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Our services


Reduce your risk of cancer.

The American Cancer Society recommends that all men and women over 45 get regular screenings to prevent colon cancer.

What is a Colonoscopy?

A colonoscopy is a procedure used most commonly to screen for colon cancer and/or to identify and correct bleeding problems. Colonoscopy is also used to evaluate persistent diarrhea, abdominal pain, and change in bowel habits. The colonoscope is a long thin flexible tube. At the tip is a video camera which projects images of the colon onto a large monitor.The colonoscope also has tiny channels in the tube for flushing water, for inflating and deflating the colon, and for passing small instruments during the procedure.

Colonoscopy is usually an outpatient procedure that the Gastroenterologist performs at an endoscopy center. During a colonoscopy, the Gastroenterologist might perform any number of tasks depending on findings. These include: taking photos to document findings, sampling tissue to submit to the lab for biopsies, removing precancerous polyps, dilating areas of narrowing, or performing cautery or applying clips to stop bleeding.

The Gastroenterologist will inject intravenous (IV) sedation to keep you drowsy and comfortable during the entire procedure.

Uses of Colonoscopy

Colonoscopy is an important way to check for colon cancer and to remove polyps, (abnormal growths on the inside lining of the colon). Polyps vary in size and shape and they usually cause no symptoms. A physician is unable to predict whether a polyp is malignant or premalignant by visual appearance. Since most cancers of the colon start out as benign polyps years before cancer develops, the best strategy for colon cancer prevention is to perform periodic colonoscopy to find and remove polyps. The technique of removing polyps via colonoscopy is called polypectomy.

The Gastroenterologist can limit insertion to the lower part of the large intestine (rectum, sigmoid, and descending colon). This limited insertion is called flexible sigmoidoscopy. Alternatively, the GI physician could advance the scope through and beyond the colon and into the last part of the small intestine called the terminal ileum. The length of colon/small intestine to examine depends on the reason for performing the procedure.

How do I prepare for my colonoscopy?

The office will provide you with detailed instructions about how to prepare for colonoscopy, with details how to thoroughly clean out the colon. This clean-out tends to be somewhat tedious and unpleasant, but most patients tolerate this without major problem. The success of colonoscopy will depend on how well the bowel is cleaned out. A colon with residual stool can’t be optimally inspected.

Various methods can be used to help cleanse the bowel, and your doctor will recommend what he or she prefers in your specific case. A clear liquid diet is taken for part or all day prior to the colonoscopy. Most typically, the patient will drink a liquid preparation that will stimulate bowel movements beginning the evening prior to the procedure.The prep is typically “split” into different portions to keep it more tolerable to take AND to better clean out the upper end (right side) of colon. Better view of the right side of the colon is crucial because flatter more subtle polyps commonly develop there. Whichever clean-out methods are recommended for you, be sure to follow instructions as directed.

Follow Directions

The colonoscopy prep reduces high roughage foods (nuts, seeds etc.) for a few days before the exam. Carefully review instructions about what to eat or drink the day before your colonoscopy, and what time to stop all food and fluid intake. You should receive specific instructions about what medications to continue, stop or modify prior to and through the day of the procedure. This is especially important for patients taking blood thinners, diabetic medication, and blood pressure medications. Colonoscopy is usually done at an outpatient endoscopy/surgery center or sometimes at the outpatient section of a hospital. You’ll get specific instructions where to go and when to arrive. After registering and presenting insurance information and (if needed) insurance pre-authorization forms, you will sign a form that verifies that you consent to having the procedure and that you understand what is involved. If there is anything that is not clear, be sure to ask for more information and clarification.

How is the colonoscopy performed?

First, you will change into a patient gown. Don’t wear makeup or bring unnecessary jewelry to the endoscopy center. During the procedure, we emphasize patient safety and comfort. A nurse or anesthesiologist will insert an intravenous line, or IV, and will administer medication to make you very sleepy (and generally unaware of the procedure).There are generally two sedation options, moderate sedation and deep sedation. Deep sedation with Propofol requires the presence of an Anesthesia professional. We will discuss with you these sedation options prior to the procedure Occasional patients prefer to receive NO sedation. Once you are adequately sedated, your doctor will first do a digital rectal exam with a gloved, lubricated finger followed by insertion of the lubricated colonoscope. As the physician advances the scope and distends the colon with air or CO2 to open-up the colon for scope passage, you might experience a sensation of cramping or urgency, depending on the level of sedation achieved.

