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An Overview of Diverticulitis

Diverticulitis is a condition where pockets formed in the colon wall (called diverticula) become inflamed. Here’s what you need to know about the condition.

Causes and Risk Factors

Diverticula can form when weak areas of the colon give due to pressure, creating pockets in the colon wall. This pressure can be influenced by many things, including diet. If you do not eat enough fiber, waste can build up in your colon and increase pressure on its walls. If these diverticula tear, they can become infected and inflamed.

There are a few notable risk factors for diverticulitis. As previously mentioned, you are at risk if you do not eat enough fiber in your diet. Not eating enough fruits, vegetables, grains, nuts, and beans can all contribute to low fiber intake. If you have a diet high in fats and red meat your risk increases as well. Exercise is a factor as well- too little regular exercise can increase risk for diverticulitis. NSAIDs like ibuprofen and aspirin can heighten your risk too. Also, people over 40, men, and people who are obese have a higher chance of developing the condition. Overall, this is a very common condition, particularly for people in Western countries as they age.

Symptoms of Diverticulitis

Diverticulitis is characterized by a few symptoms. Abdominal pain in the lower left part of the abdomen is a common symptom. This pain can persist for several days, and may be mild and slowly building or can develop suddenly. Your abdomen may be tender as a result of the pain. Other potential symptoms include nausea, vomiting, constipation, and occasionally diarrhea.

Diagnosis, Treatment and Prevention

Abdominal pain is the most common symptom of this condition, and is associated with many other potential issues. As such, doctors typically perform a number of diagnostic steps to determine the underlying issue. They may ask you about your diet, bowel movements, and symptoms. They may also perform a physical exam to investigate abdominal pain and tenderness. Your doctor might want to run blood and urine tests to check for signs of infection. In some cases, they may want to do a stool test as well. They can also order a CT scan to visualize any inflamed or infected diverticula and illuminate the severity of the diverticulitis.

Treating mild diverticulitis usually involves taking prescribed oral antibiotics. You will also need to rest and switch to a liquid diet while your colon heals. In more severe cases, people with complicated diverticulitis are hospitalized and given intravenous antibiotics. Surgery may be warranted if an abscess (a pocket of infection) forms or if there is a colon puncture or fistula. In surgery, doctors remove diseased parts of the colon and reconnect healthy parts of the organ. If infection is widespread, doctors can perform a colostomy to connect the colon to a hole in the abdomen. Doctors attach a bag to the opening where waste can pass.

You can prevent diverticulitis by eating a fiber-rich diet and exercising regularly. Seek out whole grains, legumes, fruits, and vegetables. Stay in touch with your doctor if you do have a case of diverticulitis, as they may recommend other steps to prevent recurrence.

Our experienced team at GHP has years of experience treating diverticulitis. 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.

Colorectal Polyps: What You Need to Know

Colorectal polyps are excess tissue that can form in the lining of the colon or rectum. While most are harmless, some can develop into cancer. Here’s what you need to know about polyps.

Causes, Risk Factors, and Symptoms of Colorectal Polyps

Polyps occur when certain mutations in genes cause uncontrolled cell growth. This continued growth can turn into groups of tissue- polyps- in your large intestine. Some of the risk factors for polyps include family history, being 50 or older, obesity, low exercise levels, and tobacco or alcohol use.

In many cases, polyps may not cause any symptoms at all. You may find you have a polyp only after an examination like a colonoscopy. However, in some cases polyps do cause symptoms. These include rectal bleeding, pain, changes in bowel habits, and a change in stool color (red streaks or black stool).

Neoplastic Polyps

One of the two main kinds of polyps is neoplastic. Neoplastic polyps have the potential to become cancerous. Within this classification, there are a few additional types of polyps. Adenomas are the most common type of polyp, making up around 70% of polyps. When found, it’s tested for cancer. It can take many years for these kinds of polyps to become cancerous, so with proper screenings they can be taken care of before they become a major problem. Serrated polyps are the second main type of neoplastic polyps. These can become cancerous depending on their location and size. Larger polyps have a higher risk of becoming cancerous.

Non-neoplastic Polyps

In comparison, non-neoplastic polyps usually do not turn cancerous. One common kind, hyperplastic polyps, are small and very rarely become cancerous. Another type, inflammatory polyps, are common in people with inflammatory bowel disease. These do not grow like other polyps- they develop in response to chronic inflammation. They tend to be benign. One final type is hamartomatous polyps. These may occur as part of a genetic syndrome, and tend to be benign as well.

Reducing Risk and Preventing Colorectal Cancer

In general, there are several lifestyle and screening measures you should take to reduce the risk of polyps and colorectal cancer. Eating fruits and vegetables and reducing fat intake are key dietary steps that can help you remain healthy. In addition, you should limit alcohol and tobacco consumption. Plus, staying active is a must.

