GASTROSCOPY / ENDOSCOPY

Gastroscopy / endoscopy is performed under light anaesthetic using flexible cameras through the mouth to diagnose conditions of the stomach or oesophagus. Gallstones in the bile tube can also be removed. Various conditions may be treated by endoscopy.

Professor Falk may recommend endoscopy to:

• Look for changes in the oesophagus caused by acid burn
  
• Exclude the possibility of the presence of cancer in the oesophagus as a result of reflux disease
  
• Check the stomach for ulceration or cancer
  
• Check for the presence of Barrett’s oesophagus and allow biopsy
  
• Treatment:
  
  • open narrow scarred areas
    
  • remove tumours (endoscopic mucosal resection, endoscopic submucosal dissection)
    
  • remove premalignant Barrett's Oesophagus

Only 50% of patients will show endoscopic changes despite having abnormal levels of acid in the oesophagus.

ERCP (ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY)

ERCP is a procedure used to examine the pancreatic and bile ducts. It is often used to investigate jaundice and can be used in the removal of stones. A thin, flexible tube is passed through the mouth, into the stomach and then through the first part of the small intestine (duodenum) before finally reaching the bile ducts. Special x-rays are taken using special dye (contrast material) that outlines the internal structures.

OESOPHAGEAL MANOMETRY

Manometry testing is often ordered and reported by Professor Falk prior to reflux surgery to:

• Confirm the diagnosis to achieve best results
  
• Exclude other diseases
  
• Help advise the patient regarding the potential for post-surgical side effects

It is often performed in the process of diagnosis if there is a sensation of food sticking in the oesophagus, chest pain, throat symptoms or cough.

Technique:

• Local anaesthetic is used to numb the nose and throat
  
• The small flexible tube is swallowed easily
  
• Pressure waves are measured on each swallow
  
• The pressure in the valve between the stomach and oesophagus is measured
  
• The test takes about 20 minutes

Results are not immediately available, requiring calculation, and will be sent to your referring doctor.

24 HOUR PH TESTING

Also known as acid studies, 24 hour pH testing may be suggested if your endoscopy is negative. However a trial of medication is quite effective and usually enough. Should medication not work and you are asked to see Professor Falk, acid studies are often undertaken to make absolutely sure any operation recommended is performed for the appropriate reason. It is well established that the best surgical results occur when surgeons adequately investigate patients prior to treatment.

We use 24 Hour pH Testing to:

• Confirm the diagnosis of reflux disease prior to treatment or surgery.
  
• Investigate symptoms which are not diagnostic.
  
• Diagnose atypical reflux symptoms (cough, voice, sore throat).
  
• Check the effectiveness of reflux medications.
  
• Evaluate surgery performed elsewhere.

Technique:

• The nose and throat are made numb by local anaesthetic.
  
• The tube (1.5mm) is swallowed and records acid in the oesophagus. It is best kept in for 24 hours (hence the name) and normal values are recoded.

24 HOUR REFLUX IMPEDANCE MONITORING

This is a relatively new test of great advantage. Impedance monitoring can identify reflux of non-acidic or mildly-acidic material, which doesn’t appear on acid studies but also causes symptoms. This procedure may be recommended for a number of reasons including difficulty diagnosing conditions and failure of medication to eradicate symptoms. It is particularly helpful in throat symptoms and cough and evaluating the effectiveness of reflux medications. It is performed simultaneously with 24 hr pH study using a single complex fine catheter, containing pH and impedance sensors.

Results are calculated using computer algorithms.

Indications:

• Heartburn
  
• Regurgitation
  
• Wheeze bronchospasm
  
• Choking
  
• Voice trouble (scratchy, hoarse, weak)
  
• Shortness of breath

The test detects regurgitation episodes of:

• Acid
  
• Mild acid
  
• Gas
  
• Fluid

All of these can contribute to oesophageal or reflux symptoms.

Technique:

• Similar to acid studies, testing is performed over a fine swallowed tube.