Centre for Advanced Therapeutic Endoscopy

Esophagogastroduodenoscopy (EGD) is a diagnostic procedure that uses an endoscope to visualize the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). The endoscope, a flexible tube with a light and camera at its tip, is inserted through the mouth and gently advanced through the upper gastrointestinal tract, providing real-time images on a monitor. EGD is performed to investigate symptoms such as persistent heartburn, upper abdominal pain, nausea, vomiting, difficulty swallowing, or unexplained weight loss. It is used to diagnose conditions like gastroesophageal reflux disease (GERD), ulcers, esophagitis, gastritis, and tumors. It can also identify sources of bleeding and take biopsies for further pathological examination.

• Preparation: Patients should fast for at least 8 hours before the procedure to ensure the stomach is empty. This reduces the risk of aspiration and provides a clearer view of the gastrointestinal lining.
• Procedure: The procedure is typically done under sedation to ensure patient comfort. It takes about 15 to 30 minutes. The patient lies on their side while the endoscope is carefully guided through the mouth, esophagus, stomach, and duodenum. The physician may take biopsies or perform minor treatments during the procedure.
• Recovery: Patients are monitored until the sedative effects wear off, which usually takes an hour or two. A mild sore throat or a feeling of bloating might occur but typically resolves quickly. Patients should arrange for someone to drive them home and rest for the remainder of the day.

Capsule endoscopy is a non-invasive procedure that involves swallowing a small, pill-sized camera to capture images of the digestive tract. It is used to diagnose and evaluate conditions affecting the small intestine, such as bleeding, Crohn’s disease, tumors, and other abnormalities that are not easily detected with traditional endoscopy.

Preparation

• Patients should fast for at least 12 hours before the procedure.
• Specific instructions about medication adjustments and bowel preparation will be provided by the healthcare team. Typically, a bowel cleansing agent is taken the night before to ensure clear imaging.

Procedure

• The patient swallows the capsule, which contains a tiny camera.
• As the capsule travels through the digestive tract, it takes thousands of pictures, transmitted to a recorder worn on a belt around the patient’s waist.
• The procedure typically lasts 8 hours, during which the patient can go about their normal activities, avoiding strenuous physical activity.

Recovery

• The capsule is naturally excreted in the stool within 24-48 hours.
• Patients can eat and drink as usual after the procedure unless otherwise instructed by the healthcare team.
• There may be no immediate side effects, but any abdominal pain, nausea, or vomiting should be reported to the healthcare provider.

Push enteroscopy is an endoscopic procedure that involves the use of a long, flexible tube called an endoscope, equipped with a light and camera, to examine the small intestine. During the procedure, the endoscope is inserted through the mouth and advanced beyond the stomach into the small intestine. This allows the physician to view the inner lining of the upper digestive tract in detail. Additionally, biopsies (small tissue samples) can be taken from the small intestine for further analysis.

Push enteroscopy is performed to diagnose various conditions affecting the small intestine. These include celiac disease, tumors, polyps, inflammation, and sources of gastrointestinal bleeding that could not be identified by other diagnostic methods. By taking biopsies, doctors can obtain tissue samples to examine under a microscope, providing valuable information for accurate diagnosis and treatment planning.

• Preparation: Patients are typically required to fast for at least 8 hours before the procedure to ensure that the stomach and small intestine are empty. This helps provide a clear view and reduces the risk of aspiration.
• Procedure: Push enteroscopy is usually performed under sedation to ensure comfort and minimize anxiety. The procedure itself takes about 30 to 60 minutes. During the procedure, the patient lies on their side or back while the endoscope is carefully advanced through the digestive tract.
• Recovery: After the procedure, patients are monitored until the effects of sedation wear off, which can take an hour or two. Some may experience a mild sore throat or bloating, but these symptoms typically resolve quickly. Patients are advised to arrange for someone to drive them home and to rest for the remainder of the day.

Flexible sigmoidoscopy is a diagnostic procedure that examines the rectum and the lower part of the colon (sigmoid colon) using a flexible tube called a sigmoidoscope. The scope has a light and camera to capture images of the colon lining. It is used to investigate symptoms such as rectal bleeding, changes in bowel habits, abdominal pain, and to screen for colorectal cancer. It helps diagnose conditions like polyps, tumors, inflammatory bowel disease (IBD), and diverticulosis.

