Dr Raymond Kwok provides specialist consultations for patients with gastrointestinal, liver, biliary and pancreatic disease.
There is an extensive list of conditions that he diagnoses and treats.
Amongst the more commonly seen include reflux disease, swallowing difficulties, stomach and duodenal ulcers (peptic ulcers), stomach inflammation (gastritis), stomach cancer, coeliac disease, food allergies/intolerance, irritable bowel syndrome, functional dyspepsia, oesophageal motility disorders, inflammatory bowel disease (Crohns/ulcerative colitis), colon polyps, colon cancer, gastrointestinal bleeding, liver damage/injury, viral hepatitis(A,B,C,E and others), alcoholic liver disease, fatty liver, liver cirrhosis and liver failure, liver cancer, gall stones, pancreatitis, and many more.
What is Endoscopy?
Endoscopy means looking inside the body for medical reasons. Endoscopy typically uses a thin, flexible fibre-optic instrument that is introduced into the mouth (Gastroscopy) or back passage (Colonoscopy).
Working channels within the instrument allow the passage of devices such as forceps, injectors, diathermy probes, snares, and nets which help diagnose and treat a wide range of gastrointestinal diseases. Special types of endoscopy (balloon enteroscopy and capsule endoscopy) are also used to examine the small intestine.
A gastroscopy, more commonly known outside of Australia as Oesophagogastroduodenoscopy or “OGD” for short, is an examination of the upper digestive tract using a long thin flexible fibre-optic tube. It is the best test for examining the internal lining of oesophagus, stomach and duodenum, and usually only takes 15-30 minutes.
Gastroscopy is used to investigate the cause of symptoms such as heartburn, abdominal pain, difficulty swallowing, vomiting and bleeding. Certain conditions can also be treated during gastroscopy. These commonly include:
- Bleeding from ulcers or other lesions can be stopped
- Large, dilated, bulbous veins (varices) in the oesophagus or stomach can be banded (ligation) or injected
- Polyps can be removed
- narrowed oesophagus (from reflux, eosinophilic oesophagitis etc) can be widened
- food or foreign objects that get stuck (such as accidental swallowing) can be removed
The average time it takes to perform a gastroscopy is 15-30 minutes.
A colonoscopy is an examination of the large intestine using a long thin flexible fibre-optic tube. It is the best test for examining the interxnal lining of the large intestine and the terminal ileum (last part of the small intestine), and usually takes 30-60 minutes.
Colonoscopy is used to investigate symptoms such as abnormal or change in bowel habits (constipation or diarrhea), bleeding from the anus or blood found in stools, abdominal pain, unexplained weight loss and bowel cancer screening. It is an incredibly useful test for those who are at risk of bowel cancer, either because of a family history, or because of worrying symptoms.
Polyps are very common as you get older and potentially can develop into cancer. They can be safely removed during a colonoscopy to prevent bowel cancer from occurring.
The length the small intestine is about 6 metres and cannot be adequately examined by standard gastroscopy and colonoscopy alone. Special devices are used to examine the lining of the small intestine. These include balloon enteroscopy and capsule endoscopy.
Balloon enteroscopy was originally developed in Japan in 2001 and is now used by many gastroenterologists throughout the world. It can be passed through the mouth or back passge, and uses a thin fibre-optic tube similar to a gastroscopy or colonoscopy. But it is much longer and has an overtube with a soft inflatable balloon that allows for the instrument to not lose friction, allowing passage deep into the small bowel. Diseases of the small intestine can be diagnosed, while certain conditions (such as polyps, bleeding) can be treated at the same time. The average time it takes to perform a balloon enteroscopy is 1-2 hours.
Video capsule endoscopy, sometimes known as “pill cam” is a tablet sized pill with a camera inside. It first invented in the 1990s and further developed for investigating the small intestine by English doctors in year 2000.
Once a video capsule is swallowed, it is transported smoothly and painlessly though the gastrointestinal system by natural contractions (peristalsis).
The video capsule transmits images wirelessly to a receiver that is worn by the patient. As the capsule travels through the small intestine, pictures are continuously taken and the entire length of the small intestine can be examined.
The whole procedure takes around 8 hours, but the patient is allowed to return home to rest during the recording. After recording, the receiver is returned to the doctor, and the images are then uploaded to a computer where it is interpreted. Meanwhile, the video capsule is excreted in the faeces usually in the next 1-2 days.
Is endoscopy safe and is it painful?
In general, endoscopic procedures are all very safe. In expert hands, and with state of the art equipment, serious complications are rare. Gastroscopy, colonoscopy and small bowel balloon enteroscopy are all performed by Dr Raymond Kwok with a specialist anaesthetist who provides the anaesthetic under monitoring. Patients are usually given enough sedation such that they are unaware of the procedure, let alone experience any discomfort.
Afterwards, there may be some minor discomfort from the air that is used to inflate the stomach or intestines so that proper views could be obtained. Some patients may also experience a mild sore throat that resolves within a few days. A full recovery from the procedure is expected by the next day.
During the consultation, risks of the procedures will be explained. Questions or concerns about side effects and complications are always welcome.