Stuart Akerman, MD Procedures Explained
Colonoscopy is a procedure that is typically performed under Anesthesia. Once you are comfortable and sedated, a flexible tube with a camera under the control of the doctor will be passed into the colon via the anus, to examine the rectum, colon, and possibly a short part of the end of the small intestine. In addition to taking photographs, the doctor has the ability to take biopsy samples, cauterize, inject medications, remove polyps, and even place clips to close ulcers or blood vessels that may be bleeding.
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The procedure is typically performed to evaluate many different disease processes and symptoms such as diarrhea, abdominal pain, GI bleeding, and anemia, in addition to screening for Colon Cancer.
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Risks of the procedure are small but may include and are not limited to bleeding, infection, making holes, injury to internal organs, missed lesions, incomplete exams, nausea, shortness of breath, pneumonia, cardiopulmonary events, and/or anesthesia side effects.
Upper Endoscopy is a procedure that is typically performed under Anesthesia. Before the start of the procedure, your doctor will ask you to place a short plastic piece between your teeth. This allows for the scope to easily pass through your mouth in the event of unconscious biting while sleeping under anesthesia.
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Once you are comfortable and sedated, a flexible tube with a camera under the control of the doctor will be passed into the esophagus via the mouth, to examine the esophagus, stomach, and the beginning of the small intestine which is called the duodenum. If you are having a Push Enteroscopy performed, the procedure is similar except that the scope is longer and may be advanced a bit further into the small intestine. In addition to taking photographs, the doctor has the ability to take biopsy samples, cauterize, inject medications, and even place clips to close ulcers or blood vessels that may be bleeding.
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The procedure is typically performed to evaluate many different disease processes and symptoms such as Heartburn/reflux, abdominal pain, bloating. celiac disease, GI bleeding, and anemia.
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Risks of the procedure are small but may include and are not limited to bleeding, infection, making holes, injury to internal organs, missed lesions, incomplete exams, nausea, shortness of breath, pneumonia, cardiopulmonary events, and/or anesthesia side effects.
Endoscopic Ultrasound (EUS) is a procedure that is typically performed under Anesthesia. It may be performed via the mouth (Upper EUS) of via the anus (Lower EUS). Before the start of the procedure for an Upper EUS, your doctor will ask you to place a short plastic piece between your teeth. This allows for the scope to easily pass through your mouth in the event of unconscious biting while sleeping under anesthesia.
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Once you are comfortable and sedated, a flexible tube with a camera and an additional ultrasound component under the control of the doctor will be passed into the esophagus via the mouth, to examine the esophagus, stomach, and the beginning of the small intestine which is called the duodenum. The ultrasound allows for the walls of the esophagus, stomach, and duodenum to be evaluated, as well as structures outside of the tubes such as the pancreas, gallbladder, parts of the liver, and bile tubes. In addition to taking photographs, the doctor has the ability to take biopsy samples of the deep tissues, called Fine Needle Aspiration. Occasionally a similar procedure may be performed to place markers within tumors, or to provide pain relief in certain chronic diseases.
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The procedure is typically performed to evaluate many different disease processes and symptoms such as Masses of the GI tract, pancreatitis, unexplained abdominal pain, gallstones, common bile duct stones, and cysts.
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Risks of the procedure are small but may include and are not limited to bleeding, infection, making holes, injury to internal organs, missed lesions, incomplete exams, nausea, shortness of breath, pneumonia, cardiopulmonary events, and/or anesthesia side effects. Fine needle aspiration of the pancreas also carries a small risk of pancreatitis.
Endoscopic Ultrasound
ERCP is a procedure that is typically performed under Anesthesia. It is a combined endoscopic (camera) and radiologic (XRay) yest. Before the start of the procedure, your doctor will ask you to place a short plastic piece between your teeth, and you will typically be positioned on your stomach. The small plastic piece in your mouth allows for the scope to easily pass through your mouth in the event of unconscious biting while sleeping under anesthesia.
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Once you are comfortable and sedated, a flexible tube with a camera under the control of the doctor will be passed into the esophagus via the mouth, to the beginning of the small intestine to visualize the opening of the bile and pancreatic drainage tubes, called the ampulla/papilla. The opening to the tubes is quite small, too small for the scope to be passed into. Instead, a thin wire can be passed into the bile and/or pancreatic tube, and other tools can then be passed over the wire.
