South Bay Gastroenterology Medical Group

Colonoscopy lets the physician look inside your entire large intestine, from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine. The procedure is used to look for early signs of cancer in the colon and rectum. It is also used to diagnose the causes of unexplained changes in bowel habits. Colonoscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, and bleeding. For the procedure, you will lie on your left side on the examining table. You will be sedated during your procedure. The physician will insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope (koh-LON-oh-skope). The scope transmits an image of the inside of the colon, so the physician can carefully examine the lining of the colon. The scope bends, so the physician can move it around the curves of your colon. The scope also blows air into your colon, which inflates the colon and helps the physician see better. If anything abnormal is seen in your colon, like a polyp or inflamed tissue, the physician can remove all or part of it using tiny instruments passed through the scope. That tissue (biopsy) is then sent to a lab for testing. If there is bleeding in the colon, the physician can pass a laser, heater probe, or electrical probe, or inject special medicines through the scope and use it to stop the bleeding. Bleeding and puncture of the colon are possible complications of colonoscopy. However, such complications are uncommon. Colonoscopy takes 15 to 30 minutes. You will be sedated during your procedure to keep you from feeling discomfort during the exam. You will need to remain at the endoscopy facility for 30 to 45 minutes until the sedative wears off. You will need a driver to take you home after your procedure.

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.

CANCER PREVENTION Colorectal Cancer Colorectal cancer, also known as colon cancer, develops in either the large intestine or the rectum. According to the Centers for Disease Control and Prevention (CDC), colorectal cancer is the second leading cause of cancer deaths in the United States. Cancer occurs when healthy cells become altered, growing and dividing in a way that keeps the body from functioning normally. Most cases of colorectal cancer begin as small, benign clusters of cells (polyps) on the lining of the colon or rectum. Certain types of polyps, called adenomas, can become malignant. Risk Factors for Colorectal Cancer There are several risk factors for colorectal cancer, some of which are under the patient’s control. They include the following: Being age 50 years or older Smoking Lack of exercise Excessive alcohol consumption Eating red or processed meats Obesity Certain hereditary syndromes Family history of colorectal cancer Patient history of inflammatory bowel disease Patient history of adenomas Patient history of other cancer Type 2 diabetes Symptoms of Colorectal Cancer While patients with colorectal cancer are often asymptomatic, as the disease progresses, they may experience one or more of the following symptoms: A change in bowel habits or a change in consistency of the stool Rectal bleeding or blood in the stool Persistent abdominal discomfort, such as cramps, gas or pain A feeling that the bowel does not empty completely Weakness or fatigue Unexplained weight loss Nausea or vomiting Diagnosis of Colorectal Cancer After performing a thorough physical examination and taking a full patient and family history, the doctor may administer other diagnostic tests, which may include the following: Blood tests (including a CBC), and tests for liver enzymes and tumor markers Digital rectal examination Fecal occult blood test Barium enema Colonoscopy Sigmoidoscopy Ultrasound MRI CT scans As part of a colonoscopy or sigmoidoscopy, a biopsy may be taken. Treatment of Colorectal Cancer Depending on the stage of progression of the colorectal cancer, treatment may include one or more of the following: Surgical removal of diseased and immediately adjacent tissue Radiation therapy Chemotherapy Targeted or biological therapy Prevention of Colorectal Cancer There are many steps that may be taken to lower the risk of developing colorectal cancer. Individuals may decrease their chances of developing this disease by eating a healthy low-fat diet, high in fiber and antioxidants, drinking alcohol only in moderation, exercising regularly, maintaining a healthy weight and refraining from smoking. For individuals at high risk for developing colorectal cancer, medications and surgery may be recommended. Everyone at high risk or 50 years of age and older, and African-Americans 45 years of age and older, should undergo a regularly scheduled colonoscopy, both to screen for cancer and to remove suspicious colorectal polyps at the earliest stage possible. Colonoscopy A colonoscopy is a diagnostic procedure performed to examine the inner lining of the colon, or large intestine, and the rectum. The colonoscopy procedure is performed routinely in patients over the age of 50 as a means detecting colorectal cancer in its early stages. It is also employed diagnostically to help determine the cause of abnormal bowel activity, abdominal pain or rectal bleeding. During a colonoscopy, tissue samples may be collected for a biopsy, and polyps or other abnormal growths may be removed. Reasons for A Colonoscopy Colonoscopies are recommended for people who are at increased risk of developing colorectal cancer. This type of cancer is much more effectively treated when it is detected early. Individuals at increased risk of developing colon cancer include those who: Have a personal or family history of colorectal polyps Have a personal or family history of colorectal cancer Have a personal or family history of inflammatory bowel syndrome (IBS) Are obese or have a poor diet Smoke or consume alcoholic beverages to excess Have diabetes Do not exercise regularly All individuals over the age of 50 should undergo regular colonscopies and the procedure may be recommended for younger patients at elevated risk, whether they are experiencing symptoms or not. Preparing For A Colonoscopy In order to prepare for a colonoscopy, the colon must be cleansed so that its inner surface will be visible. Prior to the colonoscopy, patients are given written instructions which may vary a bit from one physician to another. Typically, the patient is told to drink clear liquids for a day or two before the procedure, including water, tea, coffee, strained fruit juices, sports drinks and clear broths. Patients are also permitted to consume gelatin. One strict prohibition is any liquid or gelatin with a red or purple coloration.

