Ophthalmic Procedures

Gastrointestinal Endoscopy

Colorectal Cancer

What is colorectal cancer?
Colorectal cancer is a term used to refer to cancer that develops in the colon (large intestine) or the rectum. These cancers are sometimes referred to separately as colon cancer or rectal cancer, depending on where they start.

Abnormal growths in the colon or rectum
Most colorectal cancers develop slowly over several years. Before a cancer develops, a growth of tissue or tumor usually begins as a non-cancerous polyp on the inner lining of the colon or rectum. A tumor is abnormal tissue and can be benign (not cancer) or malignant (cancer). A polyp is a benign, non-cancerous tumor. Some polyps can change into cancer, but not all do. The chance of changing into a cancer depends upon the kind of polyp.

Adenomatous polyps (adenomas) - Adenomas are polyps that have the potential to change into cancer. Because of this, adenomas are called a pre-cancerous condition.

Hyperplastic and inflammatory polyps - In general, these are are not pre-cancerous. Some doctors think that some hyperplastic polyps can become pre-cancerous or might be a sign of having a greater risk of developing adenomas and cancer, particularly when these polyps grow in the ascending colon.

Dysplasia - Another kind of pre-cancerous condition is called dysplasia. Dysplasia is an area in the lining of the colon or rectum where the cells look abnormal (but not like true cancer cells) when seen under a microscope. These cells can change into cancer over time. Dysplasia is usually seen in people who have had diseases such as ulcerative colitis or Crohn’s disease for many years. Both ulcerative colitis and Crohn’s disease cause chronic inflammation of the colon.

Start and spread of colorectal cancer
If cancer forms within a polyp, it can eventually begin to grow into the wall of the colon or rectum. When cancer cells are in the wall, they can then grow into blood vessels or lymph vessels. Lymph vessels are thin, tiny channels that carry away waste and fluid. They first drain into nearby lymph nodes, which are bean-shaped structures that help fight infections. Once cancer cells spread into blood or lymph vessels, they can travel to nearby lymph nodes or to distant parts of the body, such as the liver. Spread to distant parts of the body is called metastasis.

Types of cancer in the colon and rectum
Several types of cancer can start in the colon or rectum:

Adenocarcinomas - More than 95% of colorectal cancers are adenocarcinomas. These cancers start in cells that form glands that make mucus to lubricate the inside of the colon and rectum. When doctors speak of colorectal cancer, this type of cancer is almost always what they are referring to.

Carcinoid tumors - These less common tumors develop from specialized hormone-producing cells of the intestine.

Gastrointestinal stromal tumors (GISTs) - These less common tumors develop from specialized cells in the wall of the colon called the interstitial cells of Cajal. Some are benign (non-cancerous); others are malignant (cancerous). These tumors can be found anywhere in the digestive tract, but they are unusual in the colon.

Lymphomas -These are cancers of immune system cells that typically develop in lymph nodes, but they may also start in the colon, rectum, or other organs.

Sarcomas -These tumors can start in the blood vessels as well as muscle and connective tissue in the wall of the colon and rectum. Sarcomas of the colon or rectum are rare.

Symptoms of colorectal cancer may include:

  • Blood in the stool
  • Stomach aches, pains, or cramps that do not go away
  • Losing weight and you do not know why
  • Iron-deficiency anemia
  • Change in bowel habits (constipation and/or diarrhea)

Who is at risk for colorectal cancer?
  • Adults 50 years of age and older
  • People with family history of bowel disease, polyps, colorectal cancer
  • African Americans
  • People with a poor diet and/or low physical activity
  • People who smoke and/or drink alcohol excessively

How is colorectal cancer detected?
A screening colonoscopy is considered the gold standard for early colorectal cancer detection. Read more about the colonoscopy procedure here.

When should I start getting screened?
The American College of Gastroenterology recommends a colonoscopy screening beginning at age 50. African Americans should begin screening at age 45. Anyone with family history of colorectal cancer should begin screening 10 years before the age their relative was diagnosed.

To schedule your screening colonoscopy...
Dowload It Is Time For Your Screening Colonoscopy. This document includes our instructions for scheduling, fasting and preparing for the procedure.

IMPORTANT REMINDER:
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Source: American Cancer Society

Colonoscopy

How to schedule a screening colonoscopy:
You can call us directly to schedule a screening colonsocopy. For more information, dowload It Is Time For Your Screening Colonoscopy. This document includes complete instructions for scheduling, fasting and preparing for the procedure. Our gastroenterologists are listed here.

What is a screening colonoscopy?
A screening colonoscopy is a preventative colorectal cancer exam. A screening is performed on a patient with no current symptoms (bleeding, abdominal pain, etc.). If found, a polyp or any abnormal cel growth will be removed for preventative dianosis.

Your first screening colonoscopy is recommended at age 50 and every 10 years thereafter (with normal results). Screening colonoscopies are not needed after your 75th year. Your doctor will advise you on your individual screening schedule if it differs from the 10 year guideline (higher risk or negative results after a colonoscopy may require an earlier re-screen).

