GI Tests

Argon plasma coagulation (APC)

The Basics

Argon plasma coagulation (APC), sometimes referred to as argon photocoagulation, is a medical procedure that uses argon gas during a colonoscopy or an upper endoscopy to control bleeding from certain lesions in the gastrointestinal tract. Argon gas can be used as an alternative to cauterization or using a laser to stop internal bleeding. APC may also be used to debulk tumors in patients who are not candidates for surgery.

What to Expect During the Procedure

Intravenous sedation is typically used for this procedure. An endoscope is inserted and a probe is passed through to the gastrointestinal tract. The probe is placed at a distance and delivers a jet of ionized gas that is directed at the bleeding lesion or tumor. Argon gas is emitted then ionized by an electrical current that results in the coagulation of the lesion or tumor, which stops the bleeding. The procedure is considered safe, contingent on the colon being cleaned of colonic gases.

What can be found?

APC is used to treat the following conditions:

  • bleeding from a polypectomy site
  • Barrett’s esophagus
  • esophageal cancer
  • rectal bleeding post-radiation (radiation proctitis)
  • gastric antral vascular ectasia, or “Watermelon stomach”

What happens afterwards?

After the procedure, you will be monitored in a recovery area for approximately 30 minutes. You will not be able to drive until the day after your procedure. Typically, there are no dietary restrictions after the procedure.

How to Prepare

If APC is being used to treat a problem in the colon, a colonoscopy preparation is required. If APC is being used to treat an esophageal or gastric problem, nothing can be taken by mouth for 8 hours prior to the exam, but there is no special preparation required.

Balloon Assisted Enteroscopy

The Basics

Balloon assisted enteroscopy is a technique used to access the small bowel for both diagnostic and therapeutic purposes. There are two types of balloon endoscopy: single balloon (SBE) and double balloon (DBE). The procedure was developed to treat the small intestine which is approximately 20 feet in length. Prior to the development of balloon assisted enteroscopy, the small intestine was a particularly difficult part of the gastrointestinal tract for gastroenterologists to access. Balloon assisted enteroscopy can be performed through the upper gastrointestinal tract or through the lower gastrointestinal tract. In therapeutic cases, it may be used as an alternative to surgery.

What to Expect During the Procedure

Although the procedure can be performed through either end of the gastrointestinal tract, most procedures are performed through the mouth. Going through the rectum is more commonly used to allow access to lesions in the lower part of the small bowel. Similar to other gastrointestinal endoscopy, balloon assisted enteroscopy typically requires intravenous sedation. The procedures tend to be longer than typical endoscopy and may take 1 to 3 hours.

Balloon assisted enteroscopy advances the endoscope through the small bowel by alternately inflating and deflating balloons, and pleating the small bowel over an insertion tube like a curtain over a rod. During the procedure, your doctors will record video or take pictures. Doctors may also take tissue samples or fix existing problems.

What can be found?

Balloon assisted enteroscopy is used to detect problems with your small intestine or stomach. Doctors may recommend enteroscopy if you have any of the following:

  • high immune cell count
  • small bowel tumors
  • blocked bowel passages
  • intestinal damage from radiation
  • abnormal bleeding
  • chronic low iron
  • unexplained severe diarrhea
  • unexplained malnutrition

What happens afterwards?

Following the procedure, you will spend a half hour in recovery where nurses will monitor you. You will be able to rest, and you may be offered something to drink when you are awake. Once you feel awake and alert, you will be allowed to get dressed and go home. Since you have been sedated, your reflexes will be impaired for the rest of the day. For your safety, you must arrange for transportation home from your procedure.

How to Prepare

It is required that you not eat or drink anything for eight hours prior to this exam. You must also arrange for transportation following your procedure. Patients who are having a balloon assisted enteroscopy through their rectum will need to complete colonoscopy prep. If the balloon assisted enteroscopy is done through the mouth, then no bowel preparation is required.

Balloon enteroscopy is offered at the Christiana Hospital and is an outpatient procedure.

Capsule Endoscopy

Capsule Endoscopy is a procedure that uses a tiny wireless camera—located inside a vitamin-sized capsule that you swallow—to take pictures of your digestive tract. After you swallow the capsule, it travels through your digestive tract and takes thousands of pictures, which are automatically transmitted to a recorder that you wear on a belt around your waist. After 8 hours, you will return the recorder to the office. The images saved on the recorder will be transferred to a computer with special software that combines the images together to create a video. Your doctor reviews the video to look for abnormalities within your digestive tract. Meanwhile, the capsule will leave your body naturally in your bowel movements and may be flushed down the toilet.

