Services and Procedures

When you come to Gastroenterology Associates of Cleveland (GAC) you will know you are getting the finest care available. Our doctors are some of the top specialists in the country in the treatment of gastrointestinal (“GI”) tract conditions.

Our consultative practice specializes in the initial consultation of “GI” problems including,

  • Evaluation and Diagnosis
  • Establishing a treatment plan
  • Long term management and follow-up as needed
  • Second Opinions of all gastrointestinal conditions

We pride ourselves on our

  • State-of-the-Art Technology
  • Innovative approach to disease management
  • New techniques provided onsite
  • Cutting-edge research giving us access to medicines and treatments not yet available elsewhere
This test is used to check for GERD (gastroesophageal reflux disease) and Laryngopharyngeal Reflux Disease (LRD). A tiny capsule is attached to the esophagus during an upper endoscopy.It measures the levels of stomach acid in the esophagus and sends the information to a receiver worn on your belt like a cell phone or pager. Your doctor will ask you to carry a diary to note the times when you have heartburn symptoms.
At the end of the test, usually 24 – 48 hours, your doctor will upload the information stored in the receiver to a computer and use the information to help diagnose your condition.

Breath Tests

We utilize the Quintron SC – Breathalyzer – the most advanced instrument of its kind to evaluate expired air (your breath) for suspected:

Breath testing helps us evaluate:

  • Bloating
  • Diarrhea
  • Constipation
  • Excessive Gas
  • Belching
  • Abdominal Pain
  • Intense urge to have a bowel movement after eating


Colonoscopy is a procedure that uses a long, flexible lighted scope to see inside the colon and rectum for evaluation and treatment. Colonoscopy can detect inflamed tissue, ulcers and abnormal growths.

The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus and weight loss.

During a colonoscopy, your doctor can remove growths, called polyps or take biopsies. The polyps or biopsies will then be examined under a microscope by our pathologist.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP combines the use of flouroscopy and an endoscope, a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the gallbladder (biliary) tree and pancreas so they can be seen on flouroscopy

ERCP helps the physician to diagnose problems in the liver, gallbladder, bile ducts and pancreas. ERCP

is used primarily to diagnose and treat conditions of the bile ducts, including:

  • Gallstones
  • Inflammatory strictures (scars)
  • Leaks (from trauma and surgery)
  • Cancer

Infrared Coagulation of Hemorrhoids (IRC)

A special high intensity light beam is used to shrink away hemorrhoid tissue.

Upper Endoscopy -EGD (Esophagogastroduodenoscopy)

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum(the first part of the small intestine).

Upper GI endoscopy can detect

  • Ulcers
  • Abnormal growths
  • Precancerous conditions
  • Inflammation
  • Hiatal hernia

Upper endoscopy can be used to determine the cause of

  • Abdominal pain
  • Nausea
  • Vomiting
  • Swallowing difficulties
  • Gastric reflux
  • Unexplained weight loss
  • Anemia
  • Bleeding in the upper GI tract
Upper GI endoscopy can be used to remove objects that may become lodged in the esophagus and to treat conditions such as bleeding ulcers. It can also be used to biopsy tissue in the upper GI tract. During a biopsy, a small piece of tissue is removed for later examination under the -microscope by our pathologist.

Wireless Capsule Endoscopy

Wireless capsule endoscopy involves the patient swallowing a video capsule that has a tiny camera inside it. (The capsule is a little larger than a multi-vitamin pill.) As the capsule moves through the esophagus, stomach and small intestine over the course of a day, it takes photographs. The photos are transmitted to a small data recorder that the patient wears on his or her belt. The data is then gathered and downloaded to a computer where it is interpreted by your physician.

Wireless capsule endoscopy is used to diagnose causes of GI bleeding as well as GERD (gastroesophageal reflux disease).

Pathology Laboratory

Our team also includes a board-certified pathologist who specializes in “GI” Pathology. He is on staff and available for immediate consultation with your doctor.

Our Pathology Laboratory is accredited by CLIA, a national accreditation program approved by CMS (The Centers for Medicare and Medicaid Services) and the Ohio Department of Health. This accreditation ensures that we meet the highest standard of care.

Clinical Research

Since 1993, Gastroenterology Associates of Cleveland has been actively involved in all phases of clinical research. Because of our ongoing involvement in “GI” research, we are able to offer new and emerging therapies to those patients of our who qualify for many of these research protocols.

