Procedures

At Anne Arundel Gastroenterology Associates, we are trained and experienced in sophisticated, cutting-edge technology.

Our board-certified, fellowship-trained gastroenterologists have decades of experience dealing with complex digestive conditions. Our specialists are committed to listening to your concerns and discussing your symptoms in order to correctly diagnose your condition and determine the procedure that is best for you.

While there are some procedures that can be done right in the office, others are performed routinely in The Maryland Center for Digestive Health or Anne Arundel Medical Center.  

Download colonoscopy prep instructions:

Instructions for Colonoscopy with Oral Colon Lavage, Trilytely, or Halflytely
Instructions for Colonoscopy with Magnesium Citrate / Bisacodyl Prep
Instructions for Colonoscopy with Miralax Prep
Instructions for Colonoscopy with Movi Prep
Instructions for Colonoscopy with SUPREP
Instructions for Colonoscopy for Diabetic Patients on Insulin or Oral Hypoglycemics

The following is a list of some of the diagnostic procedures and treatments we perform:

Capsule Endoscopy

A capsule endoscopy is performed so your doctor can view the small intestine to detect ulcers, polyps, sources of bleeding, and other conditions such as Crohn's disease or tumors.

The procedure is non-invasive. You will swallow a small capsule that contains a tiny camera. The camera will record images of your small intestine as it passes through. These images are transmitted to sensor pads that are placed on your stomach and stored in a small device you will wear around your waist.

After 8 hours you will return to the doctor’s office to have the pictures downloaded. The capsule will eventually pass out of your body in your bowel movement.

Download Prep Instructions

Esophageal Manometry

Esophageal manometry is performed to find out how well your esophagus is functioning and if it is able to move food to your stomach normally.

This procedure involves passing a narrow, soft tube through the nostril and into the esophagus. The tube measures pressures so your gastroenterologist can evaluate how strongly the esophagus muscle contracts when you swallow and how competent the sphincter is at the end of the esophagus. The sphincter is the valve that prevents reflux of gastric acid into the esophagus.

Your GI doctor may order this test if you have difficulty or pain when swallowing, heartburn, or chest pain.

In most cases esophageal manometry is an easily tolerated procedure. You may feel a little pressure in your nostril and slight gagging as the tube is initially passed. This sensation subsides once the tube is positioned.

The study takes approximately 30-45 minutes to perform. You will be able to drive and go to work immediately after the procedure.

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Ambulatory Reflux Monitoring

Ambulatory reflux monitoring, also called esophageal pH monitoring, is the gold standard for diagnosing gastroesophageal reflux disease (GERD). The test measures how much stomach acid backs up into the esophagus and how long it stays there. It also measures the strength of your stomach acid.

This procedure involves passing a soft tube, the size of spaghetti, through the nostril and into the esophagus. This tube is attached to a recording box that records reflux episodes in the esophagus for approximately 24 hours. This device will measure your stomach acid levels as you go about your regular activities.

In most cases, this is an easily tolerated procedure. You may feel a little pressure in your nostril and slight gagging as the tube is initially passed. This sensation subsides quickly. Even though the tube is visible, you are encouraged to go to work, eat your normal diet and foods that provoke your symptoms, and perform your normal activities during the monitoring.

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ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and X-rays to treat problems arising from the bile in your pancreatic ducts.

Gastroenterologists perform ERCP when the pancreatic ducts have become narrowed or blocked because of:

The GI doctor will advance an endoscope down the patient's throat, through the stomach, and into the small intestine (duodenum). A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into the stomach and duodenum, making them easier to see. 

Doctors may also use noninvasive tests (tests that do not physically enter the body) instead of ERCP. Noninvasive tests such as magnetic resonance cholangiopancreatography (MRCP), a type of magnetic resonance imaging (MRI), may be safer and can also diagnose many problems of the bile and pancreatic ducts.

Download Prep Instructions
Prep Instructions for Diabetic Patients

Small Intestinal Bacterial Overgrowth (SIBO) Breath Testing

Small intestinal bacterial overgrowth (SIBO) is a digestive condition that can be treated effectively but needs to be accurately diagnosed. It is defined as an increase in the number of bacteria and/or changes in the types of bacteria present in the small bowel. In most patients, SIBO is an overgrowth of the various types of bacteria that are normally found in the colon. It can cause symptoms such as abdominal pain, bloating, gas, and diarrhea.

Bacterial overgrowth may occur if the normal function of the intestine is compromised. It may also be associated with another illness that affects the function of the small intestine, such as diverticulitis, Crohn's disease, diabetes, Celiac disease, and others.

