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Colonoscopy

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About

Colonoscopy enables visualization of the entire large bowel (or colon ), from the distal rectum to the cecum . It is a safe and effective means of evaluating the lining of the large bowel. Technology has evolved to provide a very clear image of the colon lining through a video camera attached to the end of the scope. The camera connects to a computer which can store and print color images selected during the procedure. You will receive a DVD with these images after your procedure. Compared with other imaging modalities, colonoscopy is especially useful in detecting small lesions such as polyps; however, the main advantage of colonoscopy is that it allows for either sampling or complete removal of abnormal tissue.

Colonoscopy requires cleaning out your colon the day before the procedure (“bowel prep”). Colonoscopy is a 20 minute procedure, done under sedation. Your total time at Durham EndoSurgery Centre will be about two hours, which includes the check-in, procedure, and recovery times.

What is 'Screening'?

'Screening' colonoscopy simply means that there is no actual symptom causing you to undergo colonoscopy. You feel perfectly fine. Even though patients can feel perfect, that doesn't mean everything is perfect.

Colon cancer is a disease that can be significantly advanced before it gives even its first symptom. In order to discover colon cancer and polyps earlier, we 'screen' healthy patients every 5 or 10 years (depending on your family history, and according to established guidelines) to catch these silent problems as early as possible.

Although colorectal cancer is highly preventable, it is the third most common cancer and cause of cancer deaths in Canada. Both men and women face a lifetime risk of nearly 6% for the development of invasive colorectal cancer during their lifetime.

Screening for colorectal cancer is among the most common reasons for recommending colonoscopy. Proper screening can help reduce mortality rates at all ages, and colonoscopy plays an important role in this effort.


How often?

When we talk about intervals for colonoscopy, (such as every 5 or 10 years), we mean 'screening' intervals. If colonoscopy is done to investigate a particular problem, such as positive stool tests, Positive Cologic tests, bleeding, diarrhea, changes in bowel habits, or other symptoms, then intervals do not apply. In cases where patients are having specific sumptoms, your doctor will recommend colonoscopy whenever it's necessary.

When we are doing 'screening' colonoscopy, there are established guidelines that relate to your family history of either polyps or colon cancer. Based on these guidelines, your doctor can recommend the interval that sees you having the fewest possible colonoscopies, with the highest chance of detecting polyps or cancers before they become a problem.

Prepare for Colonoscopy

WHEN YOU HAVE SEDATION, YOU ARE REQUIRED TO HAVE SOMEONE DRIVE YOU HOME

A taxi is not acceptable. This is a liability issue, as a consequence of the sedation given. If you cannot get a family member or a friend to drive you home, there are taxi services in Durham that will drive both YOU AND YOUR CAR home, if you wish. (Durham EndoSurgery Centre has no financial interest in these services.) These services require you to book days ahead.

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Gastroscopy

About

Gastroscopy is an examination of the upper digestive tract (the esophagus, stomach and duodenum) using an endoscope -- a long, thin, flexible tube containing a camera and light -- to view the lining of these organs.

Gastroscopy is usually suggested to investigate the cause of abdominal pains, vomiting, or bleeding from the digestive tract, to establish or confirm a diagnosis.

The procedure is done under sedation, and lasts under 10 minutes. During the procedure, images from the scope will be stored on a computer. If any abnormalities are seen, very small samples of the lining (biopsies) can be taken for examination under a microscope.

Before you leave, you will discuss the results with your physician, and receive a DVD with the pictures from your procedure. The operative note is included on your DVD, and your referring physician will receive their copy from Durham EndoSurgery Centre within 24 hours. If biopsies are taken, you will need to return for a follow-up appointment to review these personally with your physician. This appointment is booked before you leave.

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WHEN YOU HAVE SEDATION, YOU ARE REQUIRED TO HAVE SOMEONE DRIVE YOU HOME

A taxi is not acceptable. This is a liability issue, as a consequence of the sedation given. If you cannot get a family member or a friend to drive you home, there are taxi services in Durham that will drive both YOU AND YOUR CAR home, if you wish. (Durham EndoSurgery Centre has no financial interest in these services.) These services require you to book days ahead.

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Hemorrhoid banding

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About

Hemorrhoid banding is a simple and painless procedure lasting under three minutes. It is chiefly effective in decreasing, (but not eliminating) hemorrhoid bleeding.

The procedure is usually coupled with some other examination of the colon, either colonoscopy (examination of the entire large bowel) or “rigid sigmoidoscopy” (examination of the last 30 cm only). Although the procedure is effective in decreasing bleeding, the effects are neither curative, nor permanent. Most patients can expect a decrease in bleeding by 50% or more, lasting up to two years.

Hemorrhoids are essentially varicose veins of the anus. They cannot be individually counted, just as you cannot give an exact number to the number of veins on the back of your hand; they are all interconnected. The bands are small elastics that clip the hemorrhoid veins, causing thrombosis (clotting). The bands fall off on their own within a few days. As these clotted veins are absorbed by your body, the hemorrhoids decrease in number, and bleeding decreases. Most patients will see a slight increase in bleeding for the first few days after the procedure only.

