Gastroenterology

This procedure examines the esophagus, stomach, bulb and 2nd section of the duodenum. It investigates symptoms of the upper digestive system, such as burning sensation, dyspepsia, pain in the epigastrium or gastrorrhagia with melena, with great accuracy. Possible findings include the presence of hiatal hernia, esophagitis, stomach or duodenum ulcer, and precancerous or cancerous lesions.

• Colonoscopy 
It is performed after special colon cleansing. As is the case with gastroscopy, samples are collected for histological examination whenever it is deemed necessary. The usual diagnostic indications of colonoscopy include presence of blood in stool, iron-deficiency anemia and chronic diarrhea. Colonoscopy is also important in colon cancer prevention. Individuals over the age of 50 should undergo a colonoscopy check-up regularly.
Given that colon cancer usually develops from benign polyps, if polyps are found during the procedure, it is possible to remove them and stop them from developing into cancer. Individuals with a family history of colon cancer or polyps should begin check-ups at the age of 40.

• Enteroscopy 
The endoscopic examination of the small intestine jejunum is particularly useful in patients with iron-deficiency anemia or enterorrhagia, when other types of endoscopic check-ups do not offer specific diagnosis or when a jejunum lesion is suspected in general.
• ERCP (Endoscopic Retrograde Cholangiopancreatography)
• Rectoscopy/Proctoscopy
• Fluid sampling
• Tissue sampling for histology or cytology1

Aside from diagnosis, endoscopic examinations offer the possibility of therapeutic intervention. Several procedures can be performed with the use of gastroscope and colonoscope: polyps are removed, hemostasis is established, hemorrhage is controlled, stenoses are dilated, and special endoprotheses (stents) are placed for securing the digestive tube lumen accessibility.

A special endoscope may also be used to examine the gallbladder and the pancreatic pore (Endoscopic Retrograde Cholangiopancreatography or ERCP). In addition, stones can be removed endoscopically and stents can be placed in stenotic defects inside the bile duct.

Therapeutic Endoscopies
• Endoscopic removal of foreign object
• Endoscopic treatment of esophageal varices
• Endoscopic stent placement (esophagus, stomach, small or large intestine)
• Endoscopic biliary stent placement
• Endoscopic stent replacement
• Esophageal or large bowel stricture dilation with bougie (per session)
• Endoscopic balloon dilation (TTS)
• Pneumatic dilation for esophageal achalasia
• Polypectomy
• Endoscopic treatment of achalasia with botulinum toxin injection
• Percutaneous endoscopic gastrostomy insertion
• Endoscopic therapy in gastrointestinal bleeding
• Copious endoscopic sphincterotomy
• Endoscopic drainage
• Argon plasma coagulation treatment
• Endoscopic hemorrhoid treatment

Endoscopic ultrasound or ΕUS combines endoscopy and ultrasonography techniques. It uses special endoscopes that emit ultrasounds during the endoscopy procedure. Such ultrasounds offer physicians the added ability to look deeper into the digestive tract wall and the surrounding tissues. So, the pancreas, bile ducts, and lymph nodes are clearly depicted.

The indications fall into three general categories:

Α. Esophageal, gastric and rectal cancer staging: In these types of cancer, EUS is a most accurate method of local staging.

Β. Submucosa defects of the digestive tract: Most defects of the digestive system pertain to the surface covering the digestive wall (mucosa) and can be diagnosed with conventional endoscopy. When a defect is located inside the wall (submucosa or deeper) and not on the digestive tract surface, EUS is necessary, since it offers images of the entire wall as well as the surrounding tissues.

C. Conditions of the pancreas and the biliary: EUS depicts the pancreas and the extrahepatic biliary vessels in great detail. It may clarify any CT or MRI findings and detect small tumors measuring just 5-10mm, which are not visible in other tests. Moreover, the new linear EUS system offers the possibility of guiding a fine needle which collects cytological sample (EUS-guided Fine Needle Aspiration), therefore, increasing the diagnostic accuracy of pancreatic conditions. Note that this examination can only be performed in a few specialized centers in Europe and the USA.

Endoscopic Capsules constitute an important step in the diagnostic approach for the small intestine. The system is based on image transmission from a tiny camera incorporated in a transparent capsule (26mm long) that is swallowed by the patient. The capsule transmits images wirelessly, as it moves through the digestive tract due to peristalsis. This way, the entire length of the small intestine is depicted and possible foci of hidden hemorrhage may be diagnosed.

These examinations offer useful information on digestive functions, especially since they do not require use of endoscopes and are carried out without intravenous sedation.

24 hour mobile esophagus pH measurement registers the acidity (pH) of the lower esophagus over 24 hours. It is an important technique for patients with possible gastro-esophageal reflux (GERD). It is performed by placing a thin catheter through the lower esophagus, which is connected to a small recording device (resembling a walk-man). Patients may then proceed with their daily activities. The catheter is removed on the following day and the data is analyzed with the help of a computer.

The esophageal manometer examines esophageal mobility and the sphincter adequacy via a thin catheter inserted in the esophagus through the nose. It is used to evaluate patients who find it difficult to swallow (dysphagia), as well as patients with scleroderma or other collagen disorders. The examination lasts for 15 to 20 minutes and is generally well-tolerated by the patient.

Anorectal manometry examines anal sphincter pressure and rectal sensitivity. It is used for evaluating patients with incontinence, but also in special cases of constipation.

An Η2 breath test can determine hypolactasia. It is a simple test for determining the lactase deficiency. It is performed by measuring the hydrogen levels in exhaled air samples, after drinking milk or a lactose solution.

An Η2 breath test can determine bacterial overgrowth. It is a similar test, but it is performed by measuring the hydrogen levels in exhaled air samples, after drinking a special glucose solution.