SIBO can be diagnosed by testing a patient's breath samples for levels of hydrogen and methane. There is a 24-hour preparation period before taking the test. The first 12 hours require a specific diet, and the last 12 hours require a complete fasting period. This prep removes much of the food that would feed the bacteria. You will receive the information for test prep when the test is scheduled.

In the doctor’s office, you will drink a sugar solution of glucose or lactulose and then provide breath samples every 20 minutes over a 3-hour period. This breath test measures the amount of hydrogen and methane gas produced by bacteria in the small intestine.

Once bacterial overgrowth has been diagnosed, your gastroenterologist can use an appropriate antibiotic regimen to eradicate the bacteria and relieve the symptoms. Treatment can then begin on the underlying causes to keep overgrowth from recurring.

Anorectal Manometry

Anorectal manometry is a test that evaluates pressures and sensations in the anus and rectum in patients with constipation or stool leakage. Doctors may also use it to diagnose Hirshsprung’s disease in infants or children, or to evaluate anorectal function before or after bowel surgery.

Anorectal manometry involves passing a very narrow tube with a balloon through the anus to the rectum. As the balloon is inflated, pressures throughout the rectum and anal canal are measured to determine how well the muscles in this area function.

During the procedure you will be asked to squeeze your anal muscles, push, and indicate when you feel balloon inflation. This is a very easily tolerated procedure with only perhaps a sensation of fullness in the rectum.

The procedure takes 20 minutes to perform. You will be able to go home or to work immediately after the procedure.

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Hemorrhoid Banding

Hemorrhoid banding is an outpatient procedure performed to decrease the size of internal hemorrhoids. Your GI doctor will use a thin flexible tube with a light and camera to examine your rectum for hemorrhoids and place rubber bands on the enlarged hemorrhoid tissue. This cuts off blood supply to the hemorrhoid, causing it to shrink and die within about a week.

Infrared Coagulation of Hemorrhoids

Infrared photocoagulation (coagulation therapy) is a medical procedure used to treat small and medium-sized hemorrhoids. This treatment is only for internal hemorrhoids. 

During the procedure, the doctor uses a device that creates an intense beam of infrared light. Heat created by the infrared light causes scar tissue, which cuts off the blood supply to the hemorrhoid. The hemorrhoid dies and a scar forms on the wall of the anal canal.

Enteral Stenting

Stents are devices that create space when a duct or vessel has become obstructed. An enteral stent is a type of stent that is inserted in the digestive tract when there is a growth creating an obstruction in the esophagus, stomach, small intestine, or colon. The use of enteral stents has expanded to the treatment of digestive conditions such as strictures, bleeding varices, and fistulas in the gastrointestinal tract.

Your doctor may suggest an enteral stent for two reasons:

(1) Enteral stents are often used to treat malignant obstructions. In advanced colorectal disease or esophageal cancer, doctors may recommend a stent when surgery, chemotherapy, and radiation are no longer the best option.

(2) Enteral stents can also be used as a temporary treatment to alleviate a blockage in the colon. Often, an obstruction in the colon would require immediate surgery, but a stent could convert an emergency procedure into an elective procedure and may prevent the need for a colostomy. 

If you are at increased risk for complications as a result of emergency surgery, an enteral stent could be the preferred method of treatment for you.

Barrett's Esophagus Radiofrequency Ablation

Radiofrequency ablation (RFA) therapy has been shown to be safe and effective for treating Barrett's esophagus. Radiofrequency energy waves are delivered via a catheter to the esophagus to remove diseased tissue while minimizing injury to healthy esophageal tissue. This is called ablation, which means the removal of abnormal tissue. 

While sedated, a device is inserted through the mouth into the esophagus. It delivers a controlled level of energy and power to remove a thin layer of diseased tissue.

Endoscopic Ultrasound (EUS)

For patients who have or might have pancreatic cancer, doctors may recommend they undergo an endoscopic ultrasound (EUS). During this procedure, an endoscope will be placed into the mouth, down into the stomach, and into the first part of the small intestine. 

At the top of the endoscope is a probe that emits sound waves. These sound waves are converted into detailed black and white images of the pancreas. The procedure usually takes 20-45 minutes.

See prep instructions for all procedures.

Call (410) 224-2116 to schedule an appointment for your first consultation at AAGA or you can request one online. We have several offices conveniently located in Annapolis, Pasadena, Bowie, and Kent Island.