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Enteroscopy

Management Team

Enteroscopy

Overview

Enteroscopy is a technique used for the examination of the small bowel or small intestine. The small intestine is a crucial part of the digestive system, where most of the nutrients from food are absorbed. Enteroscopy allows doctors to inspect the lining of the small intestine for abnormalities such as inflammation, ulcers, tumours, and bleeding. Enteroscopy can also be used to remove polyps or for taking tissue samples for biopsies.

Your doctor may recommend enteroscopy for a number of reasons including:

  • Chronic Abdominal Pain or Bleeding: If you are experiencing unexplained gastrointestinal symptoms such as abdominal pain, bleeding, or iron-deficiency anaemia, enteroscopy may be recommended to pinpoint the cause.
  • Investigation of Malabsorption Syndromes: For conditions like celiac disease or Crohn’s disease, enteroscopy can be used to investigate whether there is any damage to the small intestine that affects nutrient absorption.
  • Detection of Tumours and Growths: Enteroscopy can detect tumours, polyps, and other growths within the small intestine, which might otherwise go undetected in other types of imaging.
  • Evaluation of Inflammatory Bowel Diseases (IBD): Conditions such as Crohn’s disease and ulcerative colitis may affect the small intestine. Enteroscopy can help assess the extent of the disease and monitor for complications.

Before undergoing enteroscopy, patients typically need to avoid eating or drinking for at least 6–8 hours before the procedure to ensure the small intestine is clear for examination. Another step involves taking special preparations like laxatives or enemas which may be required to clean out the intestines, as a clean bowel improves the quality of the examination.

Some medications, especially blood thinners, may need to be paused before the procedure. It is important to discuss ongoing treatments with your doctor.

Enteroscopy can be performed in several ways, depending on the area of the small intestine that needs to be examined. The most common approaches include:

  • Standard Enteroscopy: In standard enteroscopy, a long, flexible tube with a camera at the tip (endoscope) is inserted into the mouth or the rectum, depending on whether the doctor is accessing the upper or lower parts of the small intestine.
  • Double-Balloon Enteroscopy (DBE): The DBE is a more advanced form of enteroscopy. It uses two balloons attached to the endoscope to help navigate through the loops of the small intestine. This method is particularly useful for examining parts of the small intestine that are hard to reach with standard enteroscopy.
  • Single-Balloon Enteroscopy (SBE): This technique is similar to DBE, but instead of using double balloon, this technique uses just a single balloon.
  • Capsule Endoscopy: In some cases, patients may swallow a small, pill-sized camera that captures images of the small intestine as it moves through the digestive tract. This is typically used when other methods are unsuccessful or unsuitable.

The common procedure remains the same for all including the following steps:

  • First, the patients are sedated to make the procedure more comfortable.
  • Next, the endoscope or balloon device is gently inserted through the mouth or rectum, depending on the part of the small intestine being examined.
  • The doctor then inspects the walls of the small intestine, looking for abnormalities. At this step, if needed, tissue samples (biopsies) can be taken for further analysis, and small growths like polyps can be removed.
  • The procedure might take up to 30 minutes to 1 hour. This depends on the complexity of the condition.

Enteroscopy offers several benefits for both diagnostic and therapeutic purposes:

  • Comprehensive Visualization: Enteroscopy allows for detailed images of the small intestine, which cannot be fully assessed through other imaging techniques such as X-rays or CT scans.
  • Early Detection: The ability to directly visualize and biopsy suspicious areas leads to earlier detection of tumours, polyps, and other pathologies.
  • Minimally Invasive: As a less invasive alternative to surgery, enteroscopy reduces recovery times and complications.
  • Treatment and Diagnosis Combined: Enteroscopy can be used to both diagnose and treat certain conditions, such as bleeding, removing polyps, or even treating strictures in the intestine.

Depending on the symptoms and medical condition, some alternative procedures may include:

  • CT or MRI Enterography: These imaging techniques use contrast to capture detailed images of the small intestine and surrounding organs, though they lack the direct visualization and therapeutic capabilities of enteroscopy.
  • Capsule Endoscopy: For patients who may not tolerate traditional enteroscopy, capsule endoscopy offers a less invasive alternative, though it does not allow for biopsies or therapeutic interventions.
  • Colonoscopy: While primarily used to examine the large intestine, a colonoscopy can sometimes provide useful information about the lower portion of the small intestine.

