I believe care must be customized
to each patient because the practice
of medicine is not a “one size fits all”.

William B. Evans, M.D.

General GI Procedures In Louisville

Upper GI Endoscopy Louisville, KY

Upper Endoscopy (EGD)

An EGD is an outpatient procedure that allows Dr. Evans to examine the lining of the upper digestive or gastrointestinal (GI) tract (the esophagus, stomach and duodenum) with the use of an endoscope (a thin flexible tube with a camera that produces live video images on a monitor). An EGD is done to evaluate persistent symptoms of abdominal pain, nausea and vomiting, or difficulty swallowing, and to find a cause when bleeding from the upper GI tract is suspected.

With an EGD, not only can the abnormalities be seen, but therapy can be administered through the endoscope. For example, instruments can be passed through the endoscope to treat bleeding, removed polyps, obtain a biopsy (a small piece of tissue), stretch (dilate) a narrowed area (stricture) and place feeding tubes for nutrition.

How Do You Prepare for the Procedure?

Before undergoing EGD, Louisville GI Doctor William Evans will go over some pre-operative instructions that you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.

  • Stop certain medications. Prior to surgery, Dr. Evans and his staff will need to be made aware of all medications that you are taking, especially blood-thinning medications. These may include Coumadin (warfarin), Plavix (clopidogrel), Xarelto (rivaroxaban), Pradaxa (dabigatran), Eliquis (apixaban) and Lovenox (enoxaparin). Since the use of these medications increases the risk of excessive bleeding, they should be stopped prior to your procedure. If you are using insulin, the dosage or timing will need to be adjusted the day of the procedure. Doctor-prescribed aspirin may be continued before your procedure. In addition, Dr. Evans asks that you provide him or his staff with a list of medications to which you are allergic.
  • Stop eating hours beforehand. Refrain from eating anything starting at midnight before your procedure is scheduled.

What Happens During EGD?

EGD is performed as an outpatient procedure. Upon checking in, you will be escorted to the “pre-op” area where an IV will be placed and nurses will take down your medical information. At this time, you will also meet with an anesthesiologist to discuss the sedation used for the procedure.

You will then be taken to a procedure room and connected to monitors that will monitor your blood pressure, heart rate and blood oxygen levels throughout the course of the procedure. Once this is finished, you will then be sedated for the duration of the procedure (not awakening until after it is complete). The procedure itself takes an average of 10-15 minutes to complete, and is painless because you will be asleep for its duration.

To prepare for the procedure, you will be placed on your left side, and a “bite block” will be inserted into your mouth (to prevent the endoscope from damaging your teeth as well as to prevent damage to the scope). The endoscope is then passed through your mouth and the exam is performed.

What Should You Expect after the Procedure?

After the EGD, you will be returned to the “post-op” area to recover from sedation. During this time, you will be monitored for any potential complications from the procedure and/or sedation. When you are fully recovered, Dr. Evans will give you an explanation of the findings from the procedure (this report is preliminary, however, and it may take several days before the final results of the biopsies or information regarding the polyps removed are complete). Along with the findings, Dr. Evans will provide you with a copy of the procedure report, patient information handouts and follow-up instructions.

Due to the effects of sedation, patients are instructed not to drive, operate machinery or make important decisions for the 24 hours following your procedure. You will need to arrange for someone to drive you home after surgery. You will be able to eat after you leave the hospital, unless instructed otherwise. The nursing staff will review these and other important post-op instructions with you prior to discharge.

Possible Complications and Risks

Bleeding can occur at a biopsy site; this is usually a minor complication and will stop on its own (or can be stopped during the exam). Rarely, more severe bleeding can occur depending on the treatments administered during the EGD.

A rare but major complication is a perforation, or tear, through the lining of the intestine. If this occurs, it is managed with hospitalization, IV fluids, and antibiotics to prevent infection, and bowel rest in the majority of cases. However, some perforations may require surgery to repair.

Uncommon risks from sedation used for EGD are: reactions to sedation medications, possible aspiration of stomach contents into the lungs and complications from heart and lung diseases.

Although complications are rare, it is important to recognize them early. Contact Dr. Evans’ office if you notice severe abdominal pain, fever and chills, difficulty swallowing or black, tarry stools.

