Gastroenterology

Gastroenterology

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CalvertHealth Gastroenterology

CalvertHealth Gastroenterology is your go-to destination for digestive health. Whether you suffer from chronic acid reflux or have severe abdominal pain, our board-certified providers have the skills and technology to diagnose and manage your gastrointestinal illness or disease.

CalvertHealth Gastroenterology is proud to be able to offer the residents of Southern Maryland Endoscopic Ultrasound (EUS) for the diagnosis and treatment of gastrointestinal disease and Fecal Microbiatia Transplant (FMT) to treat recurrent Clostridium difficile (c Diff) infection. Both procedures are performed at the CalvertHealth Endoscopy Department by board-certified gastroenterologist Dr. Saad Haque. You no longer have to travel to Baltimore, Annapolis or DC to receive these advanced techniques.

Other procedures we offer to diagnose and manage gastroenterological diseases include:

  • Screening Colonoscopy and Sigmoidoscopy
  • Capsule Endoscopy (CE)
  • Esophago-gastro-duodenoscopy (EGD) also called Upper Endoscopy
  • Endoscopic Mucosal Resection (EMR)
  • Endoscopic Retrograde Cholangio-pancreatography (ERCP)
  • Hemorrhoid Banding
  • Trans-nasal Endoscopy (TNE)
At CalvertHealth Gastroenterology we are experts in all aspects of digestive and liver health. We diagnose and manage biliary disease, GERD, liver disease, cancers of the digestive tract including colorectal cancer, hepatitis and inflammatory bowel disease including Chrohn’s Disease and Ulcerative colitis. You should talk to a gastroenterologist if you suffer from any persistent or chronic abdominal pain, excessive bloating, belching or flatulence; have trouble swallowing; have recurrent heartburn or acid reflux, hemorrhoids or rectal bleeding, chronic nausea and/or vomiting.

All our procedures (both diagnostic and curative) are performed in our office on the Medial Office Building, in the CalvertHealth Endoscopy Department or in the Same Day Surgery Department at CalvertHealth Medical Center.

Our Services

CalvertHealth Gastroenterology treats diseases and disorders of the digestive system including conditions affecting the esophagus, stomach, liver, pancreas, bile ducts, intestines, colon, and rectum. Dr. Haque specializes in colon cancer screening and polyp removal.

You should seek out a Gastroenterologist if you experience any of the following on a regular or acute basis:

  • Abdominal pain
  • Bloating, belching and flatulence
  • Choking or trouble swallowing
  • Constipation or diarrhea
  • Heartburn or acid reflux
  • Hemorrhoids or rectal bleeding
  • Nausea and vomiting
Click on any of the buttons on the left to find out about the diagnostic and curative procedures we perform.

Screening Colonoscopy


Colonoscopies are the most effective way to detect polyps in the colon. Left untreated, polyps may become cancerous, leading to potentially fatal colorectal cancer. Colorectal cancers generally have no pain or other side effects until the cancer has progressed to an advanced stage, making early detection essential. Your doctor will recommend a screening colonoscopy when you turn 50 years of age, or younger if you have a family history of cancer.

Most polyps that are detected during your colonoscopy can be removed during the procedure. Small or flat polyps will removed immediately and sent to be tested for any cancer cells. If a large polyp is discovered during your procedure, Dr. Haque is trained to perform a procedure called Endoscopic Mucosal Resection (EMR), which allows him to remove even large polyps immediately rather than having to schedule a second procedure for surgical removal of the polyp. Dr. Haque is one of the first doctors in the country trained to perform EMR and is still one of just a handful of gastroenterologists in Southern Maryland who can perform the procedure.

Dr. Haque performs hundreds of colonoscopies each year in the CalvertHealth Endoscopy Department.

Preparing for Your Procedure

Providing a clear field of vision is critically important for a successful colonoscopy. You will need to restrict food intake for up to 3 days prior to your procedure, move to a totally clear liquid diet for 24 hours prior to your procedure, and begin a regimen of over-the-counter laxatives the day before and prescription laxatives the evening before and morning of your procedure.

