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Gastroenterology Services | Taranaki | Te Whatu Ora

Public Service, Gastroenterology & Hepatology (Liver), Endoscopy (Gastroenterology)

Description

What is Gastroenterology?

Gastroenterology is the branch of medicine that looks at diseases of the oesophagus (gullet), stomach, small and large intestines (bowel), liver, gallbladder and pancreas. 

The oesophagus is the tube that joins your mouth with your stomach. It is a muscular tube that contracts to push the food through when you swallow.

The stomach is where food is broken down by acid and emptied into your intestines. The stomach has special cells lining its wall to protect it from these acids.

The intestines consist of the small intestine (duodenum, jejunum and ileum – different sections of small intestine) and the large intestine (colon and rectum).  As food passes through the small intestine, nutrients are broken down and absorbed.  When it passes into the colon, water is absorbed.  The waste that is left is passed as faeces (poo).

The liver is roughly the size of a football and is on your right side just under your ribs. It stores vitamins, sugar and iron which are used by cells in the body for energy. It also clears the body of waste products and drugs, produces substances that are used to help blood clot and aid the immune system, and produces bile which aids in digestion.

The pancreas is an elongated organ that lies in the back of the mid-abdomen. It is responsible for producing digestive juices and certain hormones including insulin, the main hormone responsible for regulating blood sugar.

A gastroenterologist is a doctor specialising in the field of medicine which involves these closely related organs.

The Gastroenterology service has a team of doctors, nurses, and other health care workers who can all help you through your treatment.

Where to find us:

The Gastroenterology Outpatient services are included in the Medical Outpatients Department, ground floor on the southern side of the hospital. 

The Endoscopy Unit is located on the ground floor, near the main entrance below the inpatient wards. 

Consultants

How do I access this service?

Referral

Access to this service is by General Practitioner or Specialist referral only

Referral Expectations

Your GP will refer you with a problem they suspect may relate to the gastrointestinal system.  The consultant who receives the referral may recommend a specialist gastroenterology consultation to establish a diagnosis or initiate treatment, or may recommend that you proceed directly to a procedure without a prior clinic appointment.

If you have a problem requiring immediate assessment, you will be referred to the Emergency Department where you will initially be seen by the registrar (trainee specialist) who will review, order investigations, and make decisions about whether hospital admission is required.   The senior members of the team will be consulted and involved where necessary.

If the problem is non-urgent, the GP will write a referral outlining the details of their concern to the Gastroenterology Department. One of the consultant gastroenterologists working in the Department reviews the referral and makes recommendations as to whether clinic assessment or direct-to-test investigation is required, and the degree of urgency with which this should happen. Urgent cases are usually seen within four weeks, but non-urgent cases may have to wait longer.

The First Specialist Appointment

After your GP’s referral has been accepted into the service, you will be offered a ‘First Specialist Appointment’ (FSA).

At the clinic appointment you will meet the gastroenterologist, or a gastroenterology advanced trainee who sees you on behalf of the specialist and will discuss your case with them. She/he will consider your condition, your circumstances and your health status as well as review any medications you are taking (please bring these with you). You will then have a physical examination, which may involve a rectal examination (the insertion of a gloved finger into your bottom to examine the lower part of the bowel).

Your GP’s referral may be triaged for you to proceed directly to an endoscopy procedure without a prior clinic appointment.

Charges

New Zealand citizens or those who have obtained permanent residence are entitled to publicly funded health care.

Non-residents may be required to pay for their health care.

Hours

Medical Outpatients:
Monday - Friday: 8:00AM - 4:30PM

Endoscopy Unit:
Monday - Friday: 7:00AM - 6:30PM

Procedures / Treatments

Endoscopy

Endoscopy is the process of looking inside body cavities, using a very tiny camera attached to the end of a long, flexible tube (endoscope). Images from the camera are sent to a television monitor so that the doctor can direct the movement of the endoscope. It is also possible to pass different instruments through the endoscope to allow small samples or growths to be removed. Endoscopy allows a doctor to make a diagnosis either by seeing directly what is causing the problem or by taking a small tissue sample for examination under a microscope (biopsy). Endoscopy can also be used as a treatment e.g. for removal of swallowed objects in the oesophagus (food pipe), healing of lesions etc.

Endoscopy is the process of looking inside body cavities, using a very tiny camera attached to the end of a long, flexible tube (endoscope). Images from the camera are sent to a television monitor so that the doctor can direct the movement of the endoscope. It is also possible to pass different instruments through the endoscope to allow small samples or growths to be removed.

