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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.


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.


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.


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.


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.


Per-oral Endoscopic Myotomy (POEM)

POEM (per-oral endoscopic myotomy) is an endoscopic procedure used to treat achalasia, a rare disorder that causes difficulty swallowing due to abnormal muscle coordination in the esophagus (“food tube”) and an inability of the bottom of the esophagus to relax. While no treatment for achalasia can make swallowing totally normal again, most patients are very pleased with the results of the POEM.

A big advantage of POEM is that it does not require surgical incisions (cuts on the skin). It is a kind of surgery, but it is all done through a flexible endoscope that is placed into your mouth and down your throat. POEM is performed under general anesthesia, so patients are unconscious during the procedure. With the endoscope, a small cut is created in the inner lining of the esophagus. A narrow tunnel is then formed so that the scope can reach the muscles in the wall of the lower esophagus. These muscles are then cut (this is called a “myotomy”), using a tiny electrical knife passed through the scope. The cut in the inner lining is then closed with small metal clips, which eventually fall off, and pass harmlessly through the digestive tract.

While POEM is used mainly to treat achalasia, it has also been successfully used in other conditions that cause abnormal esophageal motility and/or chest pain.

Benefits: POEM is a safe alternative to the traditional surgery to treat achalasia, known as a “Heller Myotomy”. This operation requires cuts on the skin of the belly and handling of the internal organs, and generally requires longer recovery times. The same esophageal muscles are cut during POEM as in the Heller myotomy, but POEM allows for easier access to these muscles, and POEM does not leave any external scars. Long-term favorable responses range from 82% to 100% – very comparable to the results with Heller myotomy. POEM is effective and safe even at the extremes of age and regardless of prior therapies, such as dilation (stretching of the esophagus with a balloon) and Botox injections. It can even be performed following unsuccessful Heller surgery.

Preparing for the procedure: A recent upper endoscopy is necessary to check for certain esophageal abnormalities. You should have clear liquids by mouth for 48 hours prior to your procedure. Blood-thinning medications will need to be stopped in advance of your scheduled procedure, to reduce chances of bleeding after the procedure. How long those drugs need to be stopped depends on which ones you are taking, and why you are taking it, so ask your doctors for instructions.

After the procedure: You will be admitted to the hospital following POEM, and for the first 24 hours you will not eat or drink. Lab work and x-rays may be performed to monitor your condition. An upper GI x-ray swallowing study is commonly done one day after the procedure, and a repeat upper endoscopy is sometimes also performed if there are any concerns about injury to the esophageal wall or bleeding. These issues can generally be managed during the same endoscopy.

After your swallowing study and/or upper endoscopy, you will usually be able to drink clear liquids. Your diet will be slowly advanced to soft foods, which will be continued for an additional week before resuming normal food. You will need to eat slowly while in an upright position and will need to take acid reducing medications for at least the first few weeks after POEM. There are generally no restrictions on physical activity following hospital discharge.

A follow-up clinic visit will be arranged with the advanced endoscopy team 1-2 weeks after your procedure. Subsequent follow-up and any additional esophageal function testing will be arranged by Center for Esophageal Diseases and Swallowing (CEDAS).


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.


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