An endoscope system with lighting is used in order to examine esophagus, stomach and duodenum. Panendoscopy sets the golden standard in the diagnosis of several diseases, particularly peptic ulcer, types of esophageal cancer or stomach cancer. Furthermore, it offers an advantage of minimal invasive treatment for upper gastrointestinal bleeding, particularly for bleeding associated with peptic ulcer and bleeding varicose vein in chronic liver disease patients. Narrowing of esophagus or opening (pyloric stenosis) between the stomach and small intestine can be enlarged with various endoscopic methods. Normal nutrition of the patient can be provided by inserting a stent (tube) in case of narrowing of esophagus associated with cancer.

Considerations before panendoscopy;

• • Patients with high blood pressure, pulmonary and cardiac diseases should be evaluated by the physician in charge in respect to the applicability of panendoscopy. The use of certain types of medication such as Kumadin should be stopped before the procedure. Patients who have gone a heart valve replacement may need to be administered antibiotics before the procedure.

• • For a good evaluation of the mucosa during the procedure, the stomach should be empty. Furthermore, the procedure poses a risk of aspirating the gastric content into the lungs as the gag reflex is stimulated during the procedure. Therefore, you should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water. Patients with diabetes should bring along their medication or insulin of morning dose in order to have these with breakfast after the procedure.

• • Possible anticipated diagnosis, previous gastric surgeries, previous panendoscopy findings, if any, systemic diseases and medication allergies should be included in detail within the procedure request slip in order to facilitate the procedure and reduce down the risk of complication.

• • The throat is anesthetized with a spray in order to decrease the gag reflex during the procedure. Patients are administered sedation through an intravenous line in special circumstances. The procedure lasts 5-30 minutes depending on the patient.

• • After the anesthesia in the throat loses its effect subsequent to panendoscopy (approximately 1 hour later), the patient can eat and continue usual life. Patients who have been administered intravenous sedation should not drive a vehicle during the day.

Panendoscopy reports can be received from the outpatient clinic secretariat as of 15:00 in the following work day.

Rectoscopy procedure involves the evaluation of rectum and the distal (the end part) 25 cm of large intestine. Rectoscopy application to anyone with anal bleeding is important for early diagnosis of rectum cancer. Furthermore, certain types of hemorrhoid can be treated with ligation method.

Considerations before retroscopy;

• • You should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water. Patients with diabetes should bring along their medication or insulin of morning dose in order to have these with breakfast after the procedure.

• • The patient should arrive at the gastroenterology outpatient clinic with an empty stomach at 08:00 for the procedure. Patients are given enema before the procedure for colon cleansing. Particularly patients with constipation problem should follow a pulpless-liquid diet one day before in order to ensure sufficient colon cleansing. The procedure might need to be repeated on a further date for those with whom sufficient colon cleansing has not been achieved. Patients should take knee-elbow position (just like groveling) during the procedure. The procedure lasts approximately 5 minutes.

Rectoscopy reports can be received from the outpatient secretariat as of 15:00 in the following day.

Fibersigmoidoscopy involves evaluating the rectum and distal (the end part) 60 cm of large intestine. Anyone with a rectal bleeding should receive rectoscopy for early diagnosis of colon cancer.

Considerations before fibersigmoidoscopy;

• • You should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water. Patients with diabetes should bring along their morning dose of medication or insulin with their meal in order to have these with breakfast after fibersigmoidoscopy.

• • The patient should arrive at the gastroenterology outpatient clinic with an empty stomach at 10:00 for the procedure. Patients are given enema before the procedure for colon cleansing. Particularly patients with constipation problem should follow a pulpless-liquid diet one day before in order to ensure sufficient colon cleansing. The procedure might need to be repeated on a further date for those with whom sufficient colon cleansing has not been achieved. Patients are given enema once or twice before the procedure for colon cleansing. The procedure lasts approximately 5-10 minutes.

Fibersigmoidoscopy reports can be received from the outpatient secretariat as of 15:00 in the following day.

Colonoscopy procedure involves the evaluation of the large intestine and, when needed, the last part of small intestine. It is required for the early diagnosis of colon cancer and diagnosis of patients with chronic diarrhea. Furthermore, polyps which leas to cancer are removed, certain types of bleeding are ligated and narrowing in the colon is enlarged by means of balloon or stent (tube) insertion in order to ensure defecation by normal means.

Considerations before colonoscopy;

• • A complete cleansing of the intestines is required for a healthy and adequate procedure. Therefore, pulpless diet to be recommended should be strictly followed for 3 days and laxative medication should be used as prescribed one night before. You should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water. Patients with diabetes should bring along their medication or insulin of morning dose with their meal in order to have these with breakfast after colonoscopy.

