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, which inflates them and helps the physician see well.

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.

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

Preparation

The colon and rectum must be completely empty for 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, Jell-O, 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 liquid solution that washes out the intestines. Your physician may give you other special instructions.

Sigmoidoscopy

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 colon. Physicians may use this procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use sigmoidoscopy to look for early signs of cancer in the colon and rectum. With sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers.

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

Colonscopy takes 30 to 30 minutes. The sedative and pain medicine should keep you from feeling much discomfort during the exam. You will need to remain at the physician’s office for 1 to 2 hours until the sedative wears off.

Preparation

Your colon must be completely empty for the colonscopy to be thorough and safe. To prepare for the procedure you may have to follow a liquid diet for 1 to 3 days before hand. A liquid diet means fat-free bouillon or broth, Jell-O, strained fruit juice, water, plain coffee, plain tea, or diet soda. You may need to take laxatives or an enema before the procedure. Also, you must arrange for someone to take you home afterward you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.

Diagnostic Testing

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Diagnostic Testing

Lower GI series

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

Before taking x-rays of your colon and rectum, the radiologist will put thick liquid called barium into your colon. This is why a lower GI series is sometimes called 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 the physician uses 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 while x-rays are taken. Different positions give different views of the intestines. After the radiologist is finished taking x-rays, you will be able to go to 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 and 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 non-sugar, 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, Jell-O, strained fruit juice, water, plain coffee, plain tea, or diet soda. To make sure your colon is empty, you might be given a laxative or an enema before the procedure. Your physician may give you other special instructions.

Upper GI Series

The upper gastrointestinal (GI) series uses x-rays to diagnose problems in the esophagus, 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, milk shake like liquid. Barium coats the inside lining of the esophagus, stomach, and duodenum and makes them show up 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 problem 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. 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.

Liver Biopsy

With a liver biopsy (BYE-op-see), the physician is able to examine a small piece of tissue from your liver for signs of damage or disease. This procedure involves using a special needle to remove 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.

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, like blood thinners, that affect blood clotting. One week before the surgery, you will have to stop taking aspirin, ibuprofen, and anticoagulants. You will also have a chest x-ray.

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 surgery. Your physician will tell you whether to take your normal medications during the fasting period and may give you other special instructions.

Procedure

Liver biopsy is considered minor surgery and is done at the hospital. The nurse will start an intravenous line to give you medication for the procedure. For the biopsy, you will lie on a hospital bed on your back or turned slightly to the left side, with your right hand above your head. After marking the outline of your liver and injection 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 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 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’s through an incision in the abdomen. The laparoscope’s sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope’s 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 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 at least two hours. The nurse will monitor your vital signs and level of pain. You may remain in the hospital for up to 24 hours after the surgery to recover from the sedative and to allow the medical staff to check you for complications before sending you home. 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 at least two hours. The nurse will monitor your vital signs and level of pain. You may remain in the hospital for up to 24 hours after the surgery to recover from the sedative and to allow the medical staff to check you for complications before sending you home. You will need to arrange to have someone 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, be sure not to exert yourself too much for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site, and you might have 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.

Upper Endoscopy

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine).

The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy.

For the procedure you will swallow a thin, flexible, lighted tube called an endoscope. Right before the procedure the physician will spray your throat with a numbing agent that may prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.

The physician can see abnormalities, like ulcers, through the endoscope that doesn’t show up well on x-rays. The physician can also insert instruments into the scope to remove samples of tissue (biopsy) for further tests.

Possible complications of the upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.

The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the physician’s office for 1 to 2 hours until the medicine wears off.

Preparation

Your stomach and duodenum must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours before hand. Also, you must arrange for someone to take you home you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.

ERCP

Endoscopic retrograde cholangiopancreatography enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion.

ERCP may be used to discover the reason for jaundice, upper abdominal pain, and unexplained weight loss. ERCP combines the use of x-rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see inside of the stomach, duodenum, and ducts in the biliary tree and pancreas.

For the procedure, you will lie on your left side on an examine table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x-rays. A radiographer will begin taking x-rays as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or work around the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. However, such problems are uncommon. You may have tenderness or a lump where the sedation was injected, but that should go away in a few days or weeks.

ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the physician’s office for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

Preparation

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home, you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.

Colonoscopy

Colonoscopy (koh-luh-NAH-skuh-pee) lets the physician look inside your entire large intestine, from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine. The procedure is used to diagnose the causes of unexplained changes in bowel habits. It is also used to look early signs of cancer in the colon and rectum. Colonscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, bleeding, and muscles spasms.

For the procedure, you will lie on your left side on the examining table. You will probably be given pain medication and a mild sedative to keep you comfortable and to help you relax during the exam. The physician will insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope (koh-LON-oh-skope). The scope transmits an image of the inside of the colon, so the physician can carefully examine the lining of the colon. The scope bends, so the physician can move the scope. The scope also bows air into your colon, which inflates the colon and helps the physician see well.

If anything unusual is in your colon, like a polyp or inflamed tissue, the physician can remove a piece of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the physician can pass a laser, heater probe, or electrical probe, or inject special medicines, through the scope and use it to stop bleeding.