Though enteroscopy is generally safe, it carries some side effects and risks including:

  • Discomfort: Patients may experience bloating, cramping, or mild discomfort after the procedure.
  • Bleeding: A small risk of bleeding can occur, particularly if a biopsy is taken or polyps are removed.
  • Perforation: Though rare, there is a very small risk of a tear or puncture in the wall of the small intestine.
  • Infection: Any invasive procedure carries a slight risk of infection, though this is uncommon.
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Endoscopic Ultrasound (EUS)

Management Team

Endoscopic Ultrasound (EUS)

Overview

Endoscopic Ultrasound (EUS) is an imaging technique that combines endoscopy and ultrasound technology. It is performed to get detailed images of the digestive organs including the pancreas, liver and also the surrounding parts like lymph nodes. The procedure involves inserting a flexible tube called endoscope equipped with an ultrasound probe at its tip. The ultrasound waves create high-resolution images, allowing for a thorough examination of soft tissues and structures that may not be visible on other imaging tests.

EUS is widely used for diagnosing and managing a variety of medical conditions. Your doctor may recommend an EUS for the following cases:

  • Cancer Detection: It is crucial for detecting and staging cancers of the pancreas, bile ducts, and other nearby organs.
  • Pancreatic Disorders: In case you are suffering from a pancreatic disorder, EUS may help in diagnosing the underlying causes such as pancreatitis, cysts or pancreatic tumours.
  • Bile Duct and Gallbladder Issues: It helps detect blockages, stones, and growths in the bile ducts and gallbladder.
  • Liver and Lymph Node Evaluation: EUS can assess abnormalities in the liver and help evaluate enlarged or suspicious lymph nodes.
  • Biopsy: Biopsies involve collection of tissue samples from suspicious areas for further analysis. If required, EUS can be used for fine-needle aspiration (FNA) biopsies.

Before undergoing EUS, patients typically need to avoid eating or drinking for at least 6 hours before the procedure. Some medications, particularly blood thinners, may need to be paused, so it is important to discuss any ongoing treatments with your doctor.

The procedure is generally performed in an outpatient setting, and it follows these steps:

  • The patient receives a sedative to ensure comfort during the procedure.
  • Once the patient is sedated, the doctor gently inserts the endoscope either through the mouth (for upper GI tract) or rectum (for lower GI tract), depending on the area being examined.
  • The ultrasound probe on the endoscope emits sound waves that generate detailed images of the organs.
  • If a suspicious area is found, a fine needle is used to obtain tissue samples for analysis.
  • The procedure usually lasts between 30 to 60 minutes. However, in case there are any complexities, it may take longer.

EUS provides several significant advantages for both diagnosis and treatment:

  • High-Resolution Imaging: It delivers clear images of soft tissues, making it a valuable tool for assessing conditions that might not be visible with CT or MRI.
  • Early Detection: EUS can detect cancers in the pancreas, liver, and bile ducts at early stages, which is essential for successful treatment outcomes.
  • Minimally Invasive: Since biopsies can be performed during the procedure, EUS avoids the need for more invasive surgeries.
  • Accurate Staging: The procedure helps determine the stage of cancer or other diseases, which is critical for planning treatment.
  • Real-Time Monitoring: The ability to monitor areas in real-time aids in the timely identification of any changes that could indicate progression or improvement.

While EUS is a powerful diagnostic tool, there are alternative procedures that might be used depending on the patient's condition:

  • CT Scan: A computed tomography (CT) scan offers detailed images of the abdomen and can help detect tumours, but it is less effective than EUS for assessing soft tissue.
  • MRI: Magnetic resonance imaging (MRI) provides clear images of soft tissues and can be an alternative for evaluating certain conditions, particularly liver abnormalities.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure uses an endoscope to inject dye into the bile ducts, allowing for X-ray imaging of the biliary system. It is especially useful for detecting bile duct blockages and for performing procedures like stone removal.
  • Ultrasound: Traditional ultrasound, often used for liver or gallbladder evaluations, can detect structural changes but lacks the detail provided by EUS.

