This is a procedure which allows the doctor to see inside your oesophagus, stomach, and the first part of the small intestine (duodenum) and examine the lining directly. What to expect The gastroscope is a plastic-coated tube about as thick as a ballpoint pen and is flexible. It has a tiny camera attached that sends images to a viewing screen. During the test you will swallow the tube but the back of your throat will be sprayed with anaesthetic so you don’t feel it. You will be offered a sedative (medicine that will make you sleepy but is not a general anaesthetic) as well. Not all patients require sedation for this procedure. If the doctor sees any abnormalities they can take a biopsy (a small piece of tissue) to send to the laboratory for testing. This is not a painful procedure and will be performed at the Day Stay Unit in a theatre suite (operating room) by a specialist doctor with nurses assisting. Complications from this procedure are very rare but can occur. They include: bleeding after a biopsy, if performed an allergic reaction to the sedative or throat spray perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). Before the procedure You will be asked not to eat anything from midnight the night before and not to take any of your medications on the day of the procedure. After the procedure You will stay in the Day Stay Unit until the sedation has worn off which usually takes 1-2 hours. You will be given something to eat or drink before you go home. If you have been sedated, you are not to drive until the following day. If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP. Gastroscopy Information Sheet (PDF, 65.4 KB)

This is a procedure which allows the doctor to see inside your large bowel and examine the surfaces directly and take biopsies (samples of tissue) if needed. Treatment of conditions can also be undertaken. What to expect The colonoscope is a flexible plastic-coated tube a little thicker than a ballpoint pen which has a tiny camera attached that sends images to a viewing screen. You will be given a sedative (medicine that will make you sleepy but is not a general anaesthetic). The tube is passed into the rectum (bottom) and gently moved along the large bowel. The procedure takes from 10 minutes to 1 hour and your oxygen levels and pulse rate are monitored throughout. Before the procedure You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test as the bowel needs to be completely clean for the procedure. Risks of a colonoscopy are rare but include: bleeding if a biopsy is performed allergic reaction to the sedative perforation (tearing) of the bowel wall. The risk of a significant complication is about 1 in a 1000 procedures.

This procedure is similar to a gastroscopy but uses a much longer tube in order to examine the small intestine.The procedure takes 20-60 minutes and often involves x-ray screening to determine the position of the tube in the small intestine. Enteroscopy Patient Information (PDF, 71.5 KB)

Flexible sigmoidoscopy is a limited form of colonoscopy in which only the lower part of the colon and rectum is examined. Preparation for the procedure is usually with enemas. The procedure can be done with or without sedation. A colonoscope is used for the procedure and biopsies, polyp removal and other treatments can be undertaken during the procedure. Flexible Sigmoidoscopy Patient Information (PDF, 51.5 KB) Fleet Enema Patient Information (PDF, 19.2 KB)

A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while you are under sedation (medication to make you drowsy). A smaller tube is then moved through the first tube into the bile duct (the tube that connects your gallbladder to your intestines), or the pancreas duct, through which dye is injected and an x-ray is taken to visualise the ducts. This procedure enables the removal of stones from the ducts without the need for surgery and also allows for the placement of small drainage tubes (stents) to relieve a blockage in the bile ducts. Possible complications include inflammation of the pancreas in 2-4% of patients, bleeding or perforation of the wall of the intestine. ERCP Patient Information (PDF, 68 KB)

Endoscopic ultrasound is a technique which uses a specialised gastroscope to obtain ultrasound images of the oesophagus, lungs, stomach, duodenum, pancreas and bile ducts. It is particularly helpful in the diagnosis and staging of cancer. EUS Patient Information (PDF, 52.2 KB) EUS-FNA Information (PDF, 52.3 KB)

This is a simple painless test to determine whether the bacteria Helicobacter pylori is present in the stomach. The test involves collecting a sample of your breath in a test tube and then you drink a small amount of fluid containing a non radioactive isotope. A further breath sample is taken 30 minutes later to complete the test.