Endoscopic ultrasound (EUS) is a procedure using an endoscope that has ultrasound capability. This procedure allows visualization of the structure beneath the mucosal lining of the stomach and also the structure immediately around the stomach such as the bile duct and pancreas. In some instances this procedure is also used in visualizing growth in the rectum. INDICATION FOR EUS EUS is used to diagnose and stage cancer in the stomach, pancreas, distal bile duct and some times in the rectum. The ultrasound allows visualization of how deep the tumor extends and whether there are small lymph nodes around the tumor. providing a localized staging. EUS may also be used to see if there are stones in the common bile duct that requires removal endoscopically. EUS is performed same as upper endoscopy when used to evaluate upper gastrointestinal tract. It will require sedation with anesthetics and preparation by fasting after midnight prior to procedure. When EUS is scheduled for rectal evaluation or colon evaluation, bowel prep with colonoscopy prep of flexible sigmoidoscopy may be ordered for the day prior to procedure. Sedation may or may not be used when EUS is done for rectal evaluation.

Endoscopic retrograde cholangiopancreatography (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.ERCP is used primarily to diagnose and treat conditions of the bile ducts including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays. For the procedure, you will lie on your stomach on an examining table in an x ray room. You will be sedated during the exam. The physician will guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. The physician will pass a small plastic tube through the scope to cannulate the bile duct or pancreatic duct. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected. If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing. Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days. ERCP takes 30 minutes to 2 hours. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears 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. PREPARATION Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home–you will not be allowed to drive because of the sedatives. The physician may give you other special instructions

WHAT IS FECAL TRANSPLANT? The human body has a lot of necessary (good) bacteria in the gastrointestinal (GI) tract. Fecal transplant involves taking stool from a healthy person and transferring it into a person suffering from a disease caused by an imbalance in the amounts of the necessary (good) bacteria. HOW DOES A FECAL TRANSPLANT WORK? Fecal transplant is most commonly used as a treatment for a disease caused by overgrowth of a bacteria called Clostridium diffiicile (or C diff) when standard therapies have failed. Fecal transplant involves transferring the necessary microorganisms from a healthy donor into a patient with C diff infection. These bacteria then begin to grow in the patient’s colon and prevent C diff from overgrowing again. HOW IS THE FECAL TRANSPLANT PROCEDURE PERFORMED The procedure is performed by administering a solution of donor stoll and saline into your GI tract during a colonoscopy. WHAT IS THE SUCCESS RATE? There are over 200 case reports in the world’s medical literature to date, reporting an overall success rate of 90-95%. South Bay Gastroenterology Medical Group is one of the very few providers offering this service.