If you take over-the-counter or prescription medications, you may need to stop or delay taking them for a period of time before your procedure. Dr. Haque will review your medication list and discuss with you what you should stop, delay or continue to take.

You will be sedated for the procedure, so you will need to be sure that you have someone to bring you to and take you home after the procedure. You will not be allowed to drive yourself.

After the procedure, you will be in recovery for a short time while the sedation wears off. Dr. Haque will review any immediate results with you while you are in recovery, and you will be allowed to go home. You may be groggy for the rest of the day, and can eat a small meal when you get home. You will be able to resume normal activities the next day.

Click here to read some frequently asked questions about colonoscopies, how to prepare and what to expect.

Capsule Endoscopy (CE)


The thought of swallowing a miniature camera to view the inside of your digestive tract used to be something out of a science fiction novel. Today it is a standard of care for diagnosing problems of the small intestine.

With a CE, your doctor can see the inside of your entire digestive tract, including and especially the small intestine which is not accessible by other procedures. Your Doctor will give you a vitamin-sized capsule to swallow and a transmitter to attach to your belt or waistband. Inside the capsule is a tiny wireless camera that will take thousands of pictures of your digestive tract as it moves its way through. The images are sent wirelessly to the transmitter on your belt to be examined by the doctor after the camera has passed through your system.

CE is used to look for the cause of gastrointestinal bleeding, diagnose certain diseases such as Chrohn’s Disease and other inflammatory bowel diseases as well as some cancers and gluten intolerance diseases such as Celiac disease. It can also be used to look for colon polyps in people who are not able to withstand a colonoscopy.

Dr. Saad Haque of Calvert Gastroenterology is specially trained to perform CE right here in the Calvert Endoscopy Center.

Preparing for Your Procedure

With any endoscopic procedure, having a clear field of vision is important to a successful outcome. That means having nothing in your upper digestive tract, from your stomach down to your small intestine. You will have to stop eating and drinking the night before your procedure and take a regimen of laxatives to empty your bowels and colon before the procedure.

If you are taking over the counter or prescription medications, you may need to stop them or delay them for some period of time prior to your procedure. Dr. Haque will review your medication list and walk you through the preparation requirements in advance of your procedure.

Unlike most endoscopic procedures, you will not be sedated during the procedure. You simply swallow the capsule, wait for the capsule to come online, then you will be able to go home or even to work. You should take it easy for the next eight hours at least so as to not dislodge the capsule. You should not engage in any strenuous activities. Dr. Haque will let you know when you can resume eating solid food.

Even though the transmitter is wireless, it should not interfere with other electronic devices. You can continue to use your cell phone, TV remote, computer or MP3 player. You should, however, avoid magnetic machines such as MRIs and other people with a CE transmitter (so your pictures don’t get sent wirelessly to the other person’s transmitter and vice versa).

The capsule and camera will pass normally through your system on their own usually within 24 hours. And no, you will not need to retrieve the camera once it has been passed. All the images will have been captured on the transmitter provided. The day after your procedure, you will be able to return the transmitter to Calvert Gastroenterology for the images to be reviewed.

Endoscopic Mucosal Resection (EMR)


EMR is a procedure that lets your doctor remove abnormal tissue from the digestive tract with a minimally invasive endoscopic procedure rather than by a more invasive surgical procedure. EMRs can be performed on lesions and polyps found in the upper and lower digestive tracts. EMR is particularly useful in removing cancerous or pre-cancerous lesions and to assess whether a cancer has grown past the duodenum – the lining of the digestive tract.

EMR uses a long flexible tube equipped with a light, camera and other instruments. The patient is under sedation and tube is inserted either through the mouth and throat or through the anus, depending on the area of the digestive tract being examined. During the procedure, your doctor is able to see the inside of the area being examined and can remove lesions or polyps or collect tissue for further analysis and testing.

Not all gastroenterologists are trained to perform EMR, and not all endoscopy centers have the appropriate equipment for the procedure. Dr. Haque of Calvert Gastroenterology is specially trained to perform EMR in the Calvert Endoscopy Center.

Preparing for Your Procedure

Preparation for an EMR will depend on the area being scoped. If your procedure is being performed on the upper digestive tract (esophagus, stomach or upper part of the small intestines), you will be required to stop eating and drinking the night before the procedure in order to totally empty your stomach and provide your doctor a clear viewing field.

