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What is Jaundice?

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Jaundice causes the whites of the eyes, skin, and mucous membranes to turn yellow as a result of heightened levels of bilirubin. Here’s what you need to know about the condition.  

Causes and Risk Factors

Jaundice is ultimately caused by bilirubin levels that are too high. Bilirubin is a yellow chemical in hemoglobin, the part of red blood cells that carries oxygen. The body builds new red blood cells when old ones break down, and the liver processes the old cells. When the liver is unable to process these old cells properly, bilirubin builds up in the blood and deposits in the skin. The yellow color of bilirubin is what causes the yellowing of skin in jaundice. 

Jaundice is relatively common in newborns- many babies develop it in their first week of life, and it often goes away without issue. In adults, jaundice can be a sign of various problems. These include liver diseases (like alcoholic liver disease, cirrhosis, and hepatitis), blood diseases, infections, blocked bile ducts, and viruses. 

Symptoms of Jaundice 

There are several symptoms of jaundice that people can experience at different levels of severity. Some people may not even have any symptoms. Ultimately, the symptoms a person experiences will depend upon underlying causes and the speed at which disease develops. In short-term cases, often caused by infections, symptoms typically include fever, abdominal pain, chills, flu-like symptoms, yellowed skin and eye whites, dark urine, and clay-colored stool. If a case is not caused by infection, symptoms can include weight loss and itchy skin. Abdominal pain is also common when pancreatic or bile duct cancers cause jaundice. 

Diagnosis

Jaundice is diagnosed through a few different steps. Doctors first perform physical exams to check for signs of liver disease. These signs include yellowing and bruising of the skin, spider angiomas (blood vessels that collect near the skin surface), and palmar erythema (red coloration in the fingertips and palms). They also perform urinalysis to check bilirubin levels in the urine, which can indicate jaundice. They often perform serum testing to confirm findings from urinalysis as well. Additionally, they may want to pursue imaging of the liver through an MRI, CT, or ultrasonography to further confirm any diagnosis. 

Treatment and Prevention for Jaundice

Treatment for jaundice entails treating the underlying causes and complications of the condition, as well as any symptoms. For instance, if acute viral hepatitis is a cause, it will go away as your liver heals.  Treatment may entail treating the hepatitis symptoms. Surgery can help unblock bile ducts in cases of blocked ducts. A drug called cholestyramine can be used to limit itching if itchy skin is a symptom. 

Preventing jaundice entails preventing the various underlying causes. This means that limiting alcohol intake, avoiding hepatitis infection, and maintaining a healthy weight and cholesterol levels can all reduce your risk. 

Our experienced team at GHP has years of experience treating conditions including jaundice. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Coronavirus and the GI system: What does the evidence tell us?

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The coronavirus continues to have an enormous impact on the way we live. Over the past several months, we have begun to learn more and more about the virus. We’ve learned about how it spreads, its symptoms, how to detect it, and potential approaches for vaccines. Crucially, the virus has several documented impacts and features related to the gastrointestinal system. Let’s take a look at the evidence. 

Note: As the medical and public health understanding of the coronavirus continues to evolve, there’s a lot we still don’t know for certain. It’s important to recognize the difference between evidence-based conclusions, emerging evidence without sufficient peer review, and speculation. We will carefully frame each point based on the amount and kinds of evidence supporting it. 

Coronavirus Symptoms Associated with the Gastrointestinal System

The coronavirus can cause a range of symptoms, from a fever to a loss of smell and a headache. We do know that it can cause gastrointestinal symptoms in some cases. These well-documented GI symptoms include loss of appetite, nausea, vomiting, and diarrhea. However, not everyone with coronavirus will experience these symptoms. 

Some interesting emerging research suggests that there may be clusters of symptoms. One of these clusters involves gastrointestinal symptoms. Researchers at King’s College London studied data from around 1,600 COVID-19 patients who logged their symptoms to the research group’s COVID Symptom Study app in March and April. They found six distinct clusters of symptoms from the data: 

  1. Flu-like with no fever. Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
  2. Flu-like with fever. Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
  3. Gastrointestinal. Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.
  4. Severe level one, fatigue. Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
  5. Severe level two, confusion. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
  6. Severe level three, abdominal and respiratory. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

As you can see, the gastrointestinal cluster includes GI symptoms like diarrhea and loss of appetite. Other clusters also contain GI symptoms. Each cluster was also associated with differing proportions of patients who required hospitalization and breathing support. The escalating severe clusters had the largest percentage of patients requiring significant medical support. 

