Colonoscopy

• Colonoscopy is a procedure that enables your Doctor to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube (flexible fiberoptic colonoscope) into the anus and advancing it slowly into the rectum and colon.

  The colon must be completely clean for the procedure to be accurate and complete. Your Doctor and his/her staff will give you detailed instructions regarding the dietary restrictions to be followed and the cleansing routine to be used. Follow the instructions carefully. If you do not, the procedure may have to be cancelled and repeated later.

  Colonoscopy is usually well tolerated and rarely causes much pain. The anaesthetist will give you a combination of sedating anaesthetic medications through a vein to help you relax and sleep during the test, and better tolerate any discomfort from the procedure. You will be lying on your left hand side during the procedure. Once asleep, the colonoscope is introduced into the anus and advanced slowly through the entire large intestine. As the colonoscope is slowly withdrawn the lining is again carefully examined. The procedure usually takes 15 to 30 minutes. In some cases, passage of the colonoscope through the entire colon to its junction with the small intestine cannot be achieved. Your Doctor will decide if the limited examination is sufficient or if other examinations are necessary.

  If your Doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy (a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If the colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Remember, the biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

  Polyps are abnormal growths from the lining of the colon, which vary in size from 2-3mm to several cm. The majority of polyps are benign (non-cancerous); your Doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is an important means of preventing colorectal cancer, as more often than not colon cancer arises from large polyps.

• Endoscopic Retrograde Cholangiopancreatogram (ERCP)

  Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialised technique used to study the ducts of the gallbladder, pancreas and liver. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts.

  During ERCP, your doctor will pass an endoscope through your mouth, oesophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays. Most patients require some therapy during ERCP such as stone removal or plastic stents (tube) insertions to unblock narrowings.

• Endoscopic Ultrasound

  Endoscopic Ultrasound or EUS allows your doctor to examine the lining and the walls of your upper gut including the oesophagus, stomach and duodenum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the gall bladder, bile duct and pancreas. Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth to the area to be examined. Your doctor then will turn on the ultrasound component to produce sound waves that create images of the digestive tract.

  EUS provides your doctor more detailed pictures of your digestive tract anatomy. Your doctor can use EUS to diagnose the cause of conditions such as abdominal pain or abnormal weight loss. Or, if your doctor has ruled out certain conditions, EUS can confirm your diagnosis and give you a clean bill of health. EUS is also used to evaluate an abnormality, such as a growth, that was detected at a prior endoscopy or by x-ray. EUS provides a detailed picture of the growth, which can help your doctor determine its nature and decide upon the best treatment. In addition, EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive.

  Practices vary among doctors, but for a EUS examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anaesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, oesophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes between 15 to 45 minutes. Most patients are very comfortable with a few who consider it only slightly uncomfortable.

• Double Balloon Enteroscopy

  Double Balloon Enteroscopy or DBE allows your doctor to examine the small bowel where other endoscopes cannot reach. Depending on the position of the abnormality your doctor will then decide which direction the procedure should enter the small bowel. If the abnormality is higher up the small bowel then an oral approach (antergrade) is preferred. If the problem is lower down the small bowel then progressing up from the colon is preferred.

  DBE has two main roles. Firstly, it can detect and treat lesions in the small bowel. In comparison to capsule endoscopy which can only “see” lesions, DBE can treat them. Some patients have a low suspicion for a small bowel lesion seen by capsule endoscopy or x-ray. To clarify if there really is a lesion we use DBE and this is a common reason to perform DBE.

  In some cases, DBE cannot treat the lesion successfully and a tattoo is made to assist in finding the correct area if surgery is required.
  Bleeding or anaemia is the most common reason to perform DBE. We call this type of situation OGIB (obscure GI bleeding). This can be a difficult area as many patients don’t have definite bleeding sites and even when treatment is performed by DBE, not all will stop bleeding. Overall, we estimate that up to 80% of patients will benefit from DBE but this may not last forever.

  For a DBE examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. You will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the DBE scope through your mouth, esophagus and stomach into the duodenum and small bowel. The instrument does not interfere with your ability to breathe. The actual examination generally takes up to 60 minutes. Most patients consider it only slightly uncomfortable. The retrograde approach is similar to colonoscopy where the colon is examined and then the scope is inserted into the small bowel where progress is then made up the small bowel. This can be difficult and overall success may be only 80-90% as difficult loops and angles make upstream progress too difficult.

• Weight Loss Procedures

  The doctors who are involved with The BMI Clinic (previously known as Gastric Balloon Australia) are Dr George Marinos, Dr Adrian Sartoretto and Dr David Links.

  The BMI Clinic specialise in non-surgical and surgical weight loss techniques. Our Sydney clinic, established in 2005, is the largest specialist practice of its kind in Australia. Our specialist doctors are world leaders in endoscopic management of weight loss and are regularly called upon to train other medical specialists in the use of intragastric balloon systems. The GBA team recognises that there is no one-size-fits-all approach in weight loss and as such we regularly utilise a number of different techniques, including:

  • Intragastric Balloon (Orbera® & Spatz3®)
  • Endoscopic Sleeve Gastroplasty (ESG)
  • Laparoscopic Gastric Bypass
  • Laparoscopic Gastric Sleeve
  • Aspire Assist®

  To maximise your weight loss, all of our programs include a personalised lifestyle retraining program, supervised by your doctor and a team of clinical experts including nurses, dietitian and, psychologists who work together with you to help achieve your weight loss goals.

  The BMI Clinic is located at:

  Suite 1.03-1.06, Level 1,
  451 New South Head Road
  DOUBLE BAY NSW 2028

  You can contact us on: 1300 859 059

  If you would like further information on The BMI Clinic please visit our website bmiclinic.com.au