If your procedure is to examine the colon, you will need to undergo a regimen of fasting and laxatives to ensure your colon is empty along with your stomach. Your doctor will explain the preparation procedures required based on the type of EMR you are receiving.

Dr. Haque will also discuss any need to stop or delay of medications that may be required prior to your procedure.

You will be sedated during the procedure, so you will stay in recovery until the effects of the sedation begin to wear off. You will not be allowed to drive yourself home, so be sure to have someone available to take you to and from the procedure. The doctor will review the immediate findings when you come out of sedation, and will have you schedule an appointment to review any results of tests that are sent out for review.

You will want to take it easy for the rest of the day after you get home, but can enjoy a light meal. You should be able to resume normal activities the next day.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)


ERCP is a specialized technique that is used to diagnose problems of the pancreas, gall bladder, bile ducts and liver. Unlike a traditional x-ray, MRI, ultrasound, CT exams and other external diagnostic procedures, ERCP lets your doctor take an x-ray from inside of your digestive tract directly, allowing for a more comprehensive visual assessment of your digestive tract and organs.

Like other endoscopic techniques, ERCP uses a long, flexible, lighted tube that is inserted into the mouth and gently guided down the throat. The tip of the tube transmits pictures back to a screen to assist the doctor in evaluating the condition of the various digestive organs and determine exactly what needs to be further examined.

The ERCP tube has an open channel through which a cannula and other instruments can be inserted. For a normal ERCP, the cannula will be used to inject a contrast agent or dye into a site and an x-ray taken. The doctor can also use the cannula to insert therapeutic devices for the removal of tissue for biopsy or insert stents to relieve obstructions in the bile or pancreatic ducts.

Dr. Saad Haque of Calvert Gastroenterology is specially trained to perform ERCP and your procedure will be performed in the Calvert Endoscopy Center for your convenience.

Preparing for Your Procedure

With any endoscopic procedure, having a clear field of vision is important to a successful outcome. That means having nothing in your upper digestive tract, from your stomach down to your small intestine. You will have to stop eating and drinking the night before your procedure. Some procedures may require the use of a laxative to empty the bowels as well.

If you are taking over-the-counter or prescription medications, you may need to stop them or delay them for some period of time prior to your procedure. Dr. Haque will review your medication lists and walk you through the preparation requirements in advance of your procedure.

Because you will be placed under sedation for the procedure, you will remain under observation for at least an hour after the procedure, and you will not be allowed to drive yourself home. The procedure itself only takes 20 minutes or so, and the doctor will review the immediate results with you as soon as you wake up. Once home, you will be groggy but will be able to eat that day and resume normal activities the next day.

Endoscopic Ultrasound (EUS)


Most people are familiar with a regular ultrasound test where you lie on a table, someone smears a lubricant on the area being imaged, generally your abdomen, and then runs a probe over the area to show images on a screen. EUS uses the same concept, but allows it to be done from inside your abdomen.

EUS uses a small ultrasound probe attached to a thin, flexible, lighted tube inserted down the throat. The tube has a tiny camera at the end and a tiny transducer that sends sound waves to create detailed images of your digestive tract, including the liver, pancreas, gall bladder and stomach to a screen for review by the doctor. EUS is used to identify sources of gastrointestinal distress and determine the stage of a gastrointestinal cancer.

The EUS procedure also allows for a number of therapeutic techniques to be performed, including the removal of tissue for further examination or lab testing, the injection of medication directly into an affected area, a fine needle to be used to extract tissue for biopsy, even the insertion of stents into cysts or ducts.

Dr. Saad Haque of Calvert Gastroenterology is specially trained to perform EUS and your procedure will be performed in the Calvert Endoscopy Center for your convenience.

Preparing for Your Procedure

With any endoscopic procedure, having a clear field of vision is important to a successful outcome. That means having nothing in your upper digestive tract, from your stomach down to your small intestine. You will have to stop eating and drinking the night before your procedure. Some procedures may require the use of a laxative to empty the bowels as well.

