The Iowa Clinic Endoscopy Center is our surgery center dedicated to gastrointestinal endoscopy. We offer state-of-the-art services, equipment and technology for adult patients. The physicians on our staff are highly qualified, bringing you the best possible care in both diagnostic and therapeutic endoscopic procedures.
- Current Guidelines For Screening Colonoscopy
- Discomfort Expected From GI Endoscopy
- What Are Gastrointestinal Endoscopes?
- What Is a Biopsy?
- What Is a Polyp and Polypectomy?
- What Is a Digestive Tract
- Why Are Examinations Done?
- Endoscopy Center Virtual Tour
- GI Endoscopy and Colonoscopy Procedure Preparation
- What to Bring With You
- Going Home Recommendations
Welcome to The Iowa Clinic Endoscopy Center
We welcome you as a patient to The Iowa Clinic Endoscopy Center. Our physicians and staff are dedicated to providing patients and their family members with personal attention. We will make every effort to ensure that you and your loved ones are made as comfortable as possible from the time of admission until your release to home. We believe that communication is essential to good healthcare. Please read through our information carefully. If you have any questions we will be happy to discuss them with you.
Please let us know, at any time, if there is something more that we can do for you to make your experience as pleasant as possible.
The Iowa Clinic Endoscopy Center is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC).
The Iowa Clinic Endoscopy Center is an ambulatory surgery center dedicated to gastrointestinal endoscopy. We offer state-of-the-art services, equipment and technology for adult patients. The physicians on our staff are highly qualified gastroenterologists. Our physicians and staff are dedicated to providing you with the best possible care, both in diagnostic and therapeutic endoscopic procedures. Click here to take a tour of The Iowa Clinic Endoscopy Center.
Current Guidelines For Screening Colonoscopy
Guidelines have been developed as a way to make recommendations for screening colonoscopy based on known risk factors for colorectal cancer. The risk factors used for this “risk stratification” are age, family history of colorectal cancer and past history of colorectal adenoma or cancer. Risk stratification is not an exact science, but the guidelines are based on the known characteristics of colorectal cancer and the opinions of knowledgeable experts.
Average risk individuals: A patient is considered average risk if he or she (1) has no family history of colorectal cancer or colorectal adenomas, (2) has no personal past history of colorectal cancer or colorectal adenomas, (3) has no complaints about his/her bowels (passing blood with a bowel movement, recent change in bowel habit, unexplained weight loss or abdominal discomfort), (4) has no findings on physical examination suspicious for an abnormal growth in the rectum or mass in the abdomen, and (5) has no unexplained iron deficiency anemia. Under current guidelines it is recommended that average risk individuals begin screening for colorectal adenomas at 50 years of age. If colonoscopic examination of the rectum, colon and cecum is satisfactory and no adenoma is found, the next examination for screening is done in 10 years. If one or two small adenomas are found, then 5 year followup is advised. If larger adenoma(s), more than two adenomas or certain microscopic features in an adenoma, then followup in 3 years is advised. Some microscopic findings may dictate the advisability of a followup examination in 3 to 12 months.
Family history of colorectal cancer: There are several known genetic traits that may be inherited which increase the risk for development of colorectal cancer. Individuals who have a first degree relative (parent, sibling, son or daughter) or two second degree relatives (grandparent, aunt, uncle) with colorectal cancer or adenoma are at higher than average risk for colorectal cancer. Under current guidelines it is recommended that individuals with a family history of colorectal cancer begin screening for colorectal adenomas at 40 years of age. If one first degree relative or two second degree relatives developed colorectal cancer before the age of 60, then examinations are recommended at 5 rather than 10 year intervals, even if no adenoma is found.
HNPCC Syndrome: In some families there are genetic traits that greatly increase the risk for developing colorectal cancer. The Hereditary Non-Polyposis Colorectal Cancer (HNPCC) Syndrome is of particular concern, because it accounts for 6 to 8 percent of colorectal cancer deaths in the United States. HNPCC may be suspected if the family history includes three or more relatives in two or more generations (at least one a first degree relative), one of whom developed colorectal cancer before the age of 50. There are additional factors that can be taken into account, including a family history of endometrial cancer, small intestine cancer, and cancer of the ureter or renal pelvis. Under current guidelines it is recommended that individuals at risk for HNPCC begin screening with biannual colonoscopy at age 25 and annual colonoscopy from age 40 to age 75. Those individuals who inherit a gene for HNPCC are at high risk (85% or more) of developing colorectal cancer, and cancers develop more rapidly than is typical for most colorectal tumors.
