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Comprehensive Gastrointestinal Health specializes in the following procedures. If you’re preparing for your procedure or would like to learn more about each one, click on the tab to get detailed information, helpful downloads, and preparation materials.
What is the colon?
The colon and rectum together are known as the large intestine. The colon is a long tube that takes in water and minerals from digested food and stores undigested solid waste.
What is a colonoscopy?
A colonoscopy involves looking at the colon from inside the body using a long, thin, flexible tube with a tiny camera on the end, through which the doctor can view your whole colon and rectum. The colonoscope is inserted into the anus and advanced through the entire colon and possibly a short distance into the small intestine (called the terminal ileum).
The image on the TV monitor is magnified many times so the doctor can see small changes in tissue. The colonoscope contains channels that allow the doctor to obtain biopsies (small pieces of tissue), remove polyps, and to introduce or withdraw fluid or air. If the doctor sees areas of inflammation or needs a sample of tissue to look for microscopic changes, biopsies or samples of tissue can be obtained.
How long does a colonoscopy take?
The procedure is generally about 20-30 minutes long. An anesthesiologist administers medications through the IV line. Most people have a deep sleep during the examination and are unaware that it was even performed.
Colorectal cancer (also known as colon cancer) is the 2nd most common cause of cancer deaths in the United States, yet it is one of the most preventable types of cancer. Approximately 1 in 20 people will develop colon cancer in their lifetime. Colorectal cancer is often curable when detected early.
Colonoscopy is the only test that allows a biopsy or removal of a polyp at the very same time it is first identified. Removing polyps during a colonoscopy could stop colon cancer from growing or even cure it.
There is no way to completely eliminate the risk of developing colorectal cancer, but the systematic detection and removal of colon polyps during screening colonoscopies is the single most important intervention to reduce your risk of developing colorectal cancer. As well, early detection of colorectal cancer by screening is the best way to improve the chance of a successful cancer cure.
Most colon cancers develop from precancerous polyps, which are abnormal growths from the wall of the colon. If these precancerous polyps are left alone, they have the potential to grow into a cancer.
Not all colon polyps have the same risk of turning into colon cancer. Precancerous polyps (adenomas and serrated polyps) could become cancerous; other types of polyps (hyperplastic, inflammatory) do not.
By performing colonoscopies, we can find these precancerous polyps and remove them before they have a chance to transition into a cancer. The development of more than 75-90% of colorectal cancer can be avoided through early detection and removal of precancerous polyps. If people took advantage of screening tests, the vast majority of deaths from colon cancer could be prevented.
This also allows us to determine who needs a closer eye on them than the average population. Instead of colonoscopies every 10 years, some people need colonoscopies every 3-5 years depending on the number and size of polyps that are present.
Most early colorectal cancers produce no symptoms at all. This is why screening for colorectal cancer is so important.
Some possible symptoms associated with colorectal cancer should prompt a visit with your physician for an evaluation:
span style="font-weight: 400;">Precancerous polyps usually cause NO SYMPTOMS, and removal of these polyps prevents colon cancer.
Colon cancers found in patients with symptoms are more advanced and less likely to be cured. Colon cancers found in people WITHOUT symptoms are not as advanced and are more frequently cured.
The biggest risk factor for developing colorectal cancer is simply aging.
span style="font-weight: 400;">Although having a family history of colon polyps or colon cancer increases your risk of developing colon cancer, 75% of colon cancers DO NOT have a family history.
Most patients say that this is the most unpleasant part of the experience. We have tried our best to make this process as easy as possible.
Please see the detailed instructions attached so that you can achieve the best preparation possible.
An excellent bowel preparation is necessary and critical because, unfortunately, the scope is unable to see through any remaining fecal debris. So any retained seeds/fibrous food or stool that are still present in the colon can block the ability to see a polyp or even a small cancer.
This is called “split dose bowel preparation” and it has been shown to improve the quality of a colonoscopy.
Split dosing consists of drinking half of your colon cleanse the day before your colonoscopy and the other half on the day of the procedure.