If you are taking over the counter or prescription medications, you may need to stop them or delay them for some period of time prior to your procedure. Dr. Haque will review your medication list and walk you through the preparation requirements in advance of your procedure.

Because you will be placed under sedation for the procedure, you will remain under observation for at least an hour after the procedure, and you will not be allowed to drive yourself home. The procedure itself only takes 20 minutes or so, and the doctor will review the immediate results with you as soon as you wake up. Once home, you will be groggy but will be able to eat that day and resume normal activities the next day.

Esophago-gastro-duodenoscopy (EGD)


Also called an Upper Endoscopy, this procedure looks for causes of esophageal and stomach irritation, including heart burn and acid reflux. While you are under sedation, Dr. Haque will insert a thin, flexible lighted tube with a camera down your throat and into your stomach, providing visibility of your digestive tract as far down as to the top of your small intestines. The camera transmits the images to a screen that the doctor can see in real time, providing opportunity to examine any suspicious irritations in your throat, esophagus or stomach.

EGDs are often used to look for ulcers or other sources of gastrointestinal bleeding and irritation that might prohibit a patient from undergoing abdominal surgery, such as gall bladder removal. They are more effective than x-rays or ultrasounds because they let the doctor actually see the inside of your digestive tract.

EGDs also allow the doctor to provide therapeutic treatment while performing the endoscopy. During the procedure, the doctor can remove suspicious polyps, take samples for testing or treat bleeding issues.

Dr. Saad Haque of Calvert Gastroenterology performs EGDs in the Calvert Endoscopy Center for your convenience.

Preparing for Your Procedure

With any endoscopic procedure, having a clear field of vision is important to a successful outcome. That means having nothing in your upper digestive tract, from your stomach down to your small intestine. You will have to stop eating and drinking the night before your procedure. Some procedures may require the use of a laxative to empty the bowels as well.

f you are taking over-the-counter or prescription medications, you may need to stop them or delay them for some period of time prior to your procedure. Dr. Haque will review your medication list and walk you through the preparation requirements in advance of your procedure.

Because you will be placed under sedation for the procedure, you will remain under observation for at least an hour after the procedure. You will not be allowed to drive yourself home. The procedure itself only takes 20 minutes or so, and the doctor will review the immediate results with you as soon as you wake up. Once home, you will be groggy but will be able to eat that day and resume normal activities the next day.

Fecal Microbiatia Transplant (FMT)


Yes, this is what it sounds like. Fecal transplants have been used for centuries as a method of boosting the immune systems of babies and adults, even animals. It is thought to be especially helpful for newborns to introduce the mother’s healthy ‘good’ bacteria into the baby so that the newborn will have an advantage in fighting off the bad bacteria that surrounds them outside the womb.

Today’s FMT is a little different, but not much. FMT has been shown to be a highly effective treatment for the newer strains of antibiotic-resistant infections, including and especially recurrent Clostridium difficile (C diff). It was approved by the FDA for this purpose and is now available from Dr. Saad Haque and performed at the Calvert Endoscopy Center.

Basically, FMT implants good bacteria into the digestive tract so that the body can more naturally restore bacterial balance and fight off C Diff. The fecal matter used is sourced from a tested, healthy donor, mixed with a saline solution and implanted into the patient during an upper endoscopy or a colonoscopy. At CMH, we use appropriately prepared frozen samples from qualified donors, sourced from FDA approved pharmacies. We don’t need a sample from your Uncle Fred or Aunt Millie.

C diff is a complication of antibiotic therapy and can result in extreme and chronic bouts of abdominal cramping, diarrhea, even fever. Your gut has both good and bad bacteria, and a balance is key to maintaining good health. Antibiotics are known to kill off all bacteria, good and bad, with the end result being that the bad bacteria often take over because there are no good bacteria to keep the bad in check.

The incidence of C diff has been on the rise across the country and around the world since 2000, despite all best efforts to minimize the overuse of antibiotics and strenuous sterilization protocols in all health institutions. For patients with recurrent C diff, the chronic cramping and diarrhea can be debilitating and even life threatening.

FMT is now considered a standard of care for recurrent C diff, and we are proud that Dr. Haque and the Calvert Endoscopy Center are able to offer this life saving treatment to our patients.

