Advanced GI Diagnostic Testing & Screenings

EGD is a procedure that enables Dr. Alvarez to examine the lining of the upper part of your gastrointestinal tract. He will examine your esophagus, stomach, and duodenum (the first portion of the small intestine). The test uses a thin, flexible tube with a lens and light source. Various instruments can be passed through the tube to allow the doctor to treat many abnormalities directly with little or no discomfort. For example, if you have been experiencing difficulty swallowing foods or liquids and a narrowed or strictured area is found in your esophagus, Dr. Alvarez will stretch this area. If polyps (usually benign growths) are found, these can be removed during your procedure. If areas of bleeding are noted, these can safely and effectively be controlled. Swallowed objects can also be removed during an EGD.

Upper endoscopy is usually performed to evaluate symptoms of persistent abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract. Upper endoscopy is more accurate than X-rays for detecting inflammation, ulcers, polyps, or esophagus, stomach, and duodenum tumors. Upper endoscopy with biopsy can detect early cancer and distinguish between benign and malignant conditions. Biopsies are taken for many reasons, including diagnosing Helicobacter pylori (the bacteria that causes peptic ulcer disease and malignancy).

For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, for at least 4 hours before arriving for your test. If you take blood pressure or heart medications, you can take those when you wake up on the morning of the test with a small sip of water. Someone must come with you to drive you home because you will be given medication to help you relax. It will make you drowsy, so you cannot drive after the test. Even though you may not feel tired, your judgment and reflexes may not be typical.

You will be given medication through a vein to make you relaxed and sleepy. While in a comfortable position on your side, the scope will be passed through the mouth and the esophagus into the stomach and duodenum. The scope will not interfere with your breathing during the test.

Endoscopy is safe and is associated with very low risk when performed by a doctor who has been specially trained and is experienced in the procedure. Complications can occur but are rare. One possible complication is perforation, in which a tear through the wall of the esophagus or stomach may allow leakage of digestive fluids. This complication may be managed simply by aspirating the fluids until the opening seals or may require surgery. Bleeding may occur from the site of the biopsy or polyp removal. It is usually minimal but rarely may require transfusions or surgery. Other risks include drug reactions and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare but remains a remote possibility.

Esophageal dilation is a procedure that allows your doctor to dilate or stretch a narrowed area of your esophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy. Alternatively, your doctor might apply a local anesthetic spray to the back of your throat and then pass a weighted dilator through your mouth and into your esophagus.

The most common cause of narrowing of the esophagus, or stricture, is scarring of the esophagus from reflux of stomach acid occurring in patients with heartburn. Patients with a narrowed portion of the esophagus often have trouble swallowing; food feels "stuck" in the chest region, causing discomfort or pain. Less common causes of esophageal narrowing are webs or rings (which are thin layers of excess tissue), cancer of the esophagus, scarring after radiation treatment, or a disorder of the way the esophagus moves [motility disorder].

An empty stomach allows for the best and safest examination, so you should have nothing to eat after midnight the night before your test and nothing to drink, including water, for at least four hours before the examination.

Esophageal dilation is performed with sedation, along with an upper endoscopy. An endoscope is passed through your mouth and into the esophagus, stomach, and duodenum. The endoscope does not interfere with your breathing. Your doctor will determine whether to use a dilating balloon or plastic dilators over a guiding wire to stretch your esophagus. During the procedure, you might experience mild pressure in the back of your throat or chest. Your doctor will then pass a tapered dilating instrument through your mouth and guide it into the esophagus.

Most patients experience no symptoms after this procedure. They can resume eating the next day, but you might experience a mild sore throat for the remainder of the day.

Although complications can occur even when the procedure is performed correctly, they are rare when performed by specially trained doctors. A perforation, or hole, of the esophagus lining, occurs in a small percentage of cases and may require surgery. A tear of the esophagus lining may occur, and bleeding may result. There are also possible risks of side effects from sedatives. It is important to recognize early signs of possible complications. Tell your doctor immediately after the test if you have chest pain, fever, trouble breathing, difficulty swallowing, bleeding, or black bowel movements.

Depending on the degree and cause of the narrowing of your esophagus, you may require repeat dilations. This allows the dilation to be performed gradually and decreases the risk of complications. Repeated dilations may not be required once the stricture or narrowed esophagus is completely dilated. If the stricture was due to acid reflux, acid-suppressing medicines can decrease the risk of stricture recurrence.

Colonoscopy is a procedure that enables Dr. Alvarez to examine the lining of the colon (large bowel) by inserting a tube about the thickness of your finger into the anus and advancing it slowly into the rectum and colon.

The colon must be completely empty of waste material for the procedure to be accurate and complete. Follow the prep instructions you are given carefully. If you do not, the procedure may be canceled and repeated later. You may have some nausea and/or vomiting with the prep. If you are not passing clear (or clear yellow) liquid with your last bowel movement, please call our office the morning of your procedure for further instructions. Please click on the protocol below to download the required procedure list.

• CLENPIQ
• PLENVU
• SUFLAVE
• SUPREP
• SUTAB
• TRILYTE

Most medications can be continued as usual; however, drugs such as aspirin or blood thinners are examples of medicines that you may need to stop before the date of your test. You will be given instructions on which medications we will need you to stop. It is also essential you alert us if you require antibiotics before undergoing dental procedures since you may need antibiotics before a colonoscopy as well.

Colonoscopy is usually well tolerated and rarely causes much pain. You will be given medication through a vein to help you relax. You will be lying on your side while the colonoscope is advanced through the large intestine. As the instrument is withdrawn, the intestine's lining is carefully examined.

Suppose Dr. Alvarez sees an area that needs evaluation. In that case, a biopsy (sample of the colon lining) may be obtained and submitted to a laboratory for analysis. If areas of bleeding are noted, these areas may be controlled through the colonoscope by injecting certain medications or by sealing off the bleeding with heat treatment (coagulation). If polyps are found, they are generally removed. If you have been experiencing rectal bleeding and internal hemorrhoids are found, laser treatment may be performed on these areas.

After the procedure, you may have some mild cramping or a bloating sensation because of the air passed into the colon during the examination. This will disappear with the passage of gas. You should be able to eat after having the procedure. Still, your diet and activities may be restricted for a few days, especially if polyps are removed.

Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. Possible complications include a perforation (tear through the bowel wall) and bleeding from the site of the biopsy or polypectomy. Although complications after colonoscopy are rare, it is crucial for you to recognize early signs of any possible complication. Contact our office if you notice any of the following symptoms: severe abdominal pain, fever, chills, or rectal bleeding of more than one-half cup. It is important to note that rectal bleeding can occur even several days after the removal of a polyp.

Infrared Coagulation (IRC) is the most widely used treatment for hemorrhoids. It is preferred over other methods because it is fast, well-tolerated by patients, and virtually problem-free. A small probe is used to contact the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the vein above the hemorrhoid, causing it to shrink and recede.

Usually, IRC is performed during a colonoscopy, so the prep for the colonoscopy is all required. If you are coming just for an IRC, you will need to take 2 Bisacodyl pills the night before your test and use one Fleet's enema the morning of your test.

You may briefly feel heat, but the procedure is generally not painful.

Generally not. Most patients return to a normal lifestyle the same day. There may be slight spot bleeding a few days later. Heavy straining or lifting should be avoided, and aspirin should not be taken for a few days.