Capsule endoscopy enables the gastroenterology physician to look inside the esophagus, stomach, and small intestine, but is primarily designed for the small intestine. The procedure can be used to discover a source of bleeding suspected to be in the small bowel, to diagnose Crohn's disease, or to help find cancers of the small bowel. At the beginning of the procedure, you will swallow a small capsule about the size of a large vitamin pill, which will wirelessly transmit images to a storage device that you will wear.

Colonoscopy uses a high definition video camera on the end of a narrow, flexible tube to allow your gastroenterologist to not only see, but also remove, precancerous lesions in the colon (large intestine). It is also useful to stop bleeding from the colon and to diagnose inflammatory bowel disease. The test is common and safe and can be done with or without sedation to maximize your comfort. A laxative preparation is needed. Availability: Humboldt, Napa, Sonoma

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialized procedure used to study and treat problems of the liver, pancreas and gallbladder. A narrow, flexible tube called an endoscope is passed through the mouth and stomach to the small intestine where small catheters are then used to inject contrast into the ducts of the liver and pancreas looking for abnormalities such as retained stones or other blockages. The procedure is more complex and lengthier than a typical upper endoscopy or colonoscopy. X-rays are taken and sedation is required. No laxative preparation is needed but your stomach must be empty for the procedure. Availability: Humboldt, Napa, Sonoma

Esophageal manometry uses a very thin catheter to measure the strength and coordination of the esophagus and the valve between the esophagus and stomach. The catheter is passed through the nose into the esophagus and small sips of water are taken allowing pressure waves to be recorded. This test is typically done by a nurse in a hospital setting. No sedation is used. No laxative preparation is needed but your stomach must be empty for the procedure. Availability: Humboldt, Napa, Sonoma

Esophageal pH testing uses a very thin catheter to measure amount of acid in the esophagus and stomach over time, usually 24 hours. The catheter is passed through the nose into the esophagus and then taped into place. You take it home and perform all of your daily activities as you would normally do while it records acid information and stores it in a small device worn as a belt. You return the next day and the catheter is gently removed. This test is typically done by a nurse in a hospital setting. No sedation is used. No laxative preparation is needed but your stomach must be empty at the start of the procedure. Once placed you may eat and drink normally. Availability: Humboldt, Napa, Sonoma

Flexible sigmoidoscopy (frequently called just sigmoidoscopy), uses a high definition video camera on the end of a narrow, flexible tube to allow your gastroenterologist to examine the part of the colon nearest the anus. With this test only a portion of the colon is seen. It is most useful for a brief look in the rectum and sigmoid colon to investigate minor bleeding or possible inflammatory bowel disease. The test is common and safe and can be done with or without sedation to maximize your comfort. A laxative preparation is needed. Availability: Humboldt, Napa, Sonoma

Hemorrhoids are small veins at the anus that frequently enlarge over our lifetime and intermittently cause trouble such as pain or bleeding. Most of the time no therapy for hemorrhoids is needed as usually symptoms will resolve on their own or with creams or a soothing bath in a few days. For persistent issues, however, hemorrhoids can be reduced by applying rubber bands (O’Regan hemorrhoid treatment) or heat (Infrared coagulation) in a series of procedures over a few months. The procedure is performed in the office and no sedation is needed. No laxative preparation is generally needed and you do not need to be fasting. Availability: Humboldt, Napa, Sonoma

Upper endoscopy or “EGD” is performed using an endoscope, which is a long, flexible tube with a camera and light at its tip. Your gastroenterologist carefully guides the endoscope through the mouth and down the throat to view the esophagus (E), stomach (gastric, G) and duodenum (D). This is very helpful for investigating problematic heartburn and upper abdominal pain, trouble swallowing and for bleeding ulcers. Sedation is generally recommended. No laxative preparation is needed but your stomach must be empty for the procedure. Availability: Humboldt, Napa, Sonoma

A flexible endoscope which has a small ultrasound device built into the end can be used in the esophagus, stomach, small bowel, or colon. The ultrasound produces sound waves that allows visual images of the digestive tract which extend beyond the inner surface lining into the wall and nearby organs. This procedure is performed under sedation. No laxative preparation is needed but your stomach must be empty for the procedure. Availability: Napa

Enteroscopy includes several types of procedures that allow your gastroenterologist to look further into the small bowel than is possible with a colonoscope or an upper endoscope. Capsule endoscopy (above) is one type of enteroscopy, but there are also dedicated flexible tubes called endoscopes, similar but longer than a colonoscope, that use balloons to help the camera reach deeply into the small bowel. These are particularly helpful if there is bleeding that cannot otherwise be reached. Availability: Humboldt, Napa, Sonoma