Ambulatory Infusion Center

We offer Remicade® infusion for our patients with Crohn’s Disease or Ulcerative Colitis. During an infusion session of our physicians or physician assistants is always on-site. All of our clinical and non-clinical staff are trained in providing infusions and any emergent situation should it arise during the course of treatment.
Our AIC is equipped with state-of-the-art medical equipment and emergency medical care is available immediately if necessary. The facility is furnished with treatment chairs and personal flat screen televisions and DVD/VCR players. Wi-Fi is available for those patients that must work during an infusion session.

If you have any questions regarding Remicade® or our infusion center, please call 216-593-7461 and speak with Nancy.

Cleveland Center for Digestive Health & Endoscopy, LLC

The Cleveland Center for Digestive Health & Endoscopy, LLC (“CCDH”) was originally founded in 1990 under the name Ambulatory Surgery Center of Northern Ohio, Incorporated. Being the first physician-owned endoscopy center in Northern Ohio, we were trailblazers and visionaries for those centers that followed. Until 2006, we operated with 2 endoscopy procedure rooms and 5 recovery beds with 5 full time and 2 part-time employees in nine hundred square feet. Our reception room seated 12 people comfortably.

After 1 year of market research and planning, we began construction in November of 2005 and in April of 2006 the Ambulatory Surgery Center of Northern Ohio moved into 8,500 square feet of space with 4 endoscopy procedure rooms, 5 pre-op beds and 5 post-op beds. Our reception room now seats 75 comfortably. We subscribe to 50 different magazines, and provide the Plain Dealer, Wall Street Journal and USA Today daily along with the Jewish News, Catholic Universe Bulletin and La Gazetta weekly for our patients, friends and family members. Two flat screen monitors on either side of the room provide ongoing entertainment in a relaxed atmosphere. A free coffee/tea bar with bottled water is available for our patients and their family.

With the move, we closed the Ambulatory Surgery Center of Northern Ohio and opened the Cleveland Center for Digestive Health and Endoscopy, LLC with the intent to offer the most comprehensive healthcare services to our patients and their family members. There are now 15 full and part-time employees.

Accredited by the Accreditation Association for Ambulatory Health Care, Inc.

Most importantly, the Cleveland Center for Digestive Health and Endoscopy is licensed by the Ohio Department of Health to operate as an ambulatory surgery center and is accredited by the Centers for Medicare and Medicaid Services (CMS) and the Accreditation Association for Ambulatory Healthcare, Incorporated. These accreditations assure all of our patients that we have gone through rigorous evaluations of our clinical operating policies and procedures,
that our physical plant (the building itself) has passed a Life Safety Code inspection and our day to day operations are financially stable.
CCDH adheres to the guidelines as outlined by the Centers for Medicare and Medicaid Services (CMS) with respect to Advance Directives and Living Wills and Patient Rights and Responsibilities. 

Care and Cleaning of Endoscopes

We go to great lengths to ensure each of our patients is well cared for and each endoscope used is meticulously cleaned and disinfected prior to being used. Dwight, our endoscope technician has passed SGNA certification as an endoscope technician having passed rigorous training in high level disinfection techniques.

GAC Institute for Gastrointestinal Pathology 

 In 2005, we became the first medical practice in Northern Ohio to develop  our   own in- house pathology laboratory that is CLIA certified to provide anatomic pathology services to our patients. By employing a full time board certified pathologist with advanced training in gastrointestinal pathology we have immediate access to our patients’ biopsy specimens. This allows immediate consultation between our pathologist and your physician.

Quality Assurance

Throughout the year all of our organizations have ongoing programs in quality assurance, risk management, patient survey tools and root cause analysis to ensure that all of our patients receive the highest standard of care available.

GAC Center for Clinical Research Excellence




Our Center for Clinical Research was established in 1993 to assist our physicians in their quest for new treatment options. By applying their clinical experience and knowledge to academic research in digestive disease all of our patients have benefited by new therapies not yet offered to the general public. The center is staffed by experienced certified principal research investigators (physicians) and clinical research coordinators. We have extensive experience in both national and international research trials. Since the inception of the center we have worked with the following sponsors (pharmaceutical companies)/CRO’s (Contract Research Organizations)
  • Abbot Immunology
  • Baxter Pharmaceuticals
  • Celltech
  • Centocor
  • Luitpold
  • National Cancer Institute
  • Novartis
  • Pfizer
  • Romark
  • Serono
  • Sucampo
  • TAP Pharmaceuticals
  • ICON
  • Kendle
  • Paragon
  • Ovation
  • Parexel
  • PPD (Pharmaceutical Product Development)
  • PRA
  • Premier
  • Quintiles, Inc.
  • Solvay

What is a Clinical Trial?

