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4015 I-45 N Suite 210-B
Conroe, TX 77304

WOODLANDS

9200 Pinecroft Dr. Suite 480
Shenandoah, TX 77380

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Phone: 281.205.1111
Fax : 281.419.2111



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Procedures

COLONOSCOPY

Colonoscopy is the endoscopic examination of the colon. Colonoscopy enables your physician to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger and has a fiber optic camera and light source into the anus and advancing it slowly into the rectum and colon.

A colonoscopy is done to enable a doctor, usually a gastroenterologist to examine the inside of the colon. It is done by using the colonoscope which is a four-foot long, flexible tube with a camera at the end.
There are many reasons why a colonoscopy may be done.
• To screen for colon cancer.
• To investigate blood in stools
• Abdominal pain
• Diarrhea
• Change of bowel habits
• Abnormality found in X-Ray or CT scan
Some people who have had a history of polyps or colon cancer and those with a family history of colon cancer may be advised to have a colonoscopy periodically to make sure that everything is normal.

Medications may be administered to promote relaxation and keep you comfortable during the procedure. During the procedure, a flexible tube called a colonoscope is inserted through the rectum into the colon. The tube is about the diameter of an index finger, and is lubricated to allow for easier insertion. Your doctor will then gently pump air or CO2 and sterilized water or saline through the colonoscope to inflate the colon so that the entire lining can be viewed.

If your doctor finds any abnormal areas, he or she may take a biopsy. If there are any polyps present, they may be removed as well. Polyps are tissue growths that are generally benign, but can develop into cancer if they are allowed to grow.

Following your colonoscopy, you will be moved to a recovery area until the effects of the medication have worn off. You may continue to feel bloated and have gas cramps. It is completely normal to pass gas both during and after the procedure–it is actually encouraged that you pass gas, as it will relieve the bloating and cramps.

Medications may make you groggy or limit your activities; follow your doctor’s advice. If you had to stop taking any medications prior to the test, your doctor will advise you on when you should resume those medications. If your doctor took any biopsies or removed any polyps, your doctors’ office will contact you when results are available.

With any medical procedure there is a risk of complications. With colonoscopy, complications are rare, but you should call your doctor immediately if you experience severe abdominal pain, a firm, bloated abdomen, vomiting, fever, or rectal bleeding.A colonoscopy poses few risks. Rarely, complications of a colonoscopy may include:
• Adverse reaction to the sedative used during the exam
• Bleeding from the site where a tissue sample (biopsy) was taken or a polyp or other abnormal tissue was removed
• A tear in the colon or rectum wall (perforation)
After discussing the risks of colonoscopy with you, your doctor will ask you to sign a consent form authorizing the procedure.

SMALL BOWEL CAPSULE ENDOSCOPY

Capsule endoscopy with PillCamTM SB video capsule enables your doctor to examine your entire small intestine. Your doctor will have you ingest a vitamin-pill sized video capsule, which has its own camera and light source. During the 8 hour exam, you are free to move about. While the video capsule travels through your body, it sends images to a data recorder you will wear on a waist belt. Afterwards your doctor will view the images on a video monitor.

Capsule endoscopy helps your doctor determine the cause for recurrent or persistent symptoms such as abdominal pain, diarrhea, bleeding or anemia. In certain chronic gastrointestinal diseases, this method can also help to evaluate the extent to which your small intestine is involved, or monitor the effect of treatment. Your doctor might use capsule endoscopy to obtain motility data such as gastric or small bowel passage time.

Preparation instructions will be given to you before the examination. An empty stomach allows optimal viewing, so you should start a liquid diet after lunch the day prior to the examination. You should have nothing to eat or drink, including water, for approximately ten hour before a small bowel examination. Your doctor will tell you when to start fasting. It is important that you discuss with your doctor in advance any prescription or over the counter medications you take regularly as you may need to adjust your usual dose before the examination. Also, alert your doctor of the presence of a pacemaker or other implanted electromedical device, previous abdominal surgery, swallowing problem or previous history of obstructions in the bowel.

The doctor or nurse will prepare you for the examination by applying a sensor array to your abdomen with adhesive sleeves. The capsule endoscope is ingested with water and passes naturally through your digestive tract while transmitting video images to a data recorder worn on a belt for approximately eight hours. You will be able to eat four hours after the capsule ingestion unless your doctor instructs you otherwise.

