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Procedure-Specific Instructions

We want you to be prepared for your procedure. Choose from the list below to learn more about:

48-hour pH monitoring (BRAVO)
BRAVO is a procedure during which a pH monitor is placed in the esophagus using a delivery device during an EGD procedure. The tiny BRAVO unit is attached to the wall of your esophagus just above the opening to your stomach and records the presence of esophageal acid exposure for a 48-hour period. During the 48-hour period, you will be asked to record any reflux symptoms that you may experience as well as times that you eat, drink and lie down.

  • Do not eat or drink after midnight.
  • Avoid antacids and PPI (anti-reflux) therapy for at least five days prior to your procedure and during your 48-hour study (unless instructed otherwise by your physician).
  • After 48 hours, the data logger stops recording and you must return the data logger and symptom diary to the hospital as directed.
  • The Bravo unit is expected to slough off during normal mucosal sloughing and pass through your bowels within seven to 14 days.
  • Do not have a magnetic resonance imaging (MRI) for 30 days after this test or until capsule passage can be confirmed.

Anorectal Manometry
Anorectal manometry is a procedure performed by an R.N. that evaluates rectal muscle tone and sensation. A small flexible manometry catheter will be inserted into the rectum, and pressure measurements will be taken while the nurse asks the patient to follow simple commands to evaluate muscle tone. A variety of patients are seen for chronic constipation, rectal pain and rectal incontinence.

  • Do not eat or drink anything after midnight.
  • You must take a Fleet enema one hour prior to arriving for this test.

Bronchoscopy
Bronchoscopy is an examination of the lining of the pharynx, larynx, trachea, bronchi and lungs using a flexible bronchoscope. During the procedure, tissue sample(s) may be taken without surgical interventions.

  • Arrive two hours prior to your scheduled appointment time.
  • Bring any inhalers and radiology films with you.
  • If your doctor's office has provided you with a mask, please make sure that you wear this upon entering the hospital.
  • You will be taken directly to endoscopy, so you will need a friend or family member present to register you.

Colonoscopy
Colonoscopy is an examination of the lining of the large intestines from the anus to the cecum (where the small bowel ends) using a flexible endoscope. During the procedure, tissue sample(s) may be taken and polyps may be removed without surgical interventions.

It is important to take all of the laxative preparation the physician orders for you. If you experience problems, call your doctor.

Endoscopic Retrograde Chalangiopancreatography (ERCP)
ERCP is an important tool in the diagnosis and treatment of many diseases of the pancreas, bile ducts, liver and gallbladder. During an ERCP, an endoscope is passed through the mouth, down the throat and into the duodenum (the first portion of the small bowel).

Throughout the procedure, the physician may inject contrast dye and use fluoroscopy (live X-ray) to visualize the bile duct, pancreatic duct and biliary tree. Therapies can be performed during the procedure to both treat and provide palliative care for many different diseases of the pancreas, bile ducts, liver and gallbladder.

Esophageal 24-hour pH Monitoring
Esophageal 24-hour pH monitoring is a procedure during which a flexible catheter will be placed in the esophagus to monitor esophageal acid exposure. Acid is normally found in the stomach but not in the esophagus. If acid is detected, it is indicative of reflux from the stomach.

The pH catheter will be inserted into the nose, down the throat and into the stomach. It will be worn for 24 hours. The catheter will transmit data to a recorder that you will use to record reflux symptoms. You will go home with written instructions and return as directed at the end of the test to return the data logger.

  • Do not eat or drink anything after midnight.
  • Do not smoke before this test.
  • Check with your physician to see if you need to stop any medications for this test, including over-the-counter medications.
  • Wear a button-down shirt (no pullovers).
  • The catheter will be taped to your nose and neck and connected to a data logger.
  • No showering, bathing or swimming until the catheter is removed.
  • After 24 hours, you must return to the hospital to have the catheter removed and to return the data logger.
  • Let your nurse know if you are allergic to the numbing medicine used at a dentist's office.

Esophageal Manometry
Esophageal manometry measures muscle pressures during the contraction and relaxation of the esophageal muscles when swallowing. The procedure is performed by inserting a flexible manometry catheter into the nose, down the throat and into the stomach. A succession of swallows will then be measured.

Esophageal manometry is used to evaluate patients with swallowing difficulties as well as provide anatomical information for patients being evaluated for esophageal surgery.

  • Do not eat or drink anything after midnight.
  • Check with your physician to see if you need to stop any medications for this test, including over-the-counter medications.
  • Let your nurse know if you are allergic to the numbing medicine used at a dentist's office.

