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Procedures

These are some of the procedures performed by the DCC physicians.


Upper Endoscopy (Panendoscopy)
Colonoscopy
Liver Biopsy
Paracentesis
Endoscopic Retrograde Cholangiopancreatography (ERCP)

 

Upper Endoscopy (Panendoscopy)
Upper endoscopy, also known as panendoscopy, is a visual examination of the lining of the esophagus, stomach and upper duodenum with a flexible endoscope.

Why it is done

The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain.

How is an upper endoscopy performed?

For the duration of your procedure, you will be instructed to lie on your left side. The lining of the stomach, esophagus and upper duodenum will be examined. If necessary, biopsies may be obtained through the endoscope. After the area has been viewed and any biopsies taken, the endoscope will be removed. Food and liquids will be restricted until your gag reflex returns. The procedure lasts between 15 to 60 minutes.

How to prepare

In order to properly perform an upper endoscopy, your physician may make the following recommendations:
You should have nothing to eat or drink (6 to 12 hours) before the test.
Under physician request, you may be asked to stop eating and drinking after midnight prior to your exam.
Some adjustments to your medications may be required, per the recommendation of your doctor.
You must inform your doctor:
If you are on Coumadin, Plavix, or other blood thinners.
If there is any chance you might be pregnant.
You also must STOP taking asprin or anti-inflammatory drugs (such as Advil, Motrin, Naprosyn, etc.) 5-7 days prior to your procedure.
If you are a diabetic, please notify our office at 305.892.3101 and we will discuss your morning diabetes medications with you. Check your finger stick glucose before leaving home and notify the nurse of the result upon arrival to the endoscopy suite.
We may request that you arrive one hour prior to your scheduled time in order to be adequately prepared for the procedure. It is recommended that a family member, friend or companion comes with you (or at least picks you up). Due to the use of sedation you will not be allowed to drive back home.

How It Feels

There is some variability from patient to patient. Some people will not feel the procedure at all. Throughout the upper endoscopy procedure, there may be a sensation of gas as well as the possible feeling of the scope in the abdomen. Occasionally the endoscope may stimulate some gagging in the back of the throat. A nurse will observe you closely during the procedure to monitor your comfort level. The local anesthetic will make swallowing awkward, though this wears off shortly after the procedure.

After the test

You will be transferred to a recovery room, until you are fully awake. Preliminary results may be given (if biopsies were performed, they may take few days for the results to be avail able). After this, you will be requested to dress-up back on your street clothes in preparation for discharge. Written post-procedure instructions will be provided at the facility.

Results

Due to the effects of sedation from the medication you received, the physician may speak with your family or delay his talk with you. The physician’s discussion may involve a post-procedure phone call or a post-procedure follow up visit. Please note it may take several days to a week before your physician receives results of any biopsies taken.

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Colonoscopy
Colonoscopy is a visual examination of the lining of the rectum and the colon with a flexible fiberoptic endoscope.

Why it is done

The procedure enables the physician to see things such as inflamed tissue, abnormal growths, and ulcers. It is most often used to look for early signs of cancer in the colon and rectum. It is also used to look for causes of unexplained changes in bowel habits and to evaluate symptoms like abdominal pain, rectal bleeding, and weight loss.

How is a colonoscopy performed?

In order to properly advance the colonoscope through the large intestine, you will be instructed to lie on your left side. An anal area inspection and a rectal exam will be performed, also with assessment of the prostate gland status in males. The lining of the rectum and colon will be examined closely. If necessary, polyps may be removed and biopsies may be obtained through the endoscope. When the area has been viewed and any tissue samples taken, the endoscope will be removed. The procedure usually lasts 15 to 60 minutes. In rare instances, the entire colon may not be well visualized due to difficulties in advancing the scope or stool still present. The physician may need to repeat the procedure at a later date or discuss an alternative treatment plan.

How to prepare

You should have nothing to eat or drink (6 to 12 hours) before the test.
Upon physician request, you may be asked to stop eating and drinking after midnight prior to your exam.
You will receive an oral preparation the day prior to your scheduled procedure.
In some cases, an enema is done either the day before or on the day of the procedure.
Some adjustments to your medications may be required, per the recommendation of your doctor.
It is recommended that a family member, friend or companion comes with you (or at least picks you up). Due to the use of sedation you will not be allowed to drive back home.

How it feels

There is some variability from patient to patient. Some people will not feel the procedure at all due to the effect of the sedation. Throughout the colonoscopy procedure, there may be a sensation of pressure, gassiness, bloating or cramping at various times. You may have a sensation of the scope moving in the colon. A nurse will observe you closely during the procedure to monitor your comfort level. If needed, extra sedation may be given.

After the test

You will be transferred to a recovery room, until you are fully awake. Preliminary results may be given (if biopsies were performed, they may take few days for the results to be available). After this, you will be requested to dress-up back on your street clothes in preparation for discharge. Written post-procedure instructions will be provided at the facility.

Results

Due to the effects of sedation from the medication you received, the physician may speak with your family or delay his talk with you. The physician’s discussion may involve a post-procedure phone call or a post-procedure follow up visit. Please note that it may take several days to a week before your physician receives the results of any biopsies taken.