Familial polyposis coli: A less common genetic trait is characterized by the development of colorectal adenomas early in life and the development of hundred or even thousands of adenomatous polyps that carry a high risk for colorectal cancer at a young age. Under current guidelines it is recommended that individuals at risk for familial polyposis coli begin screening with flexible sigmoidoscopy at age 16.
Discomfort Expected From GI Endoscopy
What Discomfort Should I Expect from GI Endoscopy?
It is not hard to imagine that GI endoscopy could be uncomfortable without sedation. At The Iowa Clinic Endoscopy Center we always start an IV for infusion of fluid by insertion of a small needle into a vein of the arm. Through this IV we can give both a sedative medication (midazolam/Versed) and an analgesic or pain reducer (either meperidine/Demerol or fentanyl.
These medications will make you drowsy, but not so sleepy you cannot be aroused or tell us if you are uncomfortable. It is likely, however, that you will have little recall of the procedure or of any discomfort during the examination.
The nurses will also apply the instruments that allow us to monitor your heartbeat, blood pressure and the adequacy of your breathing (oxygen content of your blood). These monitors will be used before, during and after the procedure, until you are fit to go home.
You should expect that, from the time you arrive until you go home, it will take about 2 ½ 3 hours. It will take time to get some details of your history, to start the IV, to talk with the physician about the procedure, to recover from the sedative, to talk again with the physician about the findings or results, and to receive your instructions.
You can expect to feel some discomfort like “gas” following your exam. This discomfort results from the air used to inflate the stomach or colon. In order to see well, the physician will introduce air, and some of this air will remain after the procedure. This air will pass, but you should be careful not to overeat until this discomfort is gone.
What Are Gastrointestinal Endoscopes?
A GI (gastrointestinal) endoscope is a medical device consisting of a flexible tube with a video camera in the tip. Illumination is provided by glass fiber (fiberoptic) bundles in the tube that transmit light from an external light source. A hollow channel through the shaft allows insertion of small instruments that can be used to take samples of tissue. Water can be injected through this channel for irrigation and, with suction, fluid can be withdrawn through this channel. The physician controls the direction of the flexible tip with four-way controls. Air can be pumped under low pressure through the endoscope to inflate the stomach or intestine.
These instruments are specially designed for visual inspection of the interior lining (mucosa) of the digestive tract. There are several types of GI endoscopes, each designed specifically for examination of a particular area of the digestive tract. The instruments come in different sizes, and the physician will select the instrument best suited for a particular patient’s examination.
The upper GI endoscope is designed for examination of the esophagus (food tube), stomach and duodenum (the first section of the small intestine), and it is passed through the mouth. The standard upper endoscope is one meter (39 inches) in length and 9.5 mm (3/8 inch) in diameter. Colonoscopes are designed for examination of the large intestine (rectum, colon and cecum), and the colonoscope is passed through the anus. Colonoscopes are longer (1.7 meter or about 5.6 feet) and somewhat larger in diameter than the upper GI endoscope.
What Is a Biopsy?
The most common intervention during GI Endoscopy is biopsy. During your time spent at The Iowa Clinic Endoscopy Center you might be asking yourself what is a biopsy? The professional team at this West Des Moines office will answer your questions and go through the procedure with you. The endoscopy biopsy is the collection of a small sample of tissue from the lining (mucosa) of the esophagus, stomach, small intestine or large intestine. These samples are taken with a small pincer-like forceps, thus making the endoscopic biopsy a non-painful procedure. Any area where there is suspicion of abnormality or disease may require an endoscopy with biopsy. These biopsies are usually submitted to a pathologist for examination with a microscope, but they may also be taken for microbiologic (bacterial, viral, fungal) testing. Biopsies are not taken only to look for cancer, but more common that the biopsies are taken for evaluation of inflammation or other benign (non-cancerous) abnormalities.
What Is a Polyp and Polypectomy?
A polyp is a deformity of the gastrointestinal tract lining which protrudes into the interior or lumen and appears to be abnormal tissue is termed a polyp. The term “polyp” is a general descriptive term that is applied to both those with the potential to become malignant or cancerous and to those which do not.