WHAT IS A FLEXIBLE SIGMOIDOSCOPY? Flexible sigmoidoscopy is the endoscopic examination of the rectum and sigmoid colon. Please note, this is not an examination of the entire colon. Flexible sigmoidoscopy enables the physician to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid or descending colon. Physicians may use the procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use it to look for early signs of cancer in the descending colon and rectum. With flexible sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon). WHAT WILL HAPPEN DURING MY FLEXIBLE SIGMOIDOSCOPY PROCEDURE? For the procedure, you will lie on your left side on the examining table. The physician will insert a short, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a sigmoidoscope (sig-MOY-duh-skope). The scope transmits an image of the inside of the rectum and colon, so the physician can carefully examine the lining of these organs. The scope also blows air into these organs, which inflates them and helps the physician see better. If anything unusual is in your rectum or colon, like a polyp or inflamed tissue, the physician can remove a piece of it using instruments inserted into the scope. The physician will send that piece of tissue (biopsy) to the lab for testing. Bleeding and puncture of the colon are possible complications of sigmoidoscopy. However, such complications are uncommon. HOW LONG DOES A FLEXIBLE SIGMOIDOSCOPY PROCEDURE LAST? Flexible sigmoidoscopy takes 10 to 20 minutes. During the procedure, you might feel pressure and slight cramping in your lower abdomen. You will feel better afterward when the air leaves your colon. PREPARATION The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe, so the physician will probably tell you to drink only clear liquids for 12 to 24 hours beforehand. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. The night before the procedure, administer the FIRST Fleets enema at least one hour before bedtime. Administer the SECOND Fleets enema at least one hour before leaving for your procedure. Your physician may give you other special instructions.

This highly effective, minimally invasive procedure is performed in our offices. During the brief and painless procedure, our physicians place a small rubber band around the tissue just above the internal hemorrhoid where there are few pain-sensitive nerve endings. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding. The procedure works by cutting off the blood supply to the hemorrhoid. This causes the hemorrhoid to shrink and fall off, typically within a day or so. You probably won’t even notice when this happens or be able to spot the rubber band in the toilet. Once the hemorrhoid is gone, the wound usually heals within one to five days. During the first 24 hours, some patients may experience a feeling of fullness or a dull ache in the rectum. This can typically be relieved with an over-the-counter pain medication. However, more than 90% of patients treated with our method have no post-procedure pain.

