Types of Endoscopy Procedures

We have listed a number of common procedures that your doctor or other member of the Mount Sinai Endoscopy Suite staff might discuss with you during your examination. Always feel free to ask questions at any point before, during, or after the exam.

Most Frequently Requested Procedures

Colonoscopy

Colonoscopy is one of the most commonly performed endoscopic procedures and refers to the visual examination of the lower part of your digestive system.

In a screening colonoscopy, your doctor examines the large intestine (colon) using an endoscope - a long, very narrow and flexible tube with a light and tiny camera at one end. The procedure is performed while you are lying comfortably on your left side. First, your doctor will administer a sedative, then insert the endoscope through the anus and move it around the bends of the colon (the colon begins in the right lower abdomen and looks like a big question mark as it moves up and around the abdomen, ending in the rectum).

What your doctor is looking for in your colon are any abnormalities or polyps-small growths in the colon which can be precancerous. If a polyp is found, your doctor may elect to remove the polyp during your colonoscopy. Polyps are common, and their early removal can prevent colon cancer from developing. Depending upon your examination and family history, your doctor will let you know when your next colonoscopy will occur.

Colonoscopy is recommended for all Americans over the age of 50 as a preventive measure for colorectal cancer.

---

EGD or Upper Endoscopy

EGD (Esophagogastroduodenoscopy),also known as "Upper Endoscopy," is the technique that examines the part of your digestive system that begins with your esophagus ("food tube") and ends with the first part of your small intestine, known as the duodenum ("doo-oh-DEE-num").

EGD is used for the evaluation of ulcers or inflammation in the stomach, duodenum, or esophagus. It is also used to rule out Barrett's esophagus, or to survey Barrett's esophagus.

The procedure involves the skillful insertion of an endoscope - a long, very narrow and flexible tube with a light and tiny camera at one end - to view the lining of your upper digestive system, and to take tiny tissue samples (biopsies) for laboratory examination if necessary. In an EGD, the endoscope is passed gently through your mouth and into the stomach and duodenum.

Therapeutic upper endoscopy is also often used to control bleeding from the upper gastrointestinal tract.

---

Endoscopic Ultrasound (EUS)

Endoscopic Ultrasound (EUS) is a highly specialized procedure in which a flexible tube is passed through the mouth into the gastrointestinal tract, just like in standard endoscopy. However, a tiny transducer is attached to the endoscope that sends out sound waves, enabling a detailed evaluation of the wall of the esophagus, stomach, duodenum, and surrounding structures, such as the liver, pancreas, gallbladder, and bile ducts.

EUS allows your doctor to see beyond the gastrointestinal tract. The following views illustrate (top image) an EUS-guided fine needle aspirate (i.e., biopsy) of a small pancreatic neuroendocrine tumor (bottom image). With in-room cytology, we are able to obtain quick and reliable diagnoses safely.

EUS is a valuable tool that expands the power of gastrointestinal endoscopy by permitting endoscopists to perform gastrointestinal and non-small-cell lung cancer staging. It is a safe and accurate method of diagnosing and staging a variety of benign and malignant (cancerous) lesions. It is also a way to obtain tissue from organs and structures surrounding the gastrointestinal tract.

---

Interventional Bronchoscopy

The Interventional Bronchoscopy Service at the Mount Sinai Medical Center provides the state-of-the-art diagnostic and therapeutic procedures necessary to care for patients with advanced pulmonary diseases. Our recently renovated bronchoscopy room provides both inpatients and outpatients with routine and advanced bronchoscopic procedures in a comfortable and safe environment. We have a comprehensive variety of the latest high-definition video bronchoscopes and video monitors.

Flexible bronchoscopy is a minimally invasive procedure that does not involve surgical incision, thereby minimizing discomfort. We employ flexible bronchoscopes to diagnose and treat patients with airway and lung disease and patients with enlarged lymph nodes inside the chest. Our unit performs nearly 500 flexible procedures each year. Our extensive experience in bronchoalveolar lavage, transbronchial biopsy, and transbronchial needle aspiration (aka Wang needle) provides for a high percentage of diagnostic success with a very low rate of potential complications.

We may administer moderate or deep sedation, or even general anesthesia to patients as needed. Outpatients who require bronchoscopy register and recover in the Mount Sinai Endoscopy Suite, which also provides a pleasant waiting area for accompanying family members and friends.

In certain cases, we can enhance our diagnostic capabilities by using state-of-the-art technologies such as endobronchial ultrasound (EBUS), virtual bronchoscopy guidance, electromagnetic guidance (SuperDimension), or ultrathin bronchoscopy. Expert consultation in pulmonary pathology is provided by the Pathology Department. The capability to combine these methods maximizes the potential of diagnostic bronchoscopy.

Additionally, we have an active therapeutic bronchoscopy service for the relief of airway obstruction including the removal of foreign bodies and tumors and the placement of airways stents.

---

Video Capsule Endoscopy

Video capsule endoscopy is used to view areas of the digestive tract that are beyond the reach of an endoscope (usually, the small intestine). This procedure provides clear visual information, allowing your doctor to make a diagnosis quickly so that treatment can begin immediately.

In this painless diagnostic test, a patient swallows a tiny camera roughly the size of a vitamin pill that travels the length of the digestive system. Over several hours, the camera travels the length of the gastrointestinal tract and takes pictures along the way. The images are stored on a portable recording device and later read by your gastroenterologist.