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Liver Biopsy
A liver biopsy is a procedure where a specially trained doctor uses a special needle to get a sample of your liver tissue to examine under a microscope. This liver tissue allows the doctor to see if your liver is healthy or to better understand what the reasons are if you have liver damage or disease.

Why it is done

Using the results from the liver biopsy, your doctor will see:
• Any liver disease or damage;
• Any abnormalities like a tumor or infection;
• Ongoing conditions like hepatitis or liver scar tissue (cirrhosis).

How is a Liver Biopsy Performed?

There are two ways to do a liver biopsy. Your doctor will discuss with you what kind of biopsy is best:
The most common way uses a special needle to remove the tissue through a very small incision in the skin.
Less often, the doctor does a liver biopsy through a vein in your neck (transjugular vein).

How to prepare

Before the procedure, do not eat anything for 6 hours before your procedure or drink anything for 3 hours before your biopsy. (You may drink clear liquids such as apple juice, Gatorade, ginger ale, or water for up to 3 hours before your procedure.)
Your doctor may give you additional instructions for this procedure. Please read them carefully.
It is recommended that a family member, friend or companion comes with you (or at least picks you up). Due to the use of sedation you will not be allowed to drive back home.

How it feels

A doctor will give you medications for your comfort or to take any blood tests if needed through an intravenous line that a nurse will place in your arm.
The doctor will ask you to lie flat with your right arm above your head. The doctor cleans the area for the biopsy and injects a local anesthetic around the insertion site. He/she will instruct you on breathing during the biopsy and when to hold your breath. The procedure itself is just few minutes long.

After the test

After the biopsy, you will have your blood pressure, pulse and oxygen levels checked often. Your nurse will check the biopsy insertion site for any signs of bleeding.
You will be allowed to drink fluids if your condition is stable. However, some patients may be asked not to eat or drink for 2 hours after the procedure.
Your blood will be drawn after the procedure to make sure everything is normal and it is safe for you to go home.
You will receive detailed instructions about how to care for yourself at home from your doctor and the nursing staff

Results

Often, your primary doctor gives you the final results of your biopsy within 5 days. This may also happen in a follow-up office visit after the liver specimen has been examined by the pathologist.

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Paracentesis
Paracentesis is a procedure to take out fluid that has collected in the belly. This fluid buildup is called ascites. Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

Why it is done

Paracentesis may be done to:
Find the cause of fluid buildup in the belly.
Diagnose an infection in the peritoneal fluid.
Check for certain types of cancer, such as liver cancer.
Remove a large amount of fluid that is causing pain or difficulty breathing or that is affecting how the kidneys or the intestines (bowel) are working.
Check for damage after a belly injury.

How to prepare

Before you have paracentesis done, tell your doctor if you:
Are taking any medicine.
Are allergic to any medicines, including numbing medicines (anesthetics).
Have had bleeding problems or are taking blood thinners, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or warfarin (Coumadin).
Are or might be pregnant.
Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems.
You may be asked to sign a consent form.

How it feels

You may feel a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is put into your belly, you may feel a temporary sharp pain or pressure.
You may feel dizzy or lightheaded if a large amount of fluid is taken out. Tell your doctor if you do not feel well during the test.
After the procedure, you may have some clear fluid draining from the site, especially if a large amount of fluid was taken out. The drainage will get less in 1 to 2 days. A small gauze pad and bandage may be needed. Ask your doctor how much drainage to expect.

After the test

Call your doctor immediately if you have:
A fever higher than 100° F (38° C).
Severe belly pain.
More redness or tenderness in your belly.
Blood in your urine.
Bleeding or a lot of drainage from the site.

Results

Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites. The fluid taken from your belly will be sent to a lab to be studied and looked at under a microscope. Results will be ready in a few hours.

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Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is a procedure that enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. It combines the the use of x-rays and an endoscope.

Why it is done

ERCP is used to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.

How to prepare
You must inform your doctor:
• If you are on Coumadin, Plavix, or other blood thinners.
• If you have had a barium x-ray or CT scan in the past 2-3 days.
• If there is any chance you might be pregnant.
You also must STOP taking asprin or anti-inflammatory drugs (such as Advil,Motrin, Naprosyn, etc.) 5-7 days prior to your ERCP procedure.
If you are a diabetic, please notify our office at 305.892.3101 and we will discuss your morning diabetes medications with you. Check your finger stick glucose before leaving home and notify the nurse of the result upon arrival to the endoscopy suite. Bring your blood glucose meter with you.
If your procedure is before 12 noon, have no solid food after midnight the night before your procedure. If your appointment is after 12 noon, you may have a light (low fat, low fiber) breakfast at least 6 hours before your procedure, then no solid food.
You may have clear liquids until 4 hours before your procedure, then have nothing at all by mouth.
You must bring a driver or arrange transportation home after your procedure. Driving is not permitted for at least 12 hours, due to drowsiness and delayed reflexes from the IV medication. You should also not conduct any business or sign any legal documents until the next day.
How it feels
You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, medicine should keep you from feeling too much discomfort.

After the test

After the procedure, you will need to stay at the hospital 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.

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