Esophageal Ultrasonoghrapy (EUS)
EUS allows a specially trained physician to use an endoscope with an ultrasound transducer to examine internal structures through the gastrointestinal (GI) tract. EUS is also especially useful for examining the wall layers of the organs of both the upper and lower GI tract. This procedure is often used as a means of diagnosing unexplained findings on an EGD, X-ray or CT scan.

Esophagogastroduodenoscopy (EGD)
EGD is the examination of the upper digestive tract, including the esophagus, stomach and duodenum (beginning of the small bowel) using a flexible endoscope. During the procedure, tissue sample(s) may be taken and therapies may be performed without surgical interventions.

Flexible Sigmoidoscopy
Flexible sigmoidoscopy is the examination of the lining of the lower portion of large intestine from the anus to the end of the sigmoid colon. It is performed much like a colonoscopy and allows for tissue samples to be taken and polyps to be removed without surgical interventions.

Hydrogen Breath Tests (HBTs)
HBTs help to determine the small intestine's ability to digest certain sugars as well as the amount of normal flora present in the small intestine. Each test consists of a baseline breath sample collection and drinking a test solution followed by the collection of breath samples at very specific time intervals.

The tests (lactose, fructose and lactulose) must be completed on a separate day due to the fact that the test solutions interfere with each other. Therefore, these tests are take-home tests that you will complete on your own and then return to the hospital once finished.

  • Do not take any antibiotics for two weeks prior to the test.
  • Do not eat, drink, smoke, sleep or exercise for at least one hour before your test.
  • The day before the exam, don't eat more than 30 grams of carbohydrates per meal. Eating any more than this will yield a false test result. To determine the amount of food this is, read the content label on the food package. Please consult your physician for your specific dietary instructions.
  • For 12 hours prior to your scheduled appointment time, do not eat or drink anything except water.
  • You will be given instructions and shown how to collect the baseline breath sample.
  • If you are only ordered for one test, you have the option of finishing that test in the hospital waiting room. If you have more than one test, you will need to complete them at home and return all of the completed tests when you are finished.
  • After ingesting the test solution, some patients experience the same abdominal symptoms for which they are completing the tests. This is a normal reaction to the test and is not a cause for alarm.
  • You must return the samples to the endoscopy department as directed.

Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement
PEG tube placement is a procedure during which a feeding tube will be placed into the stomach during an esophagogastroduodenoscopy (EGD). PEG tube placement requires that a very small incision be made in the abdomen through which the tube will enter the stomach for delivery of nutrition.

This incision is small enough that it does not require any stitches and will be dressed with a small bandage after the procedure. At the time of your appointment, you will be given further instructions regarding care for your feeding tube.

Single Balloon Enteroscopy
Single balloon enteroscopy is an extension of an EGD procedure, during which the physician will use a longer endoscope to examine further into the small bowel than is possible during a normal EGD. During the procedure, tissue sample(s) may be taken and therapies may be performed in a part of the intestine that would have previously required surgical intervention.

Small Bowel Capsule Endoscopy (M2A)
M2A is a procedure during which a small color camera pill, about the size of a multivitamin, is swallowed and allowed to pass through the entire gastrointestinal tract. As the capsule travels through your small bowel, it will transmit a video of your small bowel to the sensors placed on your abdomen. These sensors are connected to a recorder.

After the procedure, the data on the recorder will be downloaded onto a computer, enabling your physician to visually examine your small bowel. You will swallow the M2A capsule in the morning and return eight hours later to have the sensors removed and the recorder downloaded.

  • Do not take iron or vitamins with iron for five days before the scheduled test.
  • If you have had any surgery on your bowels, have a pacemaker or have an internal defibrillator, please notify your physician.
  • The day prior to your procedure, eat a normal diet until noon, then drink clear liquids only until 8 p.m. (nothing red, blue, orange or purple that could look like blood in the bowels).
  • If your doctor prescribed a magnesium citrate bowel preparation, take this at 8 p.m. the night before your test. This will empty out your bowels.
  • Do not eat or drink anything after finishing the magnesium citrate prep.
  • Please notify your physician if you have any abdominal pain or change in bowel habits after this test is completed.
  • Do not have a magnetic resonance image test (MRI) for 30 days after the M2A capsule has been swallowed or until capsule passage can be confirmed. It is very important that you do not come within close proximity of a powerful electromagnetic source, such as MRIs or HAM radios, while capsules are inside your body.