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The procedure is typically performed to evaluate many different disease processes and symptoms such as abdominal pain, jaundice, common bile duct stones, narrowing and bloackages of the bile duct, and chronic pancreatitis.
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Risks of the procedure are small but may include and are not limited to bleeding, infection, making holes, pancreatitis, injury to internal organs, missed lesions, incomplete exams, nausea, shortness of breath, pneumonia, cardiopulmonary events, and/or anesthesia side effects. Additional risks of stent placement include but are not limited to stent blockage, infection, migration, or malfunction.
Capsule Endoscopy / Deep Enteroscopy
Capsule Endoscopy is a procedure performed in our office. It is done typically for the evaluation of the small bowel, for areas not otherwise evaluated by other exams. The patient swallows a pill that has 2 cameras, and transmits the pictures to a small receiver that the patient wears on their belt or around their neck. The battery may last between 8 and 12 hours depending on the device. Once completed, the recorder is returned and the images are downloaded for review.
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Risks of capsule endoscopy are quite low, and are typically related but not limited to capsule retention and/or incomplete examinations either related to gut transit or battery rundown prior to exam completion. It is very important to make your doctor aware if you have had any bowel surgery or abdominal infections which may raise your risk of the pill camera becoming stuck.
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Deep Enteroscopy is a procedure that is typically performed under Anesthesia in the hospital, but can be performed in an outpatient status. Before the start of the procedure, your doctor will ask you to place a short plastic piece between your teeth. This allows for the scope to easily pass through your mouth in the event of unconscious biting while sleeping under anesthesia.
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Once you are comfortable and sedated, a flexible tube with a camera under the control of the doctor will be passed into the esophagus via the mouth, to examine the esophagus, stomach, and the beginning of the small intestine which is called the duodenum. The scope will have a second tube (overtube) on top of the camera tube, which will allow the doctor to pass the camera significantly further into the small intestine. In addition to taking photographs, the doctor has the ability to take biopsy samples, cauterize, and inject medications.
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The procedure is typically performed to evaluate disease processes of the small intestine, and often is performed to evaluate and/or treat findings from a capsule endoscopy exam.
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Risks of the procedure are small but may include and are not limited to bleeding, infection, making holes, injury to internal organs, missed lesions, incomplete exams, nausea, shortness of breath, pneumonia, cardiopulmonary events, and/or anesthesia side effects.
Hemorrhoid Banding is an office-based procedure to treat Internal Hemorrhoids. The procedure is painless, and done without anesthesia, so you do not need to arrange for a ride after the procedure.
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The procedure is typically performed in a series, with one hemorrhoid treated per session. While you lie on your side, the doctor will perform a rectal exam to determine the optimal treatment target. A small rubber band will be placed on the hemorrhoid to gather excess tissue, and ultimately to scar and flatten the hemorrhoid. This treatment has been found to be superior to medications alone, similar to cautery therapy, and less painful than traditional surgery.
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Potential risks of the procedure include but are not limited to pain, urinary symptoms, loss of blood, infection, or allergic reaction, along with a risk of recurrent hemorrhoidal symptoms.
HemWell is a minimally invasive technique specifically designed to treat internal hemorrhoids. It utilizes gentle, low-power radiofrequency energy to target the problematic hemorrhoidal tissue directly. Importantly, to ensure your maximum comfort and minimize anxiety, this procedure is performed under sedation right here in our facility, making the treatment experience significantly more comfortable than many traditional methods.
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The primary goal of undergoing the HemWell procedure is to achieve lasting relief from common hemorrhoid symptoms such as bleeding, itching, swelling, and general anal discomfort or pain. By applying targeted radiofrequency energy, the HemWell device causes the small blood vessels feeding the hemorrhoid to coagulate and the tissue itself to shrink or 'ablate'. This reduction in size and blood flow effectively eliminates the source of the symptoms. Compared to more invasive surgical options, HemWell aims for a quicker recovery period with less post-procedure pain, allowing you to return to your normal routine sooner.
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While the HemWell procedure is generally considered safe and well-tolerated, especially when performed under sedation for comfort, it's important to be aware of potential risks, as with any medical intervention. Following the procedure, some patients may experience temporary discomfort, mild pain, minor bleeding, or a feeling of fullness or swelling in the area. Though less common, other potential complications can include infection, thrombosis (a blood clot within a hemorrhoid), or fecal incontinence, although these are rare. We will discuss all potential risks and benefits specific to your situation in detail during your consultation, ensuring you have all the information needed to make an informed choice about your treatment.
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