Tests & Treatments

Click on any of the blue headers to find out more about the tests for each ailment

OGD/Gastroscopy, enteroscopy

This involves a small flexible tube with a light source and camera (endoscope) being placed through the mouth (usually under sedation) to assess the oesophagus, stomach and small bowel. It takes around 10 minutes, but may be longer if additional procedures are undertaken. These might include taking tissue samples (biopsies) treatment for bleeding, blockages (stenting) or removing early cancer. For a full information leaflet please download the following file

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Adapted from the British Society of Gastroenterology

Colonoscopy

This involves a flexible tube with a light source and camera (colonoscope) being placed through the anus to inspect the large bowel (Colon) and occasionally the junction of the large and small bowel. It usually takes 20 to 40 minutes and is undertaken with analgesia and sedation. This procedure also involves dietary modification for 1 to 2 days, in addition to laxatives the day before – and sometimes the morning of the procedure. If polyps are located they are usually removed immediately. For a full information leaflet please download the following file.

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Adapted from the British Society of Gastroenterology

Flexible Sigmoidoscopy

This involves a flexible tube with a light source and camera (colonoscope) being placed through the anus into the large bowel (Colon). The colonoscope is only inserted to the first part of the colon called the sigmoid colon. It takes around 10 minutes and only requires an enema for preparation. For a full information leaflet please download the following file

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Adapted from the British Society of Gastroenterology

Endoscopic Ultrasound

This involves a flexible tube with a light, camera and ultrasound probe being placed (under sedation) through the mouth. It’s designed to assess the area within or around the chest, oesophagus, stomach, pancreas, bile ducts and small bowel. Taking tissue samples (biopsies) along with assessments of abnormal masses/cancer and the draining of fluid collections can also be undertaken using this technique.

ERCP

This stands for endoscopic retrograde cholangio pancreatography and involves using a special flexible camera with a light source being placed through the mouth under sedation to assess the area within the bile ducts and pancreas. Taking tissue samples (biopsies) along with the treatment of gallstones within the bile duct, drainage of cancer or non cancer-related blockages (using stenting) can also be undertaken using this technique.

Laparoscopic Sleeve Gastrectomy

This information is for patients having an operation called a laparoscopic sleeve gastrectomy. It explains what happens before and after the operation and gives advice for what to expect when you go home.

Laparoscopic Duodenal Switch

This information is for patients having an operation called a laparoscopic duodenal switch. It explains what happens before and after the operation and gives advice for what to expect when you go home.

Laparoscopic Gastric Bypass

This information is for patients having an operation called a laparoscopic gastric bypass. It explains what happens before and after the operation and gives advice for what to expect when you go home.

Laparoscopic Adjustable Gastric Banding

This information is for patients having an operation called a laparoscopic adjustable gastric banding. It explains what happens before and after the operation. It also gives advice for what to expect when you go home.

Bioenterics Intragastric Balloon

The Bioenterics Intragastric Balloon (BIB tm) is a silicone balloon that is inserted into the stomach using an endoscope. The balloon is inflated with saline through a self sealing valve.

Up until recently the small bowel could not be examined adequately due to its length (3-5 meters) and tortuosity. The capsule endoscopy is a relatively new procedure which enables accurate images to be obtained from the entire small bowel, and also, if necessary, the large bowel.

The main indication for the procedure is obscure gastrointestinal bleeding i.e. unexplained bleeding or iron-deficiency anaemia. Other important indications include the diagnosis and evaluation of Crohn’s disease, chronic diarrhoea, coeliac disease and screening for small-bowel polyps in familial polyposis syndromes. Conditions detectable using capsule endoscopy include abnormal blood vessels, Crohn’s disease, anti-inflammatory medication-induced ulcers, polyps, lymphoma and cancer. Conditions that have been missed on standard endoscopy (e.g. ulcers) can also be detected.

Outline of procedure

After an overnight fast, you will be asked to swallow a small capsule, consisting of a camera, light source and wireless circuit. Leads are attached to the abdominal wall and connected to a data recorder worn on a belt around the waist. As the capsule moves naturally through the intestines, images are transmitted to the data recorder. You will be able to leave the hospital and return after 8 hours when the equipment is removed and the images downloaded onto a computer for analysis. The capsule is then passed naturally in the stool and discarded.

Pain in the upper abdomen is commonly caused by gallstones. The keyhole surgery for gallstones is the most effective treatment for their removal. To ensure the bile duct is clear of gallstones, an X-Ray (cholangiogram) can be performed during the operation. The operation itself can be performed as a day-case procedure or an overnight stay. Most patients will be walking and able to leave the hospital within hours of the operations, and resuming work within days. The stitches dissolve and the patient has no significant restrictions after surgery. Patients should then build up to a normal diet over a few days. For a full information leaflet please download the following file

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Gastro-oesophageal reflux is a condition where acidic liquid from the stomach flows up the gullet (oesophagus) causing heartburn. Many people have complete relief from the symptoms by taking acid suppressing drugs, neutralising agents or coating drinks. Some patients will choose an antireflux operation because they do not wish to have life long medication or they have severe reflux. Patients who have a chronic cough, sinusitis, sore throat or inflammation of the oesophagus frequently undergo this operation. Performing a key-hole operation to restore the valve between the stomach and oesophagus prevents the reflux and gives long lasting relief. For a full information leaflet please download the following file:

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Colon (Bowel) Cancer & Screening

Colon (bowel) cancer is now the second commonest cancer after lung cancer in the UK. Almost all begin as small benign growths in the lining of the colon (polyps) which can grow over the years to become cancerous. Screening is the term used to detect early or pre-cancers such as polyps which can then be treated effectively.

What are the symptoms of bowel cancer (colorectal cancer)?

The most common symptoms and signs of bowel cancer are bleeding from the back passage (anus), anaemia (causing tiredness & weakness), a change in bowel habit to normally looser stools but rarely sudden constipation, and occasionally abdominal pain. Sometimes there are no symptoms, particularly early cancers or polyps.

By detecting and removing polyps, almost all cancers can be prevented. There are several ways that these polyps, or early cancers, can be detected

Faecal occult blood tests

This is a test to detect microscopic traces of blood in three separate stool samples. On its own it is not a useful test as it can be falsely positive in half of people and therefore all positive tests are followed up with a colonoscopy. The test can also miss some polyps and even cancer.

CT Colonography

This is a CT scan which looks specifically at the colon – and is also able to detect coincidental abnormalities in the rest of the abdomen. Laxatives are given before the test and a small amount of air is inflated into the colon through an enema at the time of the test. This is accurate at detecting larger polyps but does miss small (0.5cm) polyps and does involve a small amount of radiation. In addition, if a polyp is detected, this will need to be removed at colonoscopy.

Colonoscopy

This is the standard examination of the colon and enables any abnormality to be removed (i.e. polyps) or biopsied at the same time. It is the recommended method of bowel cancer screening in the USA starting at the age of 50, and if no abnormality detected, every 10 years thereafter. People with a strong family history or previous polyps have more frequent procedures – the timing of which will depend upon the degree of risk.

Therefore if you are over 50 years of age or have a family history of colon cancer you should speak to your doctor to arrange a colonoscopy.

(From: NICE Guideline; Improving Outcomes in Colorectal Cancer, May 2004)

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