Clinical trials are research studies that evaluate the effectiveness of new medications or procedures to improve existing treatment methods and develop new ones. Over the years we have participated in clinical trials for colon cancer prevention, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), constipation, and gastroesophageal reflux disease (GERD) to name a few.

Is a Clinical Trial Right for You?

Participating in a clinical trial is a very significant, personal choice. We provide information on our research studies so that you can stay abreast of the latest research and, if you choose, discuss with your doctor the possibility of participating in a clinical trial.

Our Facility

The research facilities were designed to ensure the timely and accurate collection of research data. We have an extensive patient database to mine for future clinical trials. Our facility includes an area to draw blood, locked -20°C freezer, locked refrigerator and separate locked medication area, EKG, IV infusion area with monitored IV pumps, an independent endoscopy suite and dedicated secure phone/fax lines to ensure patient privacy.

Open Clinical Research Trials

We are actively enrolling patients in the following studies.

A. Study #: 27018966IBS2001 Irritable Bowel Syndrome with Diarrhea

Study Title: A Randomized, Double-Blind, Placebo-controlled, Parallel-group, Dose-ranging, Multicenter Study to Evaluate the Efficacy, Safety, and Tolerability of JNJ-27018966 in the Treatment of Patients with Irritable Bowel Syndrome with Diarrhea.
It is planned that 580 to 850 people with Irritable Bowel Syndrome (IBS) -Diarrhea, 18 years of age to 65 years of age will participate in this study. Participation will last about 18 weeks or approximately 4.5 months and will consist of 8 visits.
The study drug and all tests and procedures for diarrhea, and visits required by the study, are provided at no cost to the patient. If the patient completes the study, they will be paid a total of $360.00 for their participation.

To qualify, the patient will have to meet a list of inclusion and exclusion criteria that will be discussed in detail at their screening visit.

B. Study #” BUCF3002 Ulcerative Proctitis or Proctosigmoiditis

Study Title: A Phase 3, Randomized, Double-Blind, Placebo-controlled, Multicenter Study to Assess the Efficacy and Safety of Budesonide Foam (2mg/25ml BID for Two Weeks, Followed by 2mg/25ml QD for Four Weeks) Versus Placebo in Subjects with Active Mild to Moderate Ulcerative Proctitis or Proctosigmoiditis.
The sponsor of this study, Salix Pharmaceuticals, is looking at the use of budesonide foam administered rectally, and evaluating the safety and effectiveness of budesonide foam compared to placebo in subjects with ulcerative proctitis or proctosigmoiditis.
Participation this study is expected to last about 11 weeks and will involve up to 8 visits. Approximately 430 patients will participate. Patients may receive up to $475.00 for participating and completing the study.
To qualify, the patient will have to meet a list of inclusion and exclusion criteria that will be discussed in detail at their screening visit.
For more information, please contact our research coordinator by calling 216-593-7461, or sending an email to

Bravo® pH Monitoring Test



What is the Bravo pH monitoring system?

The Bravo system is a pH test to help your doctor determine if you have acid reflux. A pH test measures the degree of acidity or alkalinity in your esophagus. The test period usually lasts 24 to 48 hours, and measures acidity in two ways:

  •   How often stomach acid flows into the lower esophagus
  •   Degree of acidity during the test period

Information from the pH test helps your doctor diagnose GERD (gastroesophageal reflux disease) and plan your treatment. Bravo system consists of a capsule, approximately the size of a gel cap that is temporarily attached to the wall of your esophagus. The capsule measures pH levels in you esophagus and transmits this information wirelessly to a portable receiver you wear on your waistband.
What should I expect during a Bravo test?

You will sit or lie back while your doctor inserts the pH capsule into the esophagus. After the capsule is in place, suction is applied, drawing a small amount of tissue into the capsule. The capsule is locked in place with typically little or no discomfort.