Endoscopy allows a doctor to make a diagnosis either by seeing directly what is causing the problem or by taking a small tissue sample for examination under a microscope (biopsy).

Endoscopy can also be used as a treatment e.g. for removal of swallowed objects in the oesophagus (food pipe), healing of lesions etc.

Gastroscopy

A thin flexible tube is passed into the mouth, to the back of the throat and into the oesophagus. It is then passed down into the stomach and the first part of the small bowel. Carbon dioxide is put in through the gastroscope so that the lining of the oesophagus, stomach and small bowel can be inspected. Your endoscopist may apply a spray of local anaesthetic to the back of the throat before the procedure. This will make the back of your throat go numb, and the numbness means it may feel as though there is a lump there which requires clearing. May patients opt for sedation during their gastroscopy procedure. The aim is to help you become sleepy and relaxed, but not unconscious. The intravenous sedative medication works quickly and may have subtle effects for up to 24 hours. Interventions commonly undertaken during the procedure Biopsy A small piece of tissue is taken by forceps passed through the gastroscopy and can be sent to the laboratory for analysis. The lining of the oesophagus, stomach and small bowel is not pain sensitive, so biopsies are painless. Haemostatic procedures If there are abnormalities identified which are bleeding or look as though they may imminently bleed, procedures can be undertaken to stop the bleeding or reduce the risk of it occurring. The appropriate course of action will be chosen by your endoscopist during the procedure. Possible complications Complications from this procedure are very rare but can occur. They include: bleeding after a biopsy, if performed an allergic reaction to the sedative or throat spray perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). Before the procedure You will be asked not to eat anything from midnight the night before and not to take any of your medications on the day of the procedure. After the procedure For 24 hours after receiving sedation you should not drive a motor vehicle, operate machinery or potentially dangerous appliances, drink alcoholic beverages, make important decisions, or sign legal documents. If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP.

A thin flexible tube is passed into the mouth, to the back of the throat and into the oesophagus. It is then passed down into the stomach and the first part of the small bowel. Carbon dioxide is put in through the gastroscope so that the lining of the oesophagus, stomach and small bowel can be inspected. 

Your endoscopist may apply a spray of local anaesthetic to the back of the throat before the procedure. This will make the back of your throat go numb, and the numbness means it may feel as though there is a lump there which requires clearing.  

May patients opt for sedation during their gastroscopy procedure. The aim is to help you become sleepy and relaxed, but not unconscious. The intravenous sedative medication works quickly and may have subtle effects for up to 24 hours.

Interventions commonly undertaken during the procedure
Biopsy
A small piece of tissue is taken by forceps passed through the gastroscopy and can be sent to the laboratory for analysis. The lining of the oesophagus, stomach and small bowel is not pain sensitive, so biopsies are painless. 

Haemostatic procedures
If there are abnormalities identified which are bleeding or look as though they may imminently bleed, procedures can be undertaken to stop the bleeding or reduce the risk of it occurring. The appropriate course of action will be chosen by your endoscopist during the procedure. 

Possible complications
Complications from this procedure are very rare but can occur. They include:

  • bleeding after a biopsy, if performed
  • an allergic reaction to the sedative or throat spray
  • perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication).

Before the procedure
You will be asked not to eat anything from midnight the night before and not to take any of your medications on the day of the procedure.

After the procedure
For 24 hours after receiving sedation you should not drive a motor vehicle, operate machinery or potentially dangerous appliances, drink alcoholic beverages, make important decisions, or sign legal documents.

If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks.  A report and copies of these are sent to your GP.

Endoscopic Retrograde Cholangio Pancreatography (ERCP)

A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while you are under sedation (medication to make you drowsy). A smaller tube is then moved through the first tube into the bile duct (the tube that connects your gallbladder to your intestines), or the pancreas duct, through which dye is injected and an x-ray is taken to visualise the ducts. This procedure enables the removal of stones from the ducts without the need for surgery and also allows for the placement of small drainage tubes (stents) to relieve a blockage in the bile ducts. Possible complications Possible complications include inflammation of the pancreas in 2-4% of patients, bleeding or perforation of the wall of the intestine.

A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while you are under sedation (medication to make you drowsy). A smaller tube is then moved through the first tube into the bile duct (the tube that connects your gallbladder to your intestines), or the pancreas duct, through which dye is injected and an x-ray is taken to visualise the ducts.

This procedure enables the removal of stones from the ducts without the need for surgery and also allows for the placement of small drainage tubes (stents) to relieve a blockage in the bile ducts.

Possible complications
Possible complications include inflammation of the pancreas in 2-4% of patients, bleeding or perforation of the wall of the intestine.

