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A colonoscopy is a procedure used to view the large intestine (colon and rectum) using an instrument called a colonoscope, a flexible tube with a small camera and light source attached to its tip. A colonoscopy can be performed for screening or diagnostic purposes. While diagnostic colonoscopy is performed to confirm the presence of colorectal cancer or colorectal polyps from a person showing symptoms (blood in stools, anemia, etc.), screening colonoscopy is performed on an asymptomatic person without any prior history of the two conditions.

Screening colonoscopy is indicated for the following:

  • Family history (first degree relative) of colon cancer or polyps
  • Inflammatory bowel disease

Colonoscopy is usually performed under sedation on an outpatient basis. You will be given a laxative or enema preparation to clear your bowels before the procedure. Air will be pumped into the colon to expand it for better visibility. The colonoscope is inserted into the rectum and gently moved up the colon until it reaches the caecum (junction of small and large intestine). The colonoscope is then withdrawn slowly as the camera relays pictures of the colon and rectum lining onto a large screen for your doctor to view. Any polyps or growths detected by the colonoscope can be removed and sent to the lab for determining whether it is cancerous or not (biopsy).

Screening colonoscopy is a very sensitive test. However, some cancers, small polyps or non polypoid lesions may go unnoticed, and the procedure may be associated with the risk of bleeding, tearing or perforation of the colon lining, especially during polypectomy.

Age 50

Screening is recommended if you are 50 years of age or older, with no risk factors. The test is ordered earlier if you have a family history (first-degree relative: parent, sibling or child) of colorectal cancer or polyps. If the relative was diagnosed at <60 years of age or if two relatives were diagnosed at any age, you are advised to have a screening colonoscopy at 40 years of age or 10 years before the age of the earliest diagnosis (whichever comes first). The screening needs to be repeated every 5 years. If the relative was diagnosed at ≥60 years of age or if two relatives were diagnosed at any age, you are advised to have a screening colonoscopy at 40 years of age, and repeat every 10 years.

Esophageal cancer is a type of cancer that affects the esophagus, a tube that carries food from the mouth to the stomach. Cancer is the uncontrolled growth of abnormal cells. The accumulation of these extra cells forms a mass of tissue called tumor. According to the type of cells that are involved, esophageal cancers are classified as:

  • Adenocarcinoma of the esophagus : It is the most common type of esophageal cancer which develops from the cells of mucus-secreting glands in the esophagus.
  • Squamous cell carcinoma : It is a type of cancer which develops from cells which are on the inside lining of the esophagus.

The exact cause of esophageal cancer is not known, however certain factors such as advancing age, gastro-esophageal reflux disease (GERD), obesity, Barrett’s esophagus, diet, smoking, alcohol, chemicals and pollutants may increase your risk of developing esophageal cancer.

In the early stages of esophageal cancer, you may have no symptoms. As the cancer grows you may have weight loss, difficulty swallowing (dysphagia), chest pain, fatigue, frequent choking, indigestion, coughing, and hoarseness.

Your doctor can often detect esophageal cancer by asking you several questions about the symptoms you are experiencing can be answered by performing a thorough physical examination. Certain tests may be ordered and could assist in determining the diagnosis and may include:

  • Barium X-rays: These are diagnostic X-rays in which barium is used to diagnose tumors or other abnormal areas. You are asked to drink a liquid that contains barium while X-rays are taken. The barium coats the walls of the esophagus and stomach and makes the abnormalities visible more clearly.
  • Endoscopy: An endoscopy is a procedure in which a long thin flexible tube with a tiny camera is used to examine the lining of the esophagus, stomach, and duodenum.
  • Biopsy: A small sample of tissue is removed and examined under the microscope to look for abnormal cells.

Esophageal cancer may be treated with chemotherapy, radiotherapy, and surgery. Surgery to remove the portion of your esophagus that contains the tumor and nearby lymph nodes is called esophagectomy. The remaining section of the esophagus is connected again to your stomach.

