Diagnosis and Tests

Flexible Sigmoidoscopy

The digestive system
Flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) enables the physician to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid or descending colon. Physicians may use the procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use it to look for early signs of cancer in the descending colon and rectum. With flexible sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon).

For the procedure, you will lie on your left side on the examining table. The physician will insert a short, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a sigmoidoscope (sig-MOY-duh-skope). The scope transmits an image of the inside of the rectum and colon, so the physician can carefully examine the lining of these organs. The scope also blows air into these organs, which inflates them and helps the physician see better.

If anything unusual is in your rectum or colon, like a polyp or inflamed tissue, the physician can remove a piece of it using instruments inserted into the scope. The physician will send that piece of tissue (biopsy) to the lab for testing.

Bleeding and puncture of the colon are possible complications of sigmoidoscopy. However, such complications are uncommon.

Flexible sigmoidoscopy takes 10 to 20 minutes. During the procedure, you might feel pressure and slight cramping in your lower abdomen. You will feel better afterward when the air leaves your colon.

Preparation
The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe, so the physician will probably tell you to drink only clear liquids for 12 to 24 hours beforehand. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. The night before or right before the procedure, you may also be given an enema, which is a liquid solution that washes out the intestines. Your physician may give you other special instructions.
Fact sheets on other diagnostic tests:

Colonoscopy
ERCP
Liver Biopsy
Lower GI Series
Upper Endoscopy
Upper GI Series

Liver Biopsy

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

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

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

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

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

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

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

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

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

Like any surgery, liver biopsy does have some risks, such as puncture of the lung or gallbladder, infection, bleeding, and pain, but these complications are rare.

Capsule Endoscopy

Capsule endoscopy lets your physician examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum and ileum). This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. Your physician will use a pill-sized video capsule called an endoscope, that has its own lens and light source and will view the images on a video monitor. You might hear your physician or other medical staff refer to capsule endoscopy as small-bowel endoscopy, capsule enteroscopy or wireless endoscopy.

Preparation
An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately 12 hours before the examination. Your physician will tell you when to start fasting.

Tell your physician in advance about any medications you take, including iron, aspirin, bismuth subsalicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination. Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

Tell your physician of the presence of a pacemaker, previous abdominal surgery, previous history of obstructions in the bowel, inflammatory bowel disease or adhesions.

Procedure
Your physician will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves similar to tape. The capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately 8 hours. At the end of the procedure you will return to the office and the data recorder will be removed so images of your small bowel can be put on a computer screen for physician review.

Recovery
You will be able to drink clear liquids after 2 hours and eat a light meal after 4 hours following the capsule ingestion, unless your physician instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your physician generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.

Virtual Colonoscopy

Virtual colonoscopy (VC) uses x rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. The procedure is used to diagnose colon and bowel disease, including polyps, diverticulosis, and cancer. VC can be performed with computed tomography (CT), sometimes called a CAT scan, or with magnetic resonance imaging (MRI).

VC Procedure
While preparations for VC vary, you will usually be asked to take laxatives or other oral agents at home the day before the procedure to clear stool from your colon. You may also be asked to use a suppository to cleanse your rectum of any remaining fecal matter.

VC takes place in the radiology department of a hospital or medical center. The examination takes about 10 minutes and does not require sedatives. During the procedure,

The doctor will ask you to lie on your back on a table.
A thin tube will be inserted into your rectum, and air will be pumped through the tube to inflate the colon for better viewing.
The table moves through the scanner to produce a series of two-dimensional cross-sections along the length of the colon. A computer program puts these images together to create a three-dimensional picture that can be viewed on the video screen.
You will be asked to hold your breath during the scan to avoid distortion on the images.
The scanning procedure is then repeated with you lying on your stomach.

After the examination, the information from the scanner must be processed to create the computer picture or image of your colon. A radiologist evaluates the results to identify any abnormalities.

You may resume normal activity after the procedure, although your doctor may ask you to wait while the test results are analyzed. If abnormalities are found and you need conventional colonoscopy, it may be performed the same day.

Conventional Colonoscopy
In a conventional colonoscopy, the doctor inserts a colonoscope—a long, flexible, lighted tube—into the patient's rectum and slowly guides it up through the colon. Pain medication and a mild sedative help the patient stay relaxed and comfortable during the 30- to 60-minute procedure. A tiny camera in the scope transmits an image of the lining of the colon, so the doctor can examine it on a video monitor. If an abnormality is detected, the doctor can remove it or take tissue samples using tiny instruments passed through the scope.

For more information about conventional colonoscopy, please see the Colonoscopy fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Advantages of VC
VC is more comfortable than conventional colonoscopy for some people because it does not use a colonoscope. As a result, no sedation is needed, and you can return to your usual activities or go home after the procedure without the aid of another person. VC provides clearer, more detailed images than a conventional x ray using a barium enema, sometimes called a lower gastrointestinal (GI) series. It also takes less time than either a conventional colonoscopy or a lower GI series.

