Procedures

Gastrointestinal endoscopies help to diagnose, prevent and treat digestive and liver disorders.  They are short day procedures mainly performed under sedation. A small flexible tube camera is passed gently along the digestive tract to examine the inner lining via a magnified image projected on a TV screen.  The following are common endoscopic procedures:

Doug at NSSDH

Gastroscopy

This procedure is useful to examine the upper digestive tract including mouth, throat, oesophagus, stomach and first part of the small intestine (the duodenum). Once within the upper digestive tract, Dr Samuel may treat several conditions including swallowing difficulties with dilatation or stenting of narrow segments (strictures), thermocoagulation of bleeding vessels or ulcers, banding of dilated variceal vessels, removal of polyps or foreign bodies, Botox injection to segmental spasm or simply biopsy tissue.

Colonoscopy

With new symptoms of changes in bowel habit, rectal bleeding, or lower abdominal pain, this lower digestive tract procedure can be helpful. It is considered the "gold standard" screening test for bowel cancer prevention in higher risk individuals. It is used to remove premalignant tissue (polyps) and to assess other conditions including Crohn's and colitis, diverticular disease and haemorrhoids.

Flexible sigmoidoscopy

This is sometimes called a short colonoscopy. Sigmoidoscopy only examines the last third of the large bowel while colonoscopy examines the whole large bowel.  It has the benefit that it may be performed without sedation, that minimal preparation is required and there is even lower risk than a complete colonoscopy. It is often used in assessing for rectal bleeding or lower digestive symptoms when haemorrhoids or other benign disease are suspected.

Double balloon enteroscopy (DBE)

This is an endoscopic technique to examine and treat disorders of the small bowel. These include dilatation of Crohn's strictures, coagulation of difficult to reach bleeding vessels, direct placement through-to-skin of small bowel feeding tubes (direct PEJ), small bowel polypectomy, Peutz-Jegher surveillance programs and retrieval of retained foreign body and "pill cam".

Dr Samuel is one of the few gastroenterologists in New South Wales who performs double balloon enteroscopy (DBE).  He performs this procedure at Bankstown hospital. Most patients can have their DBE as an outpatient after a consultation with Dr Samuel. In urgent cases, doctors may contact our endoscopy fellow via the Hospital switchboard (9722 8000). Patients may need to be transferred from another facility without prior consultation. Patients outside metropolitan Sydney, may contact the rooms to arrange a video consultation before the procedure.

 

Capsule endoscopy ("pill cam")

Also known as "pill-cam" or wireless endoscopy, capsule endoscopy is used mainly to pinpoint bleeding in hidden areas in the small bowel when gastroscopy and colonoscopy fails to find the area. In Australia, we are currently researching and trialing new generation capsules for examination of the gullet and large bowel. This procedure uses a 10 - 27mm capsule, which contains a miniature camera, batteries, light source and transmitter. After swallowing, the capsule travels like a piece of food through the gastrointestinal system to provide over 50,000 high-resolution images of the stomach and small intestine over about 11 hours in total. Recording probes, taped on the abdomen, track the progress of the capsule. The images obtained by the capsule are transmitted to a data-recorder worn in a harness around the waist and later read by the gastroenterologist.

 

Percutaneous endoscopic gastrostomy (PEG) or jejunostomy (PEJ)

Percutaneous (through the skin) endoscopic (using a endoscopic instrument) gastrostomy (hole directly into the stomach) or direct jejunostomy (hole directly into the upper small bowel) is a safe medical procedure used when swallowing food is inadequate. PEG administration of feeds is a common method of nutritional support for patients in the community. It may be temporary or permanent. Direct PEJ tube is an option when PEG is considered unsuitable. The decision to proceed to a PEG or PEJ tube feeding is often difficult. This is particularly so if the decision is being made on behalf of another person. The key question to answer is “will quality of life be improved with PEG feeding?” The decision is made after close discussion with family members, nursing and medical staff and community contacts.

Doug Performing Colonoscopy

What about COVID?

In most case, you can proceed with bowel preparation and the procedure if:

  • You had a mild COVID illness and are more than 4 weeks from first diagnosis
  • You were admitted to ICU with severe COVID and are more than 8 weeks from first diagnosis
  • You are a close contact and COVID negative on bowel prep and test day
  • You have mild respiratory symptoms and are COVID PCR negative within 3 days of the test and RAT negative on test day
  • You don't have a reasonable suspicion that you are infectious with COVID

There has been no COVID positive case or close contact in any of the units where Dr Samuel operates as of May 2022. All our facilities take precautions to minimise the risk to patients and staff and keep things safe. The hospital will contact you to ask you COVID screening questions prior to your procedure. If you've had COVID diagnosed within 4 weeks of your procedure or you have persist symptoms then the staff may ask you to reschedule. This is because the balance of anaesthetic risks favour waiting 4 weeks after COVID unless it is an urgent procedure.  You will also need to reschedule if you have symptoms that might be COVID and don't have a negative COVID test. However, as you can be infectious without symptoms, and you can have symptoms with a negative COVID RAT, each hospital has their own requirements depending on the level of risk in the community at the time.  For example during the high risk transmission period of January 2022, most hospitals tested all patients with a rapid antigen test or Rapid PCR on admission. They accepted a patient's PCR result if within 24 hours of admission but postponed patients who had COVID symptoms even if the home RAT was negative. Hospitals are encouraging patients to isolate or minimise exposures 72 hours prior to admission. If you have any doubt that you might be bringing COVID with you, please get a swab both before starting your bowel preparation and before coming for your colonoscopy.  Due to the testing surge-related delays, if you are relying on PCR testing we recommend that you request the collection staff write "urgent" on the specimen.  Dr Samuel's team use full protective equipment and, at surge times, Dr Samuel and many have regular COVID surveillance tests. We encourage you to get fully vaccinated prior to your procedure if possible. You can have your colonoscopy on the same day as your COVID vaccination. However, if you are unlucky to have 2 days with nausea, fever or 'flu-like illness when you need to take your bowel preparation it will make for a challenging day.  To avoid disappointment if you are unwell on test day or unable to complete adequate bowel preparation, it is better if you have your vaccination more than 2 days before your test particularly after your first Astra Zeneca or second Pfizer COVID vaccination. Equally, if you are well but a close contact of a COVID case, you can proceed with the test. However, you must be symptom free and perform a negative COVID RAT on the morning of the test. To avoid unnecessary bowel cleansing, we recommend you also test with a COVID RAT before starting your laxative mixtures.