As soon as the capsule is attached, it begins measuring the pH levels in your esophagus. The capsule transmits these measurements wirelessly to a small receiver you wear on your waistband or belt. As long as the capsule and receiver are within 3 feet of each other, the system will measure and record your pH levels. This means you can place the receiver nearby when bathing or sleeping without interrupting the test.

The receiver is about the size of a standard pager, and has three symptom buttons. You will be instructed to press the appropriate button during the study when you experience heartburn, regurgitation, or chest pain. The Bravo Receiver is designed to prevent you from turning it off during the test period.

You will also be asked to record periods of eating and sleeping in a diary throughout the test. You can go about your daily routine without any restrictions.

Some people say they have a vague sensation that “something” is in their esophagus. Others say they feel the capsule when they eat or when food passes the capsule. Chewing food carefully and drinking liquids may minimize this sensation.

Please note: The capsule contains a tiny magnet, and you should not undergo an MRI study within 30 days of using the Bravo system.

What should I expect after the Bravo test?

When the pH study is complete, you will return the receiver and diary to your doctor’s office. The information stored in the receiver will be uploaded to a computer. Your doctor will analyze your results to determine if you have acid reflux and plan the best treatment for your heartburn symptoms.
The disposable capsule will spontaneously detach and pass through your digestive system a few days after the test period. Only a small area of esophageal tissue is affected by the capsule.

What are the possible complications of Bravo?

If you have a bleeding tendency, narrowing of the esophagus, severe irritation of the esophagus, varices, obstructions, a pacemaker, or an implantable cardiac defibrillator, you should not undergo a Bravo pH test. Additionally, because the capsule contains a small magnet, you should not have an MRI study within 30 days of undergoing the Bravo pH test.
Rare complications from using the Bravo pH Monitoring System include the following events:

  • The capsule could detach from the esophagus before the test is completeThe capsule may fail to detach from the esophagus within several days after placement, or there may be discomfort associated with the pH capsule, requiring endoscopic removal
  • Tears in the lining of the esophagus, causing bleeding and requiring possible medical intervention
  • Perforation



Several medications alter the pH level of the stomach and may affect the contractile pattern of the esophagus. Your doctor may choose to perform the test with or without stomach (acid-blocking) medications. Your doctor will let you know prior to the test if you should stop your medications or continue your medications.

pH Test Without Stomach Medications


Discontinue your stomach medications:

7 Days Before Your Test

Stop taking:

* Aciphex® (rabeprazole)
* Nexium® (esompeprazole)
* Prevacid® (lansoprazole)
* Kapidex® (dexlansoprazole)
* Prilosec® (omeproazole)
* Protonix® (pantoprazole)
* Zegerid® (omeprazole/ sodium bicarbonate)

2 Days Before Test

Stop Taking:

* Reglan® (metoclopramide)
* Pepcid® (famotidine)
* Tagament® (cimetidine)
* Zantac® (ranitdine)
* Axid® (nizatidine)
* Carafate® (sucralfate)

24 hours Before Test:

Stop any Over-the-Counter antacids:

* Tums®
* Rolaids®
* Maalox®
* Mylanta®

pH Test with Stomach Medications:

If you doctor has instructed you to complete this test while you remain on stomach medications, continue all stomach medications (and any other medications) prior to the test.

The night before your exam

* Stop eating solid foods at midnight
* Clear liquids are okay to drink (examples: water, Gatorade, clear broth and apple juice).
* Do not drink red liquids or alcoholic beverages.

The day of your exam

* Stop drinking clear liquids 6 hours before your exam.

Breath Tests

We utilize breath testing with the Quintron SC- Breathalyzer to test for:
  • Lactose Intolerance
  • Fructose Intolerance and
  • Small Intestinal Bacterial Overgrowth Syndrome (SIBO)
As our website evolves, we will provide more in depth information regarding each type of Breath Test. With this inaugural of the website, we provide the following information about Small Intestinal Bacterial Overgrowth (SIBO).

What is Hydrogen Breath Testing?

Hydrogen breath testing is used to diagnose three primary conditions. First, hydrogen breath testing detects sugars like lactose that are not properly digested and metabolized. Secondly, hydrogen breath testing detects sugars like fructose that are not absorbed in sufficient levels. Thirdly, hydrogen breath testing is used to diagnose bacterial overgrowth of the small bowel.

What is the principle of the Small Intestinal Bacterial Overgrowth (SIBO) Breath Test?

