Editing Gastroenterology (section)

== Procedures ==

=== Colonoscopy ===
{{See also|Colonoscopy}}
[[File:Diagram_showing_a_colonoscopy_CRUK_060.svg|thumb|Diagram of a colonoscopy procedure]]
A procedure using a [[Endoscope|long thin tube with a camera]] that is passed through the [[Human anus|anus]] to visualize the [[rectum]] and the entire length of the colon. The procedure is performed either to look for [[Colorectal polyp|colon polyps]] and/or [[Colorectal cancer|colon cancer]] in somebody without symptoms, referred to as [[Screening (medicine)|screening]], or to further evaluate symptoms including [[rectal bleeding]], [[Melena|dark tarry stools]], change in bowel habits or stool consistency (diarrhea, pencil-thin stool), abdominal pain, and unexplained weight loss. Before the procedure, the physician might ask the patient to stop taking certain medications including blood thinners, aspirin, diabetes medications, or [[nonsteroidal anti-inflammatory drug]]s. A [[Bowel cleansing|bowel prep]] is usually taken the night before and into the morning of the procedure which consists of an [[enema]] or [[laxative]]s, either pills or powder dissolved in liquid, that will cause diarrhea. The procedure might need to be stopped and rescheduled if there is stool remaining in the colon due to an incomplete bowel prep because the physician can not adequately visualize the colon. During the procedure, the patient is [[Sedation|sedated]] and the scope is used to examine the entire length of the colon looking for polyps, bleeding, or abnormal tissue. A [[biopsy]] or [[Polypectomy|polyp removal]] can then be performed and the tissue sent to the lab for evaluation. The procedure usually takes thirty minutes to an hour followed by a one to two hour observation period. Complications include bloating, cramping, a reaction to anesthesia, bleeding, and a [[Gastrointestinal perforation|hole through the wall]] of the colon that may require repeat colonoscopy or surgery. Signs of a serious complication requiring urgent or emergent medical attention include severe pain in the abdomen, fever, bleeding that does not improve, dizziness, and weakness.<ref>{{Cite web |title=Colonoscopy {{!}} NIDDK |url=https://www.niddk.nih.gov/health-information/diagnostic-tests/colonoscopy |access-date=2022-12-08 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

=== Sigmoidoscopy ===
{{See also|Sigmoidoscopy}}
[[File:Diagram_showing_sigmoidoscopy.svg|thumb|Sigmoidoscopy]]
A procedure similar to a colonoscopy using a long thin tube with a camera (scope) passed through the [[Human anus|anus]] but only intended to visualize the [[rectum]] and the [[Sigmoid colon|last part of the colon]] closest to the rectum. All aspects of the procedure are the same as for a colonoscopy with the exception that this procedure only lasts ten to twenty minutes and is done without sedation. This usually allows for the patient to return to normal activities immediately after the procedure is finished.<ref>{{Cite web |title=Flexible Sigmoidoscopy {{!}} NIDDK |url=https://www.niddk.nih.gov/health-information/diagnostic-tests/flexible-sigmoidoscopy |access-date=2022-12-09 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

=== Esophagogastroduodenoscopy (EGD) ===
{{See also|Esophagogastroduodenoscopy}}[[File:Endoscopy_start.jpg|thumb|Endoscopy]]A procedure using a [[Endoscope|long thin tube with a camera]] that is passed through the mouth to view the [[esophagus]] ("esophago-"), [[stomach]] ("gastro-"), and the [[duodenum]] ("duodeno-"). It is also referred to as upper endoscopy or just endoscopy. The procedure is performed for further evaluation of symptoms including persistent [[heartburn]], [[indigestion]], [[Hematemesis|vomiting blood]], [[Melena|dark tarry stools]], persistent nausea and vomiting, pain, [[Dysphagia|difficulty swallowing]], [[Odynophagia|painful swallowing]], and unexplained weight loss. It is also performed for further testing following a lab test that shows [[Anemia|low hemoglobin levels]] without a known cause or an abnormal [[Upper gastrointestinal series|barium swallow]]. The procedure can be used to diagnose many disorders through direct visualization or tissue biopsy including [[esophageal varices]], [[esophageal stricture]]s, [[gastroesophageal reflux disease]], [[Barrett's esophagus]], cancer, [[Coeliac disease|celiac disease]], [[gastritis]], [[peptic ulcer disease]], and a [[Helicobacter pylori|H. pylori]] infection. Intra-operative techniques can then be used for treatment of certain disorders like [[Banding (medical)|banding]] esophageal varices or [[Esophageal dilatation|dilating]] esophageal strictures. The patient will likely be required to not eat or drink anything starting 4 hours prior to the procedure. Sedation is usually required for patient comfort. This procedure usually lasts around thirty minutes followed by a one to two hour observation period. Side effects include [[bloating]], nausea, and a sore throat for 1 to 2 days. Complications are rare but include reaction to the anesthesia, bleeding, and a [[Gastrointestinal perforation|hole through the wall]] of the esophagus, stomach, or small intestine which could require surgery. Signs of a serious complication requiring urgent or emergent medical attention include chest pain, problems breathing, problems swallowing, throat pain that gets worse, vomiting with blood or the appearance of "[[Coffee ground vomiting|coffee-grounds]]", worsening abdominal pain, [[Blood in stool|bloody]] or black tarry stool, and fever.<ref>{{Cite web |title=Upper GI Endoscopy {{!}} NIDDK |url=https://www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-endoscopy |access-date=2022-12-09 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

