Services

 

Consultation with a gastroenterologist

Consultation with an expert gastroenterologist is the main way for your doctor to reach an accurate diagnosis and ideal treatment for you condition. During the consultation, your specialist will discuss your symptoms in detail as well as your medical history and any other background issues. A medical examination will then be performed. Your specialist may recommend tests including gastroscopy or colonoscopy, blood tests, ultrasound or x-rays. A follow-up appointment may be advised to discuss results of tests and further treatment. For complex or long term gastrointestinal or liver problems, regular reviews may be needed.

An initial consultation will usually take between 15 and 45 minutes, depending on the complexity of your problem. Follow-up appointments are generally of shorter duration.

Gastroscopy

Gastroscopy is an examination of the upper gastrointestinal tract using a thin, flexible instrument. The gastroscope is passed through the mouth into the upper gastrointestinal tract and allows direct visual inspection of the oesophagus, stomach and duodenum. Biopsies (tissue samples) may be taken during the procedure.
An intravenous sedative is given prior to the procedure, so you will be sleepy and comfortable during the examination. Gastroscopy is performed as a day procedure at a hospital of day surgery centre.

It is very rare for any complications to occur due to gastroscopy. Serious problems such as damage to the gut or anaesthetic complications occur in approximately 1 in 10,000 cases. Your doctor will discuss the procedure in more detail prior to your gastroscopy.

The sedative you are given for the procedure may affect your memory of the procedure and the events of the next hour or so. Because the sedative may interfere with your judgement or ability to concentrate, you should not drive a motor car, ride a bicycle or travel unaccompanied, use dangerous machinery or sign important documents for the remainder of the day.

It is necessary to arrange for a friend or relative to take you home from the hospital. You must have an adult staying with you in the home overnight following your procedure.

Most people require just one day off work for a gastroscopy. A medical certificate can be provided by your doctor on the day of the procedure.

Further details and preparation for gastroscopy are provided in the following documents.


Gastroscopy

 

Colonoscopy

A colonoscopy is a procedure to inspect the inside of the bowel. A thin, flexible tube is passed around the large bowel, allowing direct examination via a camera. Biopsies may be taken or polyps removed during colonoscopy.
An intravenous sedative is given prior to the procedure, so you will be sleepy and comfortable during the examination. Colonoscopy is performed as a day procedure at a hospital of day surgery centre.

Colonoscopy is generally a safe procedure. Complications are rare. These include intolerance to the bowel preparation or reaction to the sedatives. Serious complications occur in approximately 1 in 1000 examinations. Perforation (making a hole in the bowel) is extremely rare, but if it occurs surgery may be required. Rarely, major bleeding may require a blood transfusion. Your doctor will discuss this in more detail before the procedure.

The sedative you are given for the procedure may affect your memory of the procedure and the events of the next hour or so. Because the sedative may interfere with your judgement or ability to concentrate, you should not drive a motor car, ride a bicycle or travel unaccompanied, use dangerous machinery or sign important documents for the remainder of the day. 

It is necessary to arrange for a friend or relative to take you home from the hospital. You must have an adult staying with you in the home overnight following your procedure.
Most people require just one day off work for a colonoscopy procedure. A medical certificate can be provided by your doctor on the day of the colonoscopy.

Further details and preparation for colonoscopy are provided in the following documents. For most patients bowel preparation A is recommended, but the ideal preparation in your case should be discussed at the time of booking. It is essential to follow carefully the bowel preparation instructions to provide the best chance of a successful colonoscopy.


Colonoscopy with bowel
preparation A

Colonoscopy with bowel
preparation B

Capsule endoscopy

Capsule endoscopy is also known as PillCam or wireless endoscopy. Capsule endoscopy is used mainly to pinpoint bleeding in hidden areas in the small bowel. It is more sensitive than many other techniques. Capsule endoscopy uses a 10x27mm capsule, which contains a tiny camera, batteries, light source and transmitter. After swallowing, the capsule travels like a piece of food through the gastrointestinal system. It provides high-resolution images of the stomach and small intestine, taking two pictures every second for up to 11 hours, providing about 60,000 pictures in total. Recording probes, taped on the abdomen, track the progress of the capsule. The images obtained by the capsule are transmitted to a data-recorder worn in a harness around the waist.