The Inflammatory Bowel Disease (IBD) Program at South Bay Gastroenterology Highlights of our program include: Expertise: Our knowledge in every aspect of IBD care helps us deliver a broad range of treatments. Seamless care: Using a team approach, we coordinate care to address potential complications. Personalized approach: Our experts work with you to develop a customized treatment plan that reflects your unique needs and preferences. Specialized care for Crohn’s disease and ulcerative colitis at South Bay Gastroenterology includes: Selecting the best treatment: Our experts work together to select and plan the best treatment for your condition. Symptom relief: Inflammatory bowel disease symptoms can affect your ability to perform basic daily activities. We offer treatments that quickly relieve symptoms and help you stay symptom free for as long as possible (remission). Managing flare-ups and complications: Even if you achieve remission, it’s still possible to experience symptom flare-ups. Our experience helps us manage your condition so you can get the relief you need. The IBD program at South Bay Gastroenterology is led by Dr. Minh Nguyen. Dr. Nguyen is a board-certified gastroenterologist that specializes in Inflammatory Bowel Disease. He completed an Advanced Fellowship in Inflammatory Bowel Disease at Cedars-Sinai Medical Center from 2014-2015 before joining the South Bay Gastroenterology Medical Group. Inflammatory Bowel Disease Inflammatory bowel disease, also known as IBD, is a group of chronic or recurring disorders that cause the digestive tract to become inflamed. The most common forms of IBD include Crohn’s disease and ulcerative colitis. IBD is considered to be an autoimmune disease where the body’s immune system attacks various parts of the digestive tract. While IBD may occur at any point in time, it usually appears in patients between the ages of 15 and 30 years old. It has been estimated that more than one million people in the United States are affected with IBD. Risk Factors for IBD Factors that appear to increase the risk of developing IBD include the following: Family history Smoking Demographics Diet Types of IBD The most common forms of IBD include ulcerative colitis and Crohn’s disease. The similarities between the two disorders can sometimes make it difficult to diagnose which form of IBD a patient may have. The main difference is the part of the digestive tract each disorder affects. Ulcerative Colitis Ulcerative colitis affects the top layers of the large intestine and the colon. Ulcerative colitis causes the lining of the intestine to become inflamed and develop ulcers. When ulcerative colitis occurs in the rectal area, it can lead to severe diarrhea. Crohn’s Disease Crohn’s disease most often affects the last part of the small intestine and parts of the large intestine, but can occur anywhere along the digestive tract, from the mouth to the anus. Instead of affecting the top layers intestinal walls as seen with ulcerative colitis, Crohn’s disease affects all layers of the intestinal wall. Symptoms of IBD Symptoms of IBD may vary depending on the diagnosed condition. Symptoms that are shared between ulcerative colitis and Crohn’s disease may include the following: Diarrhea Bleeding from the rectum Abdominal pain or cramping Weight loss Constipation Loss of appetite Joint pain Anemia Vomiting Diagnosis of IBD After conducting a thorough physical and medical examination, the following diagnostic tests may be conducted: Blood tests Stool analysis Colonoscopy Endoscopy Barium X-ray Biopsy Treatment of IBD IBD affects each patient differently and treatment options will vary. Many cases of IBD can be managed with anti-inflammatory drugs or immunosuppressive medication that prevents the immune system from attacking the body. Modifications made to diet may help to reduce some of the symptoms of IBD and replace those nutrients that have been lost. Managing stress and resting have been shown to be helpful. Surgery, for more severe cases of IBD, may be required but will depend on the individual condition of the patient.

In a liver biopsy, the physician examines a small piece of tissue from your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged . PREPARATION Before scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those that affect blood clotting, like blood thinners. One week before the procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants. You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions. PROCEDURE Liver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot. You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes. Two other methods of liver biopsy are also available. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples from one or more parts of the liver. Physicians use this type of biopsy when they need tissue samples from specific parts of the liver. Transvenous biopsy involves inserting a tube called a catheter into a vein in the neck and guiding it to the liver. The physician puts a biopsy needle into the catheter and then into the liver. Physicians use this procedure when patients have blood-clotting problems or fluid in the abdomen. RECOVERY After the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for 1 to 2 hours. The nurse will monitor your vital signs and level of pain. You will need to arrange for someone to take you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for 8 to 12 hours, depending on your physician’s instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in your right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after surgery. These medicines decrease blood clotting, which is crucial for healing. Like any surgery, liver biopsy does have some risks, such as puncture of the lung or gallbladder, infection, bleeding, and pain, but these complications are rare.