Split dosing has been shown to be superior to same day preparation in clinical studies, BUT most importantly it decreases the likelihood that the procedure will need to be canceled and rescheduled because of a poor cleansing.
Note that this may require you to awaken early in the morning in order to complete the prep. Although inconvenient, the correct timing of drinking the prep is critical to obtaining a good colon preparation.
span style="font-weight: 400;">The colonoscopy procedure may take longer because the doctor will try to improve their views by taking time to clear debris.
The doctor may lack confidence that the inspection was as careful as they hope for and may therefore ask you to return for a follow up procedure at an earlier time than would be otherwise recommended (ex. 1 year, rather than 5 or 10 years).
If the preparation is very poor, the procedure may not be able to be completed safely and you will need to reschedule and repeat the procedure.
Contact the physician who prescribes the medication to determine how to take it before and after your procedure.
Please do not assume that you can safely follow the same medication adjustments that have been made for your previous procedures.
These medications include:
If you are taking aspirin recommended by one of your doctors, please CONTINUE to take it.
If you do not have a heart, blood vessel, or clotting disorder and you are taking aspirin on your own without a doctor’s advice, please stop taking aspirin 5 days before the procedure.
Please STOP iron supplements in the week prior to the procedure.
span style="font-weight: 400;">You can consider purchasing Miralax OTC (an over the counter laxative) and take 1-2 capfuls mixed in 8 oz. of fluid daily during the week prior to the procedure. This may help in clearing out a more constipated colon.
It seems counterintuitive, but avoiding the high fiber/high residue foods for the entire week prior to the procedure can help achieve the optimal preparation (see detailed list below).
You can also consider extending the time you drink clear liquids only to include two days prior to the procedure.
span style="font-weight: 400;">Please call the office and request a prescription for an anti-nausea medication.
strong>For at LEAST three days, up to a week if possible, AVOID HIGH RESIDUE FOODS. The preparation information includes specifics, but the list of foods to avoid includes:
These high fiber foods can make the procedure more challenging, so make every effort to avoid them in the 3 days before the procedure.
However, if you do accidentally eat a high fiber food, it is not necessary to contact us or cancel/postpone the procedure.
Schedule your procedure for the morning if possible.
If you control your diabetes with ORAL medications alone, take your normal medication dose on the morning on the day prior to your procedure. Do NOT take any more diabetes medications until after the procedure is complete and you have eaten.
If you control your diabetes with INSULIN alone, for a colonoscopy, take ½ of your normal insulin dose the day before the procedure. Do NOT take any more diabetes medications until after the procedure is complete and you have eaten.
If you control your diabetes with BOTH INSULIN and ORAL medications, follow both sets of instructions as above.
If you utilize an INSULIN PUMP, please contact your endocrinologist for specific instructions.
Check your blood sugar frequently while drinking the preparation solution and the morning of your procedure.
Here are some suggestions:
span style="font-weight: 400;">Individual response to the preparation medications varies from person to person. Some people will begin to have multiple urgent bowel movements within 30 minutes of drinking the solution and others may not have a bowel movement for 6 hours.
I would encourage everyone to stay within close range of a bathroom after beginning to drink the preparation.
Feelings of nausea, bloating, or chills are common during the preparation process. These feelings are temporary and tend to improve after bowel movements begin.
If the nausea is significant or if you do vomit, STOP the preparation for 30-60 minutes. Restart the preparation when your nausea subsides and drink the remaining preparation at a slower pace. This may mean that you are awake later into the night doing the preparation, but that is preferable to vomiting and losing any progress you have made.
You may use a saline enema or tap water enema to help clear out residual stool. These items can be purchased from Amazon, Walgreens, CVS, or Target.
Here are a few suggestions:
If you take medications for HIGH BLOOD PRESSURE, IRREGULAR HEART BEAT, SEIZURES, ASTHMA, THYROID, or PREDNISONE, then please take your medication with a sip of water the morning of your procedure.