Capsule Endoscopy allows your small intestine—an area that is not easily reached with more traditional endoscopy procedures such as EGD and Colonoscopy—to be visualized. Capsule Endoscopy is a very safe procedure, but carries a few risks. These risks include:

  1. Poor quality images after poor prep: Capsule Endoscopy requires a bowel prep intended to clear the bowel of material that could obscure images. If the bowel prep is not done properly, the images may be poor, and the test may need to be repeated.
  2. Capsule lodging in GI tract: In most cases, the capsule will leave your body naturally within several days via normal bowel movements. In rare cases, the capsule may become lodged in your digestive tract and will need to be removed endoscopically or surgically.

To prep for this procedure, please see our Prep Instructions.

Computed Tomography (CT scan) – Abdomen

The Basics

Computed Tomography, abbreviated as “CT”, is a type of radiology imaging that can be used to get images of the abdomen, as well as other parts of the body. More detailed than X-rays, an abdominal CT scan makes images by rotating around the patient so that internal organ can be viewed from multiple angles in a short period of time.

What to Expect During the Procedure

On the day of your exam, you will lie on a narrow table that will slide you into the center of the CT scanner. In most cases, you will be instructed to lie on your back with your arms raised above your head. Then, once you are positioned correctly, the CT scanner’s X-ray beam rotates around you. You will be instructed to remain still during the exam, because movement causes blurred images. In some cases, you may be asked to hold your breath for short intervals.

The CT scanner’s computer takes multiple images of the abdomen referred to as slices. Three-dimensional models of the abdominal area can be made by stacking the slices together. CT scans of the abdomen typically take less than a half hour.

What can be found?

According to the National Institutes of Health, a CT scan test may be used to look for:

  • Cause of abdominal pain or swelling
  • Hernia
  • Cause of a fever
  • Masses and tumors, including cancer
  • Infections or injury
  • Kidney stones
  • Appendicitis

What happens afterwards?

Following the scan, you should be able to return to your normal diet. You may be instructed to drink water to help flush your system if contrast material was need for your exam. You may be given special instructions if you are diabetic or if you have a heart condition.

How to Prepare

You may be asked to not eat any solid food or drink anything for a few hours prior to your procedure. Prior to the CT scan, you may need to have a special dye, called contrast material, put into your body. The dye helps to make the images taken during your scan appear more clearly.

Contrast can be given through a vein (IV) in your hand or forearm before the CT scan begins, or you may be instructed to drink the contrast material prior to the exam. The contrast will pass out of your body in the days following the exam. Let your doctor know if you have any known allergies to the contrast material. Before the CT scan, speak with your doctor about whether you may be pregnant, or if you have a chronic illness such as diabetes.

CT scan is offered at multiple locations in Delaware, including MAGIC’s Colon Health Center. Learn more at www.colonhealthcenterdelaware.com or call 302-995-2656 for an appointment.  Please note: Scheduling requires a doctor’s order.

Computed Tomography Enterography (CTE)

The Basics

Computer tomography enterography (CTE) is a type of computed tomography medical test that helps diagnose certain gastrointestinal diseases in the small intestine, sometimes referred to as the small bowel. CTE is a noninvasive imaging exam.

What to Expect During the Screening

Similar to a computed tomography (CT) scan, a CTE requires you to lay on a narrow table that will be moved into the CT scanner. You will be given an IV and contrast material will be injected into your body to ensure the images will be clear. You will be instructed to lie as still as possible during the duration of the exam. You may need to hold your breath periodically to avoid blurry images.

The CTE should take 10 to 15 minutes to complete.

What can be found?

CTE is used to assess and evaluate small bowel inflammation, bleeding sources in the small bowel, small bowel tumors, abscesses and fistulas and bowel obstructions. CTE is also used to help diagnose Crohn’s disease.

What happens afterwards?

You should be able to return to normal activities following your CTE. It may be recommended that you drink plenty of water to help flush the contrast material from your body.

