136 N Washington Ave. Ste. 204 Bergenfield, NJ 07062 T: (201)384-3323 F: (201)384-6237

  These are some of the procedures performed by the Hudson
County Gastroenterology Group P.A. physicians.

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



Upper Endoscopy (EGD)

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 aspirin 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 201-854-4646 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 or friend accompanies you to your procedure and then home since you will be given sedation and you will not be allowed to drive back home.

How does having and upper endoscopy feel?
There is some variability from patient to patient. Some people will not feel the procedure at all. Throughout the upper endoscopy, 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. The doctor  and a nurse will observe you closely during the procedure to monitor your comfort level. The local anesthetic may be given which will make swallowing awkward, although this wears off shortly after the procedure.

After the test
You will be transferred the recovery room, until you are fully awake. Preliminary results may be given. If biopsies were performed, then the results will take few days for the results to become available. After this, you will be requested to dress-up 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 have received, the physician may speak with your family or delay his talk with you. The physician’s discussion may involve 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 video colonoscope.

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 colonoscope. 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 8 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 or friend accompanies you to your procedure and then home since you will be given sedation and you will not be allowed to drive back home.

How does having a colonoscopy feel?
There is some variability from patient to patient. Most people will not feel the procedure at all due to the effect of the sedation. Throughout the colonoscopic 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. The doctor and 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 the recovery room, until you are fully awake. Preliminary results may be given but if biopsies were performed, then the results will take few days they become available. After this, you will be requested to dress-up in preparation for discharge. Written post-procedure instructions will be provided at the facility.

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

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 method uses a special needle to remove the tissue through a very small incision in the skin.
In the less frequent method, the doctor does a liver biopsy through a vein in your neck.

How to prepare?
The night before the procedure, do not eat or drink (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 does a Liver Biopsy feel?
A doctor will give you medications for your comfort and may take any blood tests through the intravenous line.
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 completed in just few minutes.

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
One of the physicians will give you the final results of your biopsy within one week. This information will be given follow-up office visit after the liver specimen has been examined by the pathologist.

Paracentesis
Paracentesis is a procedure to take out fluid that has collected in the abdomen. 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. Paracentesis also may be done to take the fluid out to relieve abdominal 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 abdomen.
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 the paracentesis so as to make sure that you do not have a bleeding or clotting problems.
You will be asked to sign a consent form.

How does having a paracentesis feel?
You may feel a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is put into your abdomen, 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 lessen 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 greater than 100° F (38° C).
Severe belly pain.
More abdominal redness or pain.
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 abdomen. The fluid taken from your abdomen will be sent to a lab to be studied and looked at under a microscope. Most of the results will become available within the same day.


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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 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 or scars, leaks associated with trauma or surgery, and cancer.

How to prepare?
You must inform your doctor?:
If you are on Coumadin, Aspirin, 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 anti-inflammatory drugs (such as Asprin, Advil, Motrin, Naprosyn, etc.) 5-7 days prior to your ERCP procedure.
If you are a diabetic, please notify our office at  201-854-4646 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.
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 associated with the IV medication. You should also not conduct any business or sign any legal documents until the next day.

How does an ERCP feel?
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 sedatives wear 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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Colon Cancer Screening

What is colorectal cancer?
Colon cancer is cancer of the large intestine (called the colon). Rectal cancer is cancer of the rectum (which is the part of the large intestine closest to the anus). These forms of cancer have many common features. They are often referred to together as colorectal cancer.

Colorectal cancer is the second leading cause of cancer deaths in the United States. Many of these deaths happen because the cancers are found too late to be effectively treated. If colorectal cancer is found early enough, it is usually very treatable and not life-threatening.

What are the signs and symptoms of colorectal cancer?
Most colorectal cancers begin as a polyp (say "pohl-ip"). At first, a polyp is a small, harmless growth in the wall of the colon. However, as a polyp gets larger, it can develop into a cancer that grows and spreads.

See your doctor if you have any of the following warning signs:
Bleeding from your rectum
Blood in your stool or in the toilet after you have a bowel movement
A change in the shape or consistency of your stool (such as diarrhea or constipation lasting several weeks)
Cramping pain in your lower stomach
A feeling of discomfort or an urge to have a bowel movement when there is no need to have one
Weakness or fatigue
Unintended weight loss
Other conditions can cause these same symptoms. You should see your doctor to find what is causing your symptoms.

What are screening tests for colorectal cancer?
Screening tests can find polyps or cancers before they are large enough to cause any symptoms. Screening tests are important because early detection means that the cancer can be more effectively treated. Your doctor will choose the tests that are right for you. The following are some screening tests for colorectal cancer:

Digital Rectal Exam. In this exam, your doctor puts his or her gloved finger into your rectum to find any growths. This exam is simple to do and is not painful. However, because this exam can find less than 10% of colorectal cancers, it must be used along with another screening test.

Barium Enema. For this test, you are given an enema (injection of fluid into the rectum) with a liquid that makes your colon show up on an X-ray. Your doctor looks at the X-ray to find abnormal spots in your entire colon. If you have an abnormal spot or if the radiologist detects polyps in your colon, your doctor will probably want you to have colonoscopy.

Fecal Occult Blood Test. This test checks your stool for blood that you can't see. Your doctor gives you a test kit and instructions to use it at home. Then you return a stool sample to your doctor for testing. If blood is found, another test is done to look for a polyp, cancer or another cause of bleeding. Your doctor will also ask you to not eat certain foods or take certain medicines that may interfere with test results a few days before the test.

Certain foods and medicines can make this test turn out positive, even though you don't really have blood in your stool. This is called a "false-positive" test. These include some raw vegetables, horseradish, red meat, non-steroidal anti-inflammatory drugs (such as ibuprofen), blood thinners, vitamin C supplements, iron supplements and aspirin. Some medical conditions, like hemorrhoids, can also cause a false-positive test result.

Stool DNA Test. This test checks your stool for cells that are shed by colon cancers or precancerous polyps. Your doctor will give you a test kit with instructions on how to collect a stool sample. Your doctor may also ask you to not eat certain foods or take certain medicines that may interfere with test results a few days before the test. If your test turns out positive, your doctor will probably want you to have a screening test called colonscopy.

Colonoscopy. Before you have this test, you are given a medicine to make you relaxed and sleepy. A thin, flexible tube connected to a video camera is put into your rectum, which allows your doctor to look at your entire colon. The tube can also be used to remove polyps and cancers during the exam. Colonoscopy may be uncomfortable, but it is usually not painful.

Virtual Colonoscopy. This is a new test that uses a computerized tomography (CT) machine to take pictures of your colon. Your doctor can then see all of the images combined in a computer to check for polyps or cancer. If your doctor finds polyps or other abnormalities in your colon, you will need to have a traditional colonscopy to examine them in more detail or to remove them.

Flexible Sigmoidoscopy. In this test, your doctor puts a thin, flexible, hollow tube with a light on the end into your rectum. The tube is connected to a tiny video camera so the doctor can look at the rectum and the lower part of your colon.

This test can be a bit uncomfortable, but it lets your doctor see polyps when they are very small (before they can be found with a fecal occult blood test). Because flexible sigmoidoscopy may miss cancerous polyps that are in the upper part of the colon, some doctors prefer a colonoscopy. Your doctor will discuss these options with you.

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