The best way to establish what type of liver disease is present and the extent of the disease, is a biopsy. It is usually performed by inserting a needle into the liver through the skin and taking a small sample of liver tissue. Examination of the sample under the microscope can demonstrate what damage or what type of disease is present. Before your doctor does this procedure, they will check whether or not you are at increased risk of bleeding by doing blood tests. Following the procedure, you will need to be monitored for several hours before you are discharged to go home. This procedure is performed under ultrasound guidance in the x-ray Department. You will be observed for 3-4 hours after the procedure with regular observations by a nurse. Complications are rare - less than 1 in a 100 and include pain, bleeding and bowel injury.

This is inflammation of the liver, commonly caused by viruses. Hepatitis B and C are viruses that can cause chronic (long term) inflammation and damage to the liver. These viruses are passed from person to person through body fluids. For more information about Hepatitis B and C see www.hepatitisfoundation.org.nz Alcohol can affect the liver and cause inflammation which, if long term, can damage the liver permanently.

Cirrhosis is the term used to describe a diseased liver that has been badly scarred, usually due to many years of injury. Many people who have developed cirrhosis have no symptoms or have only fatigue, which is very common. However, as the cirrhosis progresses, symptoms often develop as the liver is no longer able to perform its normal functions. Symptoms include: swollen legs and an enlarged abdomen easy bruising and bleeding frequent bacterial infections malnutrition, especially muscle wasting in the temples and upper arms jaundice (a yellow tinge to the skin and eyes) confusion. Cirrhosis is diagnosed using a number of tests including: blood tests, ultrasound scans and a biopsy of the liver. Treatment options depend on the severity of damage to the liver and include dietary changes and avoidance of substances such as alcohol that can further damage the liver. Medication may be given to prevent complications and treat symptoms of liver failure. There is no cure other than liver transplantation.

Peptic ulcers are areas of deep erosions that form in the lining of the digestive tract. They usually occur in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer), which is the first part of the small intestine. People with peptic ulcers can have a wide variety of symptoms and signs, can be completely symptom-free or, much less commonly, can develop potentially life-threatening complications such as bleeding. Signs and symptoms of ulcers include: pain / burning or discomfort (usually in the upper abdomen) bloating an early sense of fullness with eating lack of appetite nausea vomiting bleeding, which is made apparent by blood in the stool, either in noticeable or microscopic amounts (very brisk bleeding will result in black and tarry stools that smell bad). Smoking, alcohol, anti-inflammatory medication and aspirin increase the risk of developing ulcers. Psychological stress and dietary factors (once thought to be the cause of ulcers) do not appear to have a major role in their development. Helicobacter pylori, a bacteria that is frequently found in the stomach, is a major cause of peptic ulcers. If this is found you will be given a course of antibiotics. This bacteria can be diagnosed on blood tests, stool tests and a special breath test as well as on a tissue sample from the stomach (biopsy). Diagnosis is made by the history, examination and sometimes blood tests. You may be asked to have a gastroscopy (see above) to clarify the diagnosis and aid with treatment. Treatment consists of medication to reduce the amount of acid in the stomach which aids in the healing of ulcers, and avoidance of things that cause ulcers in the first place.

Polyps are small growths in the lining of the intestine. Usually these do not cause symptoms but as the polyps grow they may cause bleeding. Nearly all cancers start as a polyp but only a small proportion of polyps develop into cancers. Removal of polyps during colonoscopy reduces the chance of a cancer developing in the bowel.

There are two types of IBD, ulcerative colitis and Crohn’s disease. In these conditions, the immune system attacks the lining of the colon causing inflammation and ulceration, bleeding and diarrhoea. In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease areas within the entire intestine can be involved. Both diseases are chronic (long term) with symptoms coming (relapse) and going (remission) over a number of years. Symptoms depend on what part of the intestine is involved but include: abdominal pain diarrhoea with bleeding tiredness fevers inflammation around the anus (bottom) weight loss can occur if the condition has been present for some time. Diagnosis is made when the symptoms, examination and blood tests suggest inflammatory bowel disease and usually requires a colonoscopy with biopsy. Treatment depends on the severity of the symptoms and what part of the intestine is affected. Medication is aimed at reducing inflammation or suppressing the immune system which is harming the lining of the bowel. This is done via oral or intravenous medication as well as medication given as an enema or suppository (via the bottom). Other treatments include changes in the diet to optimise nutrition and health. Treatment in some cases requires surgery to remove affected parts of the bowel. For more information see http://crohnsandcolitis.org.nz/