You should also consider your risk for colorectal cancer or polyps based on family history. In some cases, you may want to pursue genetic counseling if your family has a history of colon polyps. Additionally, if you have a hereditary disorder that causes polyps, you may need earlier and more regular screenings.

Screenings themselves are a key aspect of preventing colorectal cancer. The colonoscopy remains the gold standard for screenings. It allows doctors to both detect and remove polyps to prevent colorectal cancer. In fact, annual colonoscopies reduce cancer incidence by around 89%. Screenings are now recommended earlier- at GHP we endorse annual colonoscopies for all patients ages 45-75. Visit our website to learn more.

Our experienced team at GHP has years of experience screening for and treating colorectal cancer. 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.

 

What is H. Pylori?

H. pylori is a bacteria that can infect the stomach and cause complications like stomach ulcers. Here’s an overview of how doctors identify and treat this infection.

Causes and Risk Factors

H. Pylori is very common- in the United States, around 30-40% of people are estimated to have an infection with the bacteria in their lifetime. Most It may spread through contaminated food and water, and through an infected person’s saliva or other bodily fluids. As such, risk factors include eating food that is not cooked properly or safely and drinking contaminated water. Living in crowded conditions also increases risk, as does living in a developing country where living conditions may be less sanitary and more crowded. Additionally, if you live with someone who has H. pylori, you have an increased risk.

Symptoms and Complications

Most people with H. pylori never have any symptoms. For people who do experience symptoms, they can include a burning or ache in the abdomen, loss of appetite, nausea, boating, weight loss, frequent burping, and nausea. There are some complications that can occur with H. pylori as well. The infection can damage the stomach’s protective lining and allow stomach acid to create an ulcer (an open sore). Additionally, the infection can cause gastritis (inflammation) on the stomach lining. H. pylori infection is also a risk factor for some kinds of stomach cancer.

Diagnosis

There are a few ways doctors can diagnose H. pylori. They can perform blood testing to see if you have an active or past infection. They can also perform breath testing; in this case, you swallow a pill containing carbon molecules and then breathe into a bag. Doctors check for carbon in your breath- if it’s present this means the bacteria is present. Another testing option is a stool test, in which doctors analyze a stool sample for abnormal bacteria or proteins that indicate an H. pylori infection. In some cases, your doctor may perform an upper endoscopy to visualize your stomach and take a tissue biopsy.

Treatment and Prevention

Most often, doctors treat H. pylori infection with multiple antibiotics. They may use two simultaneously to hedge against the bacteria becoming resistant to one. Your doctor may recommend other treatments depending on your case. This can include prescribing proton pump inhibitors, which block stomach acid production. They may also prescribe histamine blockers, which block histamine, the substance that triggers acid production. Often times, you may undergo follow-up testing a few weeks after treatment to determine if the bacteria has been eliminated.

You can take some steps to prevent H. pylori infection. Always wash your hands thoroughly with soap and water after using the bathroom and before eating. Only consume food that has been cooked in a clean and safe manner. Avoid unclean drinking water if possible. Doing these things can cut down on risk factors for H. pylori.

Our experienced team at GHP has years of experience diagnosing and treating H. pylori. 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.

Hereditary Diffuse Gastric Cancer: What You Need to Know

HDGC, or Hereditary Diffuse Gastric Cancer, is an inherited condition that increases your risk of stomach cancer. Here’s what you need to know about the condition.

What is Hereditary Diffuse Gastric Cancer?

Hereditary Diffuse Gastric Cancer syndrome is passed down genetically. This condition causes signet-ring shaped cells to grow on the stomach wall. It can spread throughout the stomach, and it does not usually cause a mass. As a result, it is difficult to diagnose early on before symptoms occur with typical testing like an Upper Endoscopy. Later-stage symptoms of HDGC that can indicate the condition include weight loss, loss of appetite, vomiting, nausea, trouble swallowing, and stomach pain.

Only around 1-3% of all stomach cancers are HDGC, so this is a rare condition. It puts you at a higher risk of stomach cancer and lobular breast cancer. In particular, there is a higher risk of diffuse gastric cancer for people with the syndrome. Diffuse gastric cancer is a type of stomach cancer that tends to affect most of the stomach. Somewhere around 20% of stomach cancers are of this type.

Cancer risk for people in families carrying an HDGC gene is high. The risk of developing stomach cancer by age 80 is 67% for men and 83% for women. The lifetime risk for women with HDGC developing lobular breast cancer is around 20-40%.

