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+   Colonoscopy
    Colonoscopy is a procedure that enables your doctor to examine the lining of the colon or large intestine with the aid of a miniature video camera at the end of a flexible tube. It is performed in the endoscopy suite.

When should you have Colonoscopy?
A colonoscopy is performed for:
Colon cancer screening
Patients who have had a history of polyps
Evaluation of bowel symptoms such as a change in bowel motion
Anemia
Blood in the stools
Ulcerative colitis/Crohn's disease

How should you prepare for a Colonoscopy?
The colon must be completely emptied of stool for the procedure. In general, this involves bowel cleansing, prior to the colonoscopy. You will be given instructions on the bowel preparation. Bowel preparation can involve taking a liquid called PEG or laxatives followed by water to clean out the bowel.

If you are unable to complete the preparation, it may be not be possible to perform the colonoscopy and the procedure will be postponed.

Certain medications may need to be temporarily stopped prior to the procedure. You should discuss this with your doctor prior to the endoscopy, especially if you are taking any blood thinners such as warfarin, aspirin or diabetes medication.


How is a Colonoscopy performed?
In general, you will be given moderate sedation intravenously to help you relax and help you better tolerate the procedure. You light feel some pressure, bloating or cramping during the procedure, but this is usually well tolerated. The doctor will slowly advance a colonoscope through your colon to examine its lining. The procedure is completed in 15 to 30 minutes.

What happens after a Colonoscopy?
You will be observed until the sedation has worn off, after which you will be discharged home. Do not drive or operate machinery till the next day, as the sedatives used will impair your reflexes. You will need to arrange for a friend or family member to accompany you home.

You may experience mild cramping and bloating from the air inflated into the colon. This will improve when you pass the gas. You will be able to eat normally the same day and resume your normal activities the next day.


What are the risks of a Colonoscopy?
Colonoscopy is a very safe procedure. Complications are rare, but can occur. These include bleeding (<1%) and bowel perforation (0.2%). Bleeding can occur up to about 2 weeks after a colonoscopy. Rarely surgical treatment is needed. Some patients might have reactions to the sedation.

It is important to contact your doctor if you experience symptoms of severe abdominal pain, fever or rectal bleeding after colonoscopy.

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+   Gastroscopy (OGD)
    Gastroscopy (OGD) is a procedure that enables your doctor to examine the lining of the oesophagus, stomach and the first segment of the small intestine (duodenum) with the use of a miniature video camera. It is performed in the endoscopy suite.

When should you have a Gastroscopy?
Gastroscopy is performed for:
Gastric cancer screening
Ulcers / polyps
Upper abdominal discomfort/pain
Anaemia
Gastrointestinal bleeding
Difficulty swallowing
Heartburn and reflux symptoms

How is Gastroscopy performed?
A local anaesthetic spray is administered to numb your throat. In addition, you may be given moderate sedation intravenously to make you more comfortable. The doctor will slowly advance an endoscope, a soft bendable tube smaller than your finger, through your mouth and down into your stomach. The examination is completed in about 10 minutes.

The procedure is generally well tolerated, however, you may experience mild bloating or belching as air is inflated to distend the stomach.


How should you prepare for Gastroscopy?
The stomach must be completely emptied of food and liquid for the Endoscopy. This involves fasting for at least 6 hours before the procedure. An empty stomach allows good visualization and reduces the risk of vomiting during the procedure. If there is food present, the procedure will have to be postponed.

Certain medications may need to be temporarily stopped prior to the procedure. You should discuss this with your doctor prior to the Gastroscopy, especially if you are taking any blood thinners such as warfarin, aspirin or diabetes medication.


What happens after Gastroscopy?
You will be observed until the sedation has worn off, after which you will be discharged home. Do not drive or operate machinery till the next day, as the sedatives used will impair your reflexes. You will need to arrange for a friend or family member to accompany you home.

You may experience mild bloating from the air placed in the stomach. This will improve when you pass the gas. Sometimes, a mild sore throat is experienced and it will resolve in a few days. You will be able to eat normally the same day and resume your normal activities the next day.


What are the risks of Gastroscopy?
Gastroscopy is a very safe procedure when performed by a trained physician. Complications are rare, but can occur. These include bleeding from a biopsy site, perforation or aspiration of stomach contents. Aspiration risk is minimized by fasting. Some patients might have reactions to the sedation. It is important to contact your doctor if you experience symptoms of severe chest/abdominal pain, fever or bleeding.

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+   Orbera® Managed Weight Loss System (Bioenteric Intragastric Balloon
  System-BIB)
    The ORBERA® Managed Weight Loss System is an innovative and non-surgical approach to weight loss with a proven track record.It consist of a soft silicone intragastric balloon which is temporarily placed in the stomach for a maximum of 6 months. The balloon creates a feeling of fullness and encourages healthy portion control. The ORBERA® intragastric balloon is recommended to patients who have previously failed traditional methods of weight loss.

Who is a candidate for the ORBERA® System (Bioenteric Intragastric Balloon)?
While the ORBERA® system does not require surgery, any medical procedure requires careful thought and consideration. To qualify for the ORBERA® System one must be.
Obese patients with a Body Mass Index (BMI) 27kg/m2 or greater
Motivated and ready to fully comply with a long-term supervised diet and behavior modification program designed to increase the possiblity of long-term weight loss maintenance.

BMI Indication
Your body mass index can be calculated using the following formula :
Body mass index (BMI) = weight (kg) / height (m)2


Your Height Your Weight Your BMI is:

 m

 kg

  

 

 


BMI reference Description
= < 18.5 Underweight
= 18.5-24.9 Normal Weight
= 25-29.9 Overweight
BMI of 30 or greater Obesity

NOTE: The BMI serves as an indicator of your level of healthiness in terms of weight, it is not a diagnostic tool. Kindly consult your healthcare provider on your health status.

How much weight will a patient lose?
The amount any patient will lose depends entirely on how well they adapt to the ORBERA® System, alter their eating behavior and adopt an exercise regimen.
A good aim is to try and average a loss of 1kg per week
Giving an average weight loss of 12.4 -17kg in 6 months.

The Procedure
1. The physician will first look at the stomach with an endoscopic camera and, once it is determined there are no abnormalities, will proceed with the procedure.

2. The balloon is inserted in a deflated state via a swallowing process, which is made easier with a light sedation.

3. Once inside the stomach, the balloon is immediately filled with saline water through a small filling tube. The balloon has a self-sealing valve and once it is filled, the tube is gently removed. At this point, the ballon will be too large to leave the stomach via the digestive tract. Placement procedure times can vary between 20-30 minutes.

4. After placement, the patient will remain in the clinic for observation for a period of minimum 2 hours. After this, the physician will discharge the patient into the care of the person who will take them home.


Post-procedure
Once the balloon is in place, it will take some time for the stomach to adjust to its presence. For the first week, patients will be on a full fluid diet. A dietitian will provide sample menus of what they should eat.

After that, it should take about one week to make the transition from PUREE to SOFT and finally back to SOLID foods. Again, a dietitian will be able to provide patients with meal options.

This dietary transition is important because it will not only allow patients to adjust to the balloon, but it will start them developing a new perspective on food and retraining their appetite for a healthier lifestyle.


Removal Procedure
The balloon will be removed in the same way it was placed. It will be punctured and the saline water will be suctioned up through a tube. Once deflated, the balloon will be retrieved and removed through the oesophagus under endoscopic observation. Again, a light sedation will aid this procedure.

Three days prior to removal, patients should revert to a semi-liquid diet. The day before, they must consume liquids only. Failure to follow this advice could result in the removal being rescheduled.


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