Capsule Endoscopy is a diagnostic tool helpful in taking pictures of the digestive tract including oesophagus, stomach and especially small intestine. Small intestine is a difficult area to reach through conventional endoscopy and other imaging tests as it lies between the stomach and large intestine. In video capsule endoscopy the patient swallows a capsule the size of a large vitamin pill. The capsule has a slippery coating making it easier to swallow. This capsule contains a camera, a bulb, battery and a transmitter. The camera takes thousands of pictures of the digestive tract during its passage through the digestive tract and transmits it to a recorder worn as a belt on the waist for about 24 hours to store the images. The doctor transfers these images of the recorder to a computer which converts them into a video. The capsule is passed out of the body with stool and can be flushed away.

The common diseases of the small intestine that are diagnosed through capsule endoscopy are:

  • Gastrointestinal bleeding
  • Tumors in the small intestine
  • Crohn’s disease

It may also be used for celiac disease and polyps of the small intestine


It is a non-invasive and safe procedure. The only risk is that at times the capsule gets stuck in the digestive tract and doesn’t come out even after two weeks. This is not a serious risk. The doctor will wait for some more time for it to come out on its own but if it causes bowel obstruction it is taken out through conventional endoscopy or last resort is surgery.


Before the capsule endoscopy you are required to:

  • Fast for 12 hours
  • Delay or not take any medicines

It is very important to follow your doctor’s instructions before and after the procedure otherwise the test may need to be repeated in case the images are not clear.

After swallowing the capsule

You are allowed to go home or to work but any strenuous activity should be avoided that day as it may hinder proper recording by the recorder.

Can drink clear fluids after 2 hours

Can have light lunch after 4 hours.

The recorder can be removed and packed if the capsule comes out in the stool or 8 hours after swallowing the capsule, whichever is early. If you do not see the capsule in the stool please contact your doctor.


Your doctor may take few days to a week to analyze the video and would tell you the results of the test.

Colorectal cancer is one of the most common preventable cancers. The colon and rectum make up the large intestine, which absorbs water and some nutrients from digested food, and stores the solid waste till it is expelled from the body. A colon cancer screening is the process of looking for polyps and cancerous growths on the inner wall of the colon and rectum, when no gastrointestinal symptoms of disease are present. A polyp is a noncancerous growth in the colon. Some of these may become cancerous later. Early detection and removal of colorectal polyps and malignant tumors can prevent complications and death due to colon cancer.

The people at high risk of colon cancer are:

  • People above 50 years
  • People with an inherited familial adenomatous polyposis, a condition where individuals develop numbers of polyps in colon and rectum
  • People who had colon cancer earlier
  • Women with a previous history of breast, ovarian or uterine cancer
  • People whose close family members such as parents, sibling or children have or had colon cancer
  • People with ulcerative colitis and Crohn’s disease
  • People with sedentary lifestyle, unhealthy eating habits and who smoke

People should talk to their doctor about when to go for the screening and what tests to have. One or more of the following tests may be used for colon cancer screening:

  • Flexible sigmoidoscopy: Sigmoidoscope is used to view the inside of the rectum and lower colon. A finger size thick tube with a camera at the end is inserted from the rectum and images of the inner wall of rectum and part of colon can be seen on the monitor. It can be used for taking biopsy of the polyp or tumor and for removing some polyps. But colonoscopy needs to be done to view the whole colon and remove all polyps or tumors. It is fairly safe but has small risk of bowel tear, bleeding and infection.
  • Colonoscopy: Colonoscope is similar to sigmoidoscope, but is longer and is used to examine the inner wall of the whole colon. It is inserted from the rectum and the doctor can see the images of the entire colon on the monitor. Special surgical tools can be passed through the colonoscope to take biopsy and remove polyps. Sedation is required. There is a small risk of bowel tear, bleeding or infection after the procedure.
  • Virtual Colonoscopy: It is the computed tomography scan of the colon. The person is made to lie on a table of the CT scanner which takes cross-sectional images of the colon. It is a non-invasive technique and does not require sedation. If any abnormalities are found, a colonoscopy needs to be done to remove the polyps or tumors.
  • Double Contrast Barium Enema: A small tube is inserted in the rectum and barium sulfate, a white chalky liquid, and air is pumped into the colon. The barium suspension lines the outer walls of the colon. X-ray images of the colon are then taken to reveal abnormalities on the inner wall of the colon. "IF" any abnormalities are found, a colonoscopy needs to be done to remove the polyps or tumors.
  • Fecal test: They are done with the fecal sample and are totally safe. These may not give confirmatory results, but may suggest the abnormalities in gastrointestinal tract warranting further tests. A colonoscopy needs to be repeated if results are positive, indicating the presence of cancerous growth in the colon. They are of three types:
  • Fecal occult blood test detects blood in the feces not visible to normal eyes through chemical reaction.
  • Fecal immunochemical test detects blood through specific immunochemical reaction of a protein in the blood and can detect hidden blood.
  • Stool DNA test looks for certain abnormal DNA genes in the cells shed from cancerous outgrowth or polyps in the stool sample. It is expensive as compared to the other stool tests.