Hydrogen breath testing is the most common method to diagnose small intestinal bacterial overgrowth (SIBO) in clinical practice due to its low risk, lower costs than intestinal cultures of small bowel aspirates, and ease of use. SIBO hydrogen breath testing uses the orally ingested carbohydrate lactulose as a substrate.

Hydrogen and methane gas are only produced in the body from intestinal bacteria. Bacteria ferment sugars such as lactulose to hydrogen and/or methane gas. Hydrogen and methane are absorbed by the intestinal mucosa, enter the vasculature, and get transported to the lungs. A change in the level of hydrogen and/or methane gas above 20 parts per million within 60 minutes is diagnostic for SIBO. The majority, but not all malabsorbers produce hydrogen gas. Approximately 15% of patients are methane producers rather than hydrogen producers. These patients will only be properly diagnosed by measuring methane levels. As a result, each breath specimen is measured by Metabolic Solutions for hydrogen and methane.

What causes Bacterial Overgrowth?

Normally the proximal small intestine contains no or low levels of colonic-type bacteria. Small intestinal bacterial overgrowth is the presence of anaerobic organisms in an atypical location of the small bowel. SIBO is defined as the presence of >105 colony forming units per milliliter (cfu/ml) in the proximal small intestine. It has been suggested that even 103 cfu/ml can induce symptoms of bacterial overgrowth if the bacterial species are colonic in orgin.

Two major factors are responsible for controlling the number of bacteria in the small bowel. Normal small bowel motility is the first defense against attachment of bacterial organisms to intestinal walls. Gastric acid is the second defense by destroying invading ingested organisms. Both of these mechanisms are compromised during the natural aging process and with the presence of anatomical changes, functional pH or dysmotility syndromes, or miscellaneous diseases that introduce motility derangements.

Why should I test for Bacterial Overgrowth?

The aging of the population has increased the incidence of bacterial overgrowth. Atrophic gastritis, estimated to occur in 20 to 30% of the healthy elderly population, is the most common cause of reduced gastric acid secretion. This is a predisposing factor for bacterial overgrowth.

The obsesity epidemic has led to an outbreak of new diabetes mellitus cases. SIBO occurs commonly in patients with diabetes mellitus, particularly those with gastroparesis. It appears that SIBO occurs as a consequence of impaired gastrointestinal motility due to an underlying enteric or autonomic neuropathy.

An important development for people that suffer from IBS because bacterial overgrowth can be successfully treated with antibiotics. Linking bacterial overgrowth with IBS makes sense because it relates to the frequent IBS complaint of bloating after eating. As the bacteria ferment food, gas is released into the small intestine, causing painful bloating and other symptoms.

Although the connection between IBS and bacterial overgrowth is still being studied it draws attention to the fact that bacterial overgrowth is a relatively common condition that can cause symptoms suggestive of IBS. Patients with IBS should be tested for bacterial overgrowth if they have diarrhea, abdominal pain and increased flatulence within 30-45 minutes after eating.

What types of patients have Bacterial Overgrowth?

Bacterial overgrowth within the small intestine should be considered in the differential diagnosis of any patient who presents with diarrhea, steatorrhea, weight loss, or macrocytic anemia, particularly if the patient is elderly or has had previous abdominal surgery.

Bacterial overgrowth is commonly associated with various clinical conditions that affect intestinal motility or altered pH. Disturbances in small bowel transit (e.g., chronic intestinal obstruction, intestinal stricture, blind loop) and gastric acid secretion (e.g., achlorhydria, acid suppression) are the principal predisposing factors providing a clue to patient groups at risk of this condition.

In addition, patients are at potential risk of small intestinal bacterial overgrowth with the following clinical conditions:

•Irritable bowel syndrome
•Diabetes mellitus
•Immunodeficiency syndromes
•Chronic pancreatitis
•End stage renal disease
•Inflammatory Bowel Disease
•Celiac Disease
•Short bowel syndrome
•Radiation enteritis
•Antisecretory and antimotility medications

What age does Bacterial Overgrowth occur?

The age of onset of bacterial overgrowth is variable. Bacterial overgrowth will be more common in older adults with age-related changes in dysmotility and hypochlorhdria. However, pediatric patients with any of the above conditions can develop bacterial overgrowth.

What are the symptoms of Bacterial Overgrowth?