Although EUS is generally considered safe, there are some risks to be aware of:

  • Discomfort: Some patients may experience mild discomfort during the insertion of the endoscope.
  • Bleeding: Minor bleeding can occur, especially if a biopsy is taken, but this usually resolves without issue.
  • Infection: There is a slight risk of infection at the biopsy site, although this is rare.
  • Perforation: Though uncommon, there is a very small chance of puncturing the digestive tract, requiring additional treatment
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Endoscopic Retrograde Cholangiopancreatography (ERCP)

Management Team

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Overview

ERCP is a medical examination of the digestive system which combines endoscopy with X-ray imaging. In this examination, a flexible tube called endoscope is inserted through the mouth and into the upper digestive tract. This allows the physician to inject dye into the bile and pancreatic ducts for clear X-ray imaging. It is used for diagnosing and treating conditions related to the gallbladder, bile ducts and pancreas.

An ERCP may be suggested by your doctor in the following cases:

  • Gallstones and Bile Duct Blockage: In case there is a suspicion of gallstones being trapped in the bile duct, an ERCP may be recommended. ERCP can also identify and relieve other blockages in the bile duct that may cause jaundice or pain.
  • Yellow Jaundice: ERCP may help to determine the cause of yellowing of the skin and dark urine, often related to bile duct issues.
  • Pancreatitis: in case of pancreatitis, ERCP is helpful for diagnosing the level of inflammation of the pancreas. It can also help to identify the cause of pancreatitis.
  • Pancreatic or Bile Duct Cancer: ERCP can help detect cancer in the bile ducts or pancreas.
  • Infections: ERCP is also used to identify and treat infections within the bile ducts.
  • Leaks in the Bile or Pancreatic Ducts: In cases where leaks in the bile or pancreatic ducts are suspected, ERCP is recommended for identifying and addressing these issues.

The preparation for ERCP typically involves fasting where the patient is asked not to eat or drink for up to 8 hours prior to the procedure In some cases, the patient may also be asked to stop certain medications, especially blood thinners.

ERCP is usually performed in a room equipped for X Rays. The procedure follows these steps:

  • The patient is first positioned on his/her left side, with his/her head turned to the right.
  • A mild sedative is administered to help the patient relax and remain comfortable.
  • A flexible tube (endoscope) is gently inserted through the patient's mouth and into the upper digestive tract.
  • A thin tube is then inserted through the endoscope to inject dye into the bile ducts. After this, X-rays are taken to visualize the ducts.
  • If necessary, gallstones are removed, blockages cleared, or stents placed to keep the ducts open. Electrocautery is used to make an incision in the bile duct. It is a technique that uses heat generated by an electric current to cut tissues.
  • The procedure typically lasts between 20 to 40 minutes, but it may take longer depending on its complexity.

The positive outcomes of ERCP include:

  • ERCP can identify the cause of symptoms related to the bile ducts and pancreas, such as gallstones or blockages.
  • It allows some immediate treatments, such as removing gallstones or placing stents, reducing the need for major surgery.
  • It can help relieve symptoms like jaundice and pain caused by bile duct blockages with some immediate interventions.

  • Endoscopic Ultrasound (EUS): Uses sound waves to image the bile ducts and pancreas.
  • Percutaneous Transhepatic Cholangiography (PTC): A needle is used to inject the dye into the bile ducts through the skin.
  • Magnetic Resonance Cholangiopancreatography (MRCP): an MRI to visualize bile and pancreatic ducts.
  • Ultrasound

Common side effects of ERCP may include:

  • Sore Throat: A mild, temporary sore throat may occur due to the insertion of the endoscope.
  • Pancreatitis: in rare cases, there is a risk of inflammation of the pancreas due to the close proximity of pancreas with the bile duct.
  • Bleeding: Minor bleeding can occur if an incision is made during the procedure.
  • Infection: There is a risk of infection in very rare cases.
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Gastric Balloon

Management Team

Gastric Balloon

Overview

The gastric balloon is a non-surgical weight loss procedure designed to help individuals manage their portion sizes and reduce caloric intake. It involves placing a soft, inflatable balloon in the stomach to occupy space, making it easier to eat smaller meals and feel full sooner. This method is often paired with professional coaching, which includes dietary guidance, psychological support, and exercise plans, lasting up to 12 months (6 months during the balloon placement and 6 months post-removal).