Diagnosis

People with a family history of HDGC can receive genetic testing to identify gene mutations associated with the condition. There is no single gene mutation that indicates HDGC most of the time. In fact, in families with a strong history of diffuse gastric cancer, the most common gene mutation (CDH1) for this condition only accounts for around 30-50% of cases. In all cases of gastric cancers, CDH1 mutation only cause around 1-3% of cases. So, there are a particular set of circumstances that dictate whether genetic testing should be pursued. Family history has to be taken into account. The guidelines for testing for a CDH1 may include:

  • A diffuse gastric cancer diagnosis before age 35
  • A diagnosis of both diffuse gastric and lobular breast cancer
  • Over two cases of diffuse gastric cancer in a family
  • Multiple cases of diffuse gastric cancer in a family, with one or more diagnoses occurring before age 50

Reducing Cancer Risk

People with an HDGC diagnosis or confirmed CDH1 gene mutation have a few treatment options. Unfortunately, as alluded to earlier, early screening for HDGC is very difficult since the diffuse cancer involved is hard to detect. People with a CDH1 mutation may want to consider getting their stomach removed through a prophylactic total gastrectomy, as this is the only proven way to completely prevent diffuse gastric cancer. This is a significant surgery with long-term side effects, so you should discuss the option thoroughly with your doctor. If you do not want to pursue the surgery, intensive surveillance is another option. This involves an annual EGD (Esophagogastroduodenoscopy) with multiple mucosal biopsies. Additionally, women at risk of HDGC should consider early breast cancer screening starting at age 30. They may also want to consider biannual clinical breast examinations, monthly self-examinations, and frequent breast imaging tests.

Our experienced team at GHP has years of experience screening for and treating conditions including HDGC. 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.

 

What is Anorectal Manometry?

Anorectal Manometry is a procedure that measures the function of anal and rectal muscles. This test helps doctors measure function and pressure in sphincter muscles involved in bowel movements. Here’s what you need to know about the procedure.

When is Anorectal Manometry used?

Anorectal Manometry is used to help evaluate patients with fecal incontinence or constipation. As a type of manometry, it measures the coordination and force of smooth muscles. In particular, it can help evaluate the strength and coordination of sphincter muscles. In short, Doctors use Anorectal Manometry to investigate in cases of abnormal bowel movements. So, if you have difficulty passing stool, struggle with uncontrolled bowels, or experience constipation, your doctor may recommend Anorectal Manometry. Doctors also use Anorectal Manometry to assess anal and rectal muscles pre and post-surgery, investigate functional anorectal pain, and make differential diagnoses regarding anal pain.

Preparing for the Procedure

There are a few preparatory steps you need to take before an Anorectal Manometry. Your doctor will give specific instructions before the procedure. You should not eat or drink anything starting midnight the night before the test. Additionally, your doctor may ask you to take one or two enemas a few hours before the test to empty your bowels. You should also discuss any medications you are taking before the procedure. In particular, you should not take smooth muscle relaxants the day before the procedure.

During the Anorectal Manometry Procedure

Anorectal Manometry does not involve any sedatives. During the procedure, you will lie on your left side with your knees bent. Your doctor will slowly insert a small catheter (tube) through your anal sphincter to your rectum. The catheter has a balloon attached at the end. Once the balloon is in place, your doctor will attach the exposed end of the tube to a machine that inflates the balloon. Your doctor will then measure the muscle coordination and strength in your rectum and anal sphincter. You may be asked to squeeze, push, and relax at various points as they are performing the testing. The machine measures subsequent pressure changes in the balloon. Your doctor may also measure other things like rectal volume, sensation, and muscle reflexes. Once they complete measurements, your doctor will deflate the balloon and remove the catheter and balloon. The procedure takes around 30-45 minutes in total.

After the Procedure

Since no anaesthetic is used during the test, recovery is immediate. You can resume normal activities and diet. Your doctor will discuss their findings with you after the procedure. This can take some time depending on their findings.

Depending on the findings, your doctor may make some recommendations. These may include dietary changes, using certain medication, and muscle strengthening exercise. In some cases, surgery may be required.

Our experienced team at GHP has years of experience performing procedures including Anorectal Manometry. 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.

 

Chronic Diarrhea: What You Should Know

Chronic diarrhea can be caused by a variety of things, including infections, GI disorders, food intolerance, and a reaction to medication. Let’s take a closer look at the condition.

Causes and Risk Factors

Diarrhea is chronic when it occurs three or more times per day for more than two weeks. It has several potential causes. Infection is one main cause. This infection can be parasitic, and from parasites like Giardia or Cyclospora. Infection can also be bacterial, from bacteria like Salmonella and E. coli. Some viral infections cause chronic diarrhea too, like some rhinoviruses and rotoviruses.

Outside of infections, there are several other potential causes. Pancreatic disorders like pancreatitis and cystic fibrosis can be a cause. GI diseases like Chrohn’s and IBS can cause diarrhea as well. Intolerance to foods can be at play too- lactose intolerance and fructose malabsorption are two examples. Additionally, some medications like laxatives and antibiotics can cause chronic diarrhea.