It’s important to note that while the researchers have replicated their findings with a second 1,000 person data set from June, the research is not peer-reviewed yet. However, this is certainly something to keep an eye on as more data trends emerge. 

Sewage: A Potential Method for Measuring Infection Spread

Early on in the pandemic, evidence emerged from multiple studies showing that people infected with the coronavirus shed viral particles in their poop. Whether the disease can spread through feces is still undetermined. However, there has been growing interest in sampling sewage to determine the extent of disease spread. 

This has been particularly appealing because of the lack of adequate testing in many countries. This has led to a significant undercounting of actual infection numbers. A cross-sectional CDC study conducted across multiple states used serological testing on a convenience sample with people of all ages to identify how many had developed antibodies to the disease. This gave a more accurate picture of how many people have been infected, since the presence of antibodies indicates that a person had been or was currently infected. The study found that actual infection numbers were likely 10 to 12 times higher than reported through testing. Note that large-scale seroprevalence studies like this one are continuing to be conducted to identify likely infection rates, so the results here are preliminary. 

With such a disparity between reported and actual case counts, wastewater sampling offers a convenient and accessible way to identify disease spread in a particular area. Importantly, results are quicker than those from viral and serological tests. This is helpful, timely data that can inform decisions about disease containment in the event of a flare-up. Additionally, it can help researchers see the viral ancestry of the disease, tracking different strains, viral changes over time, and spreading patterns and paths. 

There are drawbacks, though. This kind of sampling can’t prove that an entire population is completely clear of the virus. Another drawback is that we still don’t know how many copies of viral RNA need to be present in a sample for disease to be detected. This means false negatives are possible, as we don’t know the minimum number of copies that trigger detection. A lower count of copies could go undetected with an improper assumption about a minimum. 

Overall, there’s certainly a lot we still have to learn about the coronavirus and the GI system. However, as scientists conduct more and more research, we have a better opportunity to make data-informed decisions at public health, medical, governmental, interpersonal, organizational, and individual levels. 

Our experienced team at GHP has years of experience helping patients with a variety of diseases and conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Retrograde Cholangiopancreatogram (ERCP): A Brief Overview

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An Endoscopic Retrograde Cholangiopancreatogram (ERCP) is a therapeutic endoscopic procedure that helps diagnose and treat diseases in the liver, gallbladder, pancreas, and bile system. Here’s what you need to know about the procedure. 

When an ERCP is used

There are several reasons your doctor may perform an ERCP. One common reason is to diagnose and treat gallstones that are trapped in the bile duct. They may also perform an ERCP to identify the source of persistent upper right side abdominal pain, to identify a cause of pancreatitis, or to relieve bile duct obstruction caused by tumors. Often, doctors will inject a dye in the bile ducts during an ERCP to assist with X-ray imaging.

Preparing for an ERCP

There are a few important steps to prepare for an ERCP. You will need to discuss any medications you are taking with your doctor. Blood-thinning medications like Coumadin (warfarin), Eliquis (apixaban), Lovenox (enoxaparin), Plavix (clopidogrel), Pradaxa (dabigatran), and Xarelto (rivaroxaban) are especially important to discuss. These can increase the risk of severe bleeding during the procedure, and you should stop taking them before the ERCP. Also, if you use insulin, you may need to adjust timing or dosage on the day of the procedure. Your doctor will also need to know if you have any allergies to medications. Additionally, you will need to fast starting the midnight prior to your procedure. This means avoiding eating from that time until your procedure. 

During the Procedure

Prior to the ERCP procedure, you will go to a pre-op area where nurses will place an IV and take your medical information. You will also speak with an anesthesiologist about the sedation used during the procedure. 

