Additional Procedures

Procedure: During ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets the doctors see inside your bowels. After the common opening to ducts from the liver and pancreas can be seen, a narrow plastic tube called a catheter will be passed through the endoscope and into the ducts. A contrast material (dye)will then be injected into the pancreatic or biliary ducts and x-rays taken.

Benefits: ERCP is a valuable tool that is used for diagnosing many diseases of the pancreas, bile ducts, liver, and gallbladder. ERCP can be used to determine whether or not surgery is necessary and is helpful in providing the anatomic detail the surgeon needs to plan an operation when surgery is necessary.

Risks: Major complications requiring hospitalization can occur, but are uncommon during diagnostic ERCP. They can include pancreatitis (an inflammation or infection of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. Complications are often managed without surgery.

Alternatives: Alternative tests to ERCP include certain types of x-rays (CAT scan, CT) and sonography (ultrasound) to visualize the pancreas and bile ducts. In addition, dye can be injected into the bile ducts by placing a needle through the skin and into the liver. Small tubing can then be threaded into the bile ducts. Study of the blood also can provide some indirect information about the ducts and pancreas.

For additional information please visit our medical library or go to American Society for Gastrointestinal Endoscopy (ASGE)

Procedure: Combined esophageal pH-impedance monitoring allows detection of nearly all Gastroesophageal reflux episodes, acid as well as non-acid. The equipment for esophageal pH testing consists of a thin plastic-coated wire with a probe at the end that measures acidity. The plastic-coated wire is gently inserted through the nose and passed down to the end of the esophagus. It is attached to a portable recorder that is carried at the waist. Over 12-24 hours the acidity in the lower esophagus is recorded on a portable computer. When the patient experiences heartburn or other symptoms, he/she presses a button on the recorder. This event marker notes the time of the symptom so that the physician can determine whether the simultaneous acidity level is abnormal and possibly related to the symptom. The test also enables the physician to determine when acid reflux occurs in relationship to meals and to changes in position (upright or lying down).

Benefits: This test provides the physician with clear documentation of the amount of acidity in the esophagus as well as whether the presence of acid or non-acid fluid in the esophagus is associated with other symptoms, such as heartburn, chest pain, coughing, or asthma. With this information, your doctor can outline a specific treatment program or provide you with reassurance if the exam is normal.

Risks: There are no serious problems associated with the esophageal pH test. The side effects of the test are minor and may include: mild sore throat, temporary irritation of the nasal passages, nosebleeds, and irregular heartbeat. Once the tube is in place, it is usually easily tolerated.

Alternatives: There are other examinations used to study the esophagus, such as an Upper GI series and endoscopy, but they do not replace the information provided by esophageal pH measurement. Esophageal pH testing is often performed in association with a pressure recording of the esophagus, known as esophageal manometry.

For additional information regarding Esophageal pH testing, please refer to our medical library.

Procedure: Esophageal manometry is performed using a catheter that senses pressure changes in the esophagus. A thin tube is passed through the nose into the stomach. The outer end of the tube is attached to an instrument that will record the pressure. The tube is pulled slowly back into the esophagus and pressure measurements are taken at various intervals. The high pressure zone of the lower esophageal sphincter muscle is recorded first. When the tube is in the esophagus, esophageal motor function is recorded during swallows. The motor function of the upper sphincter is then studied.

Benefits: Esophageal manometry testing provides clear documentation of the muscular function of the esophagus. With this information, your doctor can outline a specific treatment program or provide you with reassurance if the exam is normal.

Risks: The side effects of the esophageal manometry are minor and may include mild sore throat, temporary irritation of the nasal passages, nose bleeds, and irregular heart beat. Occasionally, during insertion, the tube may enter the larynx (voice box) and cause coughing. When this happens, the problem is recognized immediately, and the tube is rapidly removed.

Alternatives: here are no other tests that provide precise information about esophageal manometry. There are, however, other techniques that can provide general information about esophageal function. These are: an upper GI x-ray series using swallowed liquid barium; video endoscopy to visualize the inside lining of the esophagus; and a 24-hour probe left in the end of the esophagus to measure acidity as it refluxes from the stomach, but they do not replace the information provided by esophageal manometry testing.

For additional information regarding the Esophageal manometry procedure, please refer to our medical library.

Procedure: In this procedure heat energy is delivered in a precise and highly-controlled manner to the affected tissue in an outpatient setting and no incisions are involved. Healing is aided with medications following the procedure.

Benefits: Treatments can be repeated

Call our office and schedule an appointment if you suffer from GERDs as you may have Barrett's esophagus.