Preparing for Your Procedure

The preparation for FMT depends on whether the procedure is performed using an EDG/upper endoscopy or a colonoscopy. Both procedures require a clear field of vision for the doctor. Dr. Haque will review the preparation for your procedure before you appointment, but your preparation will include some level of fasting and possibly laxatives as well as modifications to your medication schedule prior to the procedure.

You will be sedated for the procedure, so you will need to be sure that you have someone to bring you to and take you home after the procedure. You will not be allowed to drive yourself.

After the procedure, you will be in recovery for a short time while the sedation wears off. Dr. Haque will review any immediate results with you while you are in recovery, and you will be allowed to go home. You may be groggy for the rest of the day, and can eat a small meal when you get home. You will be able to resume normal activities the next day.

Hemorrhoid Banding


Let’s face it. Hemorrhoids are a pain in the…neck. It’s uncomfortable to sit or ride a bike and sometimes they bleed. Hemorrhoid Banding, also called Rubber Band Ligation, is a non-surgical method for removing a painful hemorrhoid that is performed in the office.

Hemorrhoids are caused by pressure on the rectum that causes swelling in the blood vessels and veins, allowing them to extend through the rectal wall. The pressure can be a result of constipation, straining while trying to have a bowel movement, extreme or chronic diarrhea or even prolonged sitting. They are especially common with pregnant women.

Relief can come from the use of anti-inflammatory creams, sitz baths or icing, but once there, hemorrhoids are always present. They may not be emergent, but they are there. Removal is the only way to totally eliminate the risk of a hemorrhoid becoming painful and active again.

Surgical removal of hemorrhoids is an option, and was for years the only standard of care. More recent techniques have been developed for the non-surgical removal of hemorrhoids, specifically Hemorrhoid Banding.

Hemorrhoid Banding uses a rubber band to tie off the hemorrhoid at the base, squeezing off the blood supply so the hemorrhoid falls off on its own. The in-office procedure takes just a few minutes, and the hemorrhoid generally falls off within 2 to 3 days. The base of the hemorrhoid is replaced with scar tissue, ensuring that the removed hemorrhoid can’t grow back.

Preparation for Hemorrhoid Banding is minimal and the procedure itself had some discomfort, and some patients may experience pain in the treatment area for up to 48 hours. Post procedure recovery is more rapid than from a surgical procedure, but may require that you minimize strenuous activity for a period of time.

Trans-nasal Endoscopy (TNE)


TNE uses a similar approach to regular endoscopic procedures (EGD, EUS, etc.) except that the tube is inserted through the nose rather than through the mouth and down the throat. The benefit to the patient is that the transnasal approach eliminate some of the more common side effects of traditional endoscopy, including gagging, retching, nausea and post procedure sore throat. Because TNE minimizes contact with the tongue, no sedation is required, which means that you don’t need to be accompanied to and from the procedure.

TNE is used for the same reasons as a traditional endoscopic procedure, generally to look for causes and treat disease of the gastrointestinal tract: heartburn, acid reflux and GERD; indigestion; difficult or painful swallowing; upper abdominal pain, ulcers or cancer; anemia; and gastrointestinal bleeding. It is also used for surveillance of patients with Barrett’s esophagus.

Because no sedation is required, TNE is recommended for patients who cannot have sedation due to heart or lung disease or who are pregnant as well as patients who cannot tolerate oral endoscopy due to excessive gag reflex.

Colonoscopy Q&A

What is a colonoscopy, what does it test for and why should I get one?

A colonoscopy is a procedure that examines the entire colon – all 5 feet of it. During the procedure, your doctor inserts a small flexible tube with a camera attached and weaves it all through your colon looking for polyps, tears and other areas of irritation that might cause any number of gastrointestinal problems. During a colonoscopy, the doctor looks for causes of abdominal distress, including diverticulosis, inflammatory bowel disease, bleeding, change in bowel habits, abdominal pain, and other obstructions. Most importantly, a colonoscopy is the most effective way to identify and remove pre-cancerous and cancerous polyps.

Your doctor may also order a colonoscopy after abnormal x-rays or CT scans to get a better view into the colon.