Generally, there is little or no discomfort. The physician can pause the colonoscopy to administer additional sedation, in the event of patient discomfort or intolerance. The time needed for colonoscopy will vary, depending in part on what is found and what is done. On average, the procedure takes about 30 minutes. Afterwards, our nursing staff will monitor and care for you in a recovery area until the effects of the medication have worn off. At that time, your doctor will inform you about the results of your colonoscopy and provide any additional information you need to know. We will also provide you with instructions regarding how soon you can eat and drink, plus other guidelines for resuming your normal routine. Before you leave, we will give you a copy of the colonoscopy report with photos, and will forward a copy to your referring physician. We will send any tissue specimens removed during the colonoscopy to the lab for a pathologist to analyze.

After your Colonoscopy

You will need to arrange for someone to drive and take you home after the colonoscopy. Taxi, bus and ride share is NOT typically allowed when sedation has been provided. You can resume a normal diet and your normal medication after you leave the unit. Sometimes, after colon polyp removal, your physician might request that you delay restarting blood thinners for a specified time, to prevent bleeding. You can usually resume normal or light activity for the remainder of the day of the exam, and you can drive the day after the exam. There are no restrictions on driving or activity the day after the exam. Occasionally, minor problems may persist, such as bloating, gas or mild cramping, which should disappear in 24 hours or less.

What are the risks of a colonoscopy procedure?

Although colonoscopy is a safe procedure, complications can occur. These include: perforation or puncture of the colon walls which could require surgical repair, missing some colon lesions (abnormalities), and bleeding after a biopsy or removal of a polyp. If bleeding is serious, it might require a blood transfusion or reinsertion of the colonoscope to control the bleeding. Be sure to talk with your doctor if you have any questions or concerns.

What are my alternatives to this procedure?

Although a colonoscopy is considered to be the “gold standard” to diagnose colon cancer and to diagnose and remove precancerous polyps, some patents prefer other, less invasive options. It is ALWAYS better to do SOME kind of screening rather than NOTHING, since colon cancer is the second most common cause of cancer death. Two kinds of fecal tests are available for screening. One, for detection of occult (hidden) blood is called a FIT test, and must be done yearly to have much value. Another for detection of both occult blood and cancer genetic material is called Cologuard®. Another option is a CT scan of the colon, often referred to as ‘virtual colonoscopy’ or CT colonography. The last alternative is a sigmoidoscopy, which is essentially an abbreviated colonoscopy in that the physician examines just the lower ¼ to 1/3 of the colon with a shorter scope. This procedure is best for those with low risk for colon cancer, namely those with no family history and no previous polyps. A video capsule exam is being developed but is still investigational and not covered by insurance, nor do we believe yet that it is a good alternative. Note that any positive alternative test MUST be followed by a colonoscopy. All the alternative screening tests to colonoscopy can miss polyps or cancer (false negatives) or can return positive when nothing turns out to be wrong (false positives). Consult with your Gastroenterologist if you have questions about the accuracy of any of these diagnostic tests.

What about insurance coverage?

Medicare and almost ALL private insurance including HMOs covers colonoscopy for screening with no copay or deductible. Follow-up exams after polyp removal usually do have some copay or deductible. Fecal blood tests are usually covered, Cologuard sometimes; CAT scan colonography has very limited coverage. Video colon capsule testing is not yet covered.


Upper GI Endoscopy

Shed light on your symptoms.

An Upper GI Endoscopy can help you identify the cause of your symptoms. 

What is an Upper GI endoscopy?

An upper endoscopy is a minimally invasive examination of the upper gastrointestinal tract, consisting of the esophagus, stomach, and first part of the small intestine (duodenum). This procedure is used to evaluate for causes of abdominal pain, nausea, swallowing problems, stubborn heartburn, suspected ulcers, other forms of inflammation, suspected tumors, as well as to identify and correct bleeding problems in these areas.

How do I prepare for my procedure?

Prior to endoscopy, your doctor needs to know about any medical conditions you have, including: heart and lung conditions, diabetes, pregnancy or allergies to any medication. In addition, if you have a condition which requires antibiotics before surgical procedures, your doctor needs to know; however, it is very seldom that antibiotics are needed before endoscopy. The stomach must be empty of food, usually for at least 8 hours, and empty of even simple fluid for 2 hours or more before endoscopy.

How is the endoscopy performed?

A physician and endoscopy staff will perform the procedure. An IV is started and sedation medications are administered before the scope is passed. Deep relaxation, and usually a state of being unaware of the procedure, is accomplished with the sedative. Patients who do not want any form of sedation can typically do fine during the procedure. Some physicians have patients gargle or get a spray with a topical numbing medication, but for a patient given sedation this doesn’t seem necessary in typical cases—the deep relaxation stops the natural tendency to gag for a few seconds as the scope is passed. . When the procedure begins, the patient will lie on their side. Then, the doctor will carefully pass the endoscope down your esophagus, into your stomach and duodenum. The video chip in the scope tip transmits a detailed image to the monitor the physician watches, and periodically still photos of findings are taken. During the endoscopy, the doctor may take tissue samples (biopsies) of tissue, but there are no nerve endings that would cause you to feel this and the biopsy is very safe to perform. Depending on the situation, other procedures might be performed, such as treating causes of bleeding, dilating (expanding) areas of narrowing or placing feeding tubes.

