Department of Gastroenterology

Gastroenterology outpatient clinic

A clinic providing dispensary and medical care for patients with diseases of the digestive tract.

Endoscopy

Endoscopic ultrasonography
Endosonography (EUS) is a modern examination method that combines endoscopy and ultrasound. The physician inserts a thin instrument through the mouth into the digestive tube and can use an ultrasound probe to get a very accurate view of the surrounding organs, especially the pancreas, bile ducts, oesophagus, stomach and rectum. Endosonography is especially crucial when tumours, inflammation, cysts or CT or MRI findings are suspected. It also allows the collection of tissue samples for histological examination.

ERCP
ERCP (endoscopic retrograde cholangiopancreatography) is a method that is used not only for the diagnosis, but mainly for the treatment of diseases of the biliary tract and pancreas. It is most commonly used to remove gallstones, resolve bile duct strictures or insert stents. For many patients, ERCP can replace surgery and significantly speed up treatment.

Gastroscopy
Gastroscopy is an endoscopic examination of the oesophagus, stomach and duodenum with the possibility of taking a biopsy, removing polyps (mucosal growths). Urgent gastroscopy is used to stop bleeding or to extract foreign bodies. The examination is performed fasting.

Colonoscopy
Coloscopy is an endoscopic examination of the colon method with the possibility of biopsy, removal of polyps, bleeding. Intestinal preparation with a laxative is necessary for the examination.

Sigmoideoscopy
Sigmoideoscopy is an endoscopic method used to diagnose and treat diseases of the rectum and sigmoid colon. Enema preparation is required for the examination.

Deep enteroscopy
Deep enteroscopy is the examination of the small intestine with an endoscope. Depending on the localization of the presumed pathology, the examination is performed by oral or aboral approach, allows biopsy, polypectomy, bleeding. In some cases, preparation of the bowel with a laxative is necessary for the examination.

Abdominal ultrasonography
Abdominal ultrasonography is the examination of the organs of the abdominal cavity using ultrasound.

Ultrasound elastography
Elastography is the examination of the stiffness (fibrosis) of liver tissue, which is caused by the accumulation of connective tissue in the liver.

Capsule enteroscopy/coloscopy
Capsule endoscopy is a non-invasive diagnostic capsule examination of the small and/or large intestine. The examination requires preparation of the intestine with a laxative.

Recommended web links for patients:

• Coeliac Web site
• Basic information about PEG (percutaneous endoscopic gastrostomy)treatment

Web site on non-specific intestinal inflammation (Crohn's disease, ulcerative colitis):

• www.crohn.cz
• www.crohn.cz/wc-karta
• www.wckompas.cz

Ostomy care:

• www.zivotsestomii.cz
• www.stomici.cz
• www.nejsemtabu.cz

Capsule endoscopy is a non-invasive diagnostic examination of the small or large intestine with a special device - a diagnostic capsule. Capsule endoscopy does not allow tissue samples to be taken for further examination or any medical intervention to be performed.

It is a painless examination that does not require the administration of anaesthesia. The person under examination swallows a capsule, a device the size of a larger vitamin capsule, 11 x 26 (31) mm, which is equipped with a microcamera, a light source and a transmitter. As the capsule passes through the digestive tract, it takes colour images of the intestinal mucosa, transmits them and the images are stored in a recording device worn by the subject (a belt around the abdomen). A special computer then uses the images to create a video recording of the digestive tract, which the doctor views and evaluates. The endoscopic capsule is expelled from the patient's body after a few days (up to a maximum of two weeks) through the natural route with the stool.

The reason for the examination is the suspicion of a disease of the small or large intestine and, in the case of a known disease, the assessment of the activity (extent) of the disease. The probability of success of capsule endoscopy is high, the occurrence of a serious complication is rare.

The advantage of capsule endoscopy is the non-intrusive nature of the examination (no flexible endoscopic device needs to be inserted into the bowel). Another advantage is the direct view of the mucosa of the small and/or large intestine. The intestine under investigation is imaged in its entirety in approximately 75% of cases (this is due to the speed of the endoscopic capsule's progress through the digestive tract and the durability of the batteries that provide illumination, image capture and transmission). Battery life is approximately 8 - 10 hours.

Performance alternatives:

• Alternatives to capsule endoscopy of the small intestine are X-ray examinations (CT- or MR enteroclysis) or examinations with flexible (bendable) endoscopes.
• Alternatives to capsule endoscopy of the colon are flexible endoscope examinations (colonoscopy) or X-ray examinations (CT-colography, irrigography).

Possible complications and risks:

Rarely, capsule endoscopy is associated with the risk of the capsule getting stuck above the affected (narrowed) area of the bowel or in its outflow (diverticulum). If the capsule becomes stuck, it is subsequently removed endoscopically or surgically. For safety reasons, capsule endoscopy is not performed during pregnancy. Before the examination, it should be reported if the patient has a pacemaker or cardioverter inserted. Also, for safety reasons, MRI cannot be performed at the same time as the capsule endoscopy. Eventually, there is a risk of rare inhalation of the capsule during swallowing disorders.

If you suspect that the endoscopic capsule is stuck or if you have otherwise unexplained abdominal pain in connection with the capsule endoscopy, please contact our medical facility during working hours at 311 55 2214 or the doctor at the central reception (24 hours a day) at 311 559 807, 804.

Patient's regimen before the procedure:

• A prerequisite for successful capsule endoscopy is the best possible emptying of the intestine. If the bowel is not well prepared, the risk of an inadequate examination increases. Therefore, preparation is carried out before the examination to clean the bowel (dietary restrictions, laxative preparation, sufficient fluid intake).
• At least 5 days before the procedure, you must exclude from the diet fruits and vegetables that contain peelings or grains, baked goods with coarse grains and poppy seeds.
• The day before the examination, you must follow a liquid-only diet and drink plenty of clear liquids.
• In addition, a purgative prescribed by your doctor should be taken the day before the examination and early in the morning on the day of the examination. Optimal bowel preparation is achieved by split, two-step preparation; the laxative solution, after dilution according to the enclosed instructions, should be ingested at the approximate times and intervals indicated below. In capsule colonoscopy, bowel preparation must also be performed during the examination.