LIVER DISEASE South Bay Gastroenterology’s Liver Clinic, is overseen by internationally renowned liver specialist, Tram Tran, MD. Dr Tran is an internationally renowned liver specialist and was the Medical Director of Liver Transplantation at Cedars-Sinai Medical Center and Professor of Medicine at Geffen UCLA School of Medicine. She has been triple board certified by the ABIM in Internal Medicine, Gastroenterology, and Transplant Hepatology. She now works as Senior Global Medical Director for Gilead Sciences in Medical Affairs focused on research for a cure for hepatitis B, global elimination of hepatitis C, and research on fatty liver disease. She maintains a specialized clinical practice at South Bay Gastroenterology. Dr. Tran has broad research interests in the areas of viral hepatitis B and C, liver disease in women and pregnancy and liver transplantation. She is a globally recognized speaker and has been an NIH-funded researcher in the field of chronic hepatitis B and is active in patient and community advocacy on hepatitis B prevention and treatment. She has authored and co-authored numerous abstracts, papers and books on liver disease and published in journals such as Hepatology, New England Journal of Medicine and Liver Transplantation and has served on the editorial board for Hepatology, American Journal of Gastroenterology, and Gastroenterology. Dr. Tran was Vice Chair and Chair of the AASLD Practice Guidelines Committee and was instrumental in developing national clinical standards for the care of liver patients. Liver Disease The liver is an essential organ that has many functions. The liver serves as a filter for the body by removing toxins and impurities from the blood. The liver also performs metabolically by converting food to energy. The liver also stores the fat-soluble vitamins D and E. When diseased or damaged, the ability to perform these functions can lead to serious problems. Types of Liver Disease There are more than 100 types of liver diseases. Some of the most common diseases include the following: Inflammation Fibrosis Cirrhosis Liver failure Nonalcoholic fatty liver disease These diseases often develop as a result of infection, poor blood supply, an obstruction in the bile flow or from metabolic liver disease. Symptoms of Liver Disease Liver disease, in its earliest stages, may have little or no symptoms and will often be diagnosed as the flu. As the disease develops typical symptoms develop. The symptoms of liver disease can vary, but most often include the following: Jaundice Nausea Vomiting Loss of appetite Bloated abdomen Brown urine Itching Fatigue Bloody vomit Black stools A series of tests will be conducted, including biopsy, blood tests and a comprehensive metabolic panel in order to accurately diagnosis the liver condition. Treatment of Liver Disease Some liver diseases can be effectively treated with medication, and some serious cases may require surgery to fully treat the disease. Nonalcoholic fatty liver disease Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells. Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure. Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people. Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat. Hepatitis C Hepatitis C is a disease caused by a virus that infects the liver. The virus, called the Hepatitis C virus or HCV for short, is just one of the hepatitis viruses. The other common hepatitis viruses are A and B, which differ somewhat from HCV in the way they are spread and treated. According to the Centers for Disease Control (CDC), an estimated 2.7 million people in the United States have chronic Hepatitis C infection. Auto Immune Liver Disease Autoimmune hepatitis is a disease in which the body’s own immune system attacks the liver and causes it to become inflamed.