Once you have moved to the procedure room, you will be connected to machines that monitor your vitals during the ERCP. You will be sedated during the procedure. Your doctor will feed the endoscope through your mouth and perform the procedure. The specific techniques and treatments they use will depend on your situation, and include opening blocked ducts and inserting stents. They may also take X-rays during the procedure. Contrast dye is injected through the endoscope to assist in developing X-ray imaging of your bile ducts. In total, the ERCP should take around 30-40 minutes. 

After the Procedure

After the ERCP, you will go to a post-op area to recover from sedation and the procedure and will be monitored for complications. Once you have recovered, your doctor will discuss the results with you, though any biopsies will take a few days to return. You should not operate machinery, drive, or make important decisions for 24 hours after your procedure due to sedative effects. 

It’s common to have a sore throat immediately after the procedure; throat lozenges can help treat soreness. You should follow a clear liquid diet after the ERCP, eventually transitioning to bland foods. 

The procedure has a few uncommon risks. Around 7% of patients experience pancreatitis, an inflamed pancreas. This requires hospitalization to rest the pancreas and manage inflammation. In very rare cases, this can be severe and lead to surgery, organ failure, or death. 

In very rare cases, perforation occurs during the procedure. Most of the time, this can be managed with hospitalization, bed rest, antibiotics, and bowel rest. Rarely, you may need surgery to repair the perforation. 

There is a low risk of bleeding as well, which occurs in around 0.5% of cases. When managed during the procedure, it can be stopped. Delayed bleeding requires patients to return to their doctor for treatment. 

Our experienced team at GHP has years of experience performing ERCPs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Endoscopic Ultrasound: How to Prepare

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An Endoscopic Ultrasound (EUS) is a procedure for assessing and producing images of the digestive system with an endoscope. It is also used as a modality to treat certain gastrointestinal disorders through fine-needle aspiration (FNA). Follow along for an overview of EUS. 

When an Endoscopic Ultrasound is used

An EUS can help doctors determine the source of chest pain, abdominal discomfort, and other symptoms. It can also help them evaluate the extent of disease spread in your digestive tract, and evaluate findings from other diagnostics like MRIs or CT scans. It can help evaluate conditions including Barrett’s Esophagus, Lymphoma, and various cancers. 

There are many different therapeutic procedures that can be performed during an EUS. These include celiac plexus neurolysis (EUS-CPN), pseudocyst drainage, biliary drainage (EUS-BD) and liver biopsy. Each of these treatments has a unique set of steps involved. Below, we will take a look at some general steps and approaches involved with the various diagnostics and treatments performed through an Endoscopic Ultrasound. 

Preparing for an EUS

The way you need to prepare for an EUS depends on the specifics of the procedure and any therapeutic treatments in your case. In general, you often need to fast starting the midnight before the procedure. This helps empty your stomach. You may also need to discuss any medications you are taking with your doctor before the procedure. It is especially important to stop taking any blood-thinning medications leading up to the procedure. These medications can increase the risk of severe bleeding during the Endoscopic Ultrasound. If the EUS is being performed in the rectal area, you may need to undergo a cleansing routine to prepare your bowels. This usually consists of taking a liquid laxative and sticking to a liquid diet for a day before the procedure. 

During the procedure

On the day of your Endoscopic Ultrasound procedure, you will first go to a pre-op area where your medical information will be taken and you will be given an IV. You will also discuss sedation used during the procedure with an anaesthesiologist. 

Depending on the location in your GI tract that doctors will examine or treat, they will advance an endoscope through your mouth or a colonoscope through your anus. You will be on your left side and may be sedated as this happens. Your doctor will advance the scope to the site or sites of interest and then perform any diagnostics or treatments. This can include tissue biopsies, pain-relieving injections, pseudocyst drainage, and bile duct drainage, depending on your situation. Your doctor will be able to see your GI tract through a camera at the end of the scope, and will pass any necessary instruments through the scope to perform the procedure. Most EUS examinations take under an hour, but the exact time will vary depending on what diagnostics or treatments your doctor is administering. 

After an Endoscopic Ultrasound

After your procedure, you will go to a post-op area where you will recover from any sedation and be monitored for side effects of the procedure. Once you are recovered, your doctor will share results with you. Some biopsy results may take longer to return. Given sedation side effects, you should not operate machinery, drive, or make important decisions for 24 hours following the procedure. 

