• Upper digestive system endoscopy (Esophagogastroduodenoscopy)

• Colonoscopy

• Endoscopic retrograde cholangiopancreatography (ERCP)

• Percutaneous endoscopic gastrostomy (PEG) Opening

• Endoscopic Ultrasonography (EUS)

• Video Capsule Endoscopy (VCE)

• Double-balloon enteroscopy

• Manometry – pH metry

• Gastric balloon placement (intragastric balloon)

A part of our endoscopy procedures are diagnostic, while another part consists of therapeutic interventions.

Diagnostic and therapeutic endoscopic interventions

• Polypectomy

• Sclerotherapy

• Bougie and balloon dilatation in esophageal stricture

• Stent implantation in colon and esophageal stricture

• Esophageal band ligation

• Band ligation for hemorrhoids

• Injection of sclerosing agents into the fundus varices

• Foreign body removal

• Percutaneous endoscopic gastrostomy (PEG)

• Argon plasma coagulation (APC)

• Gallstone removal from bile ducts with the help of balloon and basket

• Gastric balloon placement

Esophagogastroduodenoscopy

• It is the examination procedure of the upper gastrointestinal system; so to say esophagus, stomach and duodenum. This procedure is performed through endoscopy equipment. Said tool is soft, plastic, cable shaped in the thickness of the little finger. It is a camera system that transfers the image in the way that it passes to the television screen.

• When is gastroscopy necessary?

• Problems related with swallowing (painful swallowing, difficulty in swallowing solid or liquid foods, downward of nutrients by hanging out, etc.).

• Acid indigestion and burning not relieving with medical treatment.

• Abdominal pain (rodent natured or persistent pain in the mid-upper abdomen emerging when hungry or a few hours after eating).

• Red colored or coffee ground looking blood coming during vomiting.

• Vomiting with abdominal pain.

• Observing abnormality in stomach X-rays with barium

How to get prepared for gastroscopic examination and how is it performed?

• It is sufficient to stay hungry for 6-8 hours for the investigation. Water or light tea may be drunk during this time. If you previously have rheumatic valvular heart disease, two different antibiotic injections are made 2 hours before and 8 hours after the procedure. On the other hand, if you have congenital bleeding-related or other diseases, it is useful to report this to your physician before the procedure.

• A spray that stops nausea and vomiting, similar to that used by dentists, with an effect duration of fifteen minutes is sprayed to the throat before starting the procedure. The endoscopy procedure in very stressful patients is started after the patients are relaxed by intravenously administering relaxing medications, if there is no other medical inconvenience. Said procedure is not a surgical intervention. Therefore, it does not require anesthesia and completely sleeping.

What kind of procedure is colonoscopy and how is it performed?

• It is the imaging of whole large and small intestines and the neighboring parts of the large intestine by entering through the anus with a thin and flexible pipe with camera at the end. The examination of the portion of the large intestine close to the anus is called sigmoidoscopy. It is required to clean the bowels before the procedure with the help of the laxative. It is the most reliable method for the diagnosis of colon (large intestine) cancer. Furthermore, it protects the patients against cancer by providing the detection and removal of the polyps and similar precancerous lesions. The examination is recommended for anyone over 50 years old in order to be protected against colon cancer. It is required for those with colon cancer in the close relatives to get performed colonoscopy 10 years before the age of the youngest cancer patients in the family. The majority of colon cancers develop over the benign tumors called polyps. Colonoscopy performed at the appropriate time enables to find and remove the polyps in earlier stage before the development of cancer. In this way, the patients recover from both the cancer and surgery. Those polyps are removed from their colon should have follow-up colonoscopy performed once in every1 to 3 years according to the feature of the polyp. Colonoscopy is also used in the diagnosis and follow-up of non-cancer colon diseases such as ulcerative colitis, Crohn’s disease. Colonoscopy can recover patients from being operated by ensuring the diagnosis and treatment of large intestine bleedings.

How to get prepared for colonoscopic examination?