The benign growths from which most cancers adenocarcinoma or adenomas develop in the digestive tract. In the large intestine these typically develop as polyps (that is they are abnormal tissue protruding from the lining). The purpose of identifying those individuals who may be forming colorectal adenomas is to both remove these benign, but potentially malignant lesions, and to develop a plan for future surveillance.
What is a polypectomy? The physician will try to identify and remove any polyps which are suspicious for adenoma. A polypectomy is the surgical removal of a polyp. Most of these are diminutive (smaller than 5 mm, a little less than ¼ inch), and these can often be removed without the need for cautery. Polyps are typically found as colon polyps, in the stomach, nose, sinus, urinary bladder, and uterus. For small (5 to 10 mm) or large (greater than 10 mm) polyps, the risk of bleeding usually requires cauterization. To remove and cauterize a polyp, the physician uses a wire snare (a wire loop that can be tightly closed on the polyp) and a specialized electric current is passed to heat and seal the blood vessels of the tissue.
What Is a Digestive Tract
A system of organs make up the digestive system, and those that form the digestive tract (also called the alimentary tract or GI tract) are a series of hollow, roughly tubular organs through which a meal passes in the process of digestion, nutrient absorption and elimination of indigestible wastes. In all parts of the digestive tract, the interior hollow of the tube is called the lumen.
The esophagus (or food tube) lies in the chest, and it connects the throat to the stomach. The stomach lies in the abdomen (below the diaphragm, which separates the chest from the belly), and it is large enough to hold an entire meal. Specialized cells in the stomach lining (mucosa) secrete highly concentrated acid which, combined with the churning action of the stomach, helps break up the food and begin the process of digestion.
The small intestine is quite long (about 6 feet), and it is here that a meal is digested and that nutrients and water are absorbed into the system. The first section of the small intestine is the duodenum, it is roughly C-shaped and is about 10 inches in length. A short segment of the duodenum just beyond the stomach is bulb-shaped, and it is here that the garden variety duodenal ulcer occurs. It is in the duodenum that digestive juices from the pancreas and bile from the liver are added to the meal to digest protein, starches and fat. The second section of the small intestine, the jejunum, is about two feet in length. The third section, the ileum, is about 3 feet long. The end of the ileum (the terminal ileum) joins the large intestine at the ileocecal valve.
The large intestine includes the cecum (with its appendix), the colon and the rectum. The cecum is the roughly U-shaped portion lying below the ileocecal valve, and its appendix is the thin, worm-shaped organ well known for becoming inflamed (appendicitis). The colon is about 3 feet long, and it is here that excess water is removed from the stream of feces. Its serpentine shape and partially fixed position allow descriptive divisions of the colon into the ascending colon, the right colic (hepatic) flexure, the transverse colon, the left colic (splenic) flexure, the descending colon and the sigmoid colon. The S-shaped sigmoid colon functions with the rectum to control defecation. The anus is the outlet of the rectum.
Why Are Examinations Done?
GI endoscopy is a powerful tool for diagnosis of diseases of the digestive tract, and there are a variety of reasons for endoscopic examination of the digestive tract.
A physician may want to use GI endoscopy to investigate a symptom (a complaint that concerns the patient such as pain, nausea, difficulty swallowing, bleeding or a recent change in bowel habit), a physical finding (an abnormality such as tenderness, a mass or signs of nutritional deficiency found by the physician on physical examination), or a laboratory finding (such as anemia, a low blood count).
A physician may also recommend GI endoscopy because of his/her concern that a patient is at increased risk of certain disorders due to family history or the patient’s past history.
Finally, GI endoscopy may be utilized as a screening procedure for patients at average risk for a common disease, especially colorectal cancer. Since the great majority of colorectal cancers form from a benign growth or polyp of the type called adenoma, screening is done to find those individuals who are forming adenomas. Since colonoscopy is the most effective way to find adenomas, and it permits removal of any polyp suspicious for adenoma, it is favored by many physicians over a more limited endoscopic examination (flexible sigmoidoscopy), colon x-ray (barium enema) or chemical testing for invisible traces of blood in the stool (fecal occult blood testing).
Endoscopy Center Virtual Tour
GI Endoscopy and Colonoscopy Procedure Preparation
Please read through carefully prior to procedure.
