What is a Colonoscopy?

 A Colonoscopy is a procedure that enables your doctor to examine the lining of the colon. It is performed in the endoscopy suite.

 A soft and flexible tube, about the thickness of a finger, is gently inserted into the anus and advanced in. The tube has a built-in camera that allows your doctor to see your colon.

Who should have a Colonoscopy?

 A colonoscopy is performed for:

• Colon cancer screening
• Patients who have polyps
• Follow-up of previous polyps
• Evaluation of bowel symptoms
• Anaemia
• Blood in the stools
• Inflammatory bowel disease
• Ulcerative colitis/Crohn's disease
• Chronic Diarrhoea
  

How do I prepare for one?

 The colon must be completely emptied of stool for the procedure. In general, this involves bowel cleansing, prior to the colonoscopy. You will be given instructions on the bowel preparation.

Bowel preparation can involve taking a liquid called PEG or laxatives, and followed by water to clean out the bowel.

 If you are unable to complete the preparation, it may not be possible to perform the colonoscopy and the procedure will be postponed.

 Most medications are safe to continue before the procedure. Please inform your doctor before the examination, especially if you are taking any blood thinners warfarin, aspirin or diabetes medication.

How is a Colonoscopy performed?

Light sedation will be administered to help you relax and better tolerate any discomfort. You might feel some pressure, bloating or cramping during the procedure, but this is usually well-tolerated.

 The doctor will slowly advance a colonoscope though your colon to examine its lining. The procedure usually takes about 15 to 30 minutes to complete.

What happens after a Colonoscopy?

 You will be observed until the sedation has worn off, and will be discharged subsequently. Do not drive or operate any machinery till the next day, as the sedatives used will impair your reflexes.

 You may experience mild cramping or bloating from the air introduced into the colon. This will improve quickly when you pass gas. You will be able to eat normally within the same day and resume your normal activities the next day.

What are the risks?

 Colonoscopy is a very safe procedure. Complications are rare, but can occur. These include bleeding (<1%) and bowel perforation (0.2%). Bleeding can occur up to about two weeks after a colonoscopy. Rarely surgical treatment is needed. Some patients might have reactions to the sedation.

 It is important to contact your doctor if you experience symptoms of severe abdominal pain, fever or rectal bleeding after colonoscopy.

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What is EUS?

 EUS allows your doctor to examine the wall of your upper and lower gastro-intestinal tract. The upper tract is the oesophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the bile duct and pancreas.

 The doctor will use a thin and flexible tube called an endoscope, and pass it through your mouth or anus to the area that needs to be examined. The ultrasound component will then be turned on to produce sound waves that create visual images of the digestive tract.

Why is EUS done?

 EUS provides your doctor with more detailed pictures of your digestive tract anatomy. This information is used to diagnose the cause of conditions, such as abdominal pain or abnormal weight loss. In cases where your doctor has ruled out certain conditions, EUS can confirm this diagnosis and provide extra reassurance.

 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 the best treatment.

 In addition, EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive.

 How should I prepare for EUS?

 For EUS of the upper gastrointestinal tract, you should not eat or drink (not even water), usually six hours before the examination. You will be given clear instructions as to when you are to start fasting.

 For EUS of the rectum or colon, your doctor will instruct you to either consume a large volume of a special cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. The procedure might have to be rescheduled if you do not follow your doctor's instructions carefully on the necessary bowel preparation.

 Most medications are safe to continue for the procedure. You should discuss this with your doctor prior to the examination, especially if you are taking warfarin, aspirin, ticlopidine, clopidogrel, or medication for high blood pressure or diabetes.

 How is EUS performed?

Depending on whether the area to be examined is in the upper or lower gastro-intestinal tract, the experience is almost identical to that of these procedures - OGD or colonoscopy (Cannot be linked to the same  [hyperlink to OGD and Colonoscopy respectively]).

 What happens after EUS?

You will be observed until the sedation has worn off, and will be discharged subsequently. Do not drive or operate any machinery until the next day, as the sedatives used will impair your reflexes.

 At times, you may experience a mild sore throat but it will resolve in a few days. You will be able to eat normally within the same day and resume your normal activities the next day.

 What are the risks?

Complications are rare, but can occur. These include bleeding from a biopsy site, perforation or aspiration of stomach contents. Other uncommon risks include reactions to the sedatives used, infection, and complications from heart or lung diseases.