Disadvantages of VC
The doctor cannot take tissue samples or remove polyps during VC, so a conventional colonoscopy must be performed if abnormalities are found. Also, VC does not show as much detail as a conventional colonoscopy, so polyps smaller than 10 millimeters in diameter may not show up on the images.

BÂRRX Procedure

The BÂRRX procedure was created by BÂRRX Medical, Inc. to relieve Barrett’s esophagus. Barrett’s is a pre-cancerous condition of the lining of the esophagus from chronic exposure of the esophagus to the gastric contents of the stomach caused by gastroesophageal reflux disease, commonly known as GERD.

Their procedure termed the HALO³⁶⁰ System is designed to treat and remove the diseased esophageal lining referred to as Barrett’s esophagus, without harming the underlying tissue layers.

Procedure
The first part of the procedure involves sizing the esophagus for the ablation. A catheter is inserted into the esophagus with a balloon at the tip used in conjunction with the HALO³⁶⁰ Energy Generator to measure the diameter of the esophagus. This allows your physician to choose the appropriate ablation catheter.

Once the sizing balloon is removed, the HALO³⁶⁰ Ablation Catheter is introduced. The HALO³⁶⁰ Energy Generator and the ablation catheter work together to deliver a short burst of energy that is circumferential: 360 degrees. This burst of energy is delivered to a depth clinically proven to remove the diseased tissue while reducing the risk of injury to the deeper healthy tissue layers.

Recovery
Patients should follow the discharge instructions provided by the physician or the nursing staff after the procedure to ensure limited time of discomfort and proper healing of the esophagus. Studies show that healthy tissue will re-grow on the treated area within one month.

A follow-up appointment will be scheduled by your physician's office to conduct an upper endoscopy to inspect the treated area and determine if an additional treatment is necessary.

For additional information on the procedure visit www.barrx.com.

Lower GI Series

The digestive system
A lower gastrointestinal (GI) series uses x rays to diagnose problems in the large intestine, which includes the colon and rectum. The lower GI series may show problems like abnormal growths, ulcers, polyps, diverticuli, and colon cancer.

Before taking x rays of your colon and rectum, the radiologist will put a thick liquid called barium into your colon. This is why a lower GI series is sometimes called a barium enema. The barium coats the lining of the colon and rectum and makes these organs, and any signs of disease in them, show up more clearly on x rays. It also helps the radiologist see the size and shape of the colon and rectum.

You may be uncomfortable during the lower GI series. The barium will cause fullness and pressure in your abdomen and will make you feel the urge to have a bowel movement. However, that rarely happens because the tube used to inject the barium has a balloon on the end of it that prevents the liquid from coming back out.

You may be asked to change positions while x rays are taken. Different positions give different views of the colon. After the radiologist is finished taking x rays, you will be able to go to the bathroom. The radiologist may also take an x ray of the empty colon afterwards.

A lower GI series takes about 1 to 2 hours. The barium may cause constipation and make your stool turn gray or white for a few days after the procedure.

Preparation
Your colon must be empty for the procedure to be accurate. To prepare for the procedure you will have to restrict your diet for a few days beforehand. For example, you might be able to drink only liquids and eat only nonsugar, nondairy foods for 2 days before the procedure; only clear liquids the day before; and nothing after midnight the night before. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. To make sure your colon is empty, you will be given a laxative or an enema before the procedure. Your physician may give you other special instructions.

Upper GI Series

The digestive system
The upper gastrointestinal (GI) series uses x rays to diagnose problems in the esophagus, stomach, and duodenum (first part of the small intestine). It may also be used to examine the small intestine. The upper GI series can show a blockage, abnormal growth, ulcer, or a problem with the way an organ is working.

During the procedure, you will drink barium, a thick, white, milkshake-like liquid. Barium coats the inside lining of the esophagus, stomach, and duodenum, and makes them show up more clearly on x rays. The radiologist can also see ulcers, scar tissue, abnormal growths, hernias, or areas where something is blocking the normal path of food through the digestive system. Using a machine called a fluoroscope, the radiologist is also able to watch your digestive system work as the barium moves through it. This part of the procedure shows any problems in how the digestive system functions, for example, whether the muscles that control swallowing are working properly. As the barium moves into the small intestine, the radiologist can take x rays of it as well.

An upper GI series takes 1 to 2 hours. X rays of the small intestine may take 3 to 5 hours. It is not uncomfortable. The barium may cause constipation and white-colored stool for a few days after the procedure.

Preparation
Your stomach and small intestine must be empty for the procedure to be accurate, so the night before you will not be able to eat or drink anything after midnight. Your physician may give you other specific instructions.