Upper endoscopy, also called esophagogastroduodenoscopy, or EGD, uses a thin scope with a light and camera at its tip to look inside of the upper digestive tract — the esophagus, stomach, and first part of the small intestine, called the duodenum.
Usually performed as an outpatient procedure, upper endoscopy sometimes must be performed in the hospital or emergency room to both identify and treat conditions such as upper digestive system bleeding.

The procedure is commonly used to help identify the causes of:

• Abdominal or chest pain
• Nausea and vomiting
• Heartburn
• Bleeding
• Swallowing problems

What is Capsule Endoscopy?

Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will use a pill sized video capsule called an endoscope, which has its own lens and light source and will view the images on a video monitor. You might hear your doctor or other medical staff refer to capsule endoscopy as small bowel endoscopy, capsule enteroscopy, or wireless endoscopy.

Why is Capsule Endoscopy Done?

Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.
As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.

How Should I Prepare for the Procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.
Tell your doctor 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 doctor of the presence of a pacemaker, previous abdominal surgery, or previous history of obstructions in the bowel, inflammatory bowel disease, or adhesions.

What Can I Expect During Capsule Endoscopy?

Your doctor 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 eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review.
Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill. After ingesting the capsule and until it is excreted, you should not be near an MRI device or schedule an MRI examination.

An endoscopic retrograde cholangiopancreatogram (ERCP) is a test that combines the use of a flexible, lighted scope (endoscope) with X-ray pictures to examine the tubes that drain the liver, gallbladder, and pancreas.

The endoscope is inserted through the mouth and gently moved down the throat into the esophagus, stomach, and duodenum until it reaches the point where the ducts from the pancreas (pancreatic ducts) and gallbladder (bile ducts) drain into the duodenum.

ERCP can treat certain problems found during the test. If an abnormal growth is seen, an instrument can be inserted through the endoscope to obtain a sample of the tissue for further testing (biopsy).

Why It Is Done

ERCP is done to:

• Check persistent abdominal pain or jaundice.
• Find gallstones or diseases of the liver, bile ducts, or pancreas.
• Remove gallstones from the common bile duct if they are causing a problem such as blockage (obstruction), inflammation or infection of the common bile duct (cholangitis), or pancreatitis.
• Open a narrowed bile duct or insert a drain.
• Get a tissue sample for further testing (biopsy)

The hydrogen breath test is a test that uses the measurement of hydrogen in the breath to diagnose several conditions that cause gastrointestinal symptoms.

How is hydrogen breath testing performed?

Prior to hydrogen breath testing, the patient fasts for at least 12 hours. At the start of the test, the patient blows into and fills a balloon with a breath of air. The concentration of hydrogen is measured in a sample of breath removed from the balloon. The patient then ingests a small amount of the test sugar (lactose, sucrose, sorbitol, fructose, lactulose, etc. depending on the purpose of the test).

Additional samples of breath are collected and analyzed for hydrogen every 15 minutes for three and up to five hours.

Helicobacter pylori tests are used to detect a Helicobacter pylori (H. pylori) infection in the stomach and upper part of the small intestine (duodenum). H. pylori can cause peptic ulcers. But most people with H. pylori in their digestive systems do not develop ulcers.

Four tests are used to detect H. pylori:

Blood antibody test. A blood test checks to see whether your body has made antibodies to H. pylori bacteria. If you have antibodies to H. pylori in your blood, it means you either are currently infected or have been infected in the past.
Urea breath test. A urea breath test checks to see if you have H. pylori bacteria in your stomach. This test can show if you have an H. pylori infection. It can also be used to see if treatment has worked to get rid of H. pylori. The breath test is not always available.
Stool antigen test. A stool antigen test checks to see if substances that trigger the immune system to fight an H. pylori infection (H. pyloriantigens) are present in your feces (stool). Stool antigen testing may be done to help support a diagnosis of H. pylori infection or to determine whether treatment for an H. pylori infection has been successful.
Stomach biopsy. A small sample (biopsy) is taken from the lining of your stomach and small intestine during an endoscopy. Several different tests may be done on the biopsy sample. For more information, see the medical test Upper Gastrointestinal Endoscopy.

Why It Is Done

A Helicobacter pylori (H. pylori) test is done to:

• Determine whether an infection with H. pylori bacteria may be causing an ulcer or irritation of the stomach lining (gastritis).
• Determine whether treatment for an H. pylori infection has been successful.

For those of you that have bothersome hemorrhoids after using conservative measures such as topical creams, ointments and warm sitz baths, you may want to consider a minimally invasive procedure.

Rubber band ligation (hemorrhoid banding) is the most widely used procedure. It is painless, quick (<1min) and successful in approximately 80 percent of patients.

Rubber bands or rings are placed around the base of an internal hemorrhoid. As the blood supply is restricted, the hemorrhoid shrinks and degenerates over several days. Many patients report a sense of “tightness” after the procedure, which may improve with warm sitz baths.

Patients are encouraged to use fiber supplements to avoid constipation. Three banding sessions are performed every two weeks for removal of all three hemorrhoid columns.

For more info on hemorrhoid banding click here.