Other medications can wait until after the procedure is completed.
The first and last names of all doctors you would like us to send a copy of procedure report.
Someone to drive you home.
Your insurance cards.
Your medication list.
Here are some helpful tips about what to wear to your procedure:
Every effort will be made to keep your appointment at the scheduled time, but in medicine, unexpected delays and emergencies may occur and your wait time may be prolonged. We give each patient the attention needed for his or her procedure.
Typically we run on schedule and the duration from the time of drop off until you leave to go home runs approximately 2 hours.
After the administrative check in, a nurse will ask questions to ensure the patient understands the procedure and the reason it is planned.
The nurse will start an intravenous line (insert a needle into a vein in the hand or arm; feels similar to having blood drawn) to administer medications.
The vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful, though the first time the blood pressure cuff inflates it can be uncomfortable for 20-30 seconds.
Vital sign monitors will be placed and values checked again before starting the sedating medications.
All patients will be given oxygen during the examination through plastic tubing prongs aimed into their nostrils.
You will position yourself to be lying on your left side.
The anesthesiologist will administer medications through the IV line. Most people have a deep sleep during the examination and are unaware that it was even performed.
The average time in the procedure room is 20-30 minutes. Variability in the length of the procedure time depends upon an individual’s anatomy (some colons are easier to navigate than others), quality of the preparation, and quantity of polyps to remove or samples to obtain.
You will be recovering for approximately 30-40 minutes.
Due to the lingering effects from the sedation medication, you may not remember the physician speaking to you. If you gave permission prior to the procedure, the doctor will review the findings with your family member or responsible adult that accompanies you.
You will be able to eat and drink right after the procedure is completed.
You will NOT be able to drive or return to work for the remainder of the day. Although you will be awake by the time you are discharged, the sedative medications cause changes in reflexes and judgment that cause a person to feel well but can interfere with the ability to make decisions, similar to the effects of alcohol.
If your symptoms are mild and you have no fever, feel free to use Tylenol or other over the counter cold medications and proceed as scheduled.
If you have a fever, shortness of breath, severe cough or wheezing, please call and reschedule the procedure for when you are feeling better.
If you arrive the day of the procedure with these more concerning symptoms, the anesthesiologist may cancel the procedure in the interest of your safety.
No problem at all. Feel free to use a tampon and/or a pad.
No problem at all. Your doctor will confirm just prior to the procedure what you are comfortable with.
Although you may not remember the details of the procedure findings due to the sedation, all of the information is typed up and attached to the photos that were taken. If you have any questions later on when you are clear-headed, just call the office and we can review the details.
Colonoscopy is a safe procedure and complications are rare, but they can occur.
Risks of colonoscopy include:
What is an endoscopy?
An endoscopy (also called an upper GI scope or EGD) is a procedure that uses a long, thin, flexible tube with a tiny camera on the end, through which the doctor can examine your esophagus (swallowing tube), stomach, and the duodenum (the first part of the small intestine).
The image on the TV monitor is magnified many times so the doctor can see small changes in tissue. If the doctor sees areas of inflammation, ulcers, polyps, or tumors or needs a sample of tissue to look for microscopic changes, biopsies or samples of tissue can be obtained.
How long does an endoscopy last?
The procedure is generally 5-15 minutes long. An anesthesiologist administers medications through the IV line. Most people have a deep sleep during the examination and are unaware that it was even performed.
strong>No solid food after midnight the night before your procedure.
You may have clear liquids up until 3 hours before the procedure. This includes coffee and tea (no milk or cream), Gatorade/Propel, juice without pulp, soda, and water.
For the procedure to be thorough and safe, it is necessary for your stomach and duodenum to be empty. Three hours before your scheduled procedure time, absolutely nothing more to eat or drink!
span style="font-weight: 400;">Contact the physician who prescribes the medication to determine how to take it before and after your procedure.
Please do not assume that you can safely follow the same medication adjustments that have been made for your previous procedures.