• Preparation: Patients may need to follow a clear liquid diet and use a prescribed laxative or enema to clear the lower bowel.
• Procedure: The procedure takes about 10 to 20 minutes and may be done without sedation. The sigmoidoscope is inserted through the rectum and advanced to the sigmoid colon.
• Recovery: There is minimal recovery time, with patients typically resuming normal activities soon after. Minor discomfort, cramping, or bloating may occur.

Colonoscopy is a procedure that allows for the examination of the entire colon and rectum using a colonoscope, a long, flexible tube with a camera and light. It provides real-time images of the colon lining. Colonoscopy is used to investigate symptoms such as rectal bleeding, chronic diarrhea, constipation, abdominal pain, and to screen for colorectal cancer. It helps diagnose conditions like polyps, tumors, inflammatory bowel disease, and diverticulosis.

• Preparation: Patients must follow a clear liquid diet and use a prescribed bowel preparation to cleanse the colon.
• Procedure: Typically performed under sedation, the procedure takes about 30 to 60 minutes. The colonoscope is inserted through the rectum and advanced through the entire colon.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, cramping, or bloating may occur. Resting for the day and arranging transportation home is recommended.

Ileoscopy is an endoscopic procedure that involves examining the ileum (the last part of the small intestine) using an endoscope. This is often part of a colonoscopy where the endoscope is advanced into the ileum. It is used to diagnose conditions affecting the ileum, such as Crohn’s disease, ulcers, tumors, and sources of gastrointestinal bleeding.

• Preparation: Patients must follow a clear liquid diet and use a prescribed bowel preparation.
• Procedure: Often part of a colonoscopy and performed under sedation. The endoscope is inserted through the rectum, advanced through the colon, and into the ileum.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort or bloating may occur. Resting for the day and arranging transportation home is recommended.

Pouchoscopy is an endoscopic procedure that examines an ileoanal pouch, which is surgically created in patients who have had their colon and rectum removed (such as those with ulcerative colitis). It is used to monitor for inflammation, polyps, or other complications in the pouch.

• Preparation: Patients may need to follow a clear liquid diet and use a prescribed enema or laxative.
• Procedure: Typically performed under sedation, the procedure takes about 15 to 30 minutes. The endoscope is inserted through the anus and into the pouch.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort or bloating may occur. Resting for the day and arranging transportation home is recommended.

Linear ultrasound, or linear endoscopic ultrasound (EUS), uses a linear array probe to obtain detailed images and facilitate fine-needle biopsy (FNB) of the gastrointestinal tract and surrounding structures. It is used to diagnose and stage cancers, assess pancreatic and biliary diseases, and obtain tissue samples.

• Preparation: Patients should fast for several hours before the procedure.
• Procedure: Typically performed under sedation, the procedure takes about 30 to 60 minutes. The linear EUS probe is inserted through the mouth and advanced to the area of interest.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort or a sore throat may occur but typically resolves quickly. Arranging transportation home and resting for the day is recommended.

Endoscopic Mucosal Resection (EMR) is a procedure that involves removing larger polyps or early-stage cancers from the gastrointestinal tract using an endoscope and specialized instruments. It is used to remove polyps or early cancers that cannot be removed by standard polypectomy techniques.

• Preparation: Patients must follow a clear liquid diet and use a prescribed bowel preparation to cleanse the colon.
• Procedure: Conducted under sedation, the colonoscope and EMR instruments are inserted through the mouth or rectum to the site of the lesion. The lesion is injected with a solution to lift it, then removed. The procedure takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, cramping, or bloating may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Endoscopic Submucosal Dissection (ESD) is an advanced procedure that involves removing larger and more complex polyps or early-stage cancers from the gastrointestinal tract using an endoscope and specialized instruments. It is used to remove polyps or early cancers that cannot be removed by standard techniques or EMR.