Colonoscopy

A thin flexible tube is passed into the bottom and is steered to the point where the colon and small bowel meet. Carbon dioxide gas is put into the colon through the colonoscope so that the lining of the colon and small bowel can be inspected. Most patients opt for sedation and pain relief during their colonoscopy procedure. The aim is to help you become sleepy and relaxed, but not make you unconscious. The intravenous sedation and pain relief medication works quickly and may have subtle lasting effects for up to 24 hours. During the procedure there may be times where you feel discomfort in your abdomen. The endoscopy staff will monitor you closely and will try to make the procedure as comfortable for you as possible. Interventions commonly undertaken during the procedure Biopsy A small piece of tissue is taken by forceps passed through the colonoscope and can be sent to the laboratory for analysis. The lining of the colon is not pain-sensitive, so biopsies are painless. Polyp removal Polyps are small wart-like growths on the lining of the colon. Some polyps may, over a long period of time, grow larger and eventually develop into bowel cancers. If small polyps are identified and it is possible to remove them this will be done at the time of colonoscopy. Some larger polyps may not be suitable for removal – if this is the case they will be photographed, may be biopsied, and their location marked with a tattoo so that their safe removal can be planned for a later date. Possible complications Colonoscopy is generally a very safe procedure, though it carries a small risk of complications. Incomplete examination In most instances the entire colon is able to be examined at the time of colonoscopy, however in a small proportion this is not possible. If this is the case, there are other means by which the colon can be investigated. Arrangements for this will be made by the endoscopist. Perforation Inadvertently making a hole in the colon is rare, occurring in fewer than 1 of every 1000 diagnostic colonoscopy procedures. However, if it occurs it is a very serious complication and may require further procedures or even emergency operations to repair the perforation. Bleeding Minor bleeding occurs after every biopsy is taken, and every polyp removed. This usually settles without specific management. In the event that bleeding is severe or prolonged, a further procedure to stop it may be required. Before the procedure You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test as the bowel needs to be completely clean for the procedure. After the procedure For 24 hours after receiving sedation you should not drive a motor vehicle, operate machinery or potentially dangerous appliances, drink alcoholic beverages, make important decisions, or sign legal documents. If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP.

A thin flexible tube is passed into the bottom and is steered to the point where the colon and small bowel meet. Carbon dioxide gas is put into the colon through the colonoscope so that the lining of the colon and small bowel can be inspected.

Most patients opt for sedation and pain relief during their colonoscopy procedure. The aim is to help you become sleepy and relaxed, but not make you unconscious. The intravenous sedation and pain relief medication works quickly and may have subtle lasting effects for up to 24 hours. During the procedure there may be times where you feel discomfort in your abdomen. The endoscopy staff will monitor you closely and will try to make the procedure as comfortable for you as possible. 

Interventions commonly undertaken during the procedure
Biopsy
A small piece of tissue is taken by forceps passed through the colonoscope and can be sent to the laboratory for analysis.  The lining of the colon is not pain-sensitive, so biopsies are painless.

Polyp removal
Polyps are small wart-like growths on the lining of the colon.  Some polyps may, over a long period of time, grow larger and eventually develop into bowel cancers.  If small polyps are identified and it is possible to remove them this will be done at the time of colonoscopy.  Some larger polyps may not be suitable for removal – if this is the case they will be photographed, may be biopsied, and their location marked with a tattoo so that their safe removal can be planned for a later date.

Possible complications
Colonoscopy is generally a very safe procedure, though it carries a small risk of complications.

Incomplete examination
In most instances the entire colon is able to be examined at the time of colonoscopy, however in a small proportion this is not possible.  If this is the case, there are other means by which the colon can be investigated. Arrangements for this will be made by the endoscopist.

Perforation
Inadvertently making a hole in the colon is rare, occurring in fewer than 1 of every 1000 diagnostic colonoscopy procedures.  However, if it occurs it is a very serious complication and may require further procedures or even emergency operations to repair the perforation.

Bleeding
Minor bleeding occurs after every biopsy is taken, and every polyp removed.  This usually settles without specific management.  In the event that bleeding is severe or prolonged, a further procedure to stop it may be required.

Before the procedure
You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test as the bowel needs to be completely clean for the procedure.

After the procedure
For 24 hours after receiving sedation you should not drive a motor vehicle, operate machinery or potentially dangerous appliances, drink alcoholic beverages, make important decisions, or sign legal documents.

If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks.  A report and copies of these are sent to your GP.