Further information and instruction for capsule endoscopy are below.


PillCam SB Patient Brochure

Patient information and instructions for capsule endoscopy

Double balloon enteroscopy

Double balloon enteroscopy (DBE) is a highly specialised examination of the small intestine, only performed at a small number of centres. It involves the use of a long narrowing examining instrument, which is passed through an outer tube that prevents it from looping in the intestine. Small balloons on the tip of the outer tube and the endoscope prevent the instrument from slipping backwards and allow the examination to proceed gradually through the intestine.  The diagram below show the DBE instrument and illustrates how the procedure works.

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The small intestine is the part of the intestine between the stomach at the upper end and the colon at the lower end. The small intestine is approximately 6 metres long, making it extremely challenging to examine. Standard gastroscopy and colonoscopy are only able to examine 20cm into the upper and lower ends of the small intestine. Capsule endoscopy is often used to examine the small intestine (see section of Capsule Endoscopy). 

Abnormalities identified on capsule endoscopy can often be reached by double balloon enteroscopy. This allows examination of up to 3 metres of the upper small intestine or up to 1.5 metres of the lower small intestine. DBE can be performed through the mouth (upper DBE) or through the anus (lower DBE). Lower DBE requires bowel preparation and is performed under sedation like colonoscopy. Upper DBE does not require bowel preparation. Upper DBE is usually performed under general anaesthetic.

Further information and instruction for double balloon enteroscopy are below.


Patient information and instructions for DBE via mouth

Patient information and instructions for DBE via colon with Preparation A

Patient information and instructions for DBE via colon with Preparation B

 

Endoscopic mucosal resection

Endoscopic mucosal resection (EMR) is a less invasive alternative to surgery for removing abnormal tissues from the lining of the digestive tract. These tissues may be early-stage cancer or precancerous lesions, which may become cancerous if not removed. EMR is performed at the time of gastroscopy or colonoscopy. The abnormal tissue is usually sucked up into a cap attached to the endoscope, then removed by cutting with an electrified wire loop. Several pieces of abnormal tissue of approximately 1cm can be removed, so that abnormal areas several centimetres in size can be completely removed. Provided a cancer has not penetrated beyond the surface layer of the intestine (mucosa), small cancers can be cured by EMR with up to 95% certainty.

EMR is generally performed as a day procedure. There is sometimes mild throat or chest discomfort after an EMR. There may also be mild chest discomfort and sometimes mild discomfort on swallowing. Significant pain may indicate a complication so should be discussed urgently with you specialist.

Pictures from an EMR procedure to remove a small cancer in the oesophagus are shown below:

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Risks of the endoscopic mucosal resection include:
Bleeding.Minor bleeding occurs frequently and can usually be detected and corrected during the procedure. More significant bleeding occurs in approximately 1 in 50 patients and may cause vomiting of blood or black bowel motions either immediately after the procedure or within the first week after EMR. Admission to hospital, blood transfusion and repeat gastroscopy may be needed to treat bleeding.

Puncture (perforation). There is a slight risk (less than 1 in 100) of a puncture through the wall of the digestive tract. This is a serious complication that requires urgent treatment including the possibility of surgery.

Narrowing of the esophagus. Removing a lesion that encircles the oesophagus carries some risk of scarring that narrows the esophagus, a condition that may lead to difficulty swallowing and require further treatment.

Preparation for EMR is the same as for upper endoscopy. Because of the risk of complications following EMR, it is advised that travel to remote areas of by plane is not undertaken for 5 days after EMR.


Endoscopic Mucosal
Resection

ERCP

ERCP is a technique to examine the pancreatic and bile ducts. A flexible tube called an endoscope is passed through the oesophagus and stomach into the duodenum, and the opening of the bile duct and pancreatic ducts are identified. The aim of the procedure is to pass a small plastic tube into one or both ducts to inject dye and then take x-rays.Often, interventions such as removal of stones from the bile duct or placing of a stent in the bile duct are performed at time of ERCP. ERCP will normally only be advised when other less invasive procedures have failed to provide a clear diagnosis. You will be given a light anaesthetic for the procedure.