•Abdominal cramps
•Abdominal bloating
•Gas (flatulence)
•Weight loss
•Features associated with micronutrient deficiencies (Vitamins B12, A, D, and E, iron,   thiamine, nicotinamide)

How do I treat Bacterial Overgrowth?

The goal when treating SIBO should not be to sterilize the gastrointestinal tract but to reduce the number of pathogenic bacteria present. Antibiotic therapy against both aerobic and anaerobic organisms has been proposed to treat SIBO. Recently, rifaximin was shown to be more effective than tetracycline when treating patients with abnormal bacterial overgrowth breath tests. Current interest in the treatment of SIBO has also focused on the use of prebiotics and probiotics. Anecdotal reports have suggested efficacy of probiotics in the management of SIBO.


What is colonoscopy?

Colonoscopy is a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.

What are the colon and rectum?

The colon and rectum are the two main parts of the large intestine. Although the colon is only one part of the large intestine, because most of the large intestine consists of colon, the two terms are often used interchangeably. The large intestine is also sometimes called the large bowel. The colon and rectum are the two main parts of the large intestine.Digestive waste enters the colon from the small intestine as a semisolid. As waste moves toward the anus, the colon removes moisture and forms stool. The rectum is about 6 inches long and connects the colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus control bowel movements.

How to Prepare for Colonoscopy

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called a bowel prep. Generally, all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Acceptable liquids include

• fat-free bouillon or broth
• strained fruit juice
• water
• plain coffee
• plain tea
• sports drinks, such as Gatorade
• gelatin

A laxative or an enema may be required the night before colonoscopy. A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water. An enema is performed by flushing water, or sometimes a mild soap solution, into the anus using a special wash bottle.

Patients should inform the doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including

• aspirin
• arthritis medications
• blood thinners
• diabetes medications
• vitamins that contain iron

Driving is not permitted for 24 hours after colonoscopy to allow the sedative time to wear off. Before the appointment, patients should make plans for a ride home.

How is colonoscopy performed?

Examination of the Large Intestine

During colonoscopy, patients lie on their left side on an examination table. In most cases, a light sedative, and possibly pain medication, helps keep patients relaxed. Deeper sedation may be required in some cases. The doctor and medical staff monitor vital signs and attempt to make patients as comfortable as possible.
During colonoscopy, patients lie on their left side on an examination table.
The doctor inserts a long, flexible, lighted tube called a colonoscope, or scope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.
Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Bleeding and puncture of the large intestine are possible but uncommon complications of colonoscopy.

Removal of Polyps and Biopsy

A doctor can remove growths, called polyps, during colonoscopy and later test them in a laboratory for signs of cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.
The doctor can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.
The doctor removes polyps and takes biopsy tissue using tiny tools passed through the scope. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.


Colonoscopy usually takes 30 to 60 minutes. Cramping or bloating may occur during the first hour after the procedure. The sedative takes time to completely wear off. Patients may need to remain at the clinic for 1 to 2 hours after the procedure. Full recovery is expected by the next day. Discharge instructions should be carefully read and followed.

Patients who develop any of these rare side effects should contact their doctor immediately:

• severe abdominal pain
• fever
• bloody bowel movements
• dizziness
• weakness

At what age should routine colonoscopy begin?

Routine colonoscopy to look for early signs of cancer should begin at age 50 for most people—earlier if there is a family history of colorectal cancer, a personal history of inflammatory bowel disease, or other risk factors. The doctor can advise patients about how often to get a colonoscopy.

Points to Remember

• Colonoscopy is a procedure used to see inside the colon and rectum.
• All solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before colonoscopy.
• During colonoscopy, a sedative, and possibly pain medication, helps keep patients relaxed.
• A doctor can remove polyps and biopsy abnormal-looking tissues during colonoscopy.

• Driving is not permitted for 24 hours after colonoscopy to allow the sedative time to wear off.
To learn more and view a video on Colonoscopy, check out the American College of Gastroenterology website: CLICK HERE

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Endoscopic retrograde cholangiopancreatography 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 the endoscope, 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 left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then 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. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. 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. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. 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.

Upper Endoscopy (EGD) – What is it?

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the first part of the small intestine.

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the esophagus, stomach, and duodenum.

What problems can upper GI endoscopy detect?

 Upper GI endoscopy can detect:

* ulcers
* abnormal growths
* pre-cancerous conditions
* bowel obstruction
* inflammation
* hiatal hernia

When is upper GI endoscopy used?