At the end of the procedure, you will need to go back to your doctor to return the data recorder and sensor array. The images acquired during your exam will then be downloaded for your doctor to review. You should not have a Magnetic Resonance Imaging (MRI) examination or be near an MRI machine after ingesting the capsule until it is excreted. The capsule is disposable and passes naturally with your bowel movement. You should not feel any pain or discomfort.

Complications from capsule endoscopy rarely occur, especially when doctors who are specially trained and experienced in this procedure perform the test. One potential risk could be retention of the capsule. Although complications after capsule endoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact the physician who performed the procedure immediately if you notice any of the following symptoms: fever, trouble swallowing or increasing chest or abdominal pain.

UPPER ENDOSCOPY (EDG)

Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a procedure used to examine the lining of the esophagus (swallowing tube), stomach, and upper part of the small intestine (duodenum). The doctor may perform this procedure to diagnose and treat when possible certain disorders of the upper GI tract. Often it is used to investigate symptoms of abdominal pain, difficulty swallowing, prolonged nausea & vomiting, heartburn, unexplained weight loss, anemia, or blood in your bowel movements.

It is necessary to have a completely empty stomach for a safe and thorough examination. You should eat nothing solid for approximately 6 hours before the procedure. You may however, drink water or clear liquids up to 2 hours before procedure. Several days before the examination you should notify the physician of any prescribed or over the counter medications you take regularly, any heart or lung conditions, any major diseases, and whether you have any drug allergies. If you require antibiotics prior to undergoing dental procedures you should alert your physician, as you may need antibiotics prior to colonoscopy as well.

Your physician will review with you why EGD is being performed, potential complications from EGD, and alternative diagnostics or therapeutic tests that are available. A local anesthetic may be applied to your throat and an intravenous sedative will be given to make you more comfortable during the test. Some patients may also receive antibiotics before the procedure. Most patients remember or feel very little of the examination and many patients fall asleep during the test. The test begins with you lying comfortably on your left side. The endoscope is then passed through the mouth, esophagus and stomach into the duodenum. The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. The test usually lasts between 5 and 15 minutes.

After the test, you will be monitored in the recovery room until most of the effects of the medication have worn off. Your throat may be a little sore for a while and you may feel bloated right after the procedure because of air introduced into your stomach during the test. In most circumstances, your doctor can inform you of your test results on the day of the procedure; however, the results of any biopsies or cytology samples will take several days.

EGD is a generally safe procedure. Complications can occur but are rare when the test is performed by a physician with special training and experience in this procedure. Bleeding may occur in approximately 0.1% from a biopsy site or where a polyp was removed. It is usually minimal and rarely requires blood transfusion or surgery. Phlebitis, or localized irritation of the vein into where medication was injected, may cause a tender lump that could last several weeks, but this will go away eventually. The application of heat packs or hot moist towels may help relieve the discomfort. Other potential risks include a reaction to the sedatives used and complications from heart or lung diseases. Major complications, such as perforation, a tear that may require surgery for repair, are very uncommon (less than 1%). Although complications after EGD are uncommon, it is important for you to recognize early signs of any possible complication. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest or abdominal pain, contact your doctor immediately.

ERCP

ERCP is a procedure that enables your physician to examine the pancreatic and bile ducts. A bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and first part of the small intestine (duodenum). In the duodenum a small opening is identified (ampulla) and a small plastic tube (cannula) is passed through the endoscope and into this opening. Dye (contrast material) is injected and X-rays are taken to study the ducts of the pancreas and liver.

ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice (yellowing of the skin), or an ultrasound or CT scan that shows stones or a mass in these organs.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

It is necessary to have a completely empty stomach for a safe and comprehensive examination. You must fast for at least 4-6 hours before the procedure. An allergy to drugs containing iodine (contrast material or ñdyeî) is not a contraindication to ERCP, but it should be discussed with your physician before the procedure. The physician performing the procedure should be informed of any prescription or over the counter medications you take regularly, any heart or lung conditions, any other major diseases, and whether you have any drug allergies.

Your physician will discuss why ERCP is being performed, potential complications from ERCP, and alternative diagnostic or therapeutic tests that are available. A local anesthetic may be applied to your throat and an intravenous sedative will be given to make you more comfortable during the test. Most patients remember or feel very little of the examination. Some patients may also receive antibiotics before the procedure. The test begins with you lying face down with your head to the right on an x-ray table. The endoscope is passed through the mouth, esophagus and stomach into the duodenum. The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. The injection of contrast materials, or dye, into the ducts rarely causes discomfort. The duration of the test varies anywhere from 15 minutes to 2 hours.