All of these risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

Colonoscopy

Colonoscopy Louisville, KYPatients considering a colonoscopy in Louisville need to understand what happens during the procedure. A colonoscopy involves the use of a thin, flexible tube with a light source and camera to examine the lining of the large intestine (colon); the resulting images are displayed on a video monitor. This procedure is most commonly recommended as a screening test for colorectal, or colon, cancer. Colon cancer is the second leading cause of cancer-related deaths in the US today, with about 150,000 cases diagnosed annually. Colon cancer starts from polyps, which are abnormal growths to the colon lining. It takes years for polyps to grow into cancer, so if they are found during colonoscopy, they are then removed before cancer can develop.

An effective diagnostic tool, colonoscopy is also performed to evaluate patients for symptoms of bleeding, diarrhea and abdominal pain.

How Do You Prepare for Colonoscopy?

Before undergoing a colonoscopy in Louisville, Dr. Evans will go over some pre-operative instructions that you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.

  • Stop certain medications. Prior to surgery, Dr. Evans and his staff will need to be made aware of all medications that you are taking, especially blood-thinning medications. These may include Coumadin (warfarin), Plavix (clopidogrel), Xarelto (rivaroxaban), Pradaxa (dabigatran), Eliquis (apixaban) and Lovenox (enoxaparin). Since the use of these medications increases the risk of excessive bleeding, they should be stopped prior to your procedure. If you are using insulin, the dosage or timing will also need to be adjusted the day of the procedure. Doctor-prescribed aspirin may be continued before your procedure. In addition, Dr. Evans asks that you provide him or his staff with a list of medications to which you are allergic.
  • Use our cleansing routine the day before. Dr. Evans’ office will prescribe a cleansing routine (or “prep”), which consists of a powerful liquid laxative that is to be taken the day before the procedure in order to prepare your bowels. This cleansing routine is the MOST IMPORTANT part of the procedure. Following directions and having a good cleanse can decrease the need for an early repeat colonoscopy. Dr. Evans’ office will give you further instructions on following this cleansing routine and other details to follow on the day before the procedure. These instructions include following a clear liquid diet the day before the procedure, and drinking lots of liquids.

What Happens During a Colonoscopy?

Colonoscopy is performed as an outpatient procedure. When you check in, you will be escorted to the “pre-op” area where an IV will be placed and nurses will take your medical information. You will also meet with an anesthesiologist to discuss the sedation for the procedure.

You will then be taken to a procedure room and connected to monitors that will monitor your blood pressure, heart rate and blood oxygen levels throughout the course of the procedure. The procedure itself takes about 20-30 minutes to complete, and with you under sedation and therefore able to feel no discomfort. Since you will be completely sedated before the start of the procedure, you will not awaken until after the colonoscopy is completed. You will be placed on your left side so that the colonoscope can be inserted into the anus and advanced to the end of the colon (the cecum). (In rare cases (~1%), the scope cannot be advanced to the cecum and additional tests may be required.) The colon lining is also examined during the insertion process.

After the cecum is reached, Dr. Evans slowly withdraws the colonoscope to examine the lining of the colon more thoroughly. Depending on what is seen, he may obtain a biopsy (a small piece of tissue) for analysis.

If there is bleeding, several different methods may be used. Instruments may be advanced into the colonoscope to help with bleeding. Medications can also be injected into an area. Cauterization (sealing off blood vessels with heat treatment) may also be administered by different probes. And sometimes, small temporary clips are used to control bleeding.

If polyps are found, they are removed with a variety of different instruments that all fit through the colonoscopy. Most commonly, they will be removed with “snare polypectomy,” which is a wire loop, or snare, used to grab the polyp and then remove it from the colon lining. With larger-sized polyps, electrical current will be used with polypectomy to prevent bleeding.

None of these above-described techniques cause discomfort.

What Should You Expect after the Procedure?

Following the procedure, you will go to the “post-op” area to recover from sedation; there you will also be monitored for any potential complications from the procedure and/or sedation.

Once you are fully recovered, Dr. Evans will provide you with an explanation of the findings from your procedure, along with a copy of the procedure report, patient information handouts and follow-up instructions. He will give you a full preliminary report at this time; however, it may take several days for the final results of biopsies to return.

After having a colonoscopy, you may have some cramping or feel bloated because of the air introduced into the colon during the procedure. These symptoms will subside quickly upon passing gas.

Due to the effects of sedation, patients are instructed not to drive, operate machinery or make important decisions for the 24 hours following the procedure. You will need to arrange for someone to drive you home after surgery.

You will be able to eat after you leave the hospital, unless instructed otherwise. The nursing staff will review this and other important post-op instructions with you prior to discharge.