As of January 1, 2014, screening colonocopies are covered 100% for people insured under the Affordable Care Act | Obamacare.

What is a diagnostic colonoscopy?
A diagnostic colonoscopy is performed in order to explain a patient’s current complaints or symptoms, either as observed by the physician or reported to him/her by the patient.

Check with your insurance company to learn what portion of a diagnostic colonoscopy is covered.

Diagnostic colonoscopies are scheduled via one of our gastroenterologist's offices. If you are having irregular bowel movements, bleeding or any other complaints related to the lower digestive tract, you may need to consult with a gastroenterologist to determine if a diagnostic colonoscopy is recommended. If you need a gastroenterologist, find one here.

How is the procedure done?
A doctor inserts an endoscope (long, thin, flexible tube equipped with a tiny video camera) rectally to examine and photograph areas of the entire colon (large intestine). Your doctor will search for abnormal growths, polyps or colon cancers and will evaluate the colon for other sources of bleeding. It also allows for treatment such as removal of polyps or taking biopsies of unusual or bleeding tissue.

How long does the procedure take?
The actual procedure usually lasts about 20-30 minutes but can take longer if polyps are present, if the colon is long or twisted, or if excessive scar tissue exists. The extent of time required from check-in to check-out is approximately 2-3 hours.

Will it be painful and uncomfortable?
Quite the contrary. Patients receive sedation, usually propofol, via an IV line administered by an anesthesiologist/CRNA team. The sedative, also called twilight sleep, is a pleasant, relaxed state where you do not feel or remember anything. This allows the patient to experience a pain-free, comfortable procedure. By the time you start to wake up, the procedure has been long complete. The drugs used for sedation rarely result in nausea or vomiting.

Bowel Prep FAQs

It is extremely important that your colon be thoroughly cleaned before your colonoscopy so your doctor can see any abnormalities during the procedure.

Cleansing the colon before a colonoscopy is called bowel preparation, or "prep."
It involves taking medication that causes diarrhea for the purpose of emptying the colon. The medication is taken orally and comes in liquid or tablet form. You will also need to change your diet for a day or two before the colonoscopy. Many patients feel that the bowel prep is the most difficult part of a colonoscopy.

What are the types of bowel prep and how is my prep determined?
Several types of bowel prep medications are available. Your doctor will prescribe the type that is best for you. Your medical condition is the most important factor in deciding which type of bowel prep is prescribed. Tell your doctor if you:

  • Are pregnant or breast feeding
  • Have a history of bowel obstruction
  • Have high blood pressure
  • Have any heart, kidney or liver disease now or in the past
  • Have allergies to medicines
  • Have had difficulty with a bowel prep in the past

Other factors in determining the type of prep are: the time of the colonoscopy appointment; whether the prep is covered by your medical insurance; individual preferences such taste and amount of medication. If taste is important, our patients tell us that the Miralax/Gatorade prep is flavorless and most tolerable. Be sure to discuss the options available to you with your doctor.

What bowel preparation steps are involved before the colonoscopy?
You will need to carefully follow your doctor's instructions about the exact dose and timing of your prep. In general, here is what you can expect:

  • Changing your diet at least one day before your colonoscopy
  • Limiting your diet to clear broths, beverages and gelatin desserts
  • Not consuming dairy products or non-dairy creamers
  • Not consuming red or purple beverages, gelatins and popsicles
  • Drinking more fluids than you usually do to avoid dehydration
  • To follow carefully all the steps your doctor prescribes
  • To tell your doctor what medications you are taking

What medications interfere with bowel prep and/or colonoscopy?

Be sure to talk with your doctor about what you can and cannot take. Most medications can be continued, but these medications may interfere:

  • Aspirin products
  • Arthritis medications
  • Anticoagulants (blood thinners such as warfarin or heparin)
  • Clopidogrel
  • Insulin
  • Iron products

What are the common side effects of bowel prep?
The type and severity of side effects differ among patients. They also vary with the product used. Some patients have nausea, vomiting, bloating (swelling in the abdomen) or abdominal pain. A prep can cause kidney failure, heart failure or seizures, but this is rare. Your doctor will explain the possible side effects of the prep selected for you.

What if I forget to take the medication when I should or remember too late to finish the prep?
Call us and ask what to do if you are not able to complete the bowel prep as advised.


ColonoscopyAssist™

What is ColonoscopyAssist™?
ColonoscopyAssist™ is a program that helps uninsured and under-insured patients afford procedures to screen and diagnose colorectal cancer. They offer interest-free payment plans and grants for upper GI tract endoscopy, colonoscopy and post-colorectal cancer diagnosis support.

ColonoscopyAssist has grown to become one of the largest programs of its kind in North America. It is available in 59 cities throughout the country. Southgate Surgery Center was selected by ColonoscopyAssist as its primary surgical facility in Michigan.