The risks of ERCP include complications such as the following:

+ pancreatitis
+ Infection of the bile ducts or gallbladder
+Excessive bleeding, called hemorrhage
+ An abnormal reaction to the sedative, including respiratory or cardiac problems
+ Perforation in the bile or pancreatic ducts, or in the duodenum near the opening where the bile and pancreatic ducts empty into it
+ tissue damage from x-ray exposure
+ death, although this complication is rare

Research has found that these complications occur in about 5 to 10 percent of ERCP procedures. People with complications often need treatment at a hospital.

If you are having ERCP as an outpatient, you will be kept under observation several hours until most of the effects of the medications have worn off. Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation or treatment is necessary. You may experience bloating or pass gas due to the air introduced during the procedure. You may resume your usual diet unless instructed otherwise.

ORBERA WEIGHT LOSS SYSTEM

The Orbera Gastric Balloon is a non-surgical weight loss procedure which involves the placement of a soft, yet durable balloon into your stomach. The balloon takes up enough space in your stomach to help you adapt to healthier portion sizes. It also slows down digestion which keeps you fuller longer. It is an FDA Approved procedure designed as a two part series to achieve long term results.

In a non-surgical procedure called endoscopy, the thin deflated balloon is placed into your stomach. It is then filled with sterile saline until it is the size of a grapefruit. This is an outpatient procedure which takes about 20-30 minutes and patients resume normal activity within 24 hours. The balloon is also removed after six months by deflating the balloon before removing. This procedure is done at an Ambulatory Surgery Center with mild anesthesia.

The benefits of our Orbera weight loss system include –
• Non-surgical weight loss procedure.
• No incisions, stiches or permanent surgical scars.
• Rapid weight loss up to 3.1x compared to diet and exercise alone. Most weight lost in the first three months.
• Reversible if needed or intolerable.
• Individual one on one coaching tailored customized meal and exercise plans to achieve lasting results.
• Learn healthy habits to keep weight off even after balloon is removed.

• Adult aged 21 and over
• BMI of > 30
• Need to lose weight prior to needed orthopedic or cosmetic surgery.
• Have other comorbidities which will improve with weight loss (e.g. Diabetes, Hypertension, Fatty Liver Disease).

• Persons with previous weight loss surgeries e.g. Gastric bypass, Gastric sleeve, Gastric resection, Lap Band.
• Persons with severe damage to the liver.
• Persons with diagnosed gastroparesis and taking treatment for it.
• Persons taking prescription Aspirin, anti-inflammatory agents, anticoagulants (blood thinners) or other gastric irritants daily.
• Persons who are pregnant or breastfeeding.
• If you have an active stomach ulcer or other irritations.

• Two part system of weight loss working with an Orbera Coach post procedure.
• Orbera Coach provides personalized support and motivation you need to achieve your weight loss goals.
• Includes 12 Monthly 1:1 sessions with a registered dietitian/coach
• Includes 12 Monthly group sessions
• Hundreds of ORBERA® appropriate food recipes
• Mobile Apps: iOS and Android to keep you on tract
• Unique picture based food diary
• Utilization of the complete two system approach ensures longer lasting weight loss.

• Inability to accept a foreign object placed in your stomach.
• Nausea, vomiting, dehydration.
• Stomach pain, back pain, or acid reflux.
• Partial bowel blockage.
• Negative health consequences resulting from weight loss.
• Bacterial growth in the fluid filling the balloon which can lead to infection.
• Injury to the lining of the digestive tract, stomach or esophagus.
• Balloon deflation.

FLEXIBLE SIGMOIDOSCOPY

Flexible sigmoidoscopy is a procedure that enables your physician to examine the lining of the rectum and a portion of the colon (large bowel) by inserting a flexible tube that is about the thickness of your finger into your anus and advancing it slowly into the rectum and lower part of the colon.

The rectum and lower colon must be completely empty of waste material for the procedure to be safe, accurate and complete. Your physician will give you detailed instructions regarding the cleansing routine to be used. In general, preparation consists of two enemas prior to the procedure. In some circumstances, for example, if you have acute diarrhea or colitis, your physician may advise you to forgo any special preparation before the examination.