=== Endoscopic Retrograde Cholangiopancreatography (ERCP) ===
{{See also|Endoscopic retrograde cholangiopancreatography}}
[[File:Detailed_diagram_of_an_endoscopic_retrograde_cholangio_pancreatography_(ERCP)_CRUK_001.svg|thumb|ERCP]]
A procedure using a [[Endoscope|long thin tube with a camera]] passed through the mouth into the [[Duodenum|first part of the small intestine]] to locate, diagnose, and treat disorders related to the [[Bile duct|bile]] and [[pancreatic duct]]s. These ducts carry fluids that help with digesting food from the liver, gallbladder, and pancreas and can become narrowed or blocked as a result of [[gallstone]]s, infection, inflammation, [[pancreatic pseudocyst]]s, and tumors of the bile ducts or pancreas. As a result, one may experience back pain, [[Jaundice|yellowing of the skin]], and an abnormal lab test showing an elevated [[Hyperbilirubinemia in adults|bilirubin]] level which could necessitate this procedure. However, the procedure is not recommended if the patient has [[acute pancreatitis]] unless the level of bilirubin remains high or is increasing which could suggest the blockage is still present. The patient will likely be required to not eat or drink anything starting 8 hours prior to the procedure. After the patient is sedated, the physician will pass the scope through the mouth, esophagus, stomach, and into the duodenum to locate the [[Major duodenal papilla|opening]] where the ducts [[Ampulla of Vater|drain into the small intestine]]. The physician can then inject dye into these ducts and take X-rays which show a real time view, via [[fluoroscopy]], allowing the physician to locate and relieve the blockage. This is done through multiple techniques including [[Biliary endoscopic sphincterotomy|cutting the opening]] and creating a bigger hole for drainage, removing gallstones and other debris, dilating narrow parts of the ducts, or placing a stent which keeps the ducts open. The physician can also take a [[biopsy]] of the ducts to evaluate for cancer, infection, or inflammation. Side effects include bloating, nausea, or a sore throat for one to two days. Complications include [[pancreatitis]], infection of the [[Ascending cholangitis|bile ducts]] or [[Cholecystitis|gallbladder]], bleeding, reaction to the anesthesia, and perforation of any structures that the scope or its instruments pass but particularly the duodenum, bile duct, and pancreatic duct. Signs of a serious complication requiring urgent or emergent medical attention include bloody or [[Melena|black tarry stool]], chest pain, fever, worsening abdominal pain, worsening throat pain, problems breathing, problems swallowing, vomit that is bloody or looks like [[Coffee ground vomiting|coffee-grounds]]. Most of the time complications from this procedure require hospitalization for treatment.<ref>{{Cite web |title=Endoscopic Retrograde Cholangiopancreatography (ERCP) {{!}} NIDDK |url=https://www.niddk.nih.gov/health-information/diagnostic-tests/endoscopic-retrograde-cholangiopancreatography |access-date=2022-12-12 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

=== Ultrasound and Bowel Ultrasound ===

[[Ultrasound]] has become a standard tool in many medical settings. Its widespread availability, affordability, safety, and lack of radiation have established it as a common initial diagnostic method. In gastroenterology, ultrasound is highly accurate in diagnosing various conditions (e.g., [[Appendicitis]], [[Diverticulitis]]). Furthermore, bowel ultrasound is crucial for identifying and managing [[Inflammatory bowel disease]] and their complications, including the early detection of [[Crohn's disease]] recurrence after surgery, as highlighted in the ECCO–ESGAR guidelines.<ref>Maaser, C.; Sturm, A.; Vavricka, S.R.; Kucharzik, T.; Fiorino, G.; Annese, V.; Calabrese, E.; Baumgart, D.C.; Bettenworth, D.; Borralho Nunes, P.; et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J. Crohn’s Colitis 2019, 13, 144–164.</ref> Modern ultrasound techniques like contrast-enhanced ultrasound offer real-time functional and vascular information, improving diagnostic capabilities. Additionally, operative abdominal ultrasound is increasingly important in minimally invasive interventions, including guided [[Biopsy|biopsies]], drainage, and thermal ablation of liver lesions. 
Nevertheless, the accuracy of ultrasound is operator-dependent, and inadequate training can lead to diagnostic errors.<ref>Wüstner, M.; Radzina, M.; Calliada, F.; Cantisani, V.; Havre, R.F.; Jenderka, K.V.; Kabaalioğlu, A.; Kocian, M.; Kollmann, C.; Künzel, J.; et al. Professional Standards in Medical Ultrasound—EFSUMB Position Paper (Short Version)—General Aspects. Ultraschall Med. 2022, 43, 456–463. </ref> The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has established guidelines to define professional standards and the minimum training needed for ultrasound examinations. These guidelines outline three levels of expertise based on anatomical knowledge, the ability to assess diseases using ultrasound, and the volume of exams performed (at least 300 per year for level 1).<ref>Wüstner, M.; Radzina, M.; Calliada, F.; Cantisani, V.; Havre, R.F.; Jenderka, K.V.; Kabaalioğlu, A.; Kocian, M.; Kollmann, C.; Künzel, J.; et al. Professional Standards in Medical Ultrasound—EFSUMB Position Paper (Short Version)—General Aspects. Ultraschall Med. 2022, 43, 456–463</ref>
A recent study indicated that the majority of young Italian gastroenterologists (<40 y.o.) (58.9%) acquired their ultrasound skills during their gastroenterology training. Throughout their training, participants performed a median of 320 abdominal ultrasound examinations and 240 bowel ultrasound examinations.<ref>Cortellini F, Fichera A, Guarino AD, Laterza L, Alemanni LV, Lopetuso L, Marasco G, Costantino A. Abdominal and Bowel Ultrasound Knowledge Among Young Gastroenterologists: Results of an Italian Survey. Journal of Clinical Medicine. 2025; 14(8):2693. https://doi.org/10.3390/jcm14082693</ref>