What can I expect after my procedure?

The sedation given during the procedure causes drowsiness and impairs your judgment or reaction times, making it unsafe for you to drive or operate machinery for the day of the endoscopy. This is why we require someone else to drive you home, or a responsible adult to accompany you if you need to take a cab home. You are safe to drive the day after the endoscopy. Food can be resumed ordinarily as soon as you leave the endoscopy unit. You will receive instructions regarding medications, to resume, continue holding or to start something new.

When will I know the outcome of the endoscopy?

Doctors can state some of the outcomes of your procedure promptly after the endoscopy. In some cases, a biopsy or small procedure will be done during the test. Other than that, results will come within 1 week of your procedure.

Where will the procedure take place and how long will it take?

The upper GI endoscopy will most likely take place in an outpatient endoscopy center or outpatient GI unit of a hospital. It will take about 10 to 30 minutes to conduct the procedure.

What are the risks involved with the endoscopy?

Risks of an upper GI endoscopy are infrequent and typically minor (nausea, gassy discomfort, sore throat), but rarely more serious problems can occur. These include bleeding from the site where the doctor took the biopsy or removed a polyp, sometimes immediate, sometimes delayed for up to 7-10 day, perforation of the lining of your upper GI trac or an abnormal reaction to the sedative, including respiratory or cardiac problems.

What are my alternatives to this procedure?

The most common alternative to upper endoscopy is an upper GI x-ray examination utilizing barium. This examination requires that you swallow barium (a chalky liquid), and x-rays are taken. Some abnormalities of the upper gastrointestinal tract can be detected by studying these films; however, the procedure is generally recognized as not being as accurate as an upper endoscopy, and does not allow for biopsy and removal of tissue. CAT scans don’t show details of the interior of the organs the endoscope examines.

Esophageal Dilation

Get Relief

This procedure will help enlarge a narrow or strictured part of the esophagus. 

What is an Esophageal Dilation?

Esophageal dilation is a procedure done enlarge a narrow or strictured part of the esophagus, or in some cases to dilate the narrowed exit of the stomach or stricture in the duodenum (first part of the intestine). After gastric bariatric surgery, for example, sometimes the exit of the pouch has scarred and food will not pass, so dilation is necessary. Dilation is performed using special catheters with expandable balloons, or by passing a specially designed tapered plastic tube over a guidewire.

How do I prepare for my procedure?

The procedure is part of an upper GI endoscopy, so for information about the basic part of the procedure see our separate brochure on Upper GI Endoscopy. There are ordinarily no special preparations just for the dilation portion of the procedure, though sometimes we have you stop certain blood thinners ahead of time.

How is the procedure performed?

Ordinarily you are quite strongly sedated during the endoscopy procedure, whether or not a dilation is done. When dilation is necessary, either the physician passes a balloon catheter down the length of the scope, positions the catheter across the narrow zone and expands the balloon(s) to the desired diameter. Other times, the physician passes a thin flexible metal guidewire through the scopoe, leaves it with the tip in lower end of the stomach, removes the scope and passes the dilator device over the guidewire and down across the stricture. Sometimes the scope is then passed again to examine the area dilated. Sometimes you might sense some transient pressure in chest or upper abdomen during dilation, or after it is done, but ordinarily no significant pain; most people don’t know a dilation was done until the doctor tells you it was. Rarely, Xray fluoroscopy is needed to guide positioning of the dilator.

What can I expect after my procedure?

After the dilation is done, you will probably be observed for a short period of time and then allowed to return to your normal activities. You may resume drinking when the sedation, and/or topical anesthetic, have worn off. Any special diet instructions, if needed, will be provided. Most patients experience no unusual symptoms after this procedure, but you might experience a mild sore throat for the remainder of the day. If you received sedatives, you wouldl be monitored in a recovery area until you are ready to leave. You will not be allowed to drive after the procedure even though you might not feel tired. Someone needs to drive you home, or drive for you anytime the day of the procedure, because the sedative can affect your judgment and reaction times for the rest of the day.

How long and where does the esophageal dilation take place?

The procedure is usually done in a outpatient endoscopy center, sometimes at the hospital outpatient GI lab. The dilation adds a little time to the endoscopy procedure, perhaps up to about 15 minutes, but timing will depend on the details of what needs to be dilated.