 The possibility of complications increases slightly if a deep needle aspiration is performed during the EUS examination. These risks will be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

 It is important to contact your doctor if you experience symptoms of severe chest/abdominal pain, fever or bleeding.

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ERCP is a type of endoscopic procedure used to examine and treat the biliary tree (the gallbladder, bile and pancreatic ducts). ERCP combines X-ray and 

, allowing your physician to obtain high-quality images of the anatomy. The endoscope goes in through the mouth and reaches the small intestine where the open of the bile and pancreatic duct lies.

 ERCP may be used to identify any strictures (narrowing) in your bile and pancreatic ducts and to biopsy abnormalities and remove gallstones.

 During an ERCP, a plastic or metal stent can be left within the bile or pancreatic ducts to help drainage.

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What is a liver biopsy?

A liver biopsy is a procedure in which a small piece of the liver tissue is taken for examination under the microscope. A small needle is placed into the liver to take a tiny bit of tissue that is sent for further testing.

 Why do I need to have a liver biopsy?

A liver biopsy helps your doctor to make a specific diagnosis of a liver condition, as well as to determine the seriousness of the condition. This information will be useful to help guide the treatment of your liver condition. Your doctor will go through in detail with you prior to the liver biopsy why you need it.

 Are there complications to doing a liver biopsy?

As with all medical procedures, there are some complications associated with liver biopsies. Some patients experience some fleeting discomfort in the right side, or shoulder. This usually can be managed with painkillers and resolves quickly.

Rarely, more serious complications can occur:

• Severe pain (2%)
• Bleeding (0.3 – 0.5%)
  
• Puncture of other organs (0.01-0.1%)
  

These complications are rare, and can be usually managed without the need for surgery.

In very rare cases, a liver biopsy can potentially lead to surgery, and even death.

 How is a liver biopsy performed?

A liver biopsy can either be done bedside by the liver specialist or under ultrasound guidance by the radiologist. The liver biopsy is usually performed as an outpatient procedure in the day surgery ward.

 You will lie on your back, and an area of the skin will be targeted with the assistance of an ultrasound. The area of skin is then cleaned, and a local anaesthetic agent is used to numb the skin and the tissue below. At this point, the doctor will tell you how to breathe in and out, and hold your breath. Upon holding your breath, a thin, specially designed needle will be inserted through the skin. It will be advanced in and out of the liver. This will only take one or two seconds. The doctor may choose to give you some medication to be comfortable at this point. The tissue removed with the needle is then sent for processing by the laboratory.

 The entire procedure, from start to finish, lasts only about 15 to 20 minutes.

What will I expect on the day?

You will be admitted to the day surgery ward in the morning. Some blood tests may be done for you, to ensure that it is safe to proceed with the liver biopsy. You will then undergo the liver biopsy as described above.

 Subsequently, you will be monitored in the day surgery ward for four to six hours. During this period, the day surgery nurses will check your blood pressure and heart rate. They will also monitor you for any pain, and may give you some painkillers if needed. You will be reviewed by a doctor after this period of monitoring, and you will be examined prior to discharge.

 The whole process from admission to discharge can take up to 8 hours.

Will there be serious damage to my liver?

As only a small piece of the liver is removed compared to the liver, there will be no serious damage to the liver.

What do I need to watch out for?

Patients are advised to avoid vigorous physical exercises and avoid carrying heavy weights for the next two weeks. A medical certificate will be issued by the doctor to ensure you rest.

 If you feel faint, black out, have palpitations, or have severe pain after you return home, please seek immediate medical attention.

Are there any other alternative approaches to a liver biopsy?

 Another way of doing the liver biopsy is a transjugular liver biopsy. The needle is passed in through a tube placed in a neck vein, and tissue is taken from the liver through the blood vessel.

 The advantage of this is that there is an even lower risk of bleeding, and it is safer for those with abnormal blood clotting.

 The disadvantage is that the tissue available for diagnosis is less, and it may not yield as effective a result. The cost is also higher.

 If you have a high risk of bleeding, your doctor may discuss doing a transjugular liver biopsy instead.

If you have any further questions about the liver biopsy, please do not hesitate to contact any one of our hepatologists.

 For other other specialist endoscopic procedures, and motility and functional investigations, please click here.