Flexible sigmoidoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of pressure, bloating, or cramping at various times during the procedure. During the procedure you will be lying on your left side while the sigmoidoscope is advanced through the rectum and colon. The lining of the intestine is carefully examined as the instrument is withdrawn. The procedure usually takes anywhere from 5 to 15 minutes.

After sigmoidoscopy, the physician will explain the results to you. You may have some mild cramping or bloating sensation because of the air that has been passed into the colon during the examination. This will disappear quickly with the passage of gas. You should be able to eat and resume your normal activities after leaving your doctor’s office or the hospital.

Flexible sigmoidoscopy and biopsy are generally safe and well tolerated when performed by physicians who have had special training and experience in these endoscopic procedures. While possible complications after flexible sigmoidoscopy are rare, it is important for you to recognize early signs of any possible complication. Contact your physician immediately if you notice any: severe abdominal pain, fever and chills, or rectal bleeding of more than one half cup. It is important to note that some rectal bleeding can occur even several days after the biopsy.

H. PYLORI BREATH TEST

1- This test is administered by a nurse or Medical Assistant in the office. It takes a total of 30 minutes.

2- please fast for at least one hour before the test

3- Do not smoke, chew gum or chew tobacco the morning of the test. This will affect the test results.

4- Do not take any antibiotics, proton pump inhibitors, or Bismuth preparations (eg Protonix, Nerium, Zantac etc) within 2 weeks prior to performing this breath test.

5- Allow 15 minutes between the 2 breath tests administered. Follow the instructions of the staff nurse administering the test.

COLON CANCER SCREENING

Causing the death of 55,000 patients per year colon cancer is the #2 cancer killer in the United States. Almost all colon cancers start out as a polyp on the inside wall (lumen) of the colon. Polyps begin as small wart-like bumps the size of an unground peppercorn. Over a period of 5-10 years, some of these polyps continue to grow to be 1-2 inches in diameter. At any time a microscopic size cancer (adenocarcinoma) may develop somewhere on the polyp. This usually occurs in polyps greater than 1 cm in diameter. Once a cancer develops in the polyp, it will eventually spread throughout the polyp, into the wall of the colon, then through the wall into surrounding tissues, lymph nodes, and possibly to the liver and/or lungs. It is unknown what percentage of polyps become cancer; however, it is known that approximately 40% of adults over the age of 50 have polyps and about 5% of the population will eventually develop colon cancer. This leads to the estimation that 10 – 15% of patients with polyps will eventually develop colon cancer.

The factors involved in what causes polyps or what causes polyps to be malignant (cancerous) are also unknown. Much of the risk has been determined to be genetic. Some weak evidence exists that you are more likely to develop colon cancer if you are overweight, smoke, drink excessively, don’t exercise, and eat a diet that is high in animal fats and low in fiber, fresh fruits, and vegetables. Some supplements that have been proposed to lower the risk of colon cancer (but none proven) include calcium (1200 mg/d), fiber supplements, vitamin E (200-400 IU/d). vitamin C (500 – 1000 mg/d), folic acid (400 mgm/d) and NSAID/aspirin use.

The best way to detect colon cancer is to undergo periodic screening on order to detect polyps before they become malignant. Whenever a polyp is detected, the patient should have a complete colonoscopy to look for any other polyps and remove all of them. Taking into consideration risk and cost, the best way to do this (given our current knowledge and understanding, which will certainly change in the future with new studies and technology) is to undergo a complete colonoscopy at age 50 and every 10 years after that until age 80. Some patients are at higher risk due to family history of colon cancer or polyps and need more frequent exams beginning at age 40 or earlier. Please let us know if you have a history of colon cancer or polyps in the family. Once polyps are detected, you should have a colonoscopy every 3-5 years to detect new polyps.

Eating a healthy diet, exercising, not smoking, limiting alcohol consumption to no more than 2 drinks per day, and avoiding obesity is a good way to prevent heart disease, strokes, and many cancers. However, the most effective method of preventing colon cancer is regular screening. Please consider undergoing these tests, not only for yourself, but your loved ones as well.

If your insurance does not pay for screening colonoscopies and you do not have an acceptable reason (to the insurance company) for colonoscopy (such as rectal bleeding, diarrhea, a change in bowel movement, etc.) then the next best choice is to either pay out of pocket or undergo a barium enema/ flexible sigmoidoscopy every 5 years.