Because the lining of the rectum cannot sense pinching or trauma, the procedure is not uncomfortable. Hemorrhoid banding does not require sedation, and does not require the same bowel preparation as colonoscopy. At Durham EndoSurgery Centre, it is typically performed at the end of the day. It can easily be done in a short, 15 minute visit. You can walk in from your car, undergo the procedure, and drive home about 45 minutes later.

You should be able to drive immediately, and fine for work the following day. Although the procedure is not uncomfortable, many patients do experience a mild sensation of ‘needing to have a bowel movement’ that lasts for several hours after the procedure, or a very mild, persistent dull, pelvic cramp which has been compared to a mild menstrual cramp. Both of these symptoms are caused by the pinching of the rectal lining, and disappear within a few hours.



Long term benefits?

There are no long term benefits of hemorrhoid banding. It is simply a convenient way to improve hemorrhoid bleeding, without the need for surgery.
Sometimes hemorrhoid banding is done as part of a strategy to confirm that infrequent rectal bleeding is in fact from hemorrhoids only. Hemorrhoid bands will not affect bleeding that is from cancers, colitis, or polyps. The assumption is that after the placement of the hemorrhoid bands, it will be possible a month or two later to confirm that there has been a sustained, significant decrease in the rectal bleeding. If this is the case, it goes a long way to proving that any bleeding is hemorrhoidal in nature. By the same token, rectal bleeding that is entirely unaffected by hemorrhoid bands always needs to be thoroughly investigated. Patients who have no significant response to hemorrhoid banding must follow up with their doctor.

The time to reassess whether or not the bands have been effective in decreasing your bleeding, will be about four weeks after the procedure. The worst possible complication of haemorrhoid banding is infection, which is extremely rare. Any patient undergoing banding who is having increasing pain in the first week after banding should be reassessed by their doctor. Likewise, bleeding accruing after more than 1 week, should be reported to your doctor.

Overall, hemorrhoid banding is a useful way to treat the bleeding of moderate to severe hemorrhoids, without having to undergo more painful and invasive procedures like surgery.

Should you consider Banding?

Many patients consider banding because their hemorrhoids are causing them many difficult symptoms; but it's important to state that hemorrhoid banding will only improve certain symptoms. These are bleeding, and to a much lesser extent, prolapse (the feeling of hemorrhoids protruding after a bowel movement).

If effective, banding can reduce bleeding by approximately 50%, and the improvement might last 6 - 24 months (the time it takes your body to create new, oversized hemorrhoid veins from ones that were previously normal). To notice a difference, patients will typically be experiencing bleeding on a regular basis, at least once per week. Patients who can routinely have weeks or months between episodes of bleeding will seldom benefit from banding, as the improvements will be too small to notice.

Patients who have prolapse (the sensation of hemorrhoids protruding after a bowel movement) benefit less from banding. If the hemorrhoids are outside at all times, then typically the only longterm solution is surgery. For patients who experience prolapse only after a bowel movement, the placement of bands may induce some inflammation that can reduce the amount of prolapse.

For patients experiencing raw, itchy perianal skin, the treatment is often centred around the skin itself, rather than the hemorrhoids up inside. Banding hemorrhoids up inside the rectum does nothing to improve irritated perianal skin.

Finally, patients who experiencing outright pain with a bowel movement should not undergo banding. These patients are frequently suffering from an anal fissure, and banding will only make this much worse. The time to reassess whether or not the bands have been effective in decreasing your bleeding, will be about four weeks after the procedure.

Sometimes hemorrhoid banding is done as part of a strategy to confirm that infrequent rectal bleeding is in fact from hemorrhoids only. Hemorrhoid bands will not affect bleeding that is from cancers, colitis, or polyps. The assumption is that after the placement of the hemorrhoid bands, it will be possible a month or two later to confirm that there has been a sustained, significant decrease in the rectal bleeding. If this is the case, it goes a long way to proving that any bleeding is hemorrhoidal in nature. By the same token, rectal bleeding that is entirely unaffected by hemorrhoid bands always needs to be thoroughly investigated. Patients who have no significant response to hemorrhoid banding must follow up with their doctor.

The worst possible complication of haemorrhoid banding is infection, which is extremely rare. Any patient undergoing banding who is having increasing pain in the first week after banding should be reassessed by their doctor.

Overall, hemorrhoid banding is a useful way to treat the bleeding of moderate to severe hemorrhoids, without having to undergo more painful and invasive procedures like surgery.

Varicose vein treatment

Durham EndoSurgery Centre offers evaluation and treatment of varicose veins, in addition to endoscopic procedures. These treatments include prescription, custom fitted compression garments of all types, injection of smaller varicose veins, and office-based treatment of larger varicose veins that in the past could only be treated with surgery. Today, these veins can be treated in-office under local anaesthesia, using EVLT
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