Endoscopy

Overview:

Bravo Capsule pH Monitoring measures acid levels in your esophagus to help diagnose conditions related to acid reflux. A small capsule is temporarily attached to your esophagus during an upper endoscopy. It wirelessly records pH data for up to 48 hours, helping your doctor understand how often and how long stomach acid enters your esophagus.

Conditions Evaluated:

• Gastroesophageal reflux disease (GERD)
• Laryngopharyngeal reflux (LPR)
• Chronic cough or sore throat
• Chest pain not related to the heart
• Regurgitation or heartburn unresponsive to medication

Before the Procedure:

• You may need to stop acid-reducing medications several days before testing.
• Do not eat or drink for several hours before your procedure.
• Arrange for someone to drive you home if sedation is used.

Overview:

Colon cancer screening helps detect colorectal cancer and precancerous polyps early, often before symptoms appear. Regular screening greatly improves prevention and treatment outcomes. Several options are available (listed below), which allow doctors to view and remove polyps in one procedure. Screening usually begins at age 45, or earlier for those with higher risk.

*Screening Types:

• Colonoscopy: Common procedure used to examine the lining of the large intestine (colon) and rectum with a flexible tube with a camera (colonoscope). For average-risk individuals, a colonoscopy is recommended every 10 years, starting at age 45. A colonoscopy is the gold standard for colon cancer screening; it not only detects cancer early but can also remove polyps before they become cancer.
• High-sensitivity fecal occult blood test (FOBT): Non-invasive screening tool designed to detect microscopic amounts of blood in the stool that aren't visible to the naked eye. For average-risk individuals, this test should be performed annually.
• Cologuard®: Cologuard is a simple, at-home multitarget stool DNA test that screens for both hidden blood and altered DNA shed by cancer or precancerous polyps. Some UTMB patients may be eligible for Cologuard screening; test kits are sent via mail.
• Flexible sigmoidoscopy: Diagnostic and screening procedure that allows a physician to examine the lower part of the large intestine, specifically the rectum and sigmoid colon. For average-risk individuals, if flexible sigmoidoscopy is chosen as the primary screening method, it's typically recommended every 5 to 10 years.

*Colon cancer screenings are performed by a member of the General Gastroenterology team at our Endoscopy locations.

Conditions Identified:

• Colorectal cancer
• Precancerous polyps (adenomas)
• Inflammation from inflammatory bowel disease (IBD)
• Diverticulosis or diverticulitis
• Colonic bleeding sources
• Colonic strictures or narrowing
• Infections or ischemic changes

Overview:

A colonoscopy allows your provider to examine the inside of the large intestine using a long, flexible tube with a light and tiny camera. During the procedure, the scope is gently inserted through the rectum and advanced through the colon while air or carbon dioxide is used to expand the space for clear viewing.

A colonoscopy is the gold standard for colon cancer screening, among other diagnostic applications.

Polyps may be removed, and small tissue samples can be collected for testing. This helps detect bleeding, inflammation, or precancerous growths early, often preventing colorectal cancer and guiding treatment for chronic digestive issues.

Conditions Diagnosed:

• Colorectal cancer and polyps
• Inflammatory bowel disease (IBD)
• Unexplained bleeding or anemia
• Chronic diarrhea or constipation

Overview:

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized endoscopic procedure used to diagnose and treat problems in the bile ducts, gallbladder, and pancreas. It combines endoscopy (using a flexible tube with a camera) with X-ray imaging.

During ERCP, a scope is guided through the mouth into the small intestine. A thin tube is then inserted into the bile or pancreatic ducts, and a contrast dye is injected to make these ducts visible on X-ray. This allows the doctor not only to see blockages or narrowing but also to treat them in the same procedure.

Conditions Treated:

• Bile duct stones (choledocholithiasis)
• Biliary strictures or obstructions
• Blockages from tumors (pancreatic, bile duct, or gallbladder cancer)
• Leaks in the bile or pancreatic ducts (after surgery or injury)
• Some cases of cholangitis (infection of the bile ducts)

Overview:

Endoscopic ultrasound (EUS) combines endoscopy (a thin flexible tube with a camera) and ultrasound imaging to create detailed pictures of the digestive tract and nearby organs. The scope is passed through the mouth or rectum, and an ultrasound probe at the tip provides high-resolution images from inside the body.

EUS can be used to both diagnose and treat various gastrointestinal conditions. As a diagnostic tool, it provides detailed imaging and enables tissue sampling. As a therapeutic tool, it offers minimally invasive alternatives to surgery for drainage, pain management, and targeted interventions. It’s commonly used to evaluate mediastinal lymphadenopathy of unknown origin, pancreatic masses, and biliary tract lesions.

Conditions Treated:

• Pancreatic cysts
• Pancreatitis (chronic and acute)
• Biliary strictures or obstructions
• Bile duct stones (choledocholithiasis)
• Primary sclerosing cholangitis
• Liver metastases
• Portal hypertension
• Gastrointestinal (GI) bleeding
• Unexplained abdominal pain or bloating
• Unexplained weight loss
• Colorectal cancer

Overview:

Esophageal impedance testing measures how liquids, food, and air move through the esophagus by detecting changes in electrical resistance. It is often used alongside pH monitoring to evaluate reflux, including non-acid reflux, and provides detailed insight into esophageal function.