How to Prepare

Do not eat or drink anything except clear liquids for three hours before the exam. You will be instructed to arrive approximately one hour and 15 minutes before your CTE in order to drink an oral contrast material. Before the CTE, speak with your doctor about whether you may be pregnant, or if you have a chronic illness such as diabetes.

A CTE exam requires a doctor’s order, can be performed at several locations in Delaware and is offered at MAGIC’s Colon Health Center. Learn more at www.colonhealthcenterdelaware.com or call 302-995-2656.

Gastric Emptying (GE) Scan

The Basics

Gastric emptying (GE) scans are medical studies used for individuals who are having issues with the speed at which food empties from the stomach and enters the small intestine. The symptoms of slow emptying are primarily nausea, vomiting, and abdominal fullness after eating. The symptoms of rapid emptying are diarrhea, weakness, or light-headedness after eating.

What to Expect During the Screening

Prior to GE scan, the patient is required to eat a meal that typically consists of scrambled eggs that contain a very small amount of radioactive material. The amount of radioactive material that is ingested is so small that it does not produce side effects. You will then be led to a room where you will be positioned in front of a scanner that looks like a large camera. Over the course of three to five hours, four to six scans lasting about a minute each will be taken. The images taken will be at the rate in which food is digested. In most cases, you may return to the waiting room between images.

It is important to remain still during the scan.

What can be found?

A GE study is commonly used when there is a suspicion that there is an abnormally delayed emptying of food from the stomach, medically called delayed gastric emptying. The two most common causes of delayed gastric emptying are gastric outlet obstruction and gastroparesis.

In patients with gastroparesis, the food and the attached radioactive material remain in the stomach longer than normal (usually hours) before emptying into the small intestine. As a result, the scanner continues to show radioactivity in the area of the stomach for hours after the test meal.

What happens afterwards?

Nothing is required after the test is over. The patient may return to normal medications, activity, and eating as instructed by his/her physician. Test results may take a couple of days to analyze. If the test shows that the food is leaving the stomach slowly, medications that may be given to speed up the emptying and improve symptoms. Conversely, if rapid emptying of the stomach is found, medications may be given to slow down emptying.

How to Prepare

Other than the meal that is eaten prior to the test, you should not eat or drink anything for six hours.

A Gastric Emptying Scan is available at numerous locations but not at a MAGIC office.

Hemorrhoid Banding: The CRH O’Regan Hemorrhoid Removal System

Hemorrhoid banding, or rubber band ligation, is a fast and nonsurgical approach to hemorrhoid treatment. Unlike surgical hemorrhoidectomy, it doesn’t require fasting, sedation or post-procedure care. And unlike home remedies that provide temporary relief, the banding procedure is designed to definitively eliminate hemorrhoidal bleeding. Hemorrhoid banding is performed at the Apex office. Learn more at www.crhsystem.com or call 302-225-2380 for an appointment with a gastroenterologist.

HIDA Scan

The Basics

A hepatobiliary (HIDA) scan is an imaging procedure used to diagnose problems in the liver, gallbladder and bile ducts. A HIDA scan involves injecting a radioactive chemical called a tracer into your arm through an intravenous. The tracer mimics how bile works in your liver. Once the tracer is injected, a special medical scanner called a gamma camera tracks the flow of the tracer from your liver into your gallbladder and small intestine. HIDA scans are also sometimes called cholescintigraphy and hepatobiliary scintigraphy.

What to Expect During the Procedure

Prior to the HIDA scan, you will be asked to change into a gown. You will be laid on an exam table. The radioactive tracer is then injected into a vein in your arm. You may feel some pressure while the radioactive tracer is injected into your vein. You will be asked to remain still as the tracer travels through your bloodstream to your liver, where it’s taken up by the bile-producing cells. Then, the tracer travels with the bile from your liver into your gallbladder and through your bile ducts into your small intestine. A special gamma camera is positioned over your abdomen taking pictures of the tracer as it moves through your body. The gamma camera takes pictures continually for about an hour.

What can be found?

A HIDA scan may help in the diagnosis of several diseases and conditions, such as:

  • Gallbladder inflammation (cholecystitis)
  • Bile duct obstruction
  • Congenital abnormalities in the bile ducts, such as biliary atresia
  • Postoperative complications, such as bile leaks and fistulas
  • Assessment of liver transplant

What happens afterwards?

You may resume your normal daily activities following your HIDA scan. It’s not uncommon to have some of the tracer in your body following the scan, but it will be passed through your body in 1 to 2 days.

