Procedures

Procedures

 



In order to better understand a procedure that you have been scheduled for, please follow the links below. These links will also include instructions on preparing for the procedure.

24-hour pH Monitoring


24-hour pH monitoring is a test to measure the acid that comes up into your esophagus during a 24-hour period.  The test will also measure any movement in your esophagus, including non-acid reflux.

The test involves a GI nurse inserting a small tube into your esophagus that will stay there for 24 hours. Placement of the tube takes ½ to 1 hour. After placement, you will be able to leave the hospital. While you go about normal activities, the device measures acid and movement in your esophagus.

If the physician recommends 24-hour pH impedance monitoring, you will keep a diary to record meal times, symptoms, and time spent lying down during the 24 hours. This diary helps your physician see correlations between symptoms and reflux episodes. You will return to the hospital the following day to have the tube removed.

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Upper Endoscopy


An upper endoscopy, also called esophagogastroduodenoscopy (EGD), is a procedure that enables the physician to look inside your esophagus, stomach, and duodenum (first part of the small intestine).

During the procedure, the nurse will give you throat numbing medication and sedation to help you relax, then the physician will have you swallow a flexible tube with a light on the end (called an endoscope). The endoscope is connected to a computer and will transmit an image of the inside of your esophagus, stomach, and duodenum for the physician to view.  The physician can view abnormalities, such as bleeding and erosions, that cannot be examined with other tests. The physician may insert other instruments into the scope to treat abnormalities or to obtain samples of tissue for testing. The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for at least 1/2 hour until the medication wears off.  Possible complications of an upper endoscopy include bleeding and tearing of the stomach lining, but these complications are rare. Mild sore throat is common after the procedure.

This procedure is recommended in a variety of situations, including reflux, bleeding, and routine monitoring of conditions like Barrett's Esophagus and Eosinophilic Esophagitis.

To prepare for the procedure, your stomach and duodenum must be empty for the procedure, so you will not be able to eat or drink anything for at least 6 hours before. Also, you must arrange for someone to come to the procedure with you and take you home. Your physician may give you other special instructions regarding medications.

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Radiofrequency Ablation (RFA)


Radiofrequency Ablation (RFA) is an ablation procedure used to treat Barrett's Esophagus. The procedure is performed through the endoscope during an upper endoscopy.

During the procedure, an ablation catheter is inserted into your esophagus through the endoscope, and electrodes on the catheter are positioned on the desired treatment area. Energy is delivered to the electrodes and underlying tissue, and the catheter can then be repositioned to treat other areas. The amount of energy is controlled to remove the diseased tissue, and to reduce risk of injury to healthy tissue layers.

After the procedure, it is important that you follow the discharge instructions provided by the physician or the nursing staff to ensure proper healing of the esophagus. It is also important that you attend follow up visits to receive additional RFA treatment sessions, if necessary, and to ensure proper healing. The RFA procedure does not cure gastroesophageal reflux disease (GERD), so it is important that you continue to control reflux symptoms as recommended by your physician.

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Photodynamic Therapy (PDT)

 

Photodynamic therapy (PDT) is a treatment for esophageal cancer. PDT combines a light source and a photosensitizing agent (a drug that is activated by light) to destroy cancer cells. The photosensitizing agent (porfimer sodium, also called photofrin) collects in cancer cells and normal cells, but more so in cancer cells.

For the treatment, photofrin is administered through a vein and travels through the blood stream to cells in your body. After a couple days, the photofrin remains only in the cancer cells and skin cells. You will then have an upper endoscopy where the physician will visualize the portion of the esophagus affected with cancer by exposing it to light from a laser

During an upper endoscopy, . The light causes a chemical change, and this change can kill the cancer cells, and only slightly damage nearby normal cells. PDT can be repeated may need to be repeated in some cases.  The two major side effects associated with this treatment include reactions to bright light or sunlight, and swelling in the treated area. It is important that you protect your skin and eyes from sunlight and other bright light after photofrin has been injected and for 30 days after the injection. A reaction to bright light or sunlight (such as sunburn, swollen skin, and blistering) can occur very quickly, so the eyes and skin must be protected at all times. Swelling in the treated area may cause nausea, chest pain, abdominal pain, fever, difficulty breathing, and difficulty swallowing. You may additionally experience vomiting, constipation, or infection. If side effects occur, they should be reported to your physician right away.

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Esophageal Manometry


Esophageal manometry is a test performed to measure pressure in the esophagus. This test may also be called an esophageal motility study, and it is usually recommended to determine if a swallowing problem is due to improperly working muscles in your esophagus. When the muscles in the esophagus do not work properly, you may experience difficulty swallowing, heartburn, esophageal spasms, and possibly pneumonia. There are many possible findings from esophageal manometry tests, and your physician will discuss your results with you.


During the test, a thin tube is inserted through your nose or mouth and into your esophagus. The tube measures pressure in your esophagus as you swallow to determine if there is any abnormality. The test generally takes less than one hour. Side effects from this test are rare, but may include some gagging during the exam or mild sore throat after the exam.


To prepare for esophageal manometry, you should not eat or drink anything for 8 hours prior to the test. In some cases, your physician will give you special instructions about medications that cannot be taken prior to the test. 

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Colonoscopy


A colonoscopy is a procedure that allows a physician to look inside your large intestine to determine if inflamed tissue, abnormal growths, or ulcers are present. The procedure is recommended to look for early signs of colon or rectal cancer and also to look for causes of unexplained rectal bleeding, weight loss, abdominal pain, or other symptoms.

 

During the procedure, you will be given pain medication and a sedative to help you relax.  You will be asked to turn on your left side then the physician will insert a long, flexible tube with a light into your rectum and then colon. The tube is called a colonoscope, and it transmits an image of the inside of the colon onto a video screen for careful examination of the colon lining. The procedure lasts about 30 to 60 minutes and during it, you may feel mild cramping and discomfort.  Most abnormal growths in your colon, like polyps, can be removed during the procedure. Polyps, which are growths in the lining of the bowel, are often not cancerous, but they must be sent to the lab for testing. Removing polyps will help prevent cancers from forming. The doctor can also obtain samples of tissue to test for other diseases of the colon.

After the procedure, you must remain at the endoscopy facility until the sedative from the exam wears off. However, you will not be allowed to drive, so you must have a responsible person check in with you and drive you home following the procedure.  You may continue to feel cramps or bloating, but this usually resolves after one hour.

To prepare for this exam, you will be given specific instructions which include a strict diet in the few days before your exam. Your colon must be completely empty for the test to be useful and safe, so you will need to drink a bowel preparation fluid to help empty it. Your physician may also ask you to stop using certain medications prior to the exam.




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Fiberoptic Endoscopic Evaluation of Swallowing (FEES)


A FEES study is used to evaluate swallowing.

During the exam, a flexible tube is inserted into your throat to see what happens during a swallow. You may be asked to eat foods of different consistencies colored with dyes. This allows the physician to observe movement of food from the back of your mouth, through the throat and into your esophagus.

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This material is not intended as a substitute for professional medical care. Please consult with your physician on any matters regarding your health.