Division of Gastroenterology & Hepatology
Upper (EGD) and Lower Endoscopy (colonoscopy/flexible sigmoidoscopy)
How do I know if I should be evaluated by a specialist for upper or lower GI tract problems such as heart burn, upper or lower abdominal pain, diarrhea, constipation, rectal bleeding, cancer screening, colitis, pancreatitis and other diseases?
Check with your primary care physician for the initial assessment of your needs. Depending on the results of the initial assessment and any therapies offered, your primary care physician will then refer you to a specialist for these issues (a gastroenterologist) if warranted. This referral may be for a clinic evaluation or directly for a specific test such as a colonoscopy.
How are diseases of the GI tract diagnosed?
The initial review of your symptoms and examination by your primary physician will determine the best approach. A full range of diagnostic and at times therapeutic procedures are available at Froedtert Hospital to evaluate these diseases. These include endoscopic procedures, x-ray studies, CT scans, MRI scans, abdominal ultrasound studies and nuclear medicine scans. Endoscopy has the advantage of providing direct visualization of the lining of the intestinal tract, the ability to sample tissue for microscopic examinations if necessary and at times, the capability to provide therapy directly through the instrument.
What is an EGD? What is a colonoscopy? What is a flexible sigmoidoscopy?
EGD (esophago-gastro-duodenoscopy) is the endoscopic examination of the upper gastro-intestinal tract including the esophagus (swallowing tube), stomach, and first portion of the small intestine, called duodenum. The instrument used is a flexible fiber-optic endoscope which is introduced through your mouth.
Colonoscopy is the endoscopic examination of the entire lower GI tract (colon or large bowel/intestine) with a fiberoptic flexible instrument inserted into the rectum and advanced to the beginning of the colon.
Sigmoidoscopy refers to the examination of only the lowest portion of the colon (sigmoid colon and rectum) with a fiberoptic flexible instrument inserted into the rectum and advanced to the sigmoid colon.
What preparation is required for an Upper GI Endoscopy (EGD)?
You will need to have an empty stomach and, therefore, will be instructed not to eat or drink anything after midnight before the scheduled examination except for sips of water. You may also be instructed not to take any medications by mouth on the morning of the examination. Since you will receive sedation during the examination you will not be able to drive home by yourself and, therefore, will have to arrange for a companion to drive you home.
What is the preparation for a colonoscopy?
For a successful examination your colon has to be completely clean. This requires that you take only liquids and purging solutions on the day prior to the examination. Detailed instructions and the necessary prescriptions will be given to you when you schedule the procedure. You should be fasting except for sips of water for 6 hours prior to the procedure. Since you will receive sedation during the examination you will not be able to drive home by yourself and, therefore, will have to arrange for a companion to drive you home.
What is the preparation for a flexible sigmoidoscopy?
You will be instructed to take one or two enemas an hour before the procedure. As a rule you will not be given any sedation, and, therefore, can take your medications on the morning of the procedure.
What should I expect before the procedure?
A nurse will review your medical history and medications. Prior to an EGD or colonoscopy an intravenous (I.V.) line will be placed for the administration of medications for your sedation. Prior to an EGD your throat will be sprayed with a local anesthetic to reduce gagging.
What should I expect during the procedure?
Since EGD and colonoscopy are generally performed with sedation you may not remember much of the procedure. During an upper GI endoscopy some patients may experience some gagging, during a colonoscopy some abdominal cramping. During a flexible sigmoidoscopy you may feel the urge to defecate. If you feel any significant discomfort your doctor will back off.
How long do these procedures take?
Your time in the laboratory is determined by the admission process, the duration of the actual procedure, and the recovery time from the sedation. For an EGD or colonoscopy you can expect to spend about two hours in the GI laboratory; the actual time for an EGD is about 6 - 15 minutes, for a colonoscopy about 15 - 45 minutes depending on the findings and difficulty of the procedure. A flexible sigmoidoscopy takes about 3-5 minutes.
What are potential complications?
EGDs, colonoscopies and sigmoidoscopies are very safe procedures in skilled hands.
Nevertheless on very rare occasions complications can occur, they include bleeding, perforation of an organ which would require surgery, infection, and an adverse reaction to the administered sedation. We are prepared to deal with these problems should they occur. Please advise us of any allergies and intolerance to medications and inform us about all medications you are taking. In case of delayed complication contact us immediately. If these delayed complications occur after hours, on weekends or on holidays you may have to go to the Emergency Room at Froedtert hospital immediately to receive proper evaluation and care.
What will be my follow-up?
Follow-up arrangements will depend on your medical problem and the endoscopic findings. You and your referring physician will get a preliminary report at the time of discharge from the GI Lab. This will also contain instructions about any necessary follow-up. If biopsies are obtained, you and your physician will receive a written report usually within 10 to 14 days with further follow-up recommendations.