• • The patient is given enema once or twice for colon cleansing upon arrival at the gastroenterology outpatient clinic with an empty stomach at 10:00 for the procedure. The procedure lasts approximately 45 minutes. As intravenous sedation is applied during the procedure, patients mostly cannot remember the procedure.

Colonoscopy reports can be received from the outpatient secretariat as of 15:00 in the following day.

The procedure involves examination of bile ducts and pancreatic duct. The procedure allows removing stones in bile duct without a surgery. Benign or malign narrowing in the bile duct can be treated by means of enlargement with a balloon or stent (tube) insertion.

Considerations before ERCP;

• • Patients with high blood pressure, pulmonary and cardiac diseases should be evaluated by the physician in charge in respect to the applicability of ERCP. The use of certain types of medication such as Kumadin should be stopped before the procedure. Patients who have gone a heart valve replacement may need to be administered antibiotics before the procedure.

• • You should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water. Patients with diabetes should bring along their medication or insulin of morning dose in order to have these with breakfast after ERCP.

• • The patient should arrive at the gastroenterology outpatient clinic with an empty stomach and prescribed medication at 09:00 for the procedure. The procedure lasts approximately 45 minutes. As intravenous sedation is applied during the procedure, patients mostly cannot remember the procedure.

ERCP reports can be received from the outpatient secretariat as of 15:00 in the following day.

It is a new diagnostic approach to small intestinal diseases which involves a system that allows evaluating the intestinal segments that cannot be reached out with an endoscope.

Considerations before capsule enteroscopy;

• • You should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water.

• • Electrodes are placed onto the body for the procedure and a record is kept for 8 hours by means of a camera in the form of a capsule swallowed by the patient. Then, the record is evaluated by the physician. The camera that is swallowed is single-use for each patient and disposed by physiological means. The patient can continue all of daily activities except eating or drinking during the procedure.

The reports of capsule enteroscopy can be received from the outpatient clinic secretariat 3 working days later.

Gastrostomy in the endoscopic tube insertion procedure into the stomach of patients who cannot swallow food due to various reasons. The patient is supplied home-made or commercial formula by means of the gastronomic tube. When needed, gastronomic tube can be converted into a jejunostomy tube (small intestinal feeding tube).

Considerations before gastrostomy;
Gastrostomy can be given to inpatients or patients who apply to the outpatient clinic. Gastrostomy tube to be inserted during the procedure should be provided in advance. The patient should keep an empty stomach for 8-10 hours before the procedure. Patients do not feel pain as painkillers are administered locally and, when needed, sedation is administered intravenously. The procedure lasts approximately 15-20 minutes. With an exception of particular circumstances, the gastrostomy tube can be used 6-12 hours after the insertion. Gastrostomy tube should be controlled on a daily basis, medical dressing should be applied around it and it should be followed in respect to any possible infection. In the event of a recovery from swallowing disorder, gastrostomy tube can be removed or deformed tubes can be replaced easily without pain.

Gastrostomy reports can be received from the outpatient secretariat as of 15:00 in the following day.

When it is deemed suitable by the physician, the procedure allows examining liver tissue.

Considerations before liver biopsy;
You should not eat or drink anything after 12:00 before the procedure, yet you can have blood pressure or heart medication with a small amount of water. You should arrive at the gastroenterology outpatient clinic at 08:30 on the day of the procedure along with the referral paper and hospital file. As liver biopsy can cause bleeding on rare occasions, bleeding parameters are checked before the procedure and vital findings and - if necessary - hemoglobin are monitored for at least 4 hours after the procedure. After the administration of local anesthetics, a sample is collected from liver tissue with a special needle. At least 4 hours of bed rest is required, therefore wearing comfortable clothes and having an all-day visitor are recommended. If it is deemed suitable by the physician, the patient can start eating approximately 4 hours after the liver biopsy on condition of taking medication. The patient can return to daily life, including taking bath, on the day following the procedure.

Liver biopsy reports can be received from the secretariat of pathology department approximately 10 days later.

The test is used to research the reasons for chronic diarrhea.

Considerations before fecal fat test;
A diet that includes 100 grams of fat should be followed for 3 days prior to the test. As the amount of fat intake directly affects the result, the diet should be strictly followed for the accuracy of results. Stool should be collected in a can/bucket for 24 hours following the diet and brought to the gastroenterology laboratory for the test.

Fecal fat test reports can be received from the gastroenterology laboratory after 2 working days.

It has been performed in our gastroenterology department since 1974. The procedure involves directly displaying the abdominal wall and abdominal organs and collecting biopsy. It holds major diagnostic importance particularly for patients with abdominal fluid retention for unknown reasons.

Considerations before peritonoscopy;
Peritoneoscopy is performed surgically to inpatients. Local anesthetics and intravenous sedation are administered during the procedure. Also, general anesthesia is applied when necessary. Abdominal cavity is inflated with air so that it can be displayed with a special camera.