Your stomach should be empty. This is important for both upper GI endoscopy and for colonoscopy, because vomiting during sedation may soil the lungs and cause pneumonia. Your instructions will include the information you need to understand what you may eat or drink and when you should stop taking anything by mouth.
Blood thinners should not be used for several days before your exam. The risk of bleeding complications is much greater if your blood does not clot normally. This is especially important if there is reason to dilate (expand) a stricture (constricted narrowing), to remove a growth or polyp or to treat a possible source of bleeding. Aspirin, even in low dose (81 mg) is commonly used to inhibit blood clotting, and in most cases it should not be taken for at least 5 days before the examination. Commonly used prescription and non-prescription drugs used for pain, those called NSAIDs (ibuprofen, naproxen and prescription NSAID drugs), also effect blood clotting and should not be taken for up to 5 days before the exam. Patients with a history of stroke or coronary artery stents may be taking Plavix (clopidogrel), and these patients should ask the prescribing physician about stopping this medication. Some patients with a history of irregular heartbeat (atrial fibrillation), blood clots (deep vein thrombosis, pulmonary embolism) or stroke may be taking Coumadin (warfarin), and they should also talk with the doctor prescribing it before scheduling their procedure. After the procedure, you may be advised to avoid these medications for one to three more weeks.
It is very important to clear the large intestine of stool before colonoscopy. Any material left in the colon will interfere with the physician’s ability to see the entire lining (mucosa) of the large intestine. It is also important to know that incomplete cleansing of the bowel will prolong the examination, and may result in more discomfort either during or after the procedure. Your physician will prescribe the laxative (cathartic) preparation that is best suited to be effective with low risk of harmful effects. It is important to avoid excessive fluid loss (dehydration) during the cleansing process, and your instructions will advise you if supplemental fluids are needed.
Although not necessary for most GI endoscopy procedures, antibiotic treatment before the examination may be recommended. Patients who have serious heart valve disease or a history of endocarditis may be at risk for infection during certain GI endoscopy procedures. It is important to advise us in advance of any heart murmur or other risk factors for endocarditis. It is generally recommended you avoid some GI endoscopy procedures if you have had artificial joint replacement surgery in recent months, or to arrange for antibiotic treatment before the procedure if it cannot be delayed.
You must arrange for transportation, you will not be allowed to drive after your procedure. Because these examinations can be uncomfortable, sedation will be given to minimize your discomfort. The sedative medications will significantly limit your ability to recall the examination and its associated discomfort. It will also have the effect of impairing your judgment, alertness and coordination for the rest of the day. You must not drive, operate machinery, fly an airplane, make important decisions or engage in risky activities for the remainder of the day and evening after this sedation.
What to Bring With You
Please bring the following when coming for a procedure:
List of previous surgeries
List of all medications and dosages, including over-the-counter medications, vitamins and supplements
Going Home Recommendations
After a procedure you cannot drive home and will need an adult driver to take you home. Taxi cab, bus or any other public transportation is not acceptable, unless accompanied by another adult.
You will be given written discharge instructions.
Since it is normal to feel drowsy, dizzy or lightheaded after receiving sedation, we encourage you to refrain from the following activities for 24 hours:
Signing important papers or making important decisions;
Driving or operating any equipment or machinery;
Drinking alcoholic beverages
Charges at The Iowa Clinic Endoscopy Center are based on a facility fee for each procedure performed. We ask that you pay co-insurance fees on the day of your procedure. For your convenience, we accept cash, personal checks, Visa, MasterCard and Discover. (You will be billed separately by your physician.) Following your procedure, we will file your insurance papers for you. If the facility fee is more than your insurance plan allows, you will billed for the difference.
Services & Treatments
Our Approach to Endoscopy
We welcome you as a patient to The Iowa Clinic Endoscopy Center. Our physicians and staff are dedicated to providing patients and their family members with personal attention. We will make every effort to ensure that you and your loved ones are made as comfortable as possible from the time of admission until your release to home. We believe that communication is essential to good healthcare, so if you have any questions throughout the process, we will be happy to discuss them with you.
Our accredited Endoscopy Center offers comprehensive treatment for gastrointestinal issues affecting the digestive system. Diagnostic, therapeutic, and screening gastrointestinal endoscopic procedures include, but are not limited to:
- Esophageal Dilation
- Removal of Colon Polyps
The Iowa Clinic Endoscopy Center is located in West Des Moines