How to Prepare

To prepare for your HIDA scan, your doctor may ask you to fast up to eight hours prior to the scan. You should not fast any longer than the time period specified by your doctor. Make sure to tell your doctor which medications you regularly take, or if you have any known allergies to contrast dyes. You may receive an infusion or injection of a medication in addition to the injected radioactive tracer. The medications may be injected immediately before or during your HIDA scan.

HIDA scans are offered at numerous imaging centers but not at a MAGIC office.

Magnetic Resonance Imaging (MRI)
The Basics Magnetic resonance imaging (MRI) is a noninvasive imaging test that uses magnetic fields, radio waves and a computer to produce detailed pictures of internal body structures. Images from an MRI allow physicians to examine parts of the body to determine the presence of certain diseases. What to Expect During the Screening Most individuals find MRI exams to be completely painless. The only complaint that some patients express are feelings of claustrophobia due to being in an enclosed space. If you think that this will be an issue prior to your MRI, please speak with your physician to arrange for sedation. You will lie on a movable table that slides into the opening of the MRI machine. You will be in the room by yourself, but you can speak with the radiology technologist by microphone. Like other imaging tests, it is important that you remain perfectly still while the images are being obtained. You will hear and feel loud tapping or thumping sounds when the images are being taken by the MRI machine. You will have time to relax between images, but you will be required to remain as still as possible. When an area of your body is being imaged it is normal for the site to feel slightly warm. What can be found? MRIs can be used for issues throughout the body, but a gastroenterologist typically orders the test to diagnose or evaluate:

 

 

 

 

 

 

  • organs of the abdomen—including the liver, biliary tract,  bowel and pancreas.
  • diseases of the liver, such as cirrhosis, and abnormalities of the bile ducts and pancreas
  • inflammatory bowel disease such as Crohn’s disease and ulcerative colitis

What happens afterwards? If sedation isn’t required, you can return to your normal activities and diets. When a contrast material is used, you will be instructed to drink water to help flush it out of your system. A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you. How to Prepare There is little preparation needed for an MRI. You may be asked to change into a gown. You are typically told to keep taking medications. There are few dietary restrictions. You will be asked to remove anything metallic prior to entering the room. It is rare but certain dyes used in tattoos may contain iron and could heat up during an MRI. Tooth fillings and braces are not a problem, but the radiologist should be made aware of them. Many devices, such as pacemakers and metallic prosthetics disqualify patients for this exam. MRIs are offered at multiple locations but not at a MAGIC office.

Magnetic Resonance Cholangiopancreatography (MRCP)

The Basics

Magnetic resonance cholangiopancreatography (MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.

MRCP provides a less invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). However, MRCP does not allow any intervention to be performed, such as stone extraction, stent insertion, or biopsy.

What to Expect During the Procedure

Usually no contrast medium has to be administered for MRCP. Since MRCP is a type of MRI exam, it is typically painless. Any complaints about the procedure are about feeling claustrophobic. If you think that this will be an issue, please speak with your physician to arrange for sedation.

MRCP involves lying very still in an MRI scanner for several minutes at a time. Like an MRI, you do not feel anything while the scan takes place, although you will hear when the machine is taking images. You will usually be alone in the exam room during the MRI procedure. However, the technologist will be able to see, hear and speak with you at all times using a two-way intercom.

The entire MRCP test takes less than 20 minutes. However, it can be done in conjunction with a standard MRI of the abdomen which may make the entire exam closer to 45 minutes.

What can be found?

Physicians use MRCP to:

  • examine diseases of the liver, gallbladder, bile ducts, pancreas and pancreatic duct. These may include tumors, stones, inflammation or infection.
  • evaluate patients with pancreatitis to detect the underlying cause.
  • help to diagnose unexplained abdominal pain.

What happens afterwards?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.

How to Prepare

There is little preparation needed for an MRCP. You may be asked to change into a gown. You are typically told to keep taking medications. There are few dietary restrictions. You will be asked to remove anything metallic prior to entering the room.

It is rare but certain dyes used in tattoos may contain iron and could heat up as with an MRI. Tooth fillings and braces are not a problem, but the radiologist should be made aware of them. Pacemakers and metallic prosthetics disqualify patients for this exam.

MRCPs are offered at numerous locations but not at a MAGIC office.

