Frequently Asked Questions

Please click on a question to be linked to the answer

Why will you ask to take my picture?

We are now taking patient photos to include in our new Electronic Medical Record system.  Having patient photos will assist the staff and physicians in putting a face with a name when looking at your chart in preparation for your visit or after test results come in.  We can retake your photo at your next visit if you like.
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What is Gastroenterology?

Gastroenterology ("GI") is the medical subspecialty involving the evaluation and management of disorders of the digestive system; this includes disorders of the esophagus, stomach, small intestine, colon, liver, pancreas, and biliary system, including the gall bladder.  Swallowing difficulties, indigestion, heartburn, ulcer disease, abdominal pain, inflammatory bowel diseases, Hepatitis, polyps and cancers are some of the GI problems treated.  Gastroenterologists work closely with primary care physicians and other special consultants to provide the best medical care and recommendations for every patient.
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What are EGD and Colonoscopy, and why are they necessary?

Many problems of the digestive tract cannot be diagnosed by an x-ray.  Scopes allow us to thoroughly examine the inside of your digestive tract to detect abnormal tissue that may be causing you problems.

EGD (Esophagogastroduodenoscopy) is the examination of your upper digestive tract.  It is more accurate than an x-ray.  Sometimes, an EGD is used for treatment, such as the stretching of a narrowed esophagus, removal of polyps or swallowed foreign objects.

Colonoscopy is the examination of your lower intestinal tract or colon.  It is a major advancement in the diagnosis, prevention and treatment of colon cancer.  It is the most effective way to detect and remove polyps that can develop into cancer.  Before Colonoscopy, major surgery was necessary to remove colon polyps to determine if they were benign or malignant.  Now, most can be removed easily and safely without surgery.  In addition, many other conditions can be diagnosed such as diverticulosis, colitis, inflammatory diseases and infections.
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What exactly is an endoscope?

An endoscope is a small fiberoptic instrument that the doctor uses to examine your digestive tract.  He sees all of your tissues by manipulating the scope with the aid of a light source.

During the EGD we use a gastroscope .  This is a long flexible tube about the thickness of your finger, which is passed through your mouth into your esophagus, stomach and duodenum.

A colonoscope is longer and is passed during the Colonoscopy through the rectum to examine the entire colon lining.
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Do I need to do anything special to prepare?

For an EGD your stomach must be empty.  This means for a morning appointment you should not eat or drink after midnight the evening before your exam.

If you are scheduled an afternoon exam, you can have clear liquids (broth, apple juice, cranberry juice, soda pop, coffee, tea, lemon or pineapple jello) in the morning but nothing for 6 hours prior to your appointment. ( Unless you are a patient of Dr. Brock or Dr. Landers - they prefer you have nothing after midnight the evening before the exam .)

EGD Prep Instructions

For a Colonoscopy your colon needs to be empty of waste material.  You will achieve this by using a bowel cleansing preparation, as specified by your physician.  Complete instructions accompany the preparation.  You may have only clear liquids once you start the preparation and no solid food until after your exam. Please select the prep name you were given when you scheduled your procedure to view the instructions your physician will want you to follow (if you have trouble with the suggested prep there may be an alternate available):

Colyte - Colonoscopy Prep Instructions - AM Appointment
Colyte - Colonoscopy Prep Instructions - PM Appointment

Miralax - Colonoscopy Prep Instructions - AM Appointment
Miralax - Colonoscopy Prep Instructions - PM Appointment

Diabetic - Miralax - Colonsocopy Prep Instructions - AM Appointment
Diabetic - Miralax - Colonoscopy Prep Instructions - PM Appointment

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What will happen during the procedure?

The procedure will cause you little or no discomfort.  Your doctor will give you enough medication both before and during the procedure through a vein to make you relaxed and sleepy.  The procedure will be performed while you are lying in a comfortable position.

After the exam is over, you will be watched until most of the effects of the medication have worn off.  You may feel bloated after the procedure from air that was introduced into your system during the exam.  You should be able to eat normally afterwards unless we instruct you otherwise.