If we find a polyp, we will generally remove it during the colonoscopy and have it examined for cancerous cells. If we find a large polyp, Dr. Haque may use a different procedure, called Endoscopic Mucosal Resection (EMR) to remove it immediately. Some doctors will have a patient with a large polyp schedule a surgical procedure to have it removed, requiring general anesthesia and a longer recovery time.

If left undetected and untreated, colon polyps can grow and can become cancerous. Polyps generally do not hurt and show no signs of development until they are at a very advanced stage. Colonoscopies are the most effective way to check for and remove polyps in the colon. Colonoscopies can also look for irritations in the lining of the colon that may be the cause of other gastrointestinal distress such as chronic diarrhea or gas.

Because colon cancer rarely exhibits any symptoms until it is in advanced stages, it is recommended that everyone get a screening colonoscopy at the age of 50, younger if there is a family history of colon cancer.  Your doctor will let you know when it’s time for your screening.

 

Will it hurt?

No, you are fully sedated during the colonoscopy so will not feel anything. When you wake up, you might feel some mild discomfort in the rectal area, but that usually a result of the preparation and excessive bathroom use rather than the procedure.

 

At what age should I get a colonoscopy?

Most doctors recommend that their patients get their first colonoscopy at the age of 50. If you have a family history of colon cancer, your doctor will generally recommend you get your first colonoscopy by age 40 or younger, depending on the familial relationship and the age of onset. 

 

I had a screening colonoscopy a year ago, so I’m done right?  I don’t have to get one ever again?

Not so fast. If a polyp was found, we may recommend that you have a screening colonoscopy every two years.  If no polyps were found, you’re probably good for 5 to 10 years. But, no it’s not ‘one and done’.  Colon cancer is very stealthy so it is important to check back to be sure there are no new polyps. Dr. Haque and your primary care doctor will let you know how often you should have the procedure repeated based on your health and risk factors.

 

There is no history of colon cancer in my family. Do I still need to be screened?

Not having a family history does not let you off the hook. Your health may depend on it.

It is recommended that everyone has a screening colonoscopy at age 50 and then regularly thereafter even if there is no family history of colon cancer. Your lifetime risk of developing colon cancer is approximately 6%. Your risk is higher if there is a family history, especially if the family member developed the disease before the age of 50.

That said, there are a number of contributing factors to the development of colon cancer that have nothing to do with heredity. Risk factors include obesity, cigarette smoking, inflammatory conditions in the colon such as Crohn’s, colitis and ulcerative colitis, and excessive alcohol consumption. Your doctor will review your medical and social history and make recommendations at to when and how often you should have a colonoscopy.

 

I have a family history of colon cancer. Should I get screened before I turn 50?

You are smart to be concerned. Your risk of developing colon cancer is roughly doubled if one (1) first degree relative (parent, sibling or child) had colon cancer or polyps after age 50, and is higher if the cancer or polyps were diagnosed at a younger age or if more members of your family are affected. Certain inherited disorders, for example, polyposis syndromes and hereditary non-polyposis colorectal cancer, can also increase your risk of developing colon cancer.

Because of the increased risk, your doctor may recommend you get your first screening colonoscopy as early as 30 years old – younger if your family member or members developed it early – and may also recommend more frequent screenings.

 

The doctor found a polyp. What does that mean and what happens next?

First of all, don't panic.  Finding a polyp does not automatically mean you have cancer.

A polyp is an area of irregular cell growth. It can be a flat area with minimal extension beyond the colon wall or it can grow up and out like a small balloon or sack. One of the great things about a colonoscopy is that small polyps can be removed during the procedure and sent to the lab for testing right away. Even some large polyps can be removed at the time of the procedure using a technique called Endoscopic Mucosal Resection (EMR). Dr. Haque is one of the few gastroenterologists in Southern Maryland trained to perform EMR.

Once the polyp has been removed, it will be tested to determine whether it is benign, pre-cancerous or cancerous. And don’t worry, most are benign. Your doctor will discuss the post-procedure treatment for any polyps found and tested when you wake up and will discuss any required follow up treatments with you and your primary care doctor.