Possible Complications and Risks

One rare, though feared, complication of colonoscopy is perforation, or a tear in the lining of the intestine. The overall average risk for this complication is about one in 4,000 colonoscopies, though when it happens it may require surgery to repair.

Bleeding can occur at a biopsy site or small polypectomy site; this is a minor complication and will stop on its own or can be stopped during the exam. There is a small risk of excessive bleeding that requires hospitalization, and usually a repeat colonoscopy, to stop. This most commonly occurs after larger-sized polyp(s) is/are removed.

Uncommon risks from sedation used for the colonoscopy are: reactions to sedation medications, possible aspiration of stomach contents into lungs and complications from heart and lung diseases.

Although complications are rare, it is important to recognize them early. Contact Dr. Evans’ office if you notice severe abdominal pain, fever and chills or excessive rectal bleeding.

All of these risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

Capsule Endoscopy

Capsule Endoscopy Louisville, KYCapsule endoscopy is an FDA-approved procedure that allows Dr. Evans to examine the lining of the middle part of the gastrointestinal (GI) tract that is made up of the three parts of the small intestine (duodenum, jejunum and ileum). This procedure helps to evaluate this part of the bowel, which cannot be reached by a standard endoscope or colonoscope. The most common reason for capsule endoscopy is to search for a cause of bleeding in this area. It is also used to detect polyps, tumors, ulcers and inflammatory bowel disease of the small intestine.

For a capsule endoscopy, the patient will swallow a multivitamin-sized pill containing a video camera, a light source and a battery. The camera will take two to three pictures per second for up to 12 hours as the pill travels through the patient’s GI tract. The pictures are sent to a small recording device worn throughout the procedure. The device saves the color photos, which are transferred to a computer with special software that strings the images together into a video.

How Do You Prepare for Capsule Endoscopy?

Before undergoing a capsule endoscopy, Dr. Evans will go over some pre-operative instructions that you will need to follow in the days before your procedure. Following these instructions is essential to limit surgery risks and provide the best results.

  • Discuss your medical history and medications with Dr. Evans. Please tell Dr. Evans or his staff about any previous abdominal surgery or previous history of bowel obstructions, adhesions or history of inflammatory bowel disease. In addition, Dr. Evans asks that you provide him or his staff with a list of medications to which you are allergic.
  • Use our cleansing routine the day before. Dr. Evans’ office will prescribe a cleansing routine (or “prep”), which consists of a powerful liquid laxative that is to be taken the day before the procedure in order to prepare your bowels. This cleansing routine is the MOST IMPORTANT part of the procedure. Dr. Evans’ office will give you further instructions on following this cleansing routine and other details to follow on the day before the procedure. These instructions include following a clear liquid diet the day before the procedure, and drinking lots of liquids.

What Happens During a Capsule Endoscopy?

Capsule endoscopy is an outpatient procedure performed at Jewish Hospital in downtown Louisville. After going through registration by the staff, the patient will swallow the pill-sized capsule camera. The monitor will be attached to record images obtained. Dr. Evans will read the study and report the findings as soon as possible, though sometimes this process can take one to two weeks.

What Should You Expect after the Procedure?

Usually, two hours after the ingesting the pill, the patient is able to drink clear liquids. Four hours after ingestion, they may eat a light meal. The patient must avoid vigorous physical activity during the study. After approximately eight hours, the data recorder that was worn can be returned to the endoscopy unit at the hospital.

Possible Complications and Risks

There is potential for the capsule to become stuck at a narrowed part of the small intestine, resulting in a bowel obstruction. This usually relates to a stricture (narrowing) of the small intestine from inflammation, prior surgery or a tumor. The overall risk of this occurring is 3 percent. It’s important to recognize an obstruction early and call Dr. Evans’ office if you have unusual abdominal pain, nausea and/or vomiting.

Contact Dr. Evans and Learn More about GI Procedures

If you have questions about an upcoming colonoscopy in Louisville, upper endoscopy or capsule endoscopy, or if you need to schedule one of these GI procedures, contact Dr. Evans today. As a specially trained and knowledgeable gastroenterologist, Dr. Evans has years of surgical experience using these procedures to diagnose GI problems before they can become serious. Call his office today to learn more about the procedures described here, or to schedule an appointment with Dr. Evans.

Disclaimer: This information is intended to provide general guidance and does not provide definitive medical advice. It is not a definitive basis for diagnosis or treatment in any particular case. This material does not cover all information and is not intended as a substitute for professional medical care. It is important that you consult your doctor regarding your specific condition, contraindications and potential complications.