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Esophagogastroduodenoscopy (EGD)

Esophagogastroduodenoscopy also known as EGD (other names “Gastroscopy”, “Endoscopy”) is a fast and comfortable way to examine the upper part of the digestive tract which includes the esophagus, stomach and upper part of the small intestine called duodenum. We use an instrument called “the endoscope” which is a flexible tube made using fiberoptic technology and videography. This instrument has the ability to directly visualize the areas looking for inflammation, ulcers, infection ,polyps, cancer and many other possible problems. Via the use of this instrument a pinch of tissue can be collected called biopsy and polyps can be removed.

The entire examination usually takes less than 15 minutes. Just prior to the examination, a numbing solution will be sprayed to your throat and you will be given a small amount of a sedative medication through an intravenous injection. This is provided by a Registered Nurse, who is specially trained for this under the supervision of the doctor or by an anesthesiologist. The entire time the patient’s vital signs, oxygen saturation and electrocardiogram are monitored to make sure that everything goes right.

Although often expected by many patients, the thin flexible fiber instrument does not make you choke or gag during the procedure. You will be relaxed, comfortable and completely pain free during the procedure.

 

  • Preparation
    The stomach should be completely empty for a complete, fast and safe examination. You should not take anything by mouth after midnight except for essential medications upon rising with a sip of water. It is better not to take them if possible. You could always take them after the test. If your test is delayed for some reason, please check with the staff regarding taking the essential medications.If you are diabetic and routinely take pills to control your blood sugar do not take your diabetic medications in the morning. If you use insulin, you should not take any in the morning. We will check your blood sugar and give you a dose if needed. You should bring all your medicines with you.If you routinely take blood thinners such as Cumadin, Warfarin, Heparin, Lovenox, Plavix, Xeralto, Predexa, Effient or any other you need to discontinue them for several days. You should discuss it with Dr. Alexander directly because the number of days the medicine should be discontinued is different for different medicines. You may need to consult your cardiologist also regarding this issue.
  • After the Examination
    You will be required to rest under observation at the surgery center for at least 30 minutes after the examination. The sedative medication will wear off quickly and most people feel back to normal by the time they are dressed and ready to go home. You may eat and usually resume all of your regular medications right after the procedure except when advised otherwise. Usually, the blood thinners and aspirin might be held for a few more days. You will be informed of this if needed. You may not drive a car, motorcycle, bicycle or exercise or play any sport following your examination the entire day. You will be able to resume your regular activities the next and can go to work the next day. Dr. Alexander usually gives an appointment to see him back in the office in 2 weeks following the examination, especially if a biopsy was taken. If you have any problems  or any questions once you are home, you should contact the office. If you did not get a follow up  appointment and you have any question about it please call the office.

Colonoscopy

Colonoscopy is a simple and effective procedure for the examination of the colon.
This is done by using an instrument called colonoscope which is made with fiberoptic and video technology to allow complete inspection of the inside of the colon. It can be used to do biopsy (taking a pinch from the wall to study) and remove polyps. The examination usually take under20 minutes to complete. Before the examination you will be given a sedative medication through an intravenous injection. This is provided by a Registered Nurse specially trained in it under the supervision of Dr. Alexander or an anesthesiologist. Your vital signs, electrocardiogram and oxygen saturation will be monitored through out the examination. You will be relaxed comfortable through out the entire procedure. You may feel a little discomfort but not undue pain.

  • Preparation
    The preparation done the day before the procedure is designed to clean all the solid material form the colon. A good preparation allows for a fast, safe and complete examination. Please follow the instructions carefully, and call the office if you are unclear about what to do.There are many ways to prepare for colonoscopy.DietThe day before the examination from breakfast onwards start drinking a clear liquid diet. Clear liquid is what you can see through, water, juices (orange, apple, cranberry and pineapple) Gatorade, all sodas, coffee or tea with no milk, clear soup, Jell-O, broth, apple sauce, ices and sherbet are fine. You may drink until midnight the night before the examination.You will need to purchase 3 items. All drug stores should have them. You can get them without a prescription.

    1. Golitely Colyte – 4 liters
      Half- Lightly 2 liters
      There are some other brands also
      They are all large volume gentle laxative solution that washes the colon clean the evening before the examination. This is a prescription item you will obtain from your pharmacy. Complete directions come with the solution. You may use Gatorade of your choice to mix it instead of water. Many patients have indicated that it is easy to drink when mixed with Gatorade. The key is to drink it slowly to allow it to start working. Once it starts working with bowel movements, it is easy to continue to drink. Make sure you drink all of it. You should pick it up a day early and read the instructions. If you have any doubt call the office.
    2. Magnesium Citrate2 bottles of magnesium citrate, also called “Citroma”, the sparkling laxative. It is usually a green bottle with a soda-type cap.
    3. Fleets disposable enema in a green or white box.

    Instructions:

    At about 2 PM the day before the examination drink one bottle of Magnesium citrate. And at about 5 PM drink the second bottle. You may continue to drink clear liquids until midnight.

    Use the Fleets enema as directed about half an hour before leaving home the next morning for the examination.

    Current Medical problems and Medications

    Blood Thinners: If you routinely take blood thinners such as Coumadin, Warfarin,Lovonox, Predexa, Xeralto, Effient etc. these usually should be discontinued some days before the examination. Please discuss this directly with Dr. Alexander. You may need to consult your cardiologist also in some situations.

    Artificial Heart Valve: If you have a heart valve replacement, prosthetic valve or heart valve surgery you will need to take antibiotic prophylaxis. The antibiotics will be given intravenously before the procedure.

    Diabetes: If you are diabetic do not take your pills or insulin for diabetes on the morning of the examination as you will be on an empty stomach. Bring your medications and you will take them when you eat your first meal after the examination. We will check your blood sugar before the examination and if you need insulin due to high blood sugar we will give it to you.

    Aspirin and Plavix: Aspirin should be stopped 3 days before the examination and Plavix should be stopped 1 week before the examination.

  • After the examination
    You will be required to rest for some time after the examination. The sedative medication will wear off quickly but you cannot drive a car, ride a bicycle, motorcycle, exercise, play sports or do anything strenuous for the rest of the day. You may eat regular food resume all medications unless specified by the doctor and may go back to work the next day.Complications of colonoscopy

      It is a safe procedure, and complications are rare, but they can occur

    1. Bleeding can occur from biopsy or by removal of polyps. It is usually minimal and can be controlled.
    2. The colonoscope can cause a tear or hole in the colon. It is a very serious problem and requires surgery. It is not common.
    3. Side effects from sedative medications.

    Although colonoscopy is the best way to examine the colon, it is possible for even the most skilled doctors to miss or overlook an abnormal area in the colon.

    You should call the doctor immediately if you have any of the following problems

    • Severe abdominal pain (not just gas cramps)
    • A firm bloated belly
    • Vomiting
    • Fever
    • Rectal bleeding(greater than a couple of tablespoons-30 ml)

References:
1. Uptodate
2. ACG
3. AGA