And remember; early detection is key to treating any cancer, and colonoscopies are the most effective way to detect and treat colorectal cancers. That is why getting a screening colonoscopy by age 50 is so important.

 

What else does a colonoscopy check for?

When people hear ‘colonoscopy’ they normally think of colon cancer. And while it is a great tool for early detection and prevention of colon and other colorectal cancers, a colonoscopy is also effective in the diagnosis and/or evaluation of various GI disorders, including diverticulosis, inflammatory bowel disease, rectal bleeding, changes in bowel habits, abdominal pain and obstructions.  It is also normally ordered in response to an abnormal x-rays or CT scans to provide a closer ‘inside’ look at the problem. 

 

Everyone complains about how unpleasant it is to prepare for a colonoscopy. What do I have to do and how bad is it?

Yes, the preparation process can be very challenging for some people. We don’t make you stop eating and ask you to drink this terrible tasting stuff to be mean; we just want to do as much as we can to ensure a good outcome.

The most important part of a successful colonoscopy is that the doctor has excellent visibility into the colon. That means your entire digestive tract must be empty, and sadly, the only way to ensure that is to eliminate solid food and completely empty your bowels. This process takes up to 3 days and requires the use of very strong laxatives and other means to evacuate the colon.

To prepare for your colonoscopy, we will ask you to eliminate some foods (corn, beans, nuts and seeds) 3 days prior to the procedure. You will not be able to eat any solid food for 24 hours before the procedure. You will be able to drink clear fluids and broth, and in fact we want you to drink lots and lots of fluids to help flush out your system.

The night before your procedure, we will put you on a regimen of prescription liquid laxatives – the dreaded mixture that you have to drink. You will drink one bottle of the mixture the night before your procedure and one the morning of your procedure.

And yes, you should plan to spend a lot of time in the bathroom during this process. You might also want to stock up on soft toilet tissue and baby wipes.

We will give you full instructions on how and when to prepare for your procedure. We know it isn’t pleasant, but remember, this is all to ensure your doctor has clear field of vision into your colon so that no polyps – small or large – are missed during the exam.

 

So other than spending a lot of time in the bathroom, what else can happen during preparation?

Funny you should ask. What most people hear about is the preparation and how hard it can be to drink all the mixture. Because people react to laxatives differently, you may have some other results beyond just having to use the bathroom. Reactions can include

  • Hunger and tummy grumbling
  • Light headedness (if this happens, drink a clear fluid with calories such as a soda, juice or broth or treat yourself to some green or yellow jello. You should not have any red colored juice or jello prior to your procedure.)
  • Nausea and vomiting up of the mixture (drinking ginger ale can help!)
  • Diarrhea, which can be immediate, extreme and painful at times
  • Bloating and gas with flatulence
  • Rectal bleeding and blood in the stool or toilet*

* Rectal bleeding is often the result of a previously undetected hemorrhoid that is torn open from the increased bathroom usage. Small to moderate amounts of blood in the stool or in the toilet are normal but you should call your doctor’s office or go to the Emergency Department if the bleeding is excessive and doesn’t stop after you have evacuated your bowels.

These side effects are normally short lived and will dissipate as soon as your procedure is done. And then you can treat yourself to a nice meal!

I’m curious. Why can’t I have red juice or jello before the procedure?

One of the things we look for in a colonoscopy is irritation in the colon wall which is generally seen as a red area. Red juices and jello use food dye to get the red color which can then stain the wall of the colon and mask any irritation.

Seriously the preparation sounds dreadful. Is there any other way to check for colon cancer?

Yes, there are alternative methods to examine the colon, but none are considered as accurate at colon cancer and polyp detection as a colonoscopy. It is important to note that these alternative procedures do not allow for the immediate therapeutic removal of polyps and they are not guaranteed to identify all polyps. If a polyp is found, you will still need to go through the regular colonoscopy to remove them.

The alternative procedures include:

A flexible sigmoidoscopy with barium enema - The sigmoidoscopy examines the lower portion of the colon and is often used in conjunction with the barium enema, which takes an x-ray of your colon after you have ingested barium, a contrast agent that lets the doctor see any markers or abnormalities in your colon. This procedure still requires you to evacuate your colon by using laxatives and an enema.