Your healthcare provider might recommend the gastric balloon for:

  • Weight Loss Goals: If you need to lose weight but want to avoid surgical interventions.
  • Medical Concerns: Obesity-related conditions like hypertension, diabetes, or sleep apnoea need management through weight reduction.
  • Improved Lifestyle Habits: You require guidance to build long-term healthy eating and exercise habits.

To prepare, you may be asked to:

  • Fast for a few hours before the procedure.
  • Discuss your medical history to ensure suitability for the gastric balloon.
  • Undergo basic medical assessments like blood tests or imaging.

The gastric balloon placement is quick, usually taking 20–30 minutes, and is performed on an outpatient basis.

  • A mild sedative is administered to ensure comfort.
  • A deflated balloon is inserted into the stomach through the mouth using an endoscope.
  • The balloon is then filled with saline until it reaches the size of a grapefruit.
  • After 6 months, the balloon is deflated and removed through the same process under mild sedation.

  • Initial Weight Loss: Most weight loss occurs during the first three months. Patients typically lose 3.1 times more weight than with diet and exercise alone.
  • Sustained Effort: Success depends on your commitment to dietary changes and regular physical activity.
  • Professional Support: Coaching from experts helps maintain the progress achieved during the treatment.

  • Proven Efficacy: Decades of use with thousands of successful cases.
  • FDA-Approved Safety: Offers a reliable alternative to more invasive weight loss procedures.
  • Long-Term Impact: Encourages sustainable weight management even after the balloon is removed.

  • Bariatric Surgery: Such as gastric bypass or sleeve gastrectomy for more severe obesity cases.
  • Pharmacological Interventions: Prescription medications for weight loss.
  • Diet and Exercise Programs: Structured plans supervised by healthcare professionals.

  • Mild Discomfort: Nausea, vomiting, or abdominal pain in the initial days after placement.
  • Rare Complications: Balloon deflation, intestinal obstruction, or perforation.
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G

Oesophageal pH

Management Team

Oesophageal pH

Overview

Oesophageal pH Test is a diagnostic test performed to identify a condition called Gastroesophageal reflux (GERD) or acid reflux. It is also called Bravo test. The oesophagus is a muscular tube in the human digestive system. It carries food and liquids from the throat to the stomach. Typically, the lower oesophageal sphincter (LES) which is like a valve prevents the stomach acid from flowing back into the oesophagus. However, when the LES malfunctions, acid reflux can occur, leading to discomfort such as heartburn and potentially causing long-term damage to the oesophagus. In such cases, the oesophageal pH test is used to determine how often and for how long stomach acid enters the oesophagus.

An oesophageal pH test may be recommended by your doctor if you have the following conditions:

  • Heartburn: Persistent or frequent heartburn that may suggest acid reflux as the underlying cause.
  • Difficulty swallowing: A sensation of food or liquid getting stuck, which can result from acid-induced scarring in the oesophagus.
  • Chest pain: Unexplained chest pain that may be linked to acid reflux
  • To assess treatment effectiveness: The test can help evaluate how well treatments for acid reflux are working.
  • Diagnostic clarification: It can be used alongside other tests, such as an upper GI series or endoscopy, to provide a clearer picture of the condition of the ossiphageous.

As a preparation for the oesophageal pH test, patients are asked not to consume anything for at least 8 hours before the test. Some medications can influence the test results. Patients should discuss their medications with their doctor, who may advise discontinuing certain drugs at least 48 hours before the test.

Medications that may need to be stopped include caffeine (coffee, tea, soda, chocolate), alcohol, Reglan, Urecholine, Erythromycin, Nitroglycerin, and others like calcium channel blockers, beta blockers, and antacids such as Tagamet, Zantac, Prilosec, and others.