As you will be groggy afterwards, it is necessary to have someone available to drive you home.
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What happens if the doctor finds something abnormal?

If the doctor finds a suspicious area, he can take a biopsy with small forceps through the scope.  This will cause no additional discomfort.

Sometimes the doctor finds a polyp.  A polyp is a benign growth that can become malignant in time, if it is not removed.  It can vary in size from a tiny dot to several inches.  It the doctor feels it's necessary he may remove the polyp during the exam using a hot wire loop or hot forceps.  Again, this is done through the scope and causes you no additional pain.
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Can there be complications?

EGD, Colonoscopy and polypectomy are safe and are associated with very low risk when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.

One possible complication is perforation in which a tear through the wall of the bowel may allow leakage of intestinal fluids.  This complication usually requires surgery but may be managed with antibiotics and intravenous fluids in selected cases.

Bleeding may occur from the site of the biopsy or polyps removal.  It is usually minor and stops on its own or can be controlled by cauterization (application of electrical current) through the colonoscopy.  Rarely, transfusion s or surgery may be required.

Localized irritation of the vein may occur at the site of the medication injection.  A tender lump develops which may remain for several weeks to several months but goes away eventually.  Other risks include drug reactions and complication from unrelated diseases such as heart attack or stroke.
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What is EUS?

Understanding EUS (Endoscopic Ultrasonography)

What is it and why does Dr. Hsu do it?
Perhaps you or a loved-one has recently been diagnosed with a lump or lesion and now is scheduled for an endoscopic ultrasound (EUS).    You may be wondering what an EUS is or why you have to have one more test .  Well an EUS is different from regular imaging studies and may be the best tool available to help diagnose the lump or lesion.

EUS uses an endoscope, a long thin tube, with a mini-ultrasound on the end to produce very detailed images of the tissue.  EUS can be upper, entering through the mouth, or lower, entering through the anus.  This depends on where the doctor needs to reach with the endoscope.  An EUS can create images of the GI tract: esophagus, stomach, duodenum, colon and rectum.  EUS does more than just create images.  EUS can also be used to biopsy the pancreas, bile duct and gallbladder in addition to the GI tract.

The images and biopsies from the EUS will help your physician determine the origin of the lump or lesion and if cancerous, the extent.  If the tissue is cancerous, your physician will be able to see if the cancer has spread to any surrounding lymph glands or major blood vessels.  After the procedure, you and your physician can discuss possible treatment options, if necessary.

EUS can identify abnormalities 1cm or larger.  These abnormalities are often too small for other tests, like a CT scan, to detect.  For example, there are small pancreas cancers that can be detected with EUS that cannot be visualized currently with a CT scan.  In one comparative study of diagnostic methods, the sensitivities for tumors smaller than 3cm, were 93% EUS, 67% MRI and 53% CT.*  Basically this means that an EUS will be more likely than an MRI or CT to catch small tumors.
*Source: Johns Hopkins,

Hands-On Experience: In the words of Amy Miller, RN BSN
A good majority of the patients coming to us are quite anxious about their diagnosis or possible diagnosis.  Some of them have already been diagnosed with cancer and are coming to us for staging.  Some only know that they have a mass or other lesion, but will find out with us that they indeed do have cancer (or don’t, which is better!).
Once they are in the exam room the mood can be anywhere from, “I have no idea why I’m here” to “I can’t believe this is happening to me.”  Sometimes they have many questions, sometimes they just need a little reassurance that they are in the best place for their procedure.  It is easy to tell them that Dr. Hsu is not only extremely smart, but also a very caring doctor who will do his best to figure out their situation and recommend any next steps they need to take.  He stays with the patient as long as they have questions, sometimes for more than 30 minutes.

When I accepted the position as Dr. Hsu’s nurse, I had no idea what EUS was.  After doing this for several years, I can’t imagine not assisting Dr. Hsu with this procedure.  I also enjoy the patient interaction and doing my best to make them feel like a person, not a diagnosis.

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