Flexible Sigmoidoscopy

A thin flexible tube is passed into the bottom and steered through the lower part of the colon. Carbon dioxide gas is put into the colon through the scope so that the lining of the colon can be inspected Most patients opt for sedation and pain relief during their flexible sigmoidoscopy procedure. The aim is to help you become sleepy and relaxed, but not to make you unconscious. The intravenous sedative and pain relief medication works quickly and may have subtle lasting effects for up to 24 hours. During the procedure there may be times where you feel discomfort in your abdomen. The endoscopy staff will be monitoring you closely and will try to make the procedure as comfortable for you as possible. Interventions commonly undertaken during the procedure Biopsy A small piece of tissue is taken by forceps passed through the scope and can be sent to the laboratory for analysis. The lining of the colon is not pain-sensitive, so biopsies are painless. Polyp removal Polyps are small wart-like growths on the lining of the colon. Some polyps may, over a long period of time, grow larger and eventually develop into bowel cancers. If small polyps are identified and it is possible to remove them this will be done at the time of flexible sigmoidoscopy. Some larger polyps may not be suitable for removal – if this is the case they will be photographed, may be biopsied, and their location marked with a tattoo so that their safe removal can be planned for a later date. Possible complications Flexible sigmoidoscopy is generally a very safe procedure, though it carries a small risk of complications. Perforation Inadvertently making a hole in the colon is rare, occurring in fewer than 1 of every 3000 diagnostic flexible sigmoidoscopy procedures. However, if it occurs it is a very serious complication and may require further procedures or even emergency operations to repair the perforation. Bleeding Minor bleeding occurs after every biopsy is taken, and every polyp removed. This usually settles without specific management. In the event that bleeding is severe or prolonged, a further procedure to stop it may be required. Before the procedure You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test as the bowel needs to be completely clean for the procedure. After the procedure For 24 hours after receiving sedation you should not drive a motor vehicle, operate machinery or potentially dangerous appliances, drink alcoholic beverages, make important decisions, or sign legal documents. If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP.

A thin flexible tube is passed into the bottom and steered through the lower part of the colon.  Carbon dioxide gas is put into the colon through the scope so that the lining of the colon can be inspected

Most patients opt for sedation and pain relief during their flexible sigmoidoscopy procedure.  The aim is to help you become sleepy and relaxed, but not to make you unconscious.  The intravenous sedative and pain relief medication works quickly and may have subtle lasting effects for up to 24 hours.  During the procedure there may be times where you feel discomfort in your abdomen.  The endoscopy staff will be monitoring you closely and will try to make the procedure as comfortable for you as possible.

Interventions commonly undertaken during the procedure
Biopsy
A small piece of tissue is taken by forceps passed through the scope and can be sent to the laboratory for analysis.  The lining of the colon is not pain-sensitive, so biopsies are painless.

Polyp removal
Polyps are small wart-like growths on the lining of the colon.  Some polyps may, over a long period of time, grow larger and eventually develop into bowel cancers.  If small polyps are identified and it is possible to remove them this will be done at the time of flexible sigmoidoscopy.  Some larger polyps may not be suitable for removal – if this is the case they will be photographed, may be biopsied, and their location marked with a tattoo so that their safe removal can be planned for a later date.

Possible complications
Flexible sigmoidoscopy is generally a very safe procedure, though it carries a small risk of complications.

Perforation
Inadvertently making a hole in the colon is rare, occurring in fewer than 1 of every 3000 diagnostic flexible sigmoidoscopy procedures.  However, if it occurs it is a very serious complication and may require further procedures or even emergency operations to repair the perforation.

Bleeding
Minor bleeding occurs after every biopsy is taken, and every polyp removed.  This usually settles without specific management.  In the event that bleeding is severe or prolonged, a further procedure to stop it may be required.

Before the procedure
You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test as the bowel needs to be completely clean for the procedure.

After the procedure
For 24 hours after receiving sedation you should not drive a motor vehicle, operate machinery or potentially dangerous appliances, drink alcoholic beverages, make important decisions, or sign legal documents.

If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks.  A report and copies of these are sent to your GP.

FibroScan

A fibroScan is a non-invasive ultrasound scan of the liver that uses advanced ultrasound technology called transient elastography to measure liver stiffness. It is a quick and easy test that together allows you and your doctor to find out the state of your liver health.

A fibroScan is a non-invasive ultrasound scan of the liver that uses advanced ultrasound technology called transient elastography to measure liver stiffness. It is a quick and easy test that together allows you and your doctor to find out the state of your liver health.

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This page was last updated at 1:33PM on November 20, 2023. This information is reviewed and edited by Gastroenterology Services | Taranaki | Te Whatu Ora.