The procedure is typically quick and can be performed on an outpatient basis. It involves the following steps:

  • The patient is asked to be seated or lie on their side for the procedure.
  • A soft, thin tube is inserted through the nose or mouth and gently passed down into the oesophagus.
  • The tube is connected to a small portable device that records the pH levels in the oesophagus throughout the test.
  • The test usually lasts 12-24 hours, during which time the patient is asked to continue with their usual activities.
  • The test measures stomach acid in the oesophagus. Normal results show infrequent reflux, while abnormal results suggest acid reflux issues, guiding treatment options.

The oesophageal pH test is highly beneficial because it provides specific data about the amount and duration of acid reflux, allowing for precise treatment decisions. Some key benefits include:

  • The test helps tailor treatment strategies based on the severity of acid reflux.
  • If the results are normal, it can reassure both the doctor and patient that acid reflux is not the cause of symptoms.
  • It helps evaluate the effectiveness of treatments, such as proton pump inhibitors (PPIs), in controlling acid reflux.

While other diagnostic methods like an upper GI series or endoscopy are useful, they do not provide the same level of insight into acid reflux as the pH test. The pH test is often paired with oesophageal manometry (a test that measures oesophageal pressure) for a more comprehensive evaluation.

Despite the fact that the test is generally secure, there are a few potential side effects, such as:

  • Gagging: A minor sensation of gagging may be experienced during the insertion of the tube. Breathing techniques are typically effective in managing it.
  • Mild Discomfort: The tube may cause mild discomfort or congestion in certain patients following the procedure.
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O

Sigmoidoscopy

Management Team

Sigmoidoscopy

Overview

Sigmoidoscopy also known as flexible sigmoidoscopy is a medical procedure that involves the visual inspection of the sigmoid colon and rectum. The last part of the human colon which is located above the rectum is called sigmoid colon. While the human colon is 5-6 feet long, sigmoidoscopy only analyses 1-2 feet of the colon from the rectum. For the observation, a flexible tube with a light and camera called a sigmoidoscope, is inserted through the rectum and the internal structure is observed on the video screen.

Your doctor may recommend sigmoidoscopy as a diagnosis in the following cases:

  • Bleeding: If you experience rectal bleeding, sigmoidoscopy may be recommended since it can identify the cause of bleeding. Rectal bleedings are mostly caused due to haemorrhoids (piles) or anal fissures which involves tearing of the wall of anus. There could also be a serious underlying condition like benign polyps which can lead to rectal and colon cancer. For such cases, sigmoidoscopy plays an important role in its diagnosis.
  • Persistent diarrhoea: Persistent diarrhoea can be an indication of an underlying condition which can be identified through sigmoidoscopy.
  • Pain: if you are experiencing pain in the rectum or colon, your doctor may advise for a sigmoidoscopy to identify the cause of the pain. Common causes include haemorrhoids, anal fissures, and diverticulosis. Diverticulosis is a condition affecting the lower bowel in which small pockets are seen projecting from the bowel walls. Pain or discomfort could also be a sign of colon or rectal cancer.
  • X-Ray findings: Sigmoidoscopy is often performed to confirm the findings from a barium enema X-ray examination.
  • Detection of cancer: Colon cancer is the most common form of cancer in the country. It usually starts as benign polyps within the colon which further develop to be cancerous. If these are identified early, these polyps can easily be removed and can avoid the development of cancer. Hence it is advisable to get a sigmoidoscopy done to ensure protection from colon cancer. In cases of a family history of colon cancer, sigmoidoscopy is highly recommended.

The preparation for examination usually involves the intake of clear liquids and use of enema and laxatives by the patient. This is to ensure that the sigmoid colon and rectum are clean for observation.

Sigmoidoscopy is usually performed on outpatient basis. The examination involves the following steps:

  • The patient is asked to lay flat on his/her left side with the legs drawn up.
  • A sheet is placed between over the lower part to cover the lower body of the patient
  • A prior finger or digital examination of the anus is performed
  • The sigmoidoscope is then slowly inserted via the rectum. The colon is expanded by inflating air to ensure the smooth insertion of the tube. At this point, the patient may experience some discomfort which is similar to gas cramps.
  • The sigmoidoscope is then moved slowly around the curves to advance into the colon. It is inserted only till the patient doesn’t feel discomfort. In cases where the patient feels any discomfort due to an underlying cause, the procedure is immediately stopped.
  • The procedure requires usually requires only up to 15-20 minutes and doesn’t require any sedation due to very low chances of discomfort.