Can I choose which doctor does my procedure at Southgate Surgery Center?
If you would like to, yes. When you request your appointment, just specify the name of the gastroenterologist you prefer--Rana Sabbagh, M.D., Sudarshan Singal, M.D. or Steven Watts, M.D.. Learn more about these physicians here.

What does the $950 flat rate for a colonoscopy include?
The $950 flat rate includes all costs related to the procedure. There are no hidden charges or fine print. The price includes:

  • Physician's fee
  • Southgate Surgery Center's facility fee, including nursing costs
  • Sedation costs
  • Removal of polyps and biopsies

Do I have to be paid-in-full before my procedure?
No. ColonoscopyAssist offers a zero-interest payment plan which is not normally offered to cash pay patients at hospitals or outpatient facilities.

Is my quality of care lessened if I use the ColonoscopyAsssist program?
No. Lower co-pays, exceptional care is our mission every day. As a ColonoscopyAssist patient, you will be treated with the same respect, compassion and courtesy as any other patient with insurance, including free transportation if needed.

Does ColonoscopyAssist have a website?
Yes. The site's address is: colonoscopyassist.com. You can find more information about the program, read patients reviews, learn about colon cancer, request an appointment and much more.

How do I request an appointment?
To request an appointment you may call (847) 986-8999 or make the request online via the following link: Online Appointment Request

Who will do my procedure?
One of our board-certified gastroenterologists credentialed with the ColonoscopyAssist program will provide your care. If you have a preference, include the physician's name on your online appointment request or let the operator know whom you prefer when you call. Our current ColonoscopyAssist providers are:

Sudarshan Singal, M.D.
Steven Watts, M.D.

Upper GI Endoscopy

What is upper GI endoscopy?
Upper GI endoscopy (also called gastroscopy, EGD or Esophagogastroduodenoscopy) is a procedure that allows a physician to view the esophagus, stomach and first part of the small bowel (duodenum) through an endoscope. The patient's throat is numbed and they are given mild sedation so there is no discomfort during the procedure.

Why would I need upper GI endoscopy?
It may be helpful in diagnosing ulcers, gastritis, growths, GERD, Barrett's Esophagus, causes of bleeding or pain and cancer. It may detect the presence of pylori, a type of bacteria that causes ulcers. A sample of tissue (biopsy) may be taken, foreign objects or growths can be removed, bleeding can be stopped and narrow areas (strictures) can be opened.

When should I have this procedure done?
If you are experiencing any of the following symptoms your doctor may recommend upper GI endoscopy:

  • Nausea
  • Vomiting
  • Heartburn
  • Chronic acid reflux
  • Difficulty or pain swallowing
  • Unexplained anemia
  • Upper gastrointestinal bleeding

NOTE: Symptoms such as a little heartburn may not seem like a big deal, but it is crucial to seek a doctor's advice. Something more severe could be going on, like damage to your stomach or esophagus which could turn into cancer.

How do I schedule endoscopy?
If your family doctor or primary care physician has told you that upper GI endoscopy is needed, you can call us to directly schedule it. Our gastroenterologists do not require an office visit prior to the procedure. If you need a gastroenterologist or prefer to see one first, find one at Our Doctors page: here.

Is this covered by insurance?
Many insurance plans and Medicare will cover endoscopy. Check with your plan to find out if it is covered for you. We accept most insurances.

What is gastresophageal reflux disease (GERD)?
GERD is a more serious form of gastroesophageal reflux (GER), also commonly referred to as acid reflux. GERD occurs when stomach contents rise into the esophagus, causing a burning sensation in the chest or throat called heartburn. Occasional GER is common, but when reflux is persistent and occurs more than twice a week, it is considered GERD and can eventually lead to more serious health problems.

GERD can occur in people of all ages and those experiencing symptoms should consult a physician. If left untreated, it can lead to complications such as a bleeding ulcer. Scars from the tissue damage can lead to strictures (narrowed areas of the esophagus) and this makes swallowing difficult. GERD may also cause hoarseness, chronic cough and conditions such as asthma.

What is Barrett's Esophagus?
Barrett's Esophagus is a condition in which there is an abnormal change in the cells of the tissue lining of the esophagus.

No signs or symptoms are associated with Barrett's Esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett's Esophagus develop a rare but often deadly type of cancer of the esophagus.

While the average age of diagnosis is 50, determining when the problem started is usually difficult. Men are twice as likely to develop Barrett's Esophagus and Caucasian men are at a higher risk than men of other races. Since Barrett's Esophagus is more commonly seen in people with GERD, it is crucial to manage and improve symptoms of GERD if you are affected by it, which may lower the risk of developing Barrett's Esophagus.

Barrett's Esophagus can only be diagnosed by having an upper GI performed. Since it does not have any symptoms, it is recommended that adults 40 years and older that have had GERD for a number of years have an upper GI regularly to check for the condition.