Computerized tomography (CT) - Sometimes referred to as a ‘virtual colonoscopy’, a CT takes pictures and image of your colon but from the outside of your body. You still need to totally empty your colon the day before using laxatives and/or enemas, and the CT exposes you to radiation which has its own risks for cancer development.

Fecal Occult Blood Testing (FOBT) – Stool is tested and examined for minute amounts of blood loss (possibly from polyps or cancer) by way of a chemical reaction resulting in a color change of the stool. While FOBT is not a test to examine the colon, it is recommended annually to individuals over age 50. If occult blood is found in the stool, a follow up colonoscopy will be necessary.

It is important to remember that these alternative screening techniques are not as thorough as a colonoscopy and often will result in the patient requiring a colonoscopy to confirm or treat the results. Consequently, the current standard of care is for patients for whom it is medically appropriate to just have a regular colonoscopy.


Our Providers

Ann Chen, PA-C


Ann Chen is a Board Certified Physician Assistant (PA-C) specializing in Gastroenterology. She is a graduate of the Physician Assistant Program that was developed by the University of Wisconsin La Crosse, in partnership with the Gundersen Lutheran Medical Foundation of La Crosse and the Mayo Clinic College of Medicine.

Ann started her PA career in a busy OB/GYN clinic in Marshfield WI, working as the primary provider in the outpatient clinic and as the first assistant to five primary surgeons performing OB/GYN procedures as well as gynecologic oncology surgeries. A relocation prompted her moving from an OB/GYN setting to gastroenterology, where she had the privilege of studying under some of the country’s top physicians in the field.

While working for GI Associates in Milwaukee, WI, Ann worked with adult as well as pediatric patients on a wide range of GI disorders, including Chrohn’s disease/Ulcerative Colitis, GERD, celiac disease, IBS, cirrhosis, hepatitis and fatty liver disease.

Ann thrives in a clinical setting, taking the time to get to know her patients and their backstory. “I enjoy the clinical aspect of getting to know my patients on a personal level – something that isn’t always possible in an acute care environment like the operating room.”

Ann came to southern Maryland in 2011 and began working with Calvert Gastroenterology in 2012, where she continues to advance her skills. She was the first midlevel provider in Maryland and is still one of a very few in the county who specializes in Hemorrhoid Banding, a minimally invasive and non-surgical procedure to remove hemorrhoids.

As a Board Certified Physician Assistant, Ann is qualified to take medical histories, examine patients, order and administer tests, make diagnoses, treat illnesses, write prescriptions and assist in surgery.

Saad Haque, MD


Dr. Saad A. Haque is Board Certified in Internal Medicine, Hepatology and Gastroenterology. He did his residency in internal medicine at The Graduate Hospital, Drexel University College of Medicine in Philadelphia, and completed a fellowship in gastroenterology at Cooper University Hospital. While there, he received specialized training in Endoscopic Retrograde Cholangio-pancreatography (ERCP), a procedure used to identify and correct problems in the bile ducts and pancreas.

He continues to pursue advanced training and is certified to perform several key diagnostic and therapeutic procedures. "Technology is opening the door to incredible advancements in diagnosing and treating gastrointestinal diseases. It is very important to me to be able to offer these procedures and techniques to my patients here in Calvert and not make them go to Baltimore or DC."

Dr. Haque came to Calvert County to continue his work treating a wide range of GI disorders rather than limit his exposure to a small set of routine procedures which is often the case in more urban medical facilities. He specializes in colon cancer screening and polyp removal and is specially trained in Endoscopic Mucosal Resection (EMR), a technique used to remove large colon polyps non-surgically. He was one of the first physicians in the country to be trained and is still one of a very limited number of physicians in Southern Maryland to be trained to perform the technique. In addition to patients who come to him directly, Dr. Haque regularly receives referrals from local gastroenterologists for these difficult-to- treat colon polyps.

“Non- or minimally-invasive techniques such as endoscopy often have a better outcome than surgical procedures. They are easier on the patient, allow for quicker recovery and result in less scarring while providing excellent diagnostic and curative capabilities. I feel it is important for me to excel in as many of them as possible.”