The positive outcomes of sigmoidoscopy can include:

  • Identifying the specific cause of symptoms.
  • Monitoring conditions like colitis and diverticulosis to assess the effectiveness of treatment.
  • Detecting polyps and tumours at an early stage.

  • Colonoscopy: A more comprehensive procedure that examines the entire colon.
  • CT Colonography: An external imaging that provides detailed views of the colon.
  • Stool Tests: It is used for initial screening but may not provide detailed results.

Common side effects of sigmoidoscopy include

  • Bloating: Bloating and a feeling of fullness in the abdomen is caused by air being introduced into the bowel. These symptoms typically subside within 30 to 60 minutes.
  • Minor bleeding: If a biopsy is performed or a polyp is removed, there may be minor bleeding, though it is generally not concerning.

Sigmoidoscopy is a simple procedure that can help detect serious health issues. It allows for the accurate diagnosis of conditions, assessment of treatment plans, and also provides reassurance if the results are normal. It is one of the most valuable and simple tools for the diagnosis of the digestive tract.

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S

Colonoscopy

Management Team

Colonoscopy

Overview

Colonoscopy is a medical procedure used to examine the inner lining of the colon (large intestine) and rectum. During the procedure, a flexible tube called a colonoscope, equipped with a light and camera, is inserted into the rectum to provide a detailed view of the entire colon. This allows doctors to detect abnormalities, remove polyps, or take tissue samples for further analysis.

Your doctor may recommend a colonoscopy in the following cases:

  • Routine Screening: Individuals aged 45 or older are advised to undergo routine screening to detect early signs of colorectal cancer.
  • Rectal Bleeding: Unexplained rectal bleeding could indicate haemorrhoids, polyps, or other conditions requiring further evaluation.
  • Chronic Diarrhoea: Persistent diarrhoea may point to underlying gastrointestinal issues such as infection or inflammatory bowel disease (IBD).
  • Abdominal Pain: Unexplained abdominal pain could be a sign of conditions like diverticulosis, IBS, or colorectal cancer.
  • Family History: Those with a personal or family history of colorectal cancer or polyps need regular surveillance.
  • Inflammatory Bowel Conditions: Monitoring diseases like Crohn’s disease, ulcerative colitis, or IBS for progression or complications.

Proper preparation is critical for a successful colonoscopy. As a part of preparation, patients are required to follow a clear liquid diet (e.g., water, clear broths) for 24 hours before the procedure. For bowel cleansing, Polyethylene glycol (PEG)-based laxatives are administered to empty the colon. These osmotic laxatives, taken with large amounts of water, ensure thorough cleaning while maintaining electrolyte balance. All solid food should be avoided to ensure a clear view of the colon during the procedure.

Colonoscopy is an outpatient procedure and it usually lasts for only 15–30 minutes. The steps for performing colonoscopy include:

  • Patients are typically given mild sedatives or anaesthesia to ensure comfort.
  • The colonoscope is gently inserted through the rectum and advanced through the colon. Air is inflated into the colon to ensure expansion of colon.
  • The entire colon is examined for abnormalities. If necessary, polyps can be removed, and tissue samples may be taken for biopsy.

Benefits of colonoscopy include:

  • Early detection and prevention of colorectal cancer.
  • Removal of precancerous polyps.
  • Monitoring and managing gastrointestinal conditions like irritable bowel syndrome.

  • Sigmoidoscopy: A similar procedure which examines only the lower colon but may miss abnormalities in the upper colon.
  • CT Colonography: A procedure that uses imaging to visualize the colon but cannot perform biopsies or remove polyps.
  • Stool Tests: Useful for initial screening but lack detailed diagnostic capabilities.

