Services

Endoscopy (OGD, Small Bowel Biopsy)

What is an OGD?

An OGD is an examination of the lining of the gullet, stomach and first part of small intestine using a flexible tube, the end of which contains a very small video camera. It’s also referred to as a gastroscopy or endoscopy.

How small is the tube/what is made of/ how clean is it?

The tube is about 1 cm in diameter. It is of very complex construction but is plastic coated. Prior to every procedure it is sterilized using special equipment. The efficiency of the process is regularly monitored.

Why am I having this procedure?

Your doctor has requested this test in response to symptoms you have reported to him/her and/or findings on physical examination and/or results of blood tests and X-rays. Successful OGD will help your doctor diagnose your complaint accurately and safely.

Must I fast?

You must fast for 4 hours before the procedure unless otherwise advised. If you are taking medications and you may take them with a small glass of water.

Is it painful?

Individual response vary enormously. We cannot predict how and individual will precisely respond to any test. In general, it is not painful. Some patients find the procedure uncomfortable, particularly if the back of the throat is very sensitive.

Can the procedure be made more comfortable?

Local anaesthetic can be sprayed on the back of your throat. This will make the throat numb and should minimise any discomfort you might experience About 30-50% of patients find this sufficient to permit the examination in comfort.

Can I have anything else to make the procedure more comfortable?

It is possible to administer sedative drugs into the vein prior to the procedure. Patient’s response to this type of sedation, termed intravenous conscious sedation (IVCS) is variable. Many patients will find it very satisfactory and will have no memory of the procedure. It is important to remember that IVCS is not the same as a General Anaesthetic. A few patients may not have satisfactory responses and may remember the procedure.

Are there downsides to IVCS?

Yes. You must remain under observation in the day care ward for 1-2 hours after the procedure. You may not drive or go home unaccompanied. There is a small risk of allergic reaction to the medication. The risks of infection associated with the procedure itself, are slightly increased.

What are the risks of the procedure itself?

OGD is a very safe procedure, less than 1 in every 3,000 people undergoing this procedure will experience any sort of complication. Serious complications include bleeding, infection, injury to the wall of the oesophagus, stomach or duodenum. Treatment of such complications would involve hospitalisation, surgery, antibiotics and/or blood transfusion.

Are there alternatives?

Yes. A X-ray barium meal is an alternative procedure. It is less accurate and cannot sample tissue or permit endoscopic therapy (treatment) of certain conditions. There is a significant dose of radiation associated with the study.

Colonoscopy (FC)

An FC is an examination of the lining of the entire large intestine (bowel) using a flexible tube, the end of which contains a very small video camera.

How small is the tube/what is made of/ how clean is it?

The colonoscope is about 1.5 cm in diameter. It is of very complex construction, but is plastic coated. It is sterilized before every procedure using special equipment. The efficiency of the process is regularly monitored.

Why am I having this procedure?

Your doctor has requested this test in response to symptoms you have reported to him and/or findings on physical exam and/or results of blood tests or X-ray investigations. Successful FC will help your doctor diagnose your complaint accurately and safely.

Is it painful?

It is important to remember that individual response vary enormously. We cannot predict how an individual will precisely respond to any test. In general, it is not painful. Some patients find the procedure uncomfortable. If you find it too uncomfortable, you can ask the doctor to stop.

What must I do to prepare for the procedure?

A laxative must be taken the day prior to the procedure. Either Picolax or Moviprep may be prescribed. Sepcific instructions accompany each medication. No solid foods should be taken after breakfast on the day before. If you have had poor preparation for past colonoscopies please let us know as you may need a modified prep.

Should I stop any medications?

Please stop all iron supplements for 5 days prior to the procedure. Do not take oral diabetic tablets (e.g diamicron) the morning of the procedure. If  you take insulin or warfarin, Pradaxa, Xarelto, Eliquis or other Direct oral anticoagulants, please discuss this with us.

Can the procedure be made more comfortable?

It is possible to administer sedative drugs into the vein prior to the procedure. A patient’s response to this type of sedation, termed intravenous sedation/analgesia (IVS) can be variable. Many patients will find it very satisfactory and will have no memory of the procedure. It is important to remember that IVS is not the same as a General Anaesthetic. A few patients may not have satisfactory responses and may remember the procedure.

Are there downsides to IVS?

Yes. You must remain under observation in the day care ward for 1-2 hours after the procedure. You may not drive or go home unaccompanied. There is a small risk of allergic reaction to the medication. The risks of infection associated with the procedure itself, are slightly increased.

What are the risks of the procedure itself?

CT Colograph is an alternative procedure. It is less accurate and cannot sample tissue or permit endoscopic therapy (treatment) of certain conditions such as the removal of polyps. There are a significant doses of radiation associated with these studies.In general  it is preferred for patients who have a lot of medical problems or are very nervous about having an endoscopic procedure or are unable to be sedated.

Are there alternatives?

