Patient INFORMATION page

Endoscopy is a procedure wherein our digestive tract can be examined. During an endoscopy, an endoscope (with light and camera) is inserted into our digestive tract.

Endoscopy types:

1. Gastroscopy is also known as esophagogastroduodenoscopy or EGD. EGD visualizes our upper gastrointestinal tract which includes esophagus, stomach, and the first segment of small intestine (called duodenum).
2. Colonoscopy visualizes our entire lower gastrointestinal tract which includes anus, rectum, large intestine (sigmoid colon, descending colon, transverse colon, ascending colon), and last segment of small intestine (called ileum).
3. Sigmoidoscopy visualizes the last segment of large intestine (sigmoid colon) and rectum.

Reasons for performing endoscopy:

• Examine anatomy of gastrointestinal tract
• Investigate diseases, signs and symptoms (for example, rectal bleeding, acid reflux, anemia, etc.)
• Acquire biopsies (or samples) for further investigation of potential diseases
• Diagnose medical conditions (for example, Barrett’s esophagus, Crohn’s disease, colon cancer, etc.)

Endoscopy does NOT treat diseases. Much like X-Rays or CT scans, endoscopic procedures are investigative procedures.

Please watch Dr. Khokhotva's video below on colonoscopy.

Speak with your family doctor (or any medical physician, or nurse practitioner) and request for a referral indicating your intention of having endoscopy. Once we receive the referral letter, we will contact you personally and send a letter to your physician regarding your upcoming appointment.

To decrease a longer wait-time for a procedure, we have combined the consultation and the procedure together as one appointment. This has been a common practice among endoscopists for many years now. However, there are some special circumstances that lead us to book the procedure separately.

Colonoscopy and gastroscopy can be uncomfortable. For that reason, we use intravenous sedation during the procedure. If you wish, gastroscopy or colonoscopy can be done without sedation, and most people are comfortable. 

Yes. The medication we provide is minimal; thereby decreasing the side effects after the procedure. The purpose of sedation is to make you comfortable during the procedure; and not to make you sleep. If you are awake for the procedure and are comfortable, that is okay. It means that the medication is working.  

The amount of medication we provide is dependent on the patient’s medical history. Like any medication, these sedatives have side effects. They include nausea and vomiting, prolonged drowsiness, and longer recovery time. Too much sedation can lead to decreased level of consciousness, inability to breathe, etc.

It is important to note that you will not be allowed to go home by yourself, take a cab/Uber or bus, or drive. The taxi/Uber/bus driver is not responsible for your safety. This regulation is in your best interest and safety and NON-NEGOTIABLE. Make sure you have arranged for someone to pick you up after the procedure. If you cannot find someone, you may arrange for medical transport.

If you do not have a ride arranged, you WILL NOT GET SEDATED.

Yes, that is possible. If you prefer not to have sedation, we can accommodate your needs. There are benefits to not having sedation. There are no restrictions on daily activities after your procedure. You may drive yourself home. However, the procedure can be uncomfortable.

If you are having a colonoscopy or flexible sigmoidoscopy, you may feel some bloating and cramping during the procedure.

If you are having a gastroscopy, you may feel discomfort from the scope being inserted into your mouth.

If at any time during the procedure, without sedation, you decide to stop due to your discomfort,  we will have to end halfway and rebook it for another day for you. That would mean redoing the bowel preparation.

That is why we recommend getting sedated for the procedure to decrease that discomfort and the possibility of rebooking.

If you are getting sedated for the procedure, you cannot. You are not allowed to drive, take a taxi/Uber/bus home by yourself, operate any machinery, or drink alcohol. The taxi/Uber/bus driver will not be responsible for your health. You must have a responsible adult accompany you home. This regulation is in your best interest and safety and NON-NEGOTIABLE.   

During your procedure, you will be given anaesthetic medication that will impair your judgment and motor skills. You will be drowsy and sedated for the whole day.   

If you do not have a ride arranged, you WILL NOT GET SEDATED.

Follow the bowel preparation instruction provided to you by the clinic. You must read and follow the instructions very carefully, or your procedure may be cancelled or repeated. DO NOT FOLLOW THE INSTRUCTIONS on the laxative packets.

If you need another copy of the instructions, go to the Patient Forms page. Download your own Preparation Instructions sheet. If you have questions about these instructions, please  call our office at 519-254-4154.  

Bowel preparation medications can be bought at any pharmacy.  