• Preparation: Patients must follow a clear liquid diet and use a prescribed bowel preparation to cleanse the colon.
• Procedure: Conducted under general anesthesia, the colonoscope and ESD instruments are inserted through the mouth or rectum to the site of the lesion. The lesion is dissected and removed. The procedure takes about 90 to 120 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, cramping, or bloating may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

This procedure involves using an endoscope to place a stent in the esophagus to keep it open when it has been narrowed by tumors, strictures, or other conditions. It is used to relieve swallowing difficulties caused by malignant or benign strictures, allowing food and liquids to pass more easily.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Conducted under sedation, the endoscope and stent are inserted through the mouth to the site of the stricture. The stent is deployed to keep the esophagus open. The procedure takes about 30 to 60 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, sore throat, or chest pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that uses an endoscope and X-rays to examine the bile ducts, pancreatic ducts, and gallbladder. It is used to diagnose and treat conditions such as gallstones, strictures, or tumors in the bile ducts or pancreas.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Conducted under sedation, the endoscope is inserted through the mouth to the bile and pancreatic ducts. Contrast dye is injected, and X-rays are taken. The procedure takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, sore throat, or bloating may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Double balloon enteroscopy is a procedure that uses an endoscope and two balloons to examine the small intestine in detail. It is used to diagnose and treat conditions such as bleeding, strictures, or tumors in the small intestine.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Conducted under sedation, the endoscope and balloons are inserted through the mouth or rectum to the small intestine. The balloons are alternately inflated and deflated to advance the endoscope. The procedure takes about 60 to 120 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, sore throat, or bloating may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

ERCP with Cholangioscopy is a procedure that combines ERCP with direct visualization of the bile ducts using a Cholangioscope. This allows for more detailed examination and treatment. It is used to diagnose and treat complex biliary conditions such as difficult-to-remove stones, strictures, or tumors.

• Preparation: Patients should fast for at least 8 hours before the procedure. Medication adjustments may be necessary, and specific instructions will be provided.
• Procedure: Conducted under sedation, the endoscope and cholangioscope are inserted through the mouth to the bile ducts. The cholangioscope allows for direct visualization and treatment of the ducts. The procedure typically takes about 90 to 120 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or bloating may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Zenkers diverticulotomy is a procedure that uses an endoscope to treat Zenker’s diverticulum, a pouch that forms at the junction of the esophagus and throat. It is used to relieve symptoms of Zenker’s diverticulum, such as difficulty swallowing, regurgitation, and aspiration.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, the endoscope is inserted through the mouth to the site of the diverticulum. Specialized instruments are used to divide the septum between the diverticulum and the esophagus, allowing food to pass more easily. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or chest pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Push enteroscopy is a procedure that uses an endoscope to examine the upper part of the small intestine. It is used to diagnose and treat conditions such as bleeding, strictures, or tumors in the small intestine.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Conducted under sedation, the endoscope is inserted through the mouth to the small intestine. The procedure takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, sore throat, or bloating may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Z-POEM (Peroral Endoscopic Myotomy) is a minimally invasive procedure that involves creating an incision in the esophageal muscle to treat Zenker’s diverticulum. It is used to relieve symptoms of Zenker’s diverticulum, such as difficulty swallowing, regurgitation, and aspiration.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, an endoscope is inserted through the mouth to the site of the diverticulum. An incision is made in the esophageal muscle to divide the septum between the diverticulum and the esophagus, allowing food to pass more easily. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or chest pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

POEM (Peroral Endoscopic Myotomy) is a minimally invasive endoscopic procedure used to treat achalasia and other esophageal motility disorders. The procedure involves creating an incision in the esophageal muscle to improve swallowing. It is used to relieve symptoms of achalasia, such as difficulty swallowing, chest pain, and regurgitation.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, an endoscope is inserted through the mouth to the lower esophagus. An incision is made in the esophageal muscle to allow easier passage of food and liquids. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or chest pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

G-POEM (Gastric Peroral Endoscopic Myotomy) is a minimally invasive endoscopic procedure used to treat gastroparesis. The procedure involves creating an incision in the pyloric muscle to improve gastric emptying. It is used to relieve symptoms of gastroparesis, such as nausea, vomiting, and delayed gastric emptying.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, an endoscope is inserted through the mouth to the pylorus. An incision is made in the pyloric muscle to improve gastric emptying. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or abdominal pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