CT Colograph is an alternative procedure. It is less accurate and cannot sample tissue or permit endoscopic therapy (treatment) of certain conditions such as the removal of polyps. There are a significant doses of radiation associated with these studies.In general  it is preferred for patients who have a lot of medical problems or are very nervous about having an endoscopic procedure or are unable to be sedated.

H-Pylori Testing

Helicobacter pylori is a type of bacteria that is known to be a major cause of peptic ulcer disease. H. pylori testing detects an infection of the gastrointestinal (GI) tract caused by the bacteria.

What is being Tested?

H. pylori is very common, especially in developing countries. The bacteria are present in (colonize) the stomachs and intestines of as many as 50% of the world’s population. Most of those affected will never have any symptoms, but the presence of H. pylori increases the risk of developing ulcers (peptic ulcer disease), chronic gastritis, and gastric (stomach) cancer. The bacteria decrease the stomach’s ability to produce mucus, making the stomach prone to acid damage and peptic ulcers.

 

There are several different types of H. pylori testing that can be performed. Some are less invasive than others.

 

Noninvasive

 

  • Stool antigen test – detection of H. pylori in a stool sample
  • Urea breath test – detection of labeled carbon dioxide in the breath after drinking a solution

 

Recommendations for these tests come from published guidelines by the American Gastroenterology Association (AGA), the American College of Gastroenterologists (ACG), and the Infectious Diseases Society of America (IDSA) / the American Society for Microbiology (ASM).

 

An antibody test using a blood sample is not recommended for routine diagnosis or for evaluation of treatment effectiveness. This test detects antibodies to the bacteria and will not distinguish between a present and previous infection. If the antibody test is negative, then it is unlikely that a person has had an H. pylori infection. If ordered and positive, results should be confirmed using a stool antigen or breath test.

 

Invasive

 

Invasive tests using an endoscopy procedure are less frequently performed than noninvasive tests because they require a tissue biopsy collection. Tests include:

 

  • Histology – examination of tissue under a microscope
  • Rapid urease testing – detects urease, an enzyme produced by H. pylori
  • Culture – growing H. pylori in/on a nutrient solution
How is the sample collected for testing?

The sample collected depends on the test ordered. For the urea breath test, a breath sample is collected and then the person is given a liquid to drink. Another breath sample is collected at a timed interval. For the stool antigen test, a stool sample is collected in a clean container.

 

A more invasive test will require a procedure called an endoscopy, which involves putting a thin tube with a tiny camera on the end down the throat into the stomach. This allows for visualization of the stomach lining as well as the ability to take a small piece of tissue (a biopsy) from the lining for examination.

Is any test preparation needed to ensure the quality of the sample?

For the breath test, you may be instructed to refrain from taking certain medications:

 

  • Four weeks before the test, do not take any antibiotics or oral bismuth subsalicylate (Pepto Bismol®).
  • Two weeks before the test, do not take any prescription or over-the-counter proton pump inhibitors, such as omeprazole, lansoprazole, or esomeprazole.
  • One hour before the test, do not eat or drink anything (including water).

 

If submitting a stool sample or having a tissue biopsy collected, it may be necessary to refrain from taking any antibiotics, antacids, or bismuth treatments for 14 days prior to the test.

 

If undergoing endoscopy, fasting after midnight on the night prior to the procedure may be required.

Preparation Instructions

Morning procedure 

Either Moviprep or Picolax can be used – not both.

 

The day before the colonoscopy

Breakfast: Have breakfast as normal then take no more non-clear liquids or solid food until after the procedure

 

Lunch: Clear Soup or Bovril and/or jelly, any clear liquid.

 

PICOLAX PREP:  Take 1 sachet at 2pm followed by at least 1 ½ Litres of clear liquids

Repeat at 6pm

 

MOVIPREP: 2 Litres. Commence at 4pm, drink one glassful (250ml) every 15-30 minutes until you have drunk it all.

 

Follow with at least 1 Litre of clear liquids.

 

Dinner: Clear Soup or Bovril and/or (non-red) jelly, any clear liquid.

 

After midnight, you should not have any oral intake to facilitate sedation.

 

**Clear liquids include water, 7UP or other soft drinks (no bits, Lucozade Sport is good), tea/coffee (no milk), squash/cordial (no bits), clear fruit juice eg apple**

(2 day) Afternoon Procedure

The day before the colonoscopy

 

Breakfast: Have breakfast as normal then take no more non-clear liquids or solid food until after the procedure

LunchYou may take clear soup, Bovril, jelly or any clear liquid

 

4-5 pm: Drink 1 Litre of Moviprep (drink one glassful (250mls) every 15-30 minutes) and follow with 1 Litre of clear liquids

 

Dinner: You may take clear soup, Bovril, (non-red) jelly or any clear liquid

 

The day of the colonoscopy

First thing in the morning drink 1 Litre of Moviprep and a further 1 Litre of clear liquids.

 

There is no restriction on clear liquids until 2 hours before your appointment time.

After this you should not have any oral intake to facilitate sedation.

 

**Clear liquids include water, 7UP or other soft drinks (no bits, Lucozade sport is good), tea/coffee (no milk), squash/cordial (no bits), clear fruit juice eg apple**