Are repeat dilations necessary?

Depending on the degree and cause of the narrowing or stricture, it is common to require repeat dilations. This allows the dilation to be performed gradually and decreases the risk of complications. Once the stricture, or narrowed esophagus, is completely dilated, repeat dilations may not be required. If the stricture was due to acid reflux, acid blocker medicines can decrease the risk of stricture recurrence. Your doctor will advise you on this.

Are there any complications involved with esophageal dilation?

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

Are dilation procedures done in other GI regions?

Dilations of colon strictures, or strictures with J pouches in patients with these procedures, are sometimes performed. The basic process is similar; the main difference is the scope used is a colonoscope or a scope passed into the intestine J pouch. Bile duct or pancreas duct strictures are treated during ERCP and this procedure is described in a separate brochure.

Flexible Sigmoidoscopy

Experiencing GI Symptoms?

Minimally invasive and quick, this procedure could be used to evaluate gastrointestinal symptoms.

What is a flexible sigmoidoscopy?

A flexible sigmoidoscopy is a minimally invasive examination of the lining of the lower large intestine to evaluate gastrointestinal symptoms, such as abdominal pain, rectal bleeding, or changes in bowel habits. A sigmoidoscope is used and is a long, flexible, tubular instrument, in effect a smaller short version of a colonoscope. Use of a flexible sigmoidoscope for colon cancer/polyp screening used to be done frequently until the greater advantages of colonoscopy were understood, and now it is seldom done just for colon cancer screening in this country.

How do I prepare for my procedure?

To first prepare for your procedure make sure to talk to your physician about about any medical conditions you are prescribed and/or any over-the-counter medications, vitamins, and supplements you take, including:

  • Arthritis medications
  • Aspirin or medications that contain aspirin
  • Blood thinners
  • Diabetes medications
  • Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen
  • Vitamins that contain iron or iron supplements

In addition, prior to your procedure, the rectum and the lower colon must be completely cleansed of stool. Your doctor will give you detailed instructions on how to cleanse your colon. In general, this requires the use of one or two enemas prior to the procedure and/or may also call for a laxative and some dietary modifications. This is done to obtain accurate results.

How is the procedure performed?

For the test, the person will lie on a table while the physician inserts a sigmoid scope into the anus and slowly guides it through the rectum (lowest portion of the colon) and into the sigmoid colon. The scope inflates the colon with air to give the physician a better view. The camera sends a video image of the intestinal lining to a computer screen, allowing the physician to examine the tissues lining the sigmoid colon and rectum. Once the scope has reached the furthest point that can be comfortably reached, the physician withdraws it slowly while examining the lining of the colon again but in more detail. Sometimes very small polyps are removed during the exam, or the biopsy instrument is used to obtain other tissue samples to assess growths or inflammation. This tissue is sent to the pathology lab for analysis. Depending what is seen, sometimes a complete colonoscopy or other testing might be advised. Using sedation for the procedure varies with the reason for the procedure and other factors that should be discussed with the doctor doing the procedure. Sedation is NOT normally needed.

What can I expect after my procedure?

After a flexible sigmoidoscopy, a person can expect to resume to regular activities and a normal diet. There may be slight abdominal cramps or bloating during the first hour after the test.

How long does the procedure take and where will it take place?

The visit for the sigmoidoscopy exam takes about 20 to 30 minutes but the procedure itself generally 5-10 minutes. A health care provider performs a flexible sigmoidoscopy during an office visit or at an ambulatory endoscopy center.

What are the risks involved with the procedure?

The risks of flexible sigmoidoscopy are very infrequent and ordinarily minor. These include

  • Bleeding—rarely serious and mainly if large polyps are removed. Not all bleeding occurs immediately during the procedure; sometimes this can be delayed up to 10 days later.
  • Perforation—a hole or tear in the lining of the colon. This is the most serious complication but is very unusual.
  • Severe abdominal pain—ordinarily brief if it occurs, which is very infrequent.
  • Feeling nausea, or faint, or having brief heart rhythm changes can occur with any endoscopy procedure, but is rare to be serious.
  • The risks of complications occurring so severe as to be fatal would be extremely rare.
  • Any unexpected symptoms should be reported promptly to your physician.

What are my alternatives to this procedure?

Colonoscopy is a much more complete colon exam and is ordinarily preferred for screening the colon for polyps or cancer. An X-ray test (barium enema) or a CAT scan are alternative ways of looking at your large bowel. The main drawback of these tests is that they only provide pictures of the shape of your bowel, don’t show details of the interior lining and do not allow samples to be taken or for polyps to be removed. You would require a similar bowel preparation for these tests as well.