EDGE (Endoscopic Ultrasound-Guided Gastroenterostomy) is a minimally invasive procedure that uses endoscopic ultrasound (EUS) to create a connection between the stomach and the small intestine for patients with gastric outlet obstruction. It is used to bypass obstructions in the gastric outlet, allowing food to pass from the stomach to the small intestine.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, an endoscope with an ultrasound probe is inserted through the mouth to the stomach. A connection is created between the stomach and the small intestine using a lumen-apposing metal stent. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or abdominal pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Laparoscopic ERCP (Endoscopic Retrograde Cholangiopancreatography) combines laparoscopy and endoscopy to diagnose and treat conditions of the bile ducts, pancreatic ducts, and gallbladder. It is used to treat bile duct obstructions, remove stones, and place stents, especially in patients undergoing laparoscopic surgery for other conditions.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under general anesthesia, small incisions are made in the abdomen to insert laparoscopic instruments. An endoscope is inserted through the mouth to the bile ducts, allowing for diagnosis and treatment. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until anesthesia effects wear off. Mild discomfort, sore throat, or abdominal pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

LECS (Laparoscopy and Endoscopy Cooperative Surgery) is a minimally invasive procedure that combines laparoscopy and endoscopy to remove gastrointestinal tumors. It is used to remove tumors from the stomach or intestines with minimal invasiveness, improving recovery time and reducing complications.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under general anesthesia, small incisions are made in the abdomen to insert laparoscopic instruments. An endoscope is inserted through the mouth to assist in the removal of the tumor. The procedure typically takes about 90 to 120 minutes.
• Recovery: Patients are monitored post-procedure until anesthesia effects wear off. Mild discomfort, sore throat, or abdominal pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

This procedure involves creating a connection between the stomach and the small intestine using a lumen-apposing metal stent to bypass obstructions or for other therapeutic reasons. It is used to treat conditions such as gastric outlet obstruction, allowing food to pass from the stomach to the small intestine.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, an endoscope with an ultrasound probe is inserted through the mouth to the stomach. A connection is created between the stomach and the small intestine using a lumen-apposing metal stent. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or abdominal pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Endoscopic ultrasound (EUS) with gallbladder drainage involves using an endoscope and ultrasound to place a lumen-apposing metal stent between the gallbladder and the gastrointestinal tract for drainage. It is used to treat gallbladder conditions, such as cholecystitis, when traditional surgery is not an option.

• Preparation: Patients should fast for at least 8 hours before the procedure. Specific instructions about medication adjustments will be provided by the healthcare team.
• Procedure: Conducted under sedation, an endoscope with an ultrasound probe is inserted through the mouth to the gallbladder. A lumen-apposing metal stent is placed to create a drainage pathway. The procedure typically takes about 60 to 90 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Mild discomfort, sore throat, or abdominal pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

Gastroscopy with EndoFLIP involves the use of an endoscope and an EndoFLIP (Endolumenal Functional Lumen Imaging Probe) system to measure the geometry and function of the esophagus and stomach. It is used to assess conditions like achalasia (a narrowing of the lower part of the esophagus), gastroesophageal reflux disease (GERD), and other motility disorders by providing detailed measurements of the esophagus’ diameter and distensibility.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Conducted under sedation, the endoscope and EndoFLIP device are inserted through the mouth to measure the esophagus and stomach. The procedure takes about 30 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. A sore throat or minor discomfort may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

This procedure involves using an endoscope to inject medical glue into bleeding varices (enlarged veins) in the gastrointestinal tract, often in the esophagus or stomach, to stop bleeding. It is used to treat acute gastrointestinal bleeding from varices, commonly seen in patients with liver cirrhosis.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Conducted under sedation, the endoscope is inserted through the mouth to locate and inject glue into the varices. The procedure takes about 30 to 60 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort or a sore throat may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.

This procedure involves using an endoscope to place rubber bands around bleeding varices (enlarged veins) in the esophagus to stop bleeding. It is used to treat esophageal varices, which are prone to bleeding, especially in patients with liver cirrhosis.

• Preparation: Patients should fast for at least 8 hours before the procedure.
• Procedure: Typically performed under sedation, the endoscope is inserted through the mouth to locate and band the varices. The procedure takes about 30 to 60 minutes.
• Recovery: Patients are monitored post-procedure until sedation effects wear off. Minor discomfort, sore throat, or chest pain may occur but typically resolves quickly. Resting for the day and arranging transportation home is recommended.