Atlantic Medical Group Gastroenterology at 33 Upper Overlook Road, Summit

At Atlantic Medical Group Gastroenterology, we treat several conditions with advanced endoscopy, including:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound
• Endoscopic submucosal dissection; endoscopic mucosal resection (advance polyp removal)
• Luminal stent place
• Small bowel endoscopy
• Pancreatic cyst management and necrosectomy

Endoscopic surgical techniques include:

• Esophageal and gastric Per Oral Endoscopic Myotomy (POEM)
• Zenker’s diverticulectomy
• Transoral Incisionless Fundoplication
• Enteric stenting
• Double balloon enteroscopy
• Barrett’s esophagus management
• Endoscopic suturing

An anorectal manometry is a short procedure used to diagnose disorders of the anus and rectum, commonly referred to as “pelvic floor” disorders. We offer office-based anorectal manometry at Atlantic Medical Group Gastroenterology at Morristown. The test takes approximately 15 minutes and does not require anesthesia.

How the test is performed:

• While lying on your left side, a thin, flexible catheter (thinner than a pencil) with a small balloon at the end and four smaller balloons a little further back is lubricated and inserted only 4 to 5 inches into your rectum.
• This catheter is connected to a small hand-held device that measures pressures in your rectum and anal sphincter as you perform a series of maneuvers.
• The nurse or certified medical assistant performing the procedure will ask you to squeeze, relax and push at various times.
• After this portion of the test is complete, the balloon inside your rectum will be inflated with air to assess the sensitivity of your rectum.
• Once this portion of the test is complete, this catheter is removed and a different, smaller catheter with a balloon at the tip is inserted into your rectum to perform what is called the “balloon expulsion test.” The balloon inside your rectum is inflated with 50 mL of lukewarm water, at which time you will be asked to sit on a commode (in private) and attempt to push the balloon out.

This test is meant to simulate having a bowel movement and helps determine if you may have difficulty with evacuation, i.e., pushing out stool.

Preparation

We ask that you give yourself a Fleet enema two hours prior to the procedure, and not eat or drink anything for two hours prior to the procedure. After the test is complete, you may drive yourself home and go about your normal activities.

Motility disorders of the esophagus can present in various ways, including trouble swallowing, pain with swallowing, non-cardiac chest pain, regurgitation, coughing, or frequent belching. To diagnose and guide treatment for esophageal motility disorders, we offer high-resolution esophageal manometry.

The test usually takes 15 minutes to perform and does not require anesthesia (you can drive yourself to and from the procedure). You will be asked not to eat or drink anything after midnight on the night before your test.

How the test is performed:

• An esophageal manometry catheter is a sophisticated catheter with 36 pressure sensors that extend the length of the catheter.
• This catheter is inserted through your nose (after applying numbing ointment) and down your esophagus, with the tip of the catheter ending in your stomach.
• You are then asked to swallow a small amount of saline (salt water) 10-15 times as the catheter sensors measure the movement of muscles in your esophagus.
• The catheter is connected to a computer that provides a detailed map of your esophagus. Your physician will analyze this map to determine if you have an esophageal motility disorder and, if so, which one.

A colonoscopy is a procedure performed under anesthesia that enables your doctor to examine the inside of your colon (large intestine). The doctor will insert a long, flexible tube (about the width of an index finger) through your anus and into your colon to look for pre-cancerous polyps or early colon cancer.

Yes, you will receive sedation for the exam. The sedation most commonly used is propofol. An intravenous line will be placed in order to administer the sedation (anesthesia). This is not general anesthesia; however, you will be asleep, have little to no discomfort during the procedure, and have no recollection of the procedure afterward. Because you will be receiving sedation, you will need a driver to take you home.

It is the patient’s responsibility to check with their health insurance provider to determine their colorectal cancer screening benefits. Most insurance providers cover colonoscopy for colon cancer screening; however, insurance coverage varies and is dependent on patient age.

Preparation is a critically important part of the exam. If your bowel is not adequately cleaned out before the exam, the doctor will not be able to identify and remove polyps, which are pre-cancerous growths. Before the procedure, you will have to take an oral laxative solution (called “a bowel prep” or “preparation”) to clean out your bowel. Specific prep instructions vary, but the prep usually begins 1 to 2 days before your procedure.

Please read your prep instructions (given separately) to understand what you should do 1 or 2 days before your colonoscopy.

Yes, the procedure can still be performed while you have your menstrual cycle. Tampons or pads can be worn if preferred by the patient.

In general, most medications do not interfere with this procedure. However, if you are on insulin, your dosage may need to be adjusted or changed for the preparation period and the day of the procedure. Also, if you take anti-coagulant or blood-thinning medications, they may have to be discontinued or a “bridge medication” started before the procedure. Ask your prescribing physician about adjusting your medication at least two weeks prior to the start of procedure prep.

You will need to take off the day of the procedure. Some patients, who work evenings, also take off work the day before the procedure to complete the bowel prep. Most patients are able to return to work the next day.

It is important to arrive at the time listed in your bowel preparation packet to allow the Endo Unit to prepare you for your procedure. This includes the completion of paperwork, changing into a hospital gown, taking your vital signs, placing an IV (intravenous) in your arm, and answering any questions you have about the procedure. Please arrive on time to prevent delays in starting your procedure.

No. It is important to follow the schedule in your bowel preparation packet. Drinking the last half of the laxative closer to your procedure time will give better results and a cleaner colon for your procedure. If your bowels are not clean, your procedure may get postponed, cancelled, or need to be repeated.

After finishing your bowel prep, your stool should be watery. The color of your stool should also be clear or yellow.

Please refer to your preparation packet for detailed information.

Please contact your gastroenterology office for a prescription. Make sure you have your prep ready at least 1 week prior to your procedure, so if an instance like this occurs, it can be addressed with enough time to prep.

Yes, you can eat normally after your procedure. However, our gastroenterologists recommend eating light meals if you feel bloated or are having difficulty passing gas within the first 24 hours post-procedure. Be sure to avoid alcohol during this time.

No, alcohol makes you dehydrated because you lose more fluids than you take in. It can also affect how the relaxation medication works. You should drink a lot of clear liquids the day before your test, but not alcohol.

Please refer to your procedure packet for the most recent COVID testing instructions.