Symptoms of Chronic Diarrhea

As previously mentioned, diarrhea becomes chronic if it occurs three or more times per day for two or more weeks. Diarrhea is characterized by loose, watery stools that occur often more frequently than usual. Other symptoms include abdominal pain, abdominal cramps, bloating, nausea, blood or mucus in stool, and a fever. It also dehydrates you over time. If left untreated, this can be very dangerous. You should always see a doctor for chronic diarrhea.

Diagnosis

Chronic diarrhea itself is simple to diagnose, based on the definition outlined above. When you see a doctor for chronic diarrhea, they will work to diagnose the underlying cause. Depending on your symptoms, medical history, medications, the results of a physical exam, and other factors, they will select the appropriate testing measures. Stool samples can be tested to help identify if parasites, bacteria, or viruses are a cause. Your doctor may also want to do a blood test. If initial testing does not reveal a cause, your doctor may order an x-ray or endoscopy.

Chronic Diarrhea Treatment and Prevention

The cause of the condition dictates its treatment. With any case of diarrhea, fluid replacement is key. You should consume fluids and salts to replace those lost through diarrhea, unless otherwise ordered by your doctor. Some fruit juices and soup can be good options here. If liquids are upsetting your stomach, your doctor may recommend an IV to help rehydrate you.

Diarrhea caused by infection can often be treated with antibiotics or other medications. Your doctor will prescribe the proper medication for you depending on your case. If infection isn’t the cause, it will likely take more time to determine the underlying cause and therefore appropriate treatment. Conditions like IBS, Chrohn’s, fructose malabsorption, and Ulcerative Colitis all have their own treatment approaches. Your doctor will work with you to determine the best treatment options depending on the underlying cause.

Preventing chronic diarrhea involves mitigating risk factors for its various causes. To avoid infections that cause diarrhea, always drink safe, clean, properly-treated water. You should also use good food handling techniques, and practice good hand hygiene after using the bathroom and around food. If some foods trigger diarrhea for you, narrow down what they are and avoid them if possible.

Our experienced team at GHP has years of experience treating GI conditions like chronic diarrhea. 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.

Bile Duct Diseases: An Introduction

Bile ducts are tubes that primarily carry bile from the liver and gallbladder to the small intestine to help digest fats.

Several diseases in the bile ducts can prevent proper bile duct functioning. Read along to find out more.

Bile duct disease

There are several bile duct diseases that can occur. Gallstones are one common issue for bile ducts. These form when deposits of digestive fluid harden in the gallbladder. They can cause inflammation, increasing pressure in the gallbladder and potentially blocking a bile duct. Another common bile duct condition is cholangitis, which is inflammation in the bile duct system. This is often caused by a bacterial infection.

Bile ducts can also have strictures (narrowing). In other cases, they can leak. Cancer can also occur in the bile ducts. Bile duct cancer is rare and aggressive. Additionally, some infants are born with a condition called biliary atresia, in which bile ducts are scarred and blocked. This causes a buildup of bile in the liver and can damage it.

Symptoms of Bile Duct Diseases

Bile duct diseases tend to have some of a group of symptoms. These include abdominal pain, nausea, vomiting, itchy skin, fever, chills, weight loss, loss of appetite, and jaundice. Pain may occur in the upper abdomen and radiate to the back in some cases. Depending on the disease, these symptoms can be at differing levels of severity and present in varied ways. The progression the disease also influences the severity and types of symptoms.

Diagnosis

Doctors diagnose bile duct diseases in a few different ways. Bilirubin blood testing can identify high levels of bilirubin in your bloodstream and can diagnose jaundice. Doctors can perform an Endoscopic Retrograde Cholangiopancreatogram (ERCP) to diagnose diseases. In an ERCP, they can inject contrast dye to help image your bile ducts during an x-ray. They can also perform an Endoscopic Ultrasound (EUS) to examine your bile ducts and make a diagnosis.

Treatment

Treatments vary depending on the type of bile duct disease. ERCP, in addition to helping with diagnosis, can help treat disease. Doctors can pass tools through the endoscope during an ERCP and open blocked ducts, remove or break up gallstones, insert stents, and even remove tumors. Doctors can also help drain bile during an EUS by inserting a stent to help drain into the small intestine or stomach. One other emerging treatment involves using Radiofrequency Ablation for palliative care to treat the symptoms of bile duct cancer. This can be a way to manage pain for long-term cases of cancer.

Surgery may also be necessary in some cases. For example, with patients who have bile duct cancer, surgery can help to remove tumors. If tumors are very large, doctors may need to remove the liver and perform a liver transplant.

Our experienced team at GHP has years of experience treating conditions including bile duct diseases. 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

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

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

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.