Capsule endoscopy can be used to diagnose the cause of bleeding in the small intestine, or identify small bowel tumors or inflammatory bowel disease (Crohn's disease).

---

Other Types of Procedures

24 hour pH Testing/BRAVO©

The amount of acid 'refluxing' into the esophagus from the stomach is measured through 24-hour pH testing. The test may be used to work-up a person with severe gastroesophageal reflux disease or disease that does not respond to acid-blocking medications.

In standard 24-hour pH testing, a thin, small tube with an acid-sensing device on the tip is gently passed through your nose, down the esophagus, and positioned above the junction of the esophagus and stomach. The tube is then secured to the side of your face with tape and is attached to a portable recording device that is worn on a belt or over your shoulder. The catheter and recorder are worn for 24 hours. Additionally, you will be asked to keep a diary to record when certain events occur, such as when you eat or drink, lie down, or get up. A member of our staff will explain the study to you in detail.

The BRAVO© probe is a wireless pH monitoring device. In the BRAVO test, your doctor places the capsule probe during an endoscopy/EGD. This allows acid reflux to be recorded for 48 hours without having a catheter in your nose. For many patients this is more convenient and comfortable than having a catheter in the nose for 24 hours.

---

Anal-Rectal Manometry

Anal-rectal manometry is used to determine the cause of fecal incontinence (loss of voluntary control over the bowels resulting in leakage of stool or gas) or severe constipation. Loss of control can be attributed to damage to the muscle that contracts the anus (anal sphincter), the pelvic floor muscles, nerves, or tissue. In this study, a soft balloon is placed in the rectum and slowly inflated to test the function of the rectal reflexes. To measure the pressure in the various parts of the rectum and anal canal, a catheter is pulled through the anus. You will be asked to squeeze, relax, or try and expel the balloon. You may feel a sense of fullness but most patients do not find this test painful.

---

Cholangioscopy (Spyglass©)

Cholangioscopy is a new technology that is used in conjunction with ERCP to directly visualize the ducts of the biliary system. When injection of contrast material and X-rays are not adequate to make an proper diagnosis, your doctor may choose to perform Spyglass for direct visualization and biopsies of the duct. The Spyglass system allows a small optical fiber (camera) to be advanced through the ERCP endoscope and then directly into the ducts.

Spyglass helps delineate strictures (narrowing of the duct) from benign versus malignant etiology. The device can be steered in four directions to access and inspect, diagnose and treat disorders such as gallstones, strictures, or mass causing obstructions within the biliary tract. This system can be used to break up very large stones from the bile duct. Large stones can sometimes be difficult or impossible to remove with ERCP alone. But in conjunction with Spyglass, electrohydraulic lithotripsy (hydraulic shock wave) is used to directly fragment large stones, which can then be removed easily from the duct.

---

Confocal Endomicroscopy

Confocal endomicroscopy is an exciting new technique that allows your gastroenterologist to obtain microscopic images of the lining of your gastrointestinal tract. There are only several centers in the world performing this very specialized technique. Using confocal endomicroscopy, your doctor will be able to see precancerous areas, cancer, or infection without taking a biopsy. The technology permits your doctor to take a much 'closer' view of the GI tract.

This is Barrett's Esophagus (BE), as seen on routine endoscopy (top image) and on confocal endoscopy (bottom image). Confocal endoscopy allows a microscopic view of the lining of gastrointestinal tract, similar to what the pathologist would see looking under a microscope. With confocal, your gastroenterologist may see abnormalities at a microscopic (or cellular) level without having to take a biopsy.

---

Double Balloon Enteroscopy

Double-balloon enteroscopy involves the use of a balloon at the end of a special endoscope and a tube which fits over the endoscope, and which is also fitted with a balloon. Both the scope and overtube are inserted through the mouth and passed into the small bowel. Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. The small bowel is then pleated backwards like an accordion to the overtube. The overtube balloon is then deployed, and the balloon is deflated. The process is then continued until very distant parts of the small bowel are seen. This technique can be used to treat otherwise inaccessible parts of the small bowel.

---

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized technique used to study the ducts of the liver, gallbladder, and pancreas. Ducts are drainage routes. ERCP is often performed to evaluate these ducts or clear them out for better drainage. During ERCP, your doctor will pass an endoscope through your mouth, esophagus, and stomach into the duodenum (first part of the small intestine). After your doctor sees the opening to the common ducts that leads to the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Then contrast material (dye) is injected into the biliary or pancreatic ducts and X-rays are obtained. Under X-ray guidance, your doctor will be able to identify any abnormalities in the ducts and perform various kinds of therapy to clear the ducts. These abnormalities include stones in the ducts that can be removed and tumors (strictures) that can be treated with plastic or metal stents to bypass a blockage.

---

Esophageal Manometry

Esophageal manometry is a test used to measure pressure inside your esophagus. In this study, a thin, pressure-sensitive tube is passed through your mouth or nose and into your stomach. Once the tube is in the esophagus, you will be asked to swallow and the pressure inside the esophagus is then measured at several points. This test can be used to diagnose swallowing problems.

---

Small Bowel Enteroscopy

In small-bowel enteroscopy, your doctor inserts a longer scope into more distant parts of the small intestine.