Upper GI Endoscopy or Gastroscopy is a procedure performed to diagnose and in some cases, treat problems of the upper digestive system.

Upper GI endoscopy can be helpful in the evaluation or diagnosis of various problems, including difficult or painful swallowing, pain in the stomach or abdomen, and bleeding, ulcers, and tumors.


An upper GI endoscopy is both diagnostic and therapeutic. This means the test enables a diagnosis to be made upon which specific treatment can be given. If a bleeding site is identified, treatment can stop the bleeding, or if a polyp is found, it can be removed without a major operation. Other treatments can be given through the endoscope when necessary.


  • Difficulty or pain on swallowing
  • G.I. bleeding- hematemesis, melena, or iron-deficiency anemia
  • Troublesome heartburn
  • Persistent ulcer-like pain
  • Dyspepsia
  • With anorexia or weight loss
  • Taking aspirin or NSAIDs
  • With a history of gastric ulcer
  • Persistent nausea, vomiting, or symptoms suggestive of pyloric obstruction
  • Gastric ulcer demonstrated by barium meal
  • Duodenal biopsy for suspected malabsorption

Upper GI endoscopy is usually performed on an outpatient basis. The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the endoscopist can safely guide the instrument to carefully examine the inside lining of the upper digestive system. The high quality picture from the endoscope is shown on a TV monitor; it gives a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.

Endoscopy is a diagnostic procedure used to diagnose diseases of the digestive tract. A long flexible optic fiber with a camera and a light source at the tip is inserted through the mouth. This transmits images to a television monitor which helps the gastroenterologist to view the digestive tract from inside. During endoscopy, if surgical tools are introduced through the endoscope for taking tissue samples or to treat certain diseases of the biliary and pancreatic ducts, the procedure is called interventional endoscopy.

The interventional endoscopy procedures are broadly classified into:

Endoscopic ultrasound

Endoscopic ultrasound utilizes endoscope and high frequency sound waves to diagnose the abnormalities in digestive tract. In this procedure, an echoendoscope, a special device that has an ultrasound probe on the tip, is used to obtain the images of internal organs of the digestive tract. It is used to take biopsy of the tumors, cysts or lymph nodes through a small needle in the endoscope (fine needle aspiration) and to give injection into the nerves of the celiac plexus using imaging, when narcotics cannot provide relief from intense pain in pancreatic cancer or chronic pancreatitis.

Endoscopic Retrograde Cholangio-Pancreatography

In endoscopic retrograde cholangiopancreatography (ERCP), once the endoscope reaches the papilla, the place where the pancreas and bile ducts meet, a thin tube will be inserted through the endoscope and a dye is injected into the ducts. X-ray images are taken to diagnose any problem related to the ducts. In case a problem is detected, the doctor may give treatment at the same time. It could be used for:

  • Stone removal
  • Manometry and Sphincterotomy: Sphincter is a cylindrical muscle functioning similar to one way valve regulating the flow of bile and digestive juices from the bile and pancreatic duct into the small intestine. It sometimes becomes hard and becomes narrow. This causes the backup of digestive juices and a strong upper abdominal pain. The pressure is measured at the sphincter using manometry while doing ERCP. If doctor finds that the pressure is high, the sphincter is enlarged using electrically heated wire in ERCP.
  • Biopsy
  • Balloon Dilatation: Due to cancer, gallstones, inflammation or scar tissue narrowing of the pancreatic or bile duct, ducts may occur. A balloon is inflated inside the narrow portion of these ducts to open them through ERCP.
  • Stenting: A small plastic or metal tube is left inside the pancreatic or bile duct through ERCP to open the narrow area in them.