These medications include:
span style="font-weight: 400;">If you are taking aspirin recommended by one of your doctors, please CONTINUE to take it.
If you do not have a heart, blood vessel, or clotting disorder and you are taking aspirin on your own without a doctor’s advice, please stop taking aspirin 5 days before the procedure.
span style="font-weight: 400;">Schedule your procedure for the morning if possible.
If you control your diabetes with ORAL medications alone, do NOT take any diabetes medications on the day of your procedure. You may resume your medications after the procedure is complete and you have eaten.
If you control your diabetes with INSULIN alone, do NOT take any insulin on the day of your procedure. You may resume your medications after the procedure is complete and you have eaten.
If you control your diabetes with BOTH INSULIN and ORAL medications. Follow both sets of instructions as above.
If you utilize an INSULIN PUMP, please contact your endocrinologist for specific instructions.
Check your blood sugar frequently the morning of your procedure.
span style="font-weight: 400;">If you take medications for HIGH BLOOD PRESSURE, IRREGULAR HEART BEAT, SEIZURES, ASTHMA, THYROID, or PREDNISONE, then please take your medication with a sip of water the morning of your procedure.
Other medications can wait until after the procedure is completed.
Check your blood sugar frequently the morning of your procedure.
span style="font-weight: 400;">The first and last names of all doctors you would like us to send a copy of procedure report.
Someone to drive you home.
Your insurance cards.
Your medication list.
/p>
span style="font-weight: 400;">Every effort will be made to keep your appointment at the scheduled time, but in medicine, unexpected delays and emergencies may occur and your wait time may be prolonged. We give each patient the attention needed for his or her procedure.
Typically we run on schedule and the duration from the time of drop off until you leave to go home runs approximately 2 hours.
span style="font-weight: 400;">After the administrative check in, a nurse will ask questions to ensure the patient understands the procedure and the reason it is planned.
The nurse will start an intravenous line (insert a needle into a vein in the hand or arm; feels similar to having blood drawn) to administer medications.
The vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful, though the first time the blood pressure cuff inflates it can be uncomfortable for 20-30 seconds.
span style="font-weight: 400;">Vital sign monitors will be placed and values checked again before starting the sedating medications.
All patients will be given oxygen during the examination through plastic tubing prongs aimed into their nostrils.
You will position yourself to be lying on your left side.
A plastic mouth guard will is placed between the teeth to prevent damage to the teeth and scope.
The anesthesiologist will administer medications through the IV line. Most people have a deep sleep during the examination and are unaware that it was even performed.
span style="font-weight: 400;">The procedure is generally about 5-15 minutes long.
span style="font-weight: 400;">You will be recovering for approximately 30-40 minutes.
You may feel slightly bloated and belching will help to relieve this sensation.
You may have a sore throat. This usually lasts for less than 48 hours.
Due to the lingering effects from the sedation medication, you may not remember the physician speaking to you. If you gave permission prior to the procedure, the doctor will review the findings with your family member or responsible adult that accompanies you.
You will be able to eat and drink right after the procedure is completed.
You will NOT be able to drive or return to work for the remainder of the day. Although you will be awake by the time you are discharged, the sedative medications cause changes in reflexes and judgment that cause a person to feel well but can interfere with the ability to make decisions, similar to the effects of alcohol.
span style="font-weight: 400;">If your symptoms are mild and you have no fever, feel free to use Tylenol or other over the counter cold medications and proceed as scheduled.
If you have a fever, shortness of breath, severe cough or wheezing, please call and reschedule the procedure for when you are feeling better.
If you arrive the day of the procedure with these more concerning symptoms, the anesthesiologist may cancel the procedure in the interest of your safety.
span style="font-weight: 400;">No problem at all. Your doctor will confirm just prior to the procedure what you are comfortable with.
Although you may not remember the details of the procedure findings due to the sedation, all of the information is typed up and attached to the photos that were taken. If you have any questions later on when you are clear-headed, just call the office and we can review the details.
span style="font-weight: 400;">Endoscopy is a safe procedure and complications are rare, but they can occur.
