home by his/her companion and is advised to stay home for the rest of the day. The patient can resume usual activity the next day. Even though the physician may explain to the patient or companion regarding the findings after the procedure, it is still necessary to call the physician the next day to ensure that the patient understands the results of the examination.

What are the reasons for the examination?

The liver, bile ducts, gallbladder, pancreas and the papilla of Vater can be involved in numerous diseases, causing myriad of symptoms. ERCP is used in diagnosing and treating the following conditions:

* Gallstones in the bile duct
* Blockage of the bile duct by stones, cancer, stricture or compression from adjacent organs
* Jaundice (yellow coloring of the skin) due to obstruction of the bile duct, also causing darkening of the urine and light colored stool
* Persistent or recurrent upper abdominal pain which cannot be diagnosed by other tests
* Unexplained loss of appetite and weight loss
* Confirming the diagnosis of cancer of the pancreas or the bile duct, so that surgery or other treatment can be tailored

Liver Biopsy

In a liver biopsy, the physician examines a small piece of tissue from your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged.

Preparation
Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those that affect blood clotting, like blood thinners. One week before the procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants.

You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions.

Procedure
Liver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot.

You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.

Two other methods of liver biopsy are also available. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples from one or more parts of the liver. Physicians use this type of biopsy when they need tissue samples from specific parts of the liver.

Transvenous biopsy involves inserting a tube called a catheter into a vein in the neck and guiding it to the liver. The physician puts a biopsy needle into the catheter and then into the liver. Physicians use this procedure when patients have blood-clotting problems or fluid in the abdomen.

Recovery
After the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for 1 to 2 hours. The nurse will monitor your vital signs and level of pain.

You will need to arrange for someone to take you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for 8 to 12 hours, depending on your physician's instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in your right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after surgery. These medicines decrease blood clotting, which is crucial for healing.

Upper Endoscopy (EGD)

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, infection, tumors, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy.

For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-doh-skope). Right before the procedure, the physician will spray your throat with a numbing agent that may help prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach. The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don't show up well on x-rays. The physician can also insert instruments into the scope to remove samples of tissue (biopsy) for further tests or treat bleeding abnormalities.

Possible complications of upper endoscopy include bleeding, perforation, or mild sore throat. However, such complications are rare. The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 30 to 60 minutes, or until the medication wears off.

Preparation
Your stomach and duodenum must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours beforehand. Also, you must arrange for someone to take you home--you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.

Hemorrhoid Treatment (IRC)

At Atlantic Gastroenterology, we use the patented and proprietary CRH-O’Regan Disposable Hemorrhoid Banding System. This system is considered to be the “gold standard” and Midwest Gastroenterology is the only treatment center in Kansas City trained in this procedure. This highly effective (99%), minimally invasive procedure is performed in our offices in less than a minute, and most patients return to work that same day. We make recommendations to reduce the chance of recurrence later (currently 5% in 2 years). If there are multiple hemorrhoids, we treat them one at a time in separate visits.

During the brief and painless procedure, our physician specialist places a small rubber band around the tissue just above the internal hemorrhoid where there are few pain-sensitive nerve endings. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding. Advanced cases where the diagnosis is both internal and external hemorrhoids may require additional therapy, as rubber banding alone may not be suitable.

Our banding procedure works by cutting off the blood supply to the hemorrhoid. This causes the hemorrhoid to shrink and fall off, typically within a day or so. You probably won’t even notice when this happens or be able to spot the rubber band in the toilet. Once the hemorrhoid is gone, the wound usually heals in a week or two.

During the first 24 hours, some patients may experience a feeling of fullness or a dull ache in the rectum. This can typically be relieved with an over-the-counter pain medication. However, a remarkable 99.8% of patients treated with out method have no post-procedure pain.

In fact, thanks to design improvements, our procedure has a ten-fold reduction in complications compared to traditional banding. Our instruments are smaller, affording greater comfort for patients and better visibility for physicians. Unlike other devices, they are single use and 100% disposable.


Capsule Enteroscopy

Capsule enteroscopy is a recent, non-invasive alternative to other procedures that can help your doctor examine your small intestine to detect ulcers, polyps, sources of bleeding and other conditions and possible diseases.

Unlike an endoscopy, which examines the esophagus and parts of the stomach, or a colonoscopy that views the lower intestines and colon, a capsule enteroscopy lets your gastroenterologist. This area, which is normally difficult or impossible to visually examine, can be seen by use of a capsule enteroscopy, and the process is non-invasive and painless.

What Do I Need to Have a Capsule Enteroscopy?

Before the procedure can begin, you will need to fast for about ten hours. This makes the procedure very safe and gives the best results since there will be very little in the intestines to obstruct the capsule or its view. The capsule will be swallowed with a substance to prevent bubbles that can interfere with the images.

The small capsule you swallow contains both a source of light and a tiny camera, along with a transmitter and batteries to run them all. To record the images, which the camera takes at a rate of three or so pictures each second, a small device the size of a beeper is worn at the waist and this device receives signals from the capsule through antennae taped to your skin.

You will not be able to drink anything for two hours after swallowing the capsule, nor eat for four, and will need to return to the doctor after eight hours to have the pictures downloaded.

How Long Does a Capsule Enteroscopy Take?

As the capsule passes through your intestines, it will continue to take pictures until it completely passes from your system. This may be as short as eight hours, but is normally a matter of two to three days. The capsule may take much longer, but if it has not been eliminated in two weeks, your doctor should be notified. After the capsule has left your body, it has no further use and is discarded.

What is Capsule Enteroscopy Used For?

In addition to checking for tears and sores in the small intestine that cause bleeding, capsule enteroscopy can provide images of ulcers and polyps. It is helpful for diagnosing Crohn's disease or identifying tumors.

What Are the Benefits and Drawbacks of Capsule Enteroscopy?

As a non-invasive procedure, those having a capsule enteroscopy don't require any sedatives, hospitalization, or recovery time. Although there is a possibility the capsule may become lodged in the intestine, this is a very rare occurrence. The images are not of the best quality, however, and the speed with which the capsule moves through the intestine cannot be controlled. The camera, also, may not be facing the right way when it takes a picture, but capsule enteroscopy is an excellent tool your doctor may choose as part of your diagnosis.