Percutaneous Endoscopy Gastrostomy (PEG) Tube

The Basics

Percutaneous Endoscopy Gastrostomy is an endoscopic procedure in which a feeding tube, referred to as a PEG tube, is implanted into the stomach as a means to provide food, liquids and medications to people who are having difficulty swallowing. A PEG is placed in order to maintain adequate nutrition.

What to Expect During the Procedure

Prior to the procedure, you will be given a pain reliever and sedative through an intravenous (IV). You are also given a local anesthetic where the PEG tube will be placed. A physician places a thin, flexible endoscope into your mouth and advances the endoscope into your stomach. The endoscope is used to help navigate the gastrointestinal tract to determine correct placement of the PEG tube in the stomach lining.

The PEG tube will exit through a small incision made in the lower abdomen. The procedure lasts from 30 to 45 minutes.

Why would you have a PEG?

Your doctor may require a PEG tube if you cannot eat, digest or absorb food due to:

  • Esophageal cancer, oral surgery or stroke
  • Major surgery, burns or trauma
  • Radiation therapy
  • Inflammatory bowel disease affecting the small intestine

What happens afterwards?

Following the placement of the PEG, you will be observed closely for any complications. A nurse will help to change your dressings as needed. In the first 24 to 48 hours, you should expect to see some drainage around the PEG tube. After the dressing has been removed and the area has healed, it is important to keep the area cleaned with soap and water to avoid infection. A dietitian will teach you how to use and care for your PEG tube, and you will be started on enteral tube feeding (feeding directly through the gastrointestinal tract).

How to Prepare

You must not eat or drink for 8 hours prior to the placement of the PEG tube. PEG placements are done in the outpatient surgical center at a hospital.

Integrated Virtual Colonoscopy

 

A Virtual Colonoscopy (VC) is an imaging procedure that uses technology known as computerized tomography (CT) to produce hundreds of cross-sectional images of the rectum and entire colon.  Two dimensional images are then converted to three dimensional images of the colon, allowing the lining of the colon to be visualized by your gastroenterologist and a radiologist who specializes in VC. VC is highly accurate and is now approved by the American Cancer Society, the American College of Radiology, and the American GI Association. The test requires a bowel prep, but is non-invasive with no intravenous line and no anesthesia required.

Integrated Virtual Colonoscopy, offered at MAGIC’s Colon Health Center, brings together non-invasive, sedation-free virtual colonoscopy and standard colonoscopy. If you have no significant findings on your VC (about 85% of average risk patients), you can drive yourself home. If you do have significant polyps (about 15% of average risk patients) and are healthy enough for anesthesia, you can have a colonoscopy with polyp removal the same day.*Note that VC can be done even if you are on strong blood thinners; polyp removal is often not recommended unless blood thinners are stopped. The prescribing physician must always be consulted before strong blood thinners are stopped.

Learn more at www.colonhealthcenterdelaware.com or call 302-995-2656 for an appointment. *No doctor’s order is required for colon cancer screening. American GI Association guidelines are used to determine which patients qualify.

Ultrasound

The Basics

Sometimes referred to as sonography, ultrasound imaging creates images of internal organs through the use of sound waves. It is a noninvasive medical test that helps physicians diagnose and treat medical conditions. The test is considered safe and painless, and does not expose the body to radiation. Ultrasound images can be captured in real time.

What to Expect During the Procedure

You will be instructed to lie down on an exam table. A gel will be applied to your abdomen to help transmit the sound waves. A transducer will be pressed against your abdomen and moved back and forth to create images of your internal organs.

Most patients don’t believe the ultrasound to be uncomfortable, but you may experience slight pressure as the transducer passes over your abdomen. You won’t hear anything when the images are taken, but they may be visible on a monitor in the room.

The ultrasound should take about a half hour to complete.

What can be found?

Ultrasound examinations can help to diagnose a variety of conditions and to assess organ damage following illness. A gastroenterologist may order an ultrasound to help to determine:

  • the cause of abdominal pain
  • detect gallbladder or kidney stones
  • identify the cause of abnormal blood tests, or monitor tumors.

What happens afterwards?

After an ultrasound examination, you should be able to resume your normal activities immediately.

How to Prepare

You may be asked to not eat or drink for 6 to 8 hours before the procedure. You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

An Ultrasound exam is available at numerous locations but not at a MAGIC office.