  • Biliary Tract Disease
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Gallstones
  • Liver Cirrhosis
  • Liver Cancer
  • Liver Diseases
  • Jaundice
  • Autoimmune Liver Disease

Diagnosis and management of Inflammatory bowel disease (IBD)

At AGHA Fresno, we help diagnose and manage IBD. Inflammatory bowel disease or IBD, with the two main types being ulcerative colitis and Crohn’s disease, is characterized by chronic inflammation in the digestive tract. For more information on how we can help you, please give us a call to set up an appointment.

  • Inflammatory bowel disease, or IBD, is when there is inflammation, or swelling, in the gastrointestinal (GI) tract and a lifelong immune response.
  • IBD causes the body and immune system to think that food, bacteria and other needed things in the intestine are not supposed to be there. With this, the body attacks the cells of the bowels, causing inflammation that does not easily go away.
  • IBD affects both men and women.
  • IBD is often found in people in their late teens and 20s, though it can be found at any age.
  • Symptoms of IBD can differ from person to person and depend on the type of inflammatory bowel disease.
  • There are two main types of inflammatory bowel disease: ulcerative colitis and Crohn’s disease. Read more about each on the next tab, “What is IBD?”
  • Both Crohn’s disease and ulcerative colitis are illnesses with times of remission (when you feel well) and relapse (when you feel ill).

Diagnosis and management of Irritable Bowel Syndrome and other Gastrointestinal Motility Disorders

Irritable bowel syndrome (IBS) is one of the common disorders of the large intestine. IBS symptoms can include stomach pain, diarrhea, stomach bloating, constipation and cramping.

  • Irritable bowel syndrome (IBS) is a health issue found in your intestines (gut).
  • IBS can cause symptoms such as:
  • Belly pain.
  • Cramping.
  • Gas.
  • Bloating (or swelling) of the belly.
  • Change in stool.
  • There are different types of IBS, so each person may not have the same symptoms.
  • IBS-D: IBS With Diarrhea
  • You may often have loose stool.
  • You may often feel an urgent need to move your bowels.
  • You may often have cramps or belly pain.
  • IBS-C: IBS With Constipation
  • You may find it hard to move your bowels.
  • You may not often move your bowels.
  • You may have an urge to go but cannot go.
  • IBS-M: IBS Mixed
  • You may have symptoms of both IBS-D and IBS-C.
  • While the cause of IBS is unknown, it can still be treated.
  • IBS is a common health issue, impacting more than 35 million Americans.
  • IBS does not cause lasting harm to the bowels and does not lead to cancer.
  • IBS can impact you physically, emotionally and socially.
  • Most people with IBS are able to control their symptoms through diet, stress management and, sometimes, medication prescribed by their doctors.

Fresno Clinical Research Center

FCRC is a privately owned clinical research site that offers leading-edge phase 2 and phase 3 clinical trials particularly related to liver and other digestive diseases. The principal investigator has 18 years’ experience in conducting national and international clinical trials. Over years these clinical trials have benefited hundreds of deserving local valley patients by providing them with state-of-the-art novel treatment options that were otherwise non-existent in the entire Central California Valley.

  • Central location in Fresno adjacent to the clinical practice site
  • The state of California, Department of Public Health certified laboratory
  • Availability of electronic patient medical records (EPIC)
  • In-house capabilities for processing and shipping study samples
  • Ability to use Central IRBs designated by the study sponsor
  • On-site FibroScan®-a non-invasive bedside tool to assess liver fibrosis
  • Liver Breath Test System
  • Wireless temperature monitoring system with alarms and alert notification for ambient, cold and frozen storage for biological samples and drug supply
  • Controlled access document storage space and locked cabinets
  • Programmable -80° to -20°C freezers
  • Centrifuge for on-site processing the blood samples
  • EKG machine
  • Clinical equipment routinely inspected and dedicated to the conduct of clinical trials
  • Collaboration with the state of the art California Imaging Institute, capable of doing liver biopsies, portal pressure measurements, and all sophisticated liver and biliary imaging studies


At FCRC, there is an On-site FibroScan which is a a non-invasive bedside tool to assess liver fibrosis. A fibroscan is fast and pain-free, gives valuable information about your liver, and is safer than a liver biopsy. To learn more about the Fibroscan or how you can have this test done, please contact FCRC at (559) 712-6199.

For more information about Clinical Trials please visit FCRC's official website by clicking the link below. You will also find valuable information on FCRC's Facebook page.



Sedelia Sanchez