PegLyte and Purg-Odan are two types of laxatives we use for bowel preparation. Our main choice for colonoscopy bowel preparation is Purg-Odan. Purg-Odan has less side effects and works well with most patients. PegLyte is our second drug of choice for colonoscopy bowel preparation. Patients with certain medical conditions, or are older, or those who have had poor preparation in the past, will benefit more from taking PegLyte rather than Purg-Odan. There is less risk of dehydration and electrolyte imbalances from taking PegLyte.

Sometimes it takes a little bit longer for the laxatives to work. For some patients, it may take the last dose before the medication starts working.  

If after the last dose it still did not work, please call the clinic at 519-254-4154 to inform us of this situation. We will give you further instructions on how to proceed.

Blood thinner medications are medications that prevent blood clots from occurring. Blood clots lead to heart attacks, strokes, and death.

Each procedure requires bowel preparation. You will be provided with an instruction sheet detailing what to do, what bowel preparation medication to take, which home medications to stop taking before the procedure, etc.  

In this instruction sheet, you will be instructed which blood thinner to stop taking. Please follow the instructions carefully. If you do not follow the instructions correctly, your procedure will be CANCELLED or REBOOKED for another time.

Low dose aspirin does not need to be stopped when undergoing endoscopy. Recent scientific studies and medical guidelines have shown that this medication is SAFE to take.

Some patients become nauseated after the procedure. It is because of the sedation they were given. Feeling nauseated is not common because the amount you are given is minimal.  

If you are nauseated, do not eat or drink after the procedure. Once the effects of the medication wears off, your nausea will subside. You may take anti-nausea medications. Although, anti-nausea medications have a sedative effect as well. This means you will be more sleepy and drowsy. If, however, you are allergic to anti-nausea medications, do not take them.

Small amount of rectal bleeding may occur after the procedure. Reasons for rectal bleeding include swollen internal hemorrhoids, and/or polyps were removed. If the reason for bleeding is due to swollen hemorrhoids, we will suggest a number of lifestyle modifications, over-the-counter medications, and fibre supplements to decrease occurrences of bleeding.  

Generally, polyps are small in size and do not bleed after removal. When an endoscopist removes them, they use specialized equipment and tools to remove them completely and, at the same time, reduce the risk of complications especially bleeding. If there is bleeding from a polyp that was removed, it is usually minimal and will subside by itself.

If, however, you experience a lot of bleeding and bleeding that would not stop, please call the clinic at 519-254-4154 as soon as possible. If you also experience severe abdominal pain, despite passing gas and having bowel movements, and/or have a fever, please call us as soon as possible. If we are closed, please go to your nearest emergency department for further assessment.

Hemorrhoids are vascular tissues (or blood vessels) in the rectum and anus. They are a normal part of our anatomy. They are found internally and externally. Hemorrhoids become a problem when they are swollen and irritated. Common causes include constipation, sitting on the toilet for a long time, hard stools, straining during bowel movements, repeated heavy lifting, frequent diarrhea, obesity, or pregnancy. The increased abdominal pressure causes these veins to swell, bleed, and prolapse (protrude outside the anus with bowel movements). 

It should normally take a few seconds to have a bowel movement.  

Treatment includes dietary, lifestyle modifications, and surgical procedures. Dietary and lifestyle modifications include fibre supplementation (such as Metamucil, Benefibre) and decreasing time spent sitting on the toilet. If conservative, nonsurgical treatments fail, medical procedures are introduced. These include hemorrhoidal banding, hemorrhoidectomy, and HALRAR (hemorrhoidal artery ligation and recto-anal repair.) Even with having surgery, dietary and lifestyle modifications are necessary to prevent recurrence of hemorrhoids.

Before any treatment is provided, the doctor will need to assess the severity of your symptoms. This means having a colonoscopy or sigmoidoscopy.

Please have a look at the educational video below on hemorrhoids.

Hemorrhoidal banding (or rubber band ligation) is the application of rubber bands to the bases of the largest hemorrhoidal tissues. The purpose of the rubber band is to constrict the blood vessels (or swollen hemorrhoids.) As the rubber band tightens, the constricted hemorrhoids fall off on its own within several days. The procedure is very quick and there is no anaesthetic medication given during the procedure. You may also receive sedation, if you prefer.
After the procedure, expect some discomfort and pressure on the anus; which is normal. Some patients describe it as feeling like they need to have a bowel movement. In order for this treatment to be successful, it is important to adhere to strict dietary and lifestyle modifications (such as eating a high fibre diet, taking fibre supplements and/or laxatives, and decrease straining during bowel movements).
Complications from hemorrhoidal banding include infection, bleeding, and recurrence of swollen hemorrhoids.

