Endoscopy and Gastrointestinal Services
Conditions We Diagnose and Treat
Orange Regional Medical Center offers a range of procedures to diagnose and treat gastrointestinal conditions including:
- abdominal pain
- barrett’s esophagus
- bowel incontinence
- cancers of the esophagus, stomach, intestine and rectum
- cirrhosis of the liver
- colitis and other colon disorders
- hepatitis (diagnosis and management) and other liver diseases
- gastro-esophageal reflux disease (GERD)
- gallbladder stones
- irritable bowel syndrome (IBS)
- pancreatic disease
- polyps (tumors)
- gastrointestinal (GI) bleeding
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An esophagogastroduodenoscopy (EGD), also called an upper endoscopy, is an outpatient procedure that is used to examine your esophagus, stomach and the first part of your small intestine (called the duodenum). Your physician may recommend an EGD if you experience heartburn, gastroesophageal reflux disease (GERD), dysphagia (food sticking in your esophagus) or bleeding from the upper GI tract.
During the EGD procedure, your physician will pass an endoscope, or a long flexible tube that includes a light and tiny video camera at one end, through your mouth and guide it down into your esophagus, stomach and duodenum so that he/she can view these organs. Depending on what your physician sees, he/she may take a piece of tissue for a biopsy or perform a treatment procedure with special instruments attached to the endoscope. Some of these treatments are: dilation of an esophageal stricture (stretching a narrowing of the esophagus with a tube), stopping a bleeding ulcer in the stomach or duodenum, or taking a biopsy of the tissue in the esophagus to examine it for evidence of Barrett’s esophagus.
Preparing for your EGD
Your physician will give you specific instructions, but generally you must not eat or drink anything for six to eight hours before your test. Tell your physician about any medications you are taking. Prior to the test, an intravenous (IV) line will be inserted into your arm. You will be placed on a monitor that checks your heart rate, blood pressure and oxygen level. You will receive a type of medication called sedation through your IV line to make you comfortable, sleepy, less anxious and will help to diminish gagging.
What to expect during your EGD
Your gastroenterologist will pass the endoscope through your mouth into the back of your throat and ask you to swallow. The scope will then be passed down into your esophagus, stomach and duodenum. Using the endoscope, your physician or gastroenterologist will see a magnified picture of the lining of your upper gastrointestinal tract on a video monitor. He/she may take tissue samples for a biopsy or perform any treatment necessary. A typical EGD takes about 15 to 20 minutes, depending on whether there are any abnormalities, biopsies taken or therapies performed.
After your EGD
After your EGD, a nurse will monitor you until you are fully awake. Because of the sedation, you will need to have someone drive you home. You will be able to eat and drink when you return home. Your physician will call you with the results.
A colonoscopy is an outpatient procedure that your physician performs to examine the lining of the colon. A colonoscopy helps find ulcers, colon polyps, tumors and areas of inflammation or bleeding. Your physician uses a thin, flexible tube, called a colonscope, to look at the colon. During a colonoscopy, tissue samples are collected and abnormal growths can be taken out. A colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum.
The American Cancer Society recommends that men and women have their first colonoscopy at age 50. If you have a personal or family history of colorectal cancer, polyps or long-standing ulcerative colitis, your physician may recommend you have a colonoscopy before age 50.\
Preparing for a colonoscopy
Colonoscopies are generally well-tolerated by patients. On the day before the procedure, your physician will recommend you follow some dietary restrictions and use a colon cleansing method (drinking a cleansing solution or taking oral laxatives). Your colon must be completely clean for the test to be accurate. Before your appointment, check with your physician about any medications you are taking, including aspirin, anti-coagulants, arthritis medications or iron products. Also let him/her know if you have any allergies to medications.
What to expect during your colonoscopy
You should plan to arrive at the Hospital 2 to3 hours in advance for preparation, the procedure and recovery. Because your gastroenterologist will sedate you for your procedure, you cannot drive for at least 24 hours after the procedure.
While you are lying on your side, your physician will insert a thin flexible tube into your anus and slowly advance it into your rectum and colon. The tube contains fiberoptics that will enable your physician to view the inside of your digestive tract in color on a television monitor. During a colonoscopy, your physician will look for polyps, internal bleeding or other abnormalities. Using special instruments attached to the scope, he/she can remove polyps, take tissue samples for a biopsy or stop internal bleeding.
After your colonoscopy
A nurse will monitor you until your sedation wears off. You may have some cramping or bloating afterward. You must have someone drive you home. You should be able to eat when you return home. If your physician removed tissue for a biopsy or any polyps, he/she will notify you of your results.
Endoscopic Ultrasound (EUS) with FNA
Endoscopic Ultrasound (EUS) is a procedure that allows for diagnosis and staging of many cancers including lung, esophagus, stomach, pancreas, bile duct and rectum. In addition, EUS evaluates diseases of the lymph nodes of the chest, abdomen and pelvis, as well as masses in the liver. Orange Regional began using this technology in October 2011, with more than 200 procedures performed by December 2011.