Endoscopic Ultrasounds have a relatively low risk for complications. If you underwent Celiac Plexus Neurolysis to provide pain relief for tumors, you may experience abdominal pain for a few hours and diarrhea for a few days. More rarely, bleeding, infection, and paralysis can occur. If you underwent Pseudocyst Drainage, there is a small risk of bleeding, infection, and pancreatitis. Additionally, in under one percent of cases, perforations occur, requiring surgery to repair. If you underwent Biliary Drainage, there is a 10-20% chance of mild complications associated with bile drainage. These include bleeding, infection, and bile leakage in the abdominal cavity. If you underwent a Liver Biopsy, complications are very rare, and include a small risk of bleeding and infection. In general, if you were sedated during your procedure, there are a few uncommon complications including aspiration, adverse reactions to sedative medication, and complications from lung and heart diseases. 

Our experienced team at GHP has years of experience performing Endoscopic Ultrasounds. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Mucosal Resection (EMR): An Overview

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Endoscopic Mucosal Resection, or EMR, is a therapeutic technique that helps remove precancerous and early stage cancer lesions during an upper endoscopy or colonoscopy. This technique is a less-invasive alternative to surgery. Here’s what you need to know if you are preparing for an EMR.

When is an Endoscopic Mucosal Resection Used?

EMRs are used to remove abnormal tissues in the digestive tract. The procedure can help treat a variety of conditions including Barrett’s Esophagus, colorectal cancer, and colon polyps. This is a less invasive option than surgery for removing abnormal tissues in the digestive tract. While EMRs are often used to treat disease, your doctor may also collect tissue samples during the procedure. They can examine tissue they collect to determine a diagnosis and the scope of disease spread. 

Preparing for an EMR

There are several important steps you need to follow prior to an Endoscopic Mucosal Resection. Your physician will discuss each of these with you leading up to the procedure. First, you may need to stop taking certain medications. These include blood-thinning medications like aspirin, Plavix (clopidogrel), Xarelto (rivaroxaban), Lovenox (enoxaparin), Pradaxa (dabigatran), Coumadin (warfarin), and Eliquis (apixaban). Blood-thinners increase your risk of excessive bleeding during the procedure. Also, if you use insulin, you may need to adjust your dosage and timing before the procedure. Make sure you discuss all medications you use with your doctor. 

Additionally, you will need to follow a clear liquid diet the day before the procedure, and stay hydrated. You will also need to fast beginning the midnight before your procedure. For EMRs performed through a colonoscopy, you will also need to undergo a cleansing routine. This involves taking a liquid laxative the day before your EMR to prepare your bowels. 

During the procedure

EMRs are performed through either an upper endoscopy or a colonoscopy, depending on the location of the diseased tissue. When you arrive for your procedure, you will go to a pre-op area where nurses will take your medical information and place an IV. You will also speak with an anaesthesiologist about the sedation they will use for the procedure. 

You then will go to the procedure room and be connected to monitors that will measure your vitals during the EMR. You’ll be sedated at this point. If the procedure is done through an upper endoscopy, you will be placed on your left side and given a bite block so the endoscope can pass through your mouth safely. If it is done through a colonoscopy, you will also be placed on your left side so the colonoscope can pass through your anus and advanced into the colon. 

Your doctor will be identifying and removing lesions during the EMR. There are several ways to remove lesions. Your doctor may inject a liquid into the submucosal layer under the lesion, which acts as a pillow that lifts the lesion for easy removal. They may also use a suction or a rubber band to help lift the lesion. After the lesion is lifted, it will be captured with a snare and the removal site will be cauterized. The procedure takes around 20 to 60 minutes.  

After the Endoscopic Mucosal Resection

Following your EMR, you will move to a post-op area to recover from sedation and monitor for any complications. Once you have recovered, your doctor will talk to you about the findings and give you post-op recovery instructions. You should not drive or make important decisions for 24 hours following the EMR due to sedative effects. You should follow a clear liquid diet immediately following the procedure, and can later transition to bland foods and a more regular diet. 