While colonoscopy is generally safe, potential side effects include:

  • Bloating or Cramps: Temporary discomfort caused by air introduced during the procedure.
  • Bleeding: Minor bleeding may occur if polyps are removed or biopsies are taken.
  • Rare Complications: Perforation of the colon or adverse reactions to sedation are extremely rare.
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C

Ultrasonography Guided Liver Biopsy

Management Team

Ultrasonography Guided Liver Biopsy

Overview

A liver biopsy is regarded as a minimally invasive medical procedure in which a small sample of tissue from a patient’s liver is removed for further analysis. This makes it possible for physicians to determine what may be occurring in a person’s liver, particularly if other techniques such as blood tests or imaging do not provide appropriate clues. The liver is an organ in the body whose location is upper right side of the abdomen and serves the essential functions of cleansing poison, forming proteins, and assisting in food metabolism. Depending on the enzymes and biochemicals analysis, a biopsy can reveal a wide range of conditions including infection and inflammation to malignancy or other structural lesions.

Liver biopsy may be done at the request of the doctor for the following reasons:

  • Assessment of undiagnosed symptoms: Chronic lack of energy, jaundice, or inactive thyroid alongside abnormal test results focusing on the functioning of the liver may warrant a biopsy to be done for further diagnosis.
  • Chronic liver conditions: Other liver diseases such as hepatitis, liver fat, liver cirrhosis and other chronic liver conditions can be treated based on the patient's liver biopsy.
  • Cancer screening: If the imaging studies indicate possibility of presence of liver malignancy, then use of a liver cancer biopsy can confirm the diagnosis.
  • Evaluate progression of the disease: A liver biopsy may help give some evaluative insight on how much body damage has been inflicted over issues like auto immune hepatitis, genetic liver diseases amongst many others.
  • Assess treatment responses: It is often used for monitoring the outcome of conditions that affect the liver.

As for the procedure, your doctor will educate you on how to prepare for the biopsy You would be advised to not take any food or drink for a few hours prior to the procedure. Some medications that may cause bleeding need to be temporarily suspended. Additionally you will be advised to have a blood check performed to ensure safe clotting during the biopsy.

  • A liver biopsy is a quick procedure, taking around 15 to 20 minutes, and is performed under daycare admission process. Here is what you need to be ready for:
  • The patient will be asked to lie down flat on the back or perhaps on the left side at a slight angle.
  • Thereafter, the skin that is above the liver area will be disinfected and local anaesthesia will be injected into the region.
  • Using ultrasound or physical guidance, a thin needle is inserted to collect a small tissue sample. This part lasts only a few seconds.
  • The sample collected is sent to a pathology lab for analysis while the patient will be monitored for a few hours afterward to ensure there are no immediate complications.

A liver biopsy presents the following advantages:

  • Accurate Diagnosis: It directly reflects the health of the liver and can show a number of conditions.
  • Disease Assessment: Assists in determining the treatment depending on how far advanced the condition is.
  • Chronic Diseases Surveillance: Assesses variations over time in order to modify treatment approaches.

If a biopsy is deemed not suitable, one’s healthcare practitioner may recommend:

  • Imaging tests: Ultrasound, CT scans, or MRI for structural analysis.
  • Non-invasive techniques: FibroScan or specialized blood tests to assess liver stiffness and function.
  • Liver function tests (LFTs): These can monitor enzyme levels but don’t provide as much detail as a biopsy.

Liver biopsies are generally safe, but like any procedure, they carry some risks:

  • Mild discomfort: You might feel soreness where the needle was inserted or in your shoulder.
  • Bleeding: While rare, internal bleeding can occur but is usually manageable without surgery.
  • Bile leakage: A very rare complication if bile ducts are punctured.
  • Infection: As with any invasive procedure, there is a small chance of infection.
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Oesophageal Manometry

Management Team

Oesophageal Manometry

Overview

Oesophageal manometry is a test that measures the rhythmic muscle contractions (motility) in the oesophagus. It evaluates the function of the lower oesophageal sphincter (LES), the muscle that controls the opening between the oesophagus and the stomach, and the oesophageal body. This test helps diagnose conditions like achalasia, GERD, and swallowing disorders.