EUS is a minimally invasive procedure that provides an extremely detailed ultrasound evaluation of the anatomy around the upper and lower GI tract. Fine Needle Aspiration (FNA) biopsy of lesions in the chest, abdomen and pelvis are also possible with this technology. This state-of-the-art advancement allows for rapid visual evaluation and diagnostic biopsies of primary tumors and metastatic disease to allow patients to confidently move forward with appropriate surgical, chemotherapeutic or radiation therapies. EUS/FNA complements, and in many cases replaces, previously used imaging studies and procedures that are either more invasive or less sensitive. Accurate staging diagnoses made by EUS/FNA are extremely critical in providing optimal cancer care.
Preparing for your endoscopic ultrasound
After midnight, patients must not eat or drink anything, even water. Tell our staff about any medications you are taking and whether you are allergic to medications or latex. Since you will receive sedation, you cannot drive for 24 hours.
What to expect during your endoscopic ultrasound
Your throat may be sprayed with a local anesthetic and sedation will be given to help you relax. An endoscope, or long thin tube, will then be passed through your mouth and down into your esophagus, stomach and duodenum (part of the small intestine).This special endoscope contains a light source, a special camera and ultrasound technology that produce sound waves to create visual images of your digestive tract. Special instruments may be used to obtain tissue samples.
After your endoscopic ultrasound
A nurse will monitor you until your sedation wears off. Your throat may be sore and you may feel bloated because of air or water introduced during the exam. You must have someone drive you home. Your physician will notify you of the results.
Endoscopic Retrograde Cholangiopancreatography
Endoscopic Retrograde Cholangiopancreatography (ERCP) is used to diagnose and treat abnormalities of the ducts of the gallbladder, pancreas and liver. These ducts act as drainage channels for these organs and are sometimes called bile ducts or biliary ducts. During this procedure, a flexible tube with a camera and other tools on its end (endoscope) is inserted through the mouth and into the small intestine, near the pancreas. ERCP can collect images from the area, as well as take a small biopsy with a brush.
Preparing for your ERCP
Your physician will give you specific instructions; however, in general, patients must not eat or drink anything, even water, after midnight. Your stomach must be completely empty. Tell your physician r about any medications you are taking and whether you are allergic to medications, latex or intravenous contrast material. Since you will receive sedation, you must not drive yourself.
What to expect during your ERCP
ERCP may be performed as an outpatient procedure, or you may spend one night in the hospital. You will be given sedation. You may also be given antibiotics before the procedure. While you are lying on one side on an X-ray table, your physician will pass an endoscope, a thin lighted tube, through your mouth and then down into your esophagus, stomach and duodenum (part of the small intestine). When he/she comes to the opening to the ducts from the liver and pancreas, he/she will pass a narrow plastic catheter (thin tube) through the endoscope and into the ducts. A contrast dye will be injected through the catheter and into the ducts and X-rays will be taken. You may feel some bloating because of air that is introduced during the procedure.
Your physician may perform a procedure during your ERCP. Treatments may include:
- sphincterotomy: cutting of the muscle that surrounds the opening of the ducts to enlarge the opening
- removal of bile duct stones
- stent placement to bypass narrowed areas of the ducts
- balloon dilation to open up a narrowed area or structure
- removal of tissue samples
After your ERCP
A nurse will monitor you until the sedation wears off. Your throat may be sore, and you may feel bloated or pass gas because of air introduced during the procedure. You must have someone drive you home. You should be able to resume your normal diet when you return home. Your doctor will notify you with the results.
Endobronchial Ultrasound (EBUS) is a minimally invasive procedure designed to help surgeons and pulmonologists accurately stage lung cancers and diagnose other thoracic disorders. Orange Regional introduced this innovative technology as part of our lung cancer program in 2011, enhancing our ability to stage cancer and provide an accurate treatment plan without an invasive incision.
This procedure utilizes a specialized bronchoscope that incorporates an ultrasound probe allowing the surgeon to visualize lymph nodes in the chest. A critical step in formulating a treatment plan for the patient is determining whether these lymph nodes contain cancer cells. The scope has a transbronchial needle that is passed through the wall of the airway guided by the ultrasound image to obtain tissues samples of the target lymph nodes. A pathologist accompanies the surgeon in the operating room to provide an instant and accurate assessment of the tissue samples.
This procedure replaces mediastinoscopy, which is also performed to biopsy these lymph nodes, however it requires a small incision at the base of the neck to insert a scope.
In addition diagnosis and staging of lung cancer with this procedure, other disorders, such as lymphoma and sarcodosis, can be easily detected in the chest without the need for an incision.
Radio Frequency Ablasion (RFA)
In 2011, Orange Regional became the first hospital in Orange County to offer Radio Frequency Ablation (RFA) Therapy using the HALO System. RFA is a minimally invasive endoscopic procedure that is highly effective in treating Barrett’s esophagus. a pre-cancerous condition affecting the lining of the esophagus that is commonly caused by gastroesophageal reflux (GERD). This RFA system uses an endoscope to deliver high-frequency radio waves to destroy damaged tissue in the esophagus. It is performed in an outpatient setting with moderate sedation.
Surgery and Procedure Center
707 East Main Street
Middletown, NY 10940
Gastrointestinal procedures are performed in our Surgery and Procedure Center at the Main Campus of Orange Regional Medical Center, located on the first floor, and may be accessed by entering at the Main Entrance. The Surgery and Procedure Center contains 12 operating rooms, procedure rooms for cardiac catheterizations, endoscopy and interventional radiology, patient pre- and post-operative recovery and a waiting reception area.