Complications from an EMR are uncommon. This includes bleeding, which occurs in 5-10% of cases. Your doctor can usually stop bleeding during the procedure if they recognize it. However, bleeding can become severe if it is delayed and may require follow-up care. In other rare cases (1-2% of the time), perforation of the intestine can occur. This is often managed through antibiotics, bowel rest, and hospitalization. It may require surgery as well. Additionally, some patients have reactions to sedative medication in uncommon cases. Always contact your doctor if you have any severe symptoms like abdominal pain, a fever, or excessive rectal bleeding after the procedure, as they may indicate a severe complication. 

Our experienced team at GHP has years of experience performing EMRs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Hemorrhoid Banding: What to Expect

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Hemorrhoids are swollen veins in the lower rectum or anus. They can cause bleeding, itching, and pain. While most hemorrhoids resolve with home treatment, some can be harder to get rid of. There are several non-invasive treatments for hemorrhoids. In cases of highly symptomatic hemorrhoids, banding is one approach that can help. Here’s what you need to know about hemorrhoid banding.

When Hemorrhoid Banding is used

As mentioned above, in cases of highly symptomatic hemorrhoids, hemorrhoid banding (sometimes called rubber band ligation) may be used. These symptoms include severe pain, severe bleeding, prolapsing (protrusion through the anus), and hemorrhoids with blood clots. Hemorrhoid banding is a non-invasive, non-surgical procedure that cuts off the hemorrhoid’s blood supply. Eventually, the hemorrhoid falls off as a loss of blood supply.

Before the Procedure

In the days leading up to the procedure, your doctor may ask you to stop taking certain medications. These include ibuprofen, aspirin, or any other drug that makes it difficult for blood to clot. Your doctor may also perform some diagnostics prior to the procedure to identify the hemorrhoid and its state. This may include a physical examination, a rectal examination, a sigmoidoscopy, or an anoscopy.

During the Hemorrhoid Banding Procedure

The entire hemorrhoid banding procedure only takes about five minutes. During the procedure, your doctor will place a tube-like instrument in your anus so they can examine the hemorrhoid. They will then put a tight rubber band around the base of the hemorrhoid. This cuts off the blood supply. You may experience some discomfort during the procedure.

After the procedure

After your doctor performs the hemorrhoid banding, your doctor will advise you regarding recovery and may schedule a checkup or another appointment. You may need multiple bandings to remove a hemorrhoid. Hemorrhoids may take around a week to fall off after a successful banding procedure.

In the days following your procedure, you may have some difficulty with controlling bowel movements and passing gas. Fortunately, there are a few things you can do at home to help with this. For one, make sure you move your bowels right when you feel the urge to do so. Do not sit on the toilet for long periods of time, and don’t strain during bowel movements. To avoid constipation and straining, eat lots of fiber, stay hydrated, and exercise. Additionally, you should avoid heavy lifting for two or three weeks.

While serious complications are rare with this procedure, there are a few signs to look out for after your hemorrhoid banding. These include any signs of infection (like fever or chills), passing a lot of blood, having uncontrollable pain, having trouble urinating, and developing an aching feeling between the rectum and genitals. Call your doctor if any of these symptoms develop.

Our experienced team at GHP has years of experience performing hemorrhoid banding. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Breath Testing

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Breath testing is a noninvasive method doctors can use to diagnose gastrointestinal conditions. Here’s what you need to know about breath testing. 

Breath Testing 

Breath testing gives doctors a noninvasive way to diagnose several conditions. They can analyze your breath to detect amounts of particular gases, making diagnosis quick and simple. Typically, there are a few pre-testing steps you will need to follow, including consuming particular liquids and avoiding certain activities before or during breath testing. The specifics for each type of breath testing are discussed in the following sections. 

Bacterial Overgrowth Breath Test

This test is used to figure out if there is too much bacteria growth in the small intestine. This sort of overgrowth can prevent your body from absorbing nutrients properly. In the day prior to this test, you will need to limit your consumption of slow-digesting foods like beans and pasta. You will also need to fast for 12 hours before testing, and should not sleep, smoke, or exercise vigorously directly before or during the test. Additionally, you should avoid chewing gum, having mints, using mouthwash, or brushing your teeth the morning of. Stop using probiotics for the two weeks leading up to testing as well. You need to reschedule the testing if you have been taking antibiotics within 48 hours. Finally, you may consume water up until the time of testing, but you can’t eat or drink during the test. 

