Esophagogastroduodenoscopy (EGD), also known as Upper Endoscopy, is a procedure that enables the physician to perform a visual examination of the esophagus, stomach, and duodenum (first part of the small intestine). A thin, flexible instrument known as an endoscope (or gastroscope) is introduced through the mouth and into the swallowing tube, or esophagus. This procedure is used to identify the cause of swallowing difficulties, nausea, vomiting, reflux, indigestion, abdominal pain, or chest pain.

EGD allows the physician to view abnormalities, like ulcers or tumors, which do not show up well on x-rays. Other advantages include the ability to remove small tissue samples (biopsies) or obtain some cells with a fine brush (cytology), which can be sent to the laboratory for microscopic examination. The endoscope can also be used to treat certain digestive conditions, such as stretching areas of narrowing within the esophagus, removing benign growths or polyps, and controlling gastrointestinal bleeding.

Colonoscopy

Colonoscopy is a procedure that enables the gastroenterologist to examine the inside of the large colon, from the lowest part (the rectum) up through the colon to the lower end of the small intestine. This is accomplished by inserting a thin, flexible instrument, known as an endoscope, into the anus and then advancing it slowly into the rectum and through the colon. It is performed with visual control by either looking through the instrument or viewing a TV monitor. Because the endoscope is flexible, it can be bent to conform to the curves of the large intestine. This procedure is usually performed to diagnose unexplained changes in bowel habits, to investigate the finding of blood in the stool, and also for early detection of cancer in the colon and rectum. Colonoscopy allows the gastroenterologist to observe inflamed areas of tissue, bleeding, abnormal growths, and muscle spasms.

If anything unusual, such as inflamed tissue or polyps, is observed during the examination, a forceps can be passed through the scope and a small sample of tissue, or biopsy, removed and sent to the laboratory for analysis. If a bleeding site is identified, this can be controlled by several means, including laser, special probes, or medication. Polyps (small, benign growths that can lead to cancer) can usually be removed during an endoscopic procedure. Early removal of these polyps is an important method of preventing colorectal cancer.

Small Intestinal Endoscopy

Small intestine endoscopy enables the gastroenterologist to examine the inside of the distal duodenum and major portion of the jejunum by extra flexible enteroscope used in conjunction with a special overtube. The overtube has low-friction characteristics, which allows the enteroscope to pass down without the intragastric looping. This procedure is used to identify the cause of gastrointestinal bleeding obsure in origin or to view small intestinal abnormalities like tumors.

The exam allows the physicians to biopsy lesions for microscopic examination and can also be used treat bleeding lesions by endoscopic various modalities. The whole small intestine can be accurately examined by "capsule endoscope" or (still investigational) at laparotomy (intraoperative). Intraoperative exam may be performed by the mouth, by a surgical enterostomy or by the anal canal. Counter pressure is applied by the surgeon to straighten out acute angles and to prevent large loops during this procedure.

Capsule Endoscopy

Capsule Ensocopy enables your doctor to examine the three portions (duodenum, jejunum, ileum) of your small intestine.   Your doctor will use a vitamin-pill sized video capsule as an endoscope, which has its own camera and light source.  While the video capsule travels through your body, images are sent to a data recorder you will wear on a waist belt.  Most patients consider the test comfortable.  Afterwards, your doctor will view he images on a video monitor.

Capsule Endoscopy helps your doctor determine the cause for recurrent or persistent symptoms such as abdominal pain, diarrhea, bleeding or anemia, in most cases where other diagnostic procedures failed to determine the reason for your symptoms.  In certain chronic gastointestinal diseases, the method can help to evaluate the extent to which your small intestine is involved or to monitor the effect of therapeutics.  Your doctor might use Capsule Edoscopy to obtain motility data such as gastric or small bowel passage time.

ERCP

Endoscopic retrograde cholangiopancreatography, also known as ERCP, is a diagnostic procedure used to examine the duodenum, bile ducts, gall bladder, and pancreas. A thin, flexible instrument known as a duodenoscope is inserted through the mouth, down the esophagus into the stomach and duodenum (first part of small intestine). Once the physician has positioned the duodenoscope appropriately, a dye (contrast media) is injected through the instrument into the bile ducts and/or the pancreatic duct. X-rays can then be taken of these areas. ERCP is used in diagnosing and treating gallstones, blockages of the bile ducts, jaundice, upper abdominal pain, unexplained weight loss, and cancer of the pancreas or bile duct.

If the examination identifies the presence of a gallstone or narrowing of the bile ducts, instruments can be inserted into the duodenoscope to remove or work around the obstruction. If the physician views an abnormality, a small sample of tissue (biopsy) can be removed through the instrument. Also, using electrocautery (electric heat) the physician can perform small incision to biliary and/or pancreatic sphincters. Biliary and pancreatic stenting can be performed in selected cases.

Laser Treatment

The neodymium-YAG laser tumor destruction in the esophagus or rectum/colon is used for palliation for inoperable tumors. The laser tumor destruction is usually applied from below to upwards using high energies in pulses of 2 seconds or more. Contact and noncontact laser photoablation in which energy is rapidly transferred from the laser beam for tumor destruction. The palliative effort of the laser treatment lasts few weeks to few months, and further sessions may be required. It may be necessary to place a stent if recurrence is rapid.

Photodynamic therapy (PDT), "smart laser" can be used to treat in patients with Barrett's precancerous (dysplastic) lesions and Barrett's superficial cancers. PDT starts with an injection into your vein of a drug called, Photofrin. Two days after the drug injection, you will have an endoscopy of your esophagus. A special light through an optic fiber will be inserted to light up the diseased area with red light. The red light comes from a low-powered laser and activates the drug in the diseased tissue for selective destruction of Barrett's segment. Two days after you received the PDT, you will have another endoscopy to inspect the diseased area of the esophagus for reaction to PDT. Whether you receive another light treatment, depends on how your esophagus reacted. You will have a visit every 3 or 6 months after you receive the PDT treatment. You may have an endoscopy of the esophagus and biopsies will be taken for microscopic examination as before. Depending on the biopsy results, you may undergo further tests or treatment.