Your doctor may recommend oesophageal manometry in the following cases:

  • Dysphagia (Difficulty Swallowing): To determine if the cause is due to muscle problems in the oesophagus.
  • Chest Pain: If chest pain is suspected to be related to oesophageal motility issues rather than heart problems.
  • Gastroesophageal Reflux Disease (GERD): To assess the function of the LES and determine if it is causing acid reflux.
  • Achalasia: A disorder where the oesophagus has difficulty moving food to the stomach due to poor muscle function, often resulting in swallowing difficulties.
  • Pre-Surgical Assessment: To evaluate oesophageal function before certain surgeries, such as fundoplication for GERD.

Patients are usually instructed to avoid food and drinks for 8 hours before the procedure. Certain medications that affect oesophageal function (e.g., calcium channel blockers, sedatives, antacids) may need to be stopped 48 hours before the test. Notify your doctor of any allergies, medical conditions, or medications, as some may affect the results.

Oesophageal manometry is typically done as an outpatient procedure. The steps include:

  • Local anaesthesia or a mild sedative may be administered to reduce discomfort.
  • A thin, flexible tube (catheter) is inserted through the nose or mouth and passed down the oesophagus.
  • The catheter has sensors that measure the pressure and contractions in different parts of the oesophagus while you swallow small amounts of water.
  • The test usually takes about 20-30 minutes, and patients can resume normal activities afterward.

  • Diagnosis of the cause of swallowing difficulties and other oesophageal problems.
  • Provides valuable information for treatment planning, especially in conditions like achalasia and GERD.

  • Upper Endoscopy: Visual examination of the oesophagus using a flexible tube with a camera.
  • Barium Swallow: An X-ray test that can detect structural problems in the oesophagus.

  • Discomfort: Some discomfort, such as a sore throat or nasal irritation, may occur.
  • Gagging or Coughing: Common reactions during the test as the catheter is inserted.
  • Infection or Bleeding: Though rare, infection or bleeding may occur if the catheter causes any injury to the oesophagus.
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O

Oesophageal Dilatation

Management Team

Oesophageal Dilatation

Overview

Oesophageal dilatation is a medical procedure used to widen a narrowed or blocked oesophagus. This narrowing (stricture) can occur due to various conditions, such as gastroesophageal reflux disease (GERD), oesophageal cancer, or injury. The procedure is typically performed using a balloon or bougie (a thin, flexible instrument) to gently stretch the affected area, improving the ability to swallow food and liquids.

Your doctor may recommend oesophageal dilatation in the following cases:

  • Oesophageal Stricture: Caused by chronic acid reflux, radiation therapy, or injury, leading to difficulty swallowing.
  • Dysphagia: Difficulty swallowing, often due to narrowing of the oesophagus, which can be addressed through dilation.
  • Food Impaction: When food gets stuck in the oesophagus, especially if there is a narrowing or obstruction.
  • Post-Surgical Treatment: To address complications like strictures after surgery, such as those following fundoplication for GERD.

  • Fasting: Patients are typically asked to avoid eating or drinking for at least 6 hours before the procedure to reduce the risk of aspiration during the procedure.
  • Medication Adjustments: Some medications, especially anticoagulants or those affecting oesophageal motility, may need to be paused or adjusted.
  • Consultation: Discuss any recent health changes, allergies, or past complications with your healthcare provider.

Oesophageal dilatation is generally performed on an outpatient basis and involves the following steps:

  • Sedation: Patients may be given a sedative to relax and reduce discomfort.
  • Insertion of Balloon/Bougie: A flexible tube (endoscope) is passed through the mouth and into the oesophagus, where the narrowing is identified. A balloon or bougie is then gently inflated or inserted to widen the stricture.
  • Post-Procedure Monitoring: The procedure typically lasts between 15-30 minutes, and patients are monitored for any immediate complications, such as bleeding or perforation.

  • Improves the ability to swallow food and liquids.
  • Can help prevent food impaction and other complications caused by strictures.

  • Oesophageal Stent Placement: A tube inserted to keep the oesophagus open.
  • Surgical Treatment: In severe cases, surgery may be required to correct the narrowing.

  • Minor Bleeding: Occasional minor bleeding may occur, especially if a biopsy is taken during the procedure.
  • Perforation: Although rare, there is a small risk of perforation (a tear in the oesophagus).
  • Infection: As with any medical procedure, infection is a possibility.
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