Hemorrhoidectomy is the surgical removal of swollen hemorrhoids. It is performed at the hospital with general anaesthesia. It is a very painful procedure, so we try to avoid it, if possible.
After the procedure, you may have a lot of pain and a long recovery time. There may be some bleeding associated with bowel movements. It is important to prevent straining and constipation after the procedure to decrease pain and complications. In order for this treatment to be successful, it is important to adhere to strict dietary and lifestyle modifications (such as eating a high fibre diet, taking fibre supplements and/or laxatives, and decrease straining during bowel movements).
Complications from a hemorrhoidectomy include infection, bleeding, narrowing of anal canal, recurrence of swollen hemorrhoids.

HALRAR (or Hemorrhoidal Artery Ligation and Recto-Anal Repair) is a surgical treatment for swollen hemorrhoids performed at the clinic. As the name suggests, it is a two-part procedure. The first part, HAL, includes tying up (with sutures) the hemorrhoidal artery that supplies blood to the hemorrhoids. By blocking (or obstructing) the blood supply to the hemorrhoids, swelling decreases. The second part, RAR, includes pulling up into the rectum(with sutures) the prolapsing hemorrhoids. Symptom relief is usually immediate, but it may be a few weeks. Similar to the other hemorrhoidal treatment procedures, its success is dependent on the patient’s willingness to change dietary and lifestyle practices.  
Complications from HALRAR are minimal. They include minor pain, discomfort and, temporary urinary retention.

The first step in treating problematic hemorrhoids is to do a consultation and a physical assessment. To decrease wait-time, we have combined the consultation and the assessment as one appointment. The general surgeon will perform the physical assessment via a colonoscopy or sigmoidoscopy. Without this assessment, the general surgeon cannot decide the adequate intervention. This step CANNOT BE SKIPPED.  

After the assessment, the doctor usually recommends dietary and lifestyle modifications. See above for further information. If conservative, non-procedural treatments fail, then surgical treatment options are introduced. The general surgeon may provide the hemorrhoidal banding on the day of the appointment. However, depending on the severity of the swollen hemorrhoids, the doctor may make different recommendations.

FIT is a non-invasive test for colorectal cancer screening. This test detects microscopic blood in the stool. What is different about this test, compared to traditional FOBT, is it is very specific in detecting human blood in the lower gastrointestinal tract. FIT is a more accurate test than FOBT. There are no dietary or medical restrictions. However, if a colorectal polyp or cancer is not bleeding, FIT will not detect it. Only one sample is required. Once there is a positive result, a colonoscopy is indicated to investigate the reasons.

FIT detects blood in the stool. The patient does the test at home and sends the specimen to the lab for analysis. Detection of blood means there is bleeding in the gastrointestinal tract. A positive result means further investigation of that bleeding. A colonoscopy is then indicated.  

Colonoscopy is a procedure of visualizing the entire large intestine (or colon.)  

Both tests are forms of colorectal cancer screening. A colonoscopy is a more accurate test than FOBT/FIT for a couple of reasons: a polyp can be detected and removed (at the same time) and the source of the bleeding can be identified and located. Because colonoscopy is a procedure, there are risks involved. Bowel preparation is required.  

Polyps found in the colon are called colonic polyps. These should not be confused with fundic gland polyps (polyps found in the stomach.) Colonic polyps are abnormal cells growing along the lining of our colon.  

There are two types of colonic polyps:  

1. hyperplastic and inflammatory polyps, and
2. adenomatous polyps (or adenomas).  

Hyperplastic polyps are harmless polyps. They do not typically become cancerous. Harmless polyps are usually small in size (between 1-5 mm in diameter).

Adenomas are pre-cancerous polyps. If left inside the colon, it can grow. Having an adenomatous polyp does not mean you have cancer. It means that it could become cancer overtime if not removed. Once removed, they will be sent to a lab for further analysis. The final lab results will eventually tell us what type of polyp it was.

Before you go home, the nurse will inform you of your results; along with giving you a paper copy of it. On your discharge instructions, it may say that the polyp we removed was either hyperplastic or an adenoma. We will not know the actual type of polyp removed until we receive the results from the lab. 