Further information and instructions regarding ERCP are below:


Patient information and instructions for ERCP Resection

HALO radiofrequency ablation

The HALO radiofrequency ablation (RFA) system is designed to destroy the pre-cancerous tissue in Barrett’s oesophagus thereby eliminating the cancer risk. It provides uniform and controlled therapy at a consistent depth, which can remove Barrett’s lining cells from the oesophagus and allow the regrowth of normal cells. The HALO 360 Ablation System uses a balloon based electrode to eradicate Barrett’s lining cells circumferentially within the oesophagus. This is used as the initial treatment for circumferential Barrett’s mucosa. The HALO 90 Ablation System is an electrode system that is mounted on the end of an endoscope, allowing the physician to treat smaller areas of diseased tissue. This is generally used at followup endoscopies, for any remaining smaller areas of Barrett’s mucosa.

Careful assessment of patients with dysplastic Barrett’s is essential to ensure that HALO RFA is the appropriate and optimal treatment. Decision making is complex in individuals with high grade dysplasia. Therefore, the usual workup after referral will include: consultation, thorough endoscopic assessment and biopsy mapping.

A procedure to remove areas of visibly abnormal tissue called “endoscopic mucosal resection” (EMR, see above) may be required to both assess and treat that area prior to HALO RFA. In patients in whom early cancer is detected, further tests will be required to fully assess the stage of the disease, which will in turn determine the treatment options available, including the possibility of surgery.

HALO radiofrequency ablation is available at very few centres in Victoria. It is performed by Dr Taylor and Dr Cameron at St Vincent’s Hospital.

More detailed information regarding HALO radiofrequency ablation and associated procedures is below.


HALO Radiofrequency Ablation
Patient info Rooms
version, 2014

Intestinal ultrasound

Uncontrolled Crohn’s disease and ulcerative colitis has a significant impact on a patient’s quality of life. As such, the overall aim of treatment is to heal the bowel to prevent disability and hospitalisation, while maximising quality of life. Until now in Australia, the only way to assess the activity of Crohn’s or colitis was with colonoscopy, MRI or CT scans. High resolution intestinal ultrasound is well established in Europe for the assessment of Crohn’s and colitis. The benefits of intestinal ultrasound are that it is a quick, inexpensive, non-invasive procedure that requires no bowel preparation, anaesthesia or fasting. It is completely risk free for patients and results are comparable with other diagnostic modalities used in inflammatory bowel disease. Once a patient has been diagnosed with Crohn’s or colitis, intestinal ultrasound can be used to monitor disease activity.

Dr Antony Friedman is Australia’s first gastroenterologist trained in intestinal ultrasound and has set up Australia’s only intestinal ultrasound service within the Gastroenterology Department at The Alfred hospital. 

All patients require the referral form below to be completed by their GP or specialist.


Intestinal Ultrasound Referral

 

Our fees

Fees for consultations

Specialist consulting fees are in line with market rates and are well below the  AMA recommended fees. For consultations, Medicare will cover a large portion of the specalist consultation fee when there is a valid referral from a general practitioner or specialist.

Full pensioners and DVA patients are bulk billed, which means that they have no out of pocket expense. Part pensioners are charged a reduced rate.Payments made on the day are charged at a reduced rate and can be made by all forms of payment including credit card.

We participate in Medicare online billing, which means that the Medicare rebate will generally appear in your account within 48 hours.

Fees for gastroscopy, colonoscopy,other endoscopic procedures and hospital based care

We participate in direct billing arragments with all health funds. This means that you will generally not receive accounts from us for hospital based services such as gastroscopy, colonoscopy, endoscopic procedures and consultations.  There may be some out of pocket costs for associated pathology and anaesthetic services. Further details can be obtained by contacting our office directly.