Risks of endoscopy include:
What is a flexible sigmoidoscopy?
A flexible sigmoidoscopy (also called a “flex sig” for short) allows the doctor to examine the end part of the colon and rectum.
A long, thin, flexible tube with a tiny camera on the end is inserted into the anus and advanced through the lower third of the colon and rectum. The scope blows air to inflate the colon to allow the doctor to more carefully examine the colon.
The doctor can insert instruments through the scope that can sample the colon tissue or remove polyps (abnormal growths from the wall of the colon).
Will I feel anything during the procedure?
Most individuals will be fully awake during the procedure because it is so short, approximately 10 minutes in duration.
If you are not sedated, then you will be able to feel the small tube being inserted and feel pressure, bloating, or slight cramping as the scope is advanced the short distance. Some individuals will receive sedating medications through an IV line and will not be likely to feel or remember any part of the procedure.
What is a capsule endoscopy?
Capsule endoscopy allows for examination of the small intestine. This middle portion of your gastrointestinal tract, which includes three portions of the small intestine (duodenum, jejunum, ileum), cannot be easily reached with standard endoscopy methods.
How is a capsule endoscopy performed?
You will be given a pill sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body.
Your doctor will be able to view these pictures after they are downloaded. This may provide information on structural changes in your small intestine.
Why is a capsule endoscopy done?
The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, Crohn’s disease, ulcers, and tumors of the small intestine.
Click the link to learn more details.
We understand that endoscopic procedures will never be considered a “fun” experience. We aim to make the process as pleasant, effortless, and efficient as possible, while simultaneously maintaining the highest quality and safety standards. Learn more about how we are trying to make your colonoscopy experience easier.
ADENOMA DETECTION RATE
The detection goals that have been established are to find at least one adenomatous polyp in:
NOTE: for the most accurate methodology, values are calculated only for patients age >50 for their first–time screening or surveillance examinations after 10 years; surveillance examinations for a history of polyps or family history of colon cancer/polyps and other symptomatic indications are excluded.
Dr. Troy’s Adenoma Detection Rate:
Dr. Nathanson’s Adenoma Detection Rate:
Prior to his joining us at Comprehensive Gastrointestinal Health, Dr. Nathanson had calculated adenoma detection rates that also were significantly higher than standard quality goals. Because these numbers were calculated using a different methodology, Comprehensive Gastrointestinal Health has decided that, rather than publish these rates, it will measure Dr. Nathanson’s adenoma detection rate using the procedures he performs in our endoscopy suite by the same method that is used to calculate Dr. Troy’s rate. This data will be compiled and updated on our website.
SESSILE SERRATED LESION DETECTION RATE
CECAL INTUBATION RATE
WITHDRAWAL TIME
Calculations reflect procedures performed from July 1, 2017 through December 31, 2021.
Critical care trained nurses and board-certified anesthesiologists provide first-rate anesthesia care.
Comprehensive Gastrointestinal Health, LLC has partnered with Mobile Anesthesiologists, LLC to coordinate outstanding care before, during, and after your procedure.
Mobile Anesthesiologists will communicate important instructions and reminders to you by email and phone to help you better prepare for your procedure.
Information within the emails does not contain protected health information.
You will receive a phone call reminding you to provide your health history, medications, and previous surgeries.
Mobile Anesthesiologists uses a secure online portal. The link to the portal will be texted to the preferred phone number that you have provided us. If you have any further questions or concerns, visit Mobile Anesthesiologists website at www.zzzmd.com or call at the numbers provided here.
If you have any general questions, call Mobile Anesthesiologists at:
(773) 355-5300
If you have any questions regarding the anesthesia you will be given or the online history form, call Mobile Anesthesiologists at:
(773) 756-5844
If you have any billing questions, before or after your procedure, please do not hesitate to contact the billing staff at Mobile Anesthesiologists at:
(855) 457-9900
Call us at (224) 407-4400 or fill in the appointment form.