• It is required to clean the bowels before the procedure with the help of the laxative.
• The details are told to the patient by specialist physician as the preparation phase varies according to the person.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

• It is used in the diagnosis and treatment of elements such as gallstones, tumors that may cause inflammation of the bile ducts (cholangitis), inflammation of the pancreas (pancreatitis) by creating stricture or blockage in the bile ducts and pancreatic duct. The intervention is performed using a videoendoscopic device (duodenoscope). The procedure is carried out for a time ranging from 20 minutes to one hour. The patient is examined before the procedure and the necessary tests are seen. The person to be performed ERCP must be hungry for at least 8 hours before the procedure. In addition, if there is usage of anticoagulant medications such as Aspirin, Coumadin, these should be stopped a week before the procedure.

• ERCP procedure is performed by laying the patients in the left lateral position on the X-ray table. Local anesthetic spray is sprayed into the patient’s throat in order to swallow the endoscope before the procedure comfortably, and sedatives and analgesics are administered intravenously. Thus, although the patient is dormant during the procedure, the patient is conscious and can be communicated when needed. The patient, who was performed sedation, is entered orally via side viewing endoscope. Duodenoscope allows the visualization of the transition to the second part of the duodenum and the region that bile ducts are opened to the intestine.

EUS

• Ultrasonography is a method in clinical practice commonly used especially in the diagnosis of digestive system diseases. Although, it is similar to X-ray with the imaging feature, it does not contain radiation.

• Endoscopic ultrasound (EUS) is performed by placing a mini ultrasound device that emits sound waves and records in the tip of the devices used in digestive system endoscopy and called as endoscope.

• EUS is used for staging tumors that occur in the digestive system or in organs adjacent to the digestive system (tumor size and depth, metastasis of lymph nodes and adjacent organs, etc.) and to examine the lesions localized under the epithelium in the digestive system, as it shows the wall layers in the digestive system in detail.

• It is a very helpful method in the evaluation of especially esophagus, stomach, pancreas and biliary ducts; and it is conditionally superior to other imaging methods.

• Tissue samples from the tumors originating from the digestive system and organs adjacent to the digestive system can be obtained via EUS; cysts and similar formations can be emptied (interventional EUS).

VCE

•The digestive system is in the form of a long channel that extends from mouth to anus. Although it is possible to examine esophagus, stomach, duodenum and colon that creates the beginning and the last part of this channel by endoscopic methods such as gastroscopy and colonoscopy, it is not possible to examine its middle part consisting of three parts called duodenum, jejunum and ileum.

• Capsule endoscopy, which is a method developed for this purpose, is a video capsule in a large pill size that has its own light source and camera.

How is VCE performed?

1. 12 hours of hunger.

2. Sensors are placed on the patient.

3. Data recorder and battery system are dressed to the patient via special belts.

4. The capsule is swallowed.

5. The patient may begin to consume clear liquids foods 2 hours after the capsule is swallowed, and can eat a light lunch after about 4 hours.

6. The patient is discharged or the equipment on her/him is removed after 12 hours of recording; delivered to the unit.

7. The patient should not do heavy exercise and not to have MRI imaging etc. performedon the day of the procedure.

VCE – Imaging Samples

Normal intestine

PEG Placement

Feeding tube insertion to the stomach is called PEG. The procedure is performed during endoscopy and takes roughly 20 minutes. As a general rule, PEG insertion indication is present in patients that cannot be fed longer than 3 weeks. The inserted tube is not used for about 12 hours. However, nutritious foods and nutrients are easily administered through the tube afterwards. The tube must usually be replaced annually.

• Who should be opened PEG?

It can be inserted to the patients;

• In oncological disorders

– Tumors in ear, nose and throat region.

– Tumors in the upper region of the gastrointestinal system.

– Palliative in cases that cannot be operated.

• Neurological disorders

– Cerebrovascular stroke,

– Brain tumors,

– Bulbar paralysis,

– Parkinson’s disease,

– Cerebral palsy and

– End-stage Alzheimer’s disease and unable to swallow food

• It is a procedure that makes life quite easy in terms of both the patient and those making the care of the patient. The patient should not drive because the effect of sedation administered before the procedure will last 3-4 hours more Therefore, it is absolutely recommended to come to their appointment with someone to get them back to their homes.

Gastric Balloon Placement

It is placed endoscopically, and removed endoscopically.

– The balloon endoscopically placed into the stomach is filled with 500-700 ml normal saline.