During Bacterial Overgrowth Breath testing, you will first breathe into a small machine. Then, you’ll consume a lactulose solution (this may cause abdominal pain or diarrhea for some people). 90 minutes later, you will breathe into the machine again. Last, you will wait an additional 30 minutes and breathe into the small machine. 

Fructose Breath Test

Fructose testing helps determine whether you may have trouble absorbing fructose. Symptoms like gas, bloating, diarrhea, and cramping can be a sign of fructose malabsorption. Fructose is a sugar that is in many plants you may consume, like onions, artichokes, and pears.

Preparation for this test is similar to the aforementioned testing. The day before the test, you need to limit consumption of slow-digesting foods. Stop taking medications leading up to the test. You must fast for 12 hours before testing, and shouldn’t smoke, sleep, or exercise vigorously right before or during testing. Also, you should not chew gum, use mouthwash, brush your teeth, or have mints the morning of testing. You may consume water up until the time of testing, but you can’t eat or drink during the test. Finally, you should let your doctor know if you have taken antibiotics recently or if you have been having diarrhea. 

Three hours prior to the testing, you will need to consume 12oz of Coca-Cola. When you arrive for the test, you will breathe into a machine that will measure for hydrogen gas. You will breathe into the machine in 30 minute intervals for three hours. 

Pylori Breath Test

H. Pylori breath testing helps doctors detect the presence of H. Pylori bacteria in your stomach or small intestine. This bacteria can cause diseases and increase your risk of gastric cancer. Two common conditions associated with the bacteria are gastritis and gastric ulcers. 

To prepare for H. Pylori breath testing, you should stop taking proton pump inhibitors like Prilosec OTC or Nexium. These can lead to false readings. You will also need to stop taking antibiotics two weeks before testing. Additionally, you should stop taking Sucralfate, Pepto-Bismol, and Carafate. Finally, you will need to fast for the hour leading up to the test. 

During testing, you will first give a breath sample. Then, you will drink a Pranactin-Citric solution and give another breath sample 15 minutes later. 

Lactose Breath Test

Lactose breath testing helps diagnose lactose intolerance. This intolerance prevents you from being able to digest lactose (a sugar found in milk) properly. Common symptoms of this intolerance are bloating, gas, cramping, and diarrhea after consuming dairy products. 

Preparation for this testing is similar to preparing for a Bacterial Overgrowth or Fructose test. The day before testing, you will need to limit consumption of slow-digesting foods like beans and pasta. You also need to fast for 12 hours before testing, and should not sleep, smoke, or exercise vigorously directly before or during the test. Additionally, you should avoid chewing gum, having mints, using mouthwash, or brushing your teeth the morning of. You will need to be off of any antibiotics for two weeks before testing. You may consume water up until the time of testing, but you can’t eat or drink during the test. Tell your doctor if you have had any recent diarrhea, as this can affect testing. 

Three hours before the test, you will need to consume 12oz of skim or fat-free milk. During the test, you will need to drink a beverage with lactose. This can cause intolerance symptoms. After this, every fifteen minutes, you will blow into inflatable bags that will be tested for hydrogen levels. An elevated hydrogen level means that lactose is not digested properly. 

Our experienced team at GHP has years of experience performing breath testing. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

GI Luminal Stenting

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GI Luminal Stenting is a procedure that inserts a stent in the GI tract to relieve obstruction. Here’s everything you need to know about the procedure. 

When it’s used

GI Luminal Stents can relieve obstructions in the GI tract. Obstructions are caused by numerous diseases, like GI cancers. They can cause blockages of food, fluid, and waste, and lead to symptoms like vomiting, nausea, and severe abdominal pain. This can be life-threatening in some cases. Surgery used to be the only option to relieve obstructions. Fortunately, stents now provide a less invasive method. 