Conditions Diagnosed:

• Gastroesophageal reflux disease (GERD)
• Non-acid reflux
• Dysphagia (difficulty swallowing)
• Hiatal hernia
• Reflux-related symptoms not explained by acid alone

Before the Procedure:

• Do not eat or drink for 6 hours before the test
• Stop certain medications (such as acid reducers) if instructed
• Inform your doctor of any medical conditions or allergies

Overview:

Esophageal manometry is a diagnostic test that measures the strength and coordination of muscle contractions (pressure) in the esophagus during swallowing. It helps evaluate how well the esophagus moves food from the throat to the stomach and identifies abnormalities in muscle function.

Conditions Diagnosed:

• Achalasia
• Dysphagia (difficulty swallowing)
• Esophageal spasms
• Ineffective esophageal motility
• Non-cardiac chest pain
• Motility disorders

Before the Procedure:

• Do not eat or drink for 6 hours before the test
• Avoid certain medications as instructed by your provider
• Inform your doctor of any medical conditions or recent procedures

Overview:

Flexible sigmoidoscopy allows providers to view the rectum and lower part of the colon. A thin, flexible tube with a camera is gently inserted into the rectum and guided through the lower colon to inspect the lining for inflammation, ulcers, or abnormal growths. Air may be used to slightly expand the area for better visibility. The test can detect bleeding or early signs of colorectal disease quickly, often without sedation.

Conditions Diagnosed:

• Rectal bleeding
• Polyps or tumors in the lower colon
• Ulcerative colitis
• Diverticulosis

Before the Procedure:

You may use enemas or mild laxatives to clear the lower colon and follow a light diet the day before.

Overview:

An ileoscopy is performed to examine the last portion of the small intestine, called the ileum. During the procedure, a thin, flexible scope is passed through the rectum and colon into the ileum, allowing the provider to directly view the tissue lining. Biopsies may be taken if inflammation or ulcers are found. This test helps diagnose small bowel disorders that cause chronic symptoms or bleeding and may be done immediately after a colonoscopy for a complete intestinal evaluation.

Conditions Diagnosed:

• Crohn’s disease
• Small bowel inflammation
• Bleeding or ulcers in the ileum

Before the Procedure:

A full bowel prep is needed to clear the intestines. You’ll fast for several hours before the procedure.

Overview:

Push enteroscopy, also known as a push endoscopy, uses a longer endoscope to explore the upper small intestine beyond the stomach. During the procedure, the scope is gently passed through the mouth and into the small bowel, allowing your provider to inspect areas that standard endoscopy cannot reach. Air may be used to expand the bowel for better visualization. Biopsies or treatments such as dilation or lesion removal can be performed at the same time, reducing the need for additional procedures.

Conditions Diagnosed:

• Small bowel bleeding
• Celiac disease
• Tumors or strictures
• Malabsorption disorders

Before the Procedure:

Do not eat or drink for several hours beforehand. Sedation will be administered to help you relax.

Overview:

Single balloon enteroscopy (SBE) is a specialized endoscopic procedure used to examine and treat the small intestine. It uses a flexible scope with an overtube and balloon system that helps advance the instrument deep into the small bowel. The procedure may be performed through the mouth (upper approach) or rectum (lower approach), depending on the area being evaluated. It allows for direct visualization, biopsy, and treatment of small bowel conditions.

Conditions Diagnosed:

• Small bowel bleeding (obscure gastrointestinal bleeding)
• Polyps and small intestine tumors
• Inflammatory bowel disease affecting the small intestine (e.g., Crohn’s disease)
• Vascular lesions (angiodysplasia)
• Ulcers or strictures in the small intestine
• Celiac disease (in select cases)
• Abnormal imaging findings requiring further evaluation

Before the Procedure:

• Fasting for 8–12 hours prior (for upper approach)
• Bowel preparation for lower approach, as directed
• Medication review, especially blood thinners, diabetes medications, and supplements
• Arrange transportation due to sedation or anesthesia
• Follow all pre-procedure instructions provided by the care team

Overview:

An upper endoscopy, also known as an esophagogastroduodenoscopy (EGD), is a procedure that allows a healthcare provider to examine the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). Using a thin, flexible tube with a camera, the provider can identify abnormalities, collect tissue samples (biopsies), and perform certain treatments without the need for surgery.

Common Conditions Diagnosed or Treated with EGD:

• Acid reflux (GERD)
• Esophagitis (inflammation of the esophagus)
• Barrett's esophagus
• Stomach and duodenal ulcers
• Gastritis (inflammation of the stomach lining)
• Difficulty swallowing (dysphagia)
• Esophageal strictures (narrowing of the esophagus)
• Celiac disease
• Gastrointestinal bleeding
• Polyps in the esophagus, stomach, or duodenum
• Removal of swallowed foreign objects
• Dilation (stretching) of narrowed areas of the esophagus
• Control of bleeding in the upper digestive tract
• Biopsy of abnormal tissue for further evaluation

Overview:

Video capsule endoscopy uses a small, pill-sized camera that you swallow to record images of your digestive tract as it moves naturally through the system. The capsule transmits images to a recorder worn on your waist, capturing thousands of pictures of areas unreachable by traditional scopes. The test is completely noninvasive—no sedation, tubes, or recovery time—and helps identify small bowel bleeding, inflammation, and other conditions with exceptional clarity.

Conditions Diagnosed:

• Small bowel bleeding
• Crohn’s disease
• Celiac disease
• Tumors or polyps in the small intestine

Before the Procedure:

You’ll fast and may follow a liquid diet the day before. Avoid certain medications if instructed.