Polyps can be difficult to find. The smaller the size, the less likely it will be visible to remove. This is where the bowel preparation becomes extremely important. If you follow the bowel preparation instructions completely, your colon will be clean. The cleaner the colon, the more likely the doctor can see these polyps. If you cheat on your bowel preparation, you are cheating yourself with the possibility of a polyp not being removed. 

Polyps do not generally cause symptoms; mainly due to its small size. Once the polyp grows, then symptoms become more evident. These include rectal bleeding, changes in stool colour and bowel habits, pain, and iron deficiency anemia. 

Our body continually generates new healthy cells to replace old, damaged ones and this process is usually regulated. However, some cells grow at a faster rate than the time it takes for the old ones to be removed. In the case of colonic polyps, these are abnormal cells growing along the lining of our colon. Mutations in certain genes can cause polyp growth.

Hyperplastic (or harmless) polyps may be caused by a genetic mutation or a response to injury or irritation. During tissue repair process, some cells may pile up and become a polyp. Inflammatory polyps are caused by inflammatory bowel disease such as Crohn’s or ulcerative colitis.  

Adenomatous (or pre-cancerous) polyps may be caused by genetic mutation. It is still unclear how these polyps form. There are, however, risk factors involved with forming adenomas; such as smoking.

It is important to regularly check your colon for presence of polyps.

After your colonoscopy procedure, we will make a recommendation as to when your next colonoscopy should be. We will also contact your family physician when you are due next.

Diverticulosis or diverticular disease is the presence of diverticula in the colon (or large intestine). Diverticula are pockets that form on the lining of our large intestine. Diverticula form over time when there is increased pressure during a bowel movement. That increased pressure weakens our colon lining and over time, it stretches into a balloon or pocket, or diverticula. Likelihood of having diverticulosis increases over time. Patients who are 50 years old have a 50% chance of having diverticulosis.

Diverticulitis occurs when some of the diverticula break open, or tear from overstretching; which are due to straining during a bowel movement. The diverticula become inflamed and/or infected. Symptoms include diarrhea, cramping, pain, bleeding, bloating, and fever. Different treatments are provided depending on the severity of the diverticulitis attack. They include providing antibiotic medication, hospital admission, or surgery.

Fibre supplementation (such as a Metamucil) has been shown to prevent worsening diverticulosis and diverticulitis. You may also include fibre supplements into your diet. Eating seeds are no longer believed to lead to diverticulitis attacks. It has been disproven by recent scientific studies.

Anal fissure is a chronic wound that can appear in the anal canal. It is not irritated hemorrhoids. What distinguishes anal fissure from irritated hemorrhoids, is that anal fissures are usually painful. Irritated hemorrhoids usually bleed and there is no (or very minimal) pain. Anal fissure is caused by overstretching of anal lining during constipated or large calibre bowel movements and the skin or anal lining tears. The skin tear eventually heals. But it can reoccur and become a chronic problem.

Diagnosis is done by physical assessment (via a digital rectal examination).

Treatment includes fibre supplementation, or in combination with laxative medications, and diltiazem cream. These fibre supplements and laxatives will change the consistency of the bowel movement such that further bowel movements will not cause irritation and ongoing trauma as the skin tear is healing. Diltiazem cream medication is applied on the outside of the anal opening and it allows the anal muscles to relax. By relaxing the anal muscles, it allows the bloodflow to that area to improve and the anal fissure heals overtime. Healing time takes several months. If nonsurgical treatments fail to improve the symptoms, surgical treatment is introduced. A follow-up appointment is required to discuss this in greater detail.

Please watch Dr. Khokhotva's video below regarding anal fissures. 

Acid reflux is stomach acid flowing back into the esophagus. Gastroesophageal reflux disease (GERD) is acid reflux reoccurring over time. Symptoms include heartburn (burning sensation in your chest), food regurgitation, trouble swallowing (or dysphagia). Some factors that can worsen acid reflux include smoking, eating large meals, or eating late.

Diagnosis include a consultation by your family doctor or performing a gastroscopy.

Treatment includes lifestyle changes and medications. These involve decreasing or cessation of smoking, eating small meals, eating early, staying/sitting upright for at least 3 hours after eating, lying on your left side when sleeping, elevating head of bed while sleeping. Medications essentially block gastric acid production, thereby reducing symptoms.

Barrett’s esophagus is a condition caused by chronic irritation of esophagus from chronic acid reflux. Over time, this can lead to cancer development and requires repeated examination of the esophagus to prevent progression.