Preparing for GI Luminal Stenting

To prepare for stenting, there are a few pre-operative steps you may need to take. For lower GI stenting, you will need to adhere to a cleansing routine leading up to the procedure. This consists of a liquid laxative you will take the day before the procedure, preparing your bowels. You will also be instructed to consume only clear liquids the day before, and drink lots of fluids in general. For upper GI stenting, you may be asked to stop eating the midnight before the procedure.

You will also need to discuss any medications you are prescribed with your doctor. It’s especially important to mention any blood-thinners you are taking. These increase the risk of excessive bleeding, and you will need to stop taking them before the procedure. Additionally, if you use insulin, you will need to adjust your dosage and timing leading up to the procedure. 

During the procedure

Directly before your procedure, you will go to a pre-operation area where nurses will place an IV and take your medical information. You will also talk with an anaesthesiologist about the sedation used during the procedure. Machines will monitor your vitals throughout the stenting procedure. 

Your doctor will place the stent by using an endoscope. Depending on if the stent is being placed in the upper or lower GI tract, an endoscopy or colonoscopy will first be performed to evaluate the area. Once the blocked section is examined, the stent will be placed through the endoscope. 

Stents are simply hollow tubes made of flexible wire that is tacked to a mesh. The stent will be advanced through the endoscope with a guide wire. When it is positioned, your doctor will expand the stent to help open the obstruction. 

After GI Luminal Stenting

You will go to a post-operation area following the procedure. There, nurses will monitor you for any signs of complications from the sedation or procedure. Once you are recovered, your doctor will discuss preliminary findings with you. Some findings (like those from biopsies) may take several days to come back. 

You shouldn’t drive, operate machinery, or make important decisions for 24 hours following the procedure due to potential lingering sedative effects. You should also follow a clear liquid diet for a few days following the procedure, eventually transitioning to a bland diet. You’ll formally receive all of these instructions before you leave. 

Complications from GI Luminal Stenting are rare. Perforation occurs in less than 5% of cases, and requires surgery to repair. Stents can also migrate on rare occasion. When this happens, patients experience obstruction symptoms again, and should contact their doctor to remove or replace the stent. 

Our experienced team at GHP has years of experience performing GI Luminal Stenting. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Single Balloon Enteroscopy: A Closer Look

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Single Balloon Enteroscopy is a procedure that allows doctors to examine the small intestine. Follow along for everything you need to know about the procedure.

When Single Balloon Enteroscopy used

A Single Balloon Enteroscopy is used to examine, diagnose, and treat diseases in both the upper and lower GI tract. The advantage of the procedure is that it gives access to the entire small intestine, which is around 20 feet long on average. Other procedures cannot provide reach to effectively examine or treat the small intestine. The Single Balloon Enteroscopy lets doctors get access and live imaging of parts of the GI tract that are otherwise inaccessible. This is important for examining sources of GI bleeding, taking biopsies, removing polyps or foreign objects, and enlarging strictures.

Preparing for the procedure

There are a few important pre-operative steps you need to take prior to a Single Balloon Enteroscopy. You will need to discuss any medications you are taking with your doctor. Certain blood-thinning medications can pose risks of excessive bleeding during the procedure. Additionally, if you take insulin, you may need to adjust timing and dosage leading up to the procedure.

You will need to adhere to a clear liquid diet the day before the procedure. You will also be asked to refrain from eating starting the midnight before the procedure. In addition to these steps, you will need to use a cleansing routine the day before your procedure. This entails a liquid laxative that clears and prepares your bowels for examination. Your doctor will give clear instructions for all of these important steps leading up to your Single Balloon Enteroscopy.

During Single Balloon Enteroscopy

On the day of your procedure, you will first check in to a pre-op area where nurses will place an IV and take medical information. You will also meet with an anaesthesiologist to discuss sedation during the procedure.

The procedure takes around 60-75 minutes total. Your doctor will use a balloon system consisting of a flexible endoscope with a camera, an overtube, and an attached inflatable balloon at the tip of the overtube. They first insert the endoscope down your throat and into your intestine (you will have a mouthguard to protect your teeth and the endoscope). They will inflate the balloon to anchor the overtube, and then advance the endoscope further into your small intestine. Cyclically, they can then deflate the balloon, advance the overtube, reinflate the balloon, withdraw the overtube to shorten and straighten your small intestine, and advance the endoscope further. This pleats the small intestine over the overtube, shortening the small intestine’s length.