Upper GI endoscopy can be used to determine the cause of:

* abdominal pain
* nausea
* vomiting
* swallowing difficulties
* gastric reflux
* unexplained weight loss
* anemia
* bleeding in the upper GI tract

Upper GI endoscopy can be used to remove stuck objects, including food, and to treat conditions such as bleeding ulcers. It can also be used to biopsy tissue in the upper GI tract. During a

How to Prepare for Upper GI Endoscopy

The upper GI tract must be empty before upper GI endoscopy. Generally, no eating or drinking is allowed for 4 to 8 hours before the procedure. Smoking and chewing gum are also prohibited during this time.

Patients should tell their doctor about all health conditions they have—especially heart and lung problems, diabetes, and allergies— and all medications they are taking. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are often given during upper GI endoscopy.

Medications and vitamins that may be restricted before and after upper GI endoscopy include

* nonsteroidal anti-inflammatory drugs such as aspirin, Advil and Aleve
* blood thinners
* blood pressure medications
* diabetes medications
* antidepressants
* dietary supplements

Driving is not permitted for 12 to 24 hours after upper GI endoscopy to allow sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home.

How is upper GI endoscopy performed?


Upper GI endoscopy is conducted at our Endoscopy Center or a hospital outpatient center

Patients may receive a local, liquid anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex. An intravenous (IV) needle is placed in a vein in the arm if a sedative will be given. Sedatives help patients stay relaxed and comfortable. While patients are sedated, the doctor and medical staff monitor vital signs.

During the procedure, patients lie on their back or side on an examination table. An endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a video monitor, allowing close examination of the intestinal lining. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier to see. Special tools that slide through the endoscope allow the doctor to perform biopsies, stop bleeding, and remove abnormal growths.

Recovery from Upper GI Endoscopy

After upper GI endoscopy, patients are moved to a recovery room where they wait about an hour for the sedative to wear off. During this time, patients may feel bloated or nauseated. They may also have a sore throat, which can stay for a day or two. Patients will likely feel tired and should plan to rest for the remainder of the day. Unless otherwise directed, patients may immediately resume their normal diet and medications.

Some results from upper GI endoscopy are available immediately after the procedure. The doctor will often share results with the patient after the sedative has worn off. Biopsy results are usually ready in a few days.
What are the risks associated with upper GI endoscopy?

Risks associated with upper GI endoscopy include

* abnormal reaction to sedatives
* bleeding from biopsy
* accidental puncture of the upper GI tract

Patients who experience any of the following rare symptoms after upper GI endoscopy should contact their doctor immediately:

* swallowing difficulties
* throat, chest, and abdominal pain that worsens
* vomiting
* bloody or very dark stool
* fever

Wireless Capsule Endoscopy

What is Small Bowel Capsule Endoscopy?

Wireless Capsule Endoscopy (also called PillCam SB®) helps your doctor determine the cause for recurrent or persistent symptoms such as abdominal pain, diarrhea, bleeding or anemia, in most cases where other diagnostic procedures failed to determine the reason for your symptoms. In certain chronic gastrointestinal diseases, the method can help to evaluate the extent to which your small intestine is involved or to monitor the effect of your treatment

Small bowel capsule endoscopy enables your doctor to examine the three portions (duodenum, jejunum, and ileum) of your small intestine. Your doctor will use a vitamin-sized pill video capsule as an endoscope, which has its own camera and light source. While the video capsule travels through your body, images are sent to a data recorder you will wear on a waist belt. Most patients consider the test comfortable. Afterwards, your doctor will view the images on a computer monitor.

PillCam SB® is not for everyone. PillCam® video capsules should not be used in patients with: known or suspected gastrointestinal obstructions; strictures or fistulas; cardiac pacemakers or other implantable devices; and swallowing disorders. Your doctor will advise you.

What should I expect during PillCam SB® endoscopy?

The staff will prepare you for the examination by applying a sensor array to your abdomen in a belt that you wear around your waist. The PillCam® is swallowed and passes naturally through your digestive tract for approximately seven to eight hours.

You will be able to eat four hours after swallowing the capsule ingestion unless your doctor instructs you otherwise. The capsule is disposable and passes naturally with your bowel movement. You should not feel any pain or discomfort when you pass the capsule during a bowel movement.

If you want to know more about the PillCam or this procedure, please call our office at 216-593-7700 to schedule an appointment with on of our physicians.

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