– It provides pat person to lose weight by reducing the person’s food intake with the help of diet.

– It stays in stomach for 6 months. It should not be left more than 6 months.

– It must absolutely be implemented by gastroenterologists with endoscopy experience, and the patient’s follow-up should be carefully made.

Who can be performed gastric balloon?

– It provides maximum benefit to the patient in reducing the risk of other diseases due to obesity (Type II diabetes, cardiovascular diseases, joint diseases, and so on) significantly.

– It helps to reduce surgical risks by slimming the obese patients, who will be operated for any reason, before surgery.

– It ensures obese people to lose weight a minimum of around 20-25% within 6 months.

– The patients, who will be performed, to be well adjusted individuals with good expectations is an important condition in terms of being successful in the treatment.

In what conditions should gastric balloon not performed?

• Alcoholics, fat drug addicts.

• Those who have mental disorders (can be used for 3 months in a psychiatrist’s supervision).

• Fat people using NSAIDs, anticoagulants and systemic corticosteroids.

• Fat patients with previous laparotomy.

• Fat patients with previous major laparoscopic surgery.

• Fat people that have infectious intestinal disease.

• Fat people with gastrointestinal problems such as esophagitis, ulcers.

• Fat people that do not comply with body mass index criteria

Endoscopy is the examination of the interior of hollow organs like the stomach by directly imaging with advanced optical devices.

How to get prepared for endoscopic examination?

It is sufficient to stay hungry for 6-8 hours for the investigation. Water or light tea may be drunk during this time. If you previously have rheumatic valvular heart disease, two different antibiotic injections are made 2 hours before and 8 hours after the procedure. On the other hand, if you have congenital bleeding-related or other diseases, it is useful to report this to your physician before the procedure.

• The diagnosis and treatment of hepatitis B and C infections of the liver, alcohol-induced liver disease, fatty liver disease and other metabolic diseases are carried out successfully.

• The treatment and close follow-up of cirrhosis, which is an advanced stage of liver failure that can occur for various reasons, and its complications can be possible.

• Needle biopsy of the liver, which is very important for the diagnosis of liver disease, the determination of the degree of liver damage and response to the performed treatment, is performed safely in our patients that require.

• Ablation therapy used in the treatment of primary and metastatic liver tumors is carried out together with our interventional radiology clinic.

FIBROSCAN

* A method that can be used to measure the degree of damage in the liver caused by the disease in liver diseases related with different causes

* It is also a helper in the evaluation of response to performed treatments

* Chronic viral hepatitis (hepatitis B and C)

* Fatty liver disease

* Chronic liver diseases due to other causes

* The diagnosis and follow-up of liver cirrhosis

“Do not postone!

Early Diagnosis and Correct Surgical Intervention Can Give Opportunities of Long Life to the Patients.”

Approximately 850 thousand people on earth catch colon (large intestine) cancer every year and one of every 4000 people dies due to this cancer.

Risk Factors;

Advanced Age: Risk increases after 50 years of age. It increases two times more within every 10 years.
Family history : People who has first and second degree relatives with colon cancer.
Polyp: People with family history of polyp related diseases or whose previous tests results revealed polyp.
Inflammatory bowel disease: People with Ulcerative colitis and Crohn disease
Life style: People who do not do exercise, drink alcohol and smoke.

What is colonoscopy?

It is a procedure of imaging interior surface of large intestines with telescope and recording. Most sensitive technique recommended in scanning program. When this procedure is performed by using anesthetic agents, it is completely trouble-free and painless. It is possible to obtain biopsy specimen from intestines and extract polyps which might progress and become cancer,

“Colon Cancer Is a Disease Which Might Be Prevented Due To Screening Programs.”

Who should have intestinal screening?

• All women and men above 50 years of age
• People who is diagnosed with colon cancer below 60 years of age and has first or second degree relatives with colon cancer
• People with inflammatory bowel syndrome, Crohn disease and Ulcerative colitis, (8 to 10 years after the beginning of disease)
• People with polyps or family history of polyp

Fecal occult blood should be analyzed every year, left colonoscopy should be performed once in five years, colonoscopy should be performed once in 10 years and specified program should be started at the age of 40.