Polyps are benign growths involving the lining of the bowel (noncancerous tumors or neoplasms). They can occur in several locations in the gastrointestinal tract but are most common in the colon. They vary in size from less than a quarter of an inch to several inches in diameter. They look like small bumps growing from the lining of the bowel and protruding into the lumen (bowel cavity). They sometimes grow on a “stalk” and look like mushrooms. Many patients have several polyps scattered in different parts of the colon. HOW COMMON ARE COLON POLYPS? WHAT CAUSES THEM? Polyps are very common in adults, who have an increased chance of acquiring them as they age. While quite rare in 20-year-olds, it’s estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp. We don’t know what causes polyps. Some experts believe a high-fat, low-fiber diet can be a predisposition to polyp formation. There may be a genetic risk to develop polyps as well. WHAT ARE KNOWN RISKS FOR DEVELOPING POLYPS? The biggest risk factor for developing polyps is being older than 50. A family history of colon polyps or colon cancer increases the risk of polyps. Also, patients with a personal history of polyps or colon cancer are at risk of developing new polyps. In addition, there are some rare polyp or cancer syndromes that run in families and increase the risk of polyps occurring at younger ages. ARE THERE DIFFERENT TYPES OF POLYPS? There are two common types: hyperplastic polyp and adenoma. The hyperplastic polyp is not at risk for cancer and, therefore, is not as significant. The adenoma, however, is thought to be the precursor (origin) for almost all colon cancers, although most adenomas never become cancers. A biopsy (or small piece of removed tissue) is the only way to differentiate between hyperplastic and adenomatous polyps. Although it’s impossible to tell which adenomatous polyps will become cancers, larger polyps are more likely to become cancers and some of the largest ones (those larger than 1 inch) can already contain small areas of cancer. Because your doctor cannot be certain of the tissue type by the polyp’s appearance, doctors generally recommend removing all but the smallest polyps. HOW ARE POLYPS FOUND? Most polyps cause no symptoms. Larger ones can cause blood in the stools, but even they are usually asymptomatic. Therefore, the best way to detect polyps is by screening individuals with no symptoms. Several other screening techniques are available: testing stool specimens for traces of blood, performing sigmoidoscopy to look into the lower third of the colon, or using a radiology test such as a barium enema. If one of these tests finds or suspects polyps, your doctor will generally recommend colonoscopy to remove them. Because colonoscopy is the most accurate way to detect polyps, many experts now recommend colonoscopy as a screening method so that any polyps found or suspected can be removed during the same procedure. HOW ARE POLYPS REMOVED? Most polyps found during colonoscopy can be completely removed during the procedure. Various removal techniques are available; most involve severing them with a wire loop and/or burning the polyp base with an electric current. This is called polyp resection. Because the bowel’s lining isn’t sensitive to cutting or burning, polyp resection doesn’t cause discomfort. Resected polyps are then examined under a microscope to determine the tissue type and to detect any cancer. WHAT ARE THE RISKS OF POLYP REMOVAL? Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure. Possible complications, which are uncommon, include bleeding from the polypectomy site and perforation (a hole) of the colon. Bleeding from the polypectomy site can be immediate or delayed for several days; persistent bleeding can almost always be stopped by treatment during colonoscopy. Perforations usually require surgery to repair. HOW OFTEN DO I NEED COLONOSCOPY IF I HAVE POLYPS REMOVED? Your doctor will decide when your next colonoscopy is necessary. The timing depends on several factors, including the number and size of polyps removed, the polyps’ tissue type and the quality of the colon cleansing for your previous procedure. The quality of cleansing affects your doctor’s ability to see the surface of the colon.If the polyps were small and the entire colon was well seen during your colonoscopy, doctors generally recommend a repeat colonoscopy in three years. If your repeat colonoscopy doesn’t show any indication of polyps, you might not need another procedure for an additional five years. However, if the polyps were large and flat, your doctor might recommend an interval of only months before a repeat colonoscopy to assure complete polyp removal. Your doctor will discuss those options with you.

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy. For the procedure the physician will use a thin, flexible, lighted tube called an endoscope. You will be sedated during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach. The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don’t show up well on x rays. The physician can also insert instruments into the scope to remove samples of tissue (biopsy) for further tests or treat bleeding abnormalities. Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure. The procedure takes 15 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 30 to 45 minutes until the medication wears off. You will need someone to drive you home after your procedure.

WOMEN’S HEALTH Our compassionate team’s mission is to provide high quality digestive care through all stages of a women’s life. Women are more susceptible than men to certain GI problems because of the physiological differences in their digestive tracts. Women experience gastrointestinal symptoms related to pregnancy and hormonal fluctuations. Our female physicians offer clinical expertise in women’s gastrointestinal health and treatment with a caring personal touch. Our team which includes experts in Inflammatory Bowel Disease, offers a comprehensive multidisciplinary approach to women’s gastrointestinal issues. The following procedures are performed by our female physicians. PROCEDURES Capsule Endoscopy Colonoscopy ERCP Endoscopic Ultrasound (EUS ) Flexible sigmoidoscopy Liver Biopsy Polyp Removal Upper Endoscopy Hemorrhoid Banding