The endoscope is also able to inflate your intestine, rinse it with water, and guide biopsy and cautery instruments. Since you will be sedated, given pain medications, and given a local oral anaesthetic, the procedure is pain-free.

After the procedure

Following the procedure, you will return to a post-op area to recover from sedation. Nurses will monitor you for potential complications. After recovery, your doctor will discuss findings with you, although some results for biopsies and polyp removal can take a few more days to be finalized). You should not drive, make important decisions, or operate machinery for 24 hours after the procedure due to sedative effects.

You may feel bloated for a few hours after the procedure, which is normal. There are few severe complications and risks associated with Single Balloon Enteroscopy. On rare occasions, the procedure can cause perforation, excessive bleeding, and complications from sedation. If you experience excessive rectal bleeding, severe abdominal pain, or a fever, contact your doctor immediately.

Our experienced team at GHP has years of experience performing Single Balloon Enteroscopies We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Radiofrequency Ablation: What You Should Expect

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Radiofrequency ablation (RFA) is a procedure that utilizes radio waves to destroy diseased tissue. Here’s what you need to know if you are preparing for the procedure. 

When it’s used

Radiofrequency ablation can be used during an upper endoscopy to treat Barrett’s esophagus. People with Barrett’s esophagus have an increased risk of esophageal cancer, and RFA can eliminate this risk by destroying pre-cancerous tissue in the esophagus. Patients with both high and low grade dysplasia should almost always pursue radiofrequency ablation. It has an 80-90% success rate in removing Barrett’s esophagus long-term. There is a chance that Barrett’s can develop again after a successful procedure. However, repeat treatments are effective and often able to eliminate abnormal tissues entirely. 

Preparing for Radiofrequency Ablation

To prepare for RFA, your physician will discuss preoperative steps with you. First, you will need to talk to them about medications you are taking that could be a risk factor. For example, blood-thinning medications can increase the risk of excessive bleeding during the procedure. Additionally, if you use insulin, you may need to adjust dosage or timing leading up to the RFA. Your doctor will also ask you about any allergies to medications. You will be instructed to stop eating at midnight the day before the procedure. 

During the procedure

Before the procedure, you will be on an IV and will give your medical information in a pre-op area. An anaesthesiologist will then discuss sedation for the procedure. Then, you will go to the procedure room. Doctors will connect you to monitors that measure your heart rate, blood pressure, and blood oxygen levels.

Your doctor will perform radiofrequency ablation during an upper endoscopy. You will be on your left side. A bite block will be in your mouth to prevent damage to your teeth or the endoscope. You will be under sedation for the duration of the procedure. 

Your doctor will advance the endoscope into your esophagus and examine the Barrett’s esophagus. If they see any visible abnormalities, they may perform an endoscopic mucosal resection. This involves either injecting or banding any identified lesions and then using a snare device to capture, cut, and remove them. If this is not necessary, your doctor will perform RFA. They will inflate a balloon-catheter to make contact with the targeted area and apply heat energy for a second or so. 

After the Radiofrequency Ablation

Afterwards, you will wait in a post-op area where you can recover from the sedation while being monitored for any complications. Once you have recovered, your doctor will discuss their findings with you. Some results may take days or weeks to return. They will also give you information on any follow-up appointments. 

For the first 24 hours after the procedure, you should not drive or make important decisions due to sedative effects. Your doctor will also recommend a clear liquid diet for a few days following the treatment. 

Patients commonly feel some chest discomfort and have difficulty swallowing for a few days after the procedure. Your doctor will be prescribe medications to help with any pain or nausea. You will also need to take a proton pump inhibitor twice a day for 30 days. 

Complications

There are a few complications that can occur from the procedure. In around 6% of cases a stricture or narrowing of scar tissue develops in the esophagus. Doctors can treat this with dilation during an upper endoscopy. Another more rare complication is a tear in the esophagus, which occurs less than .02% of the time. 

Our experienced team at GHP has years of experience performing radiofrequency ablation. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.