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Colon - Fecal immunochemical test
Fecal immunochemical test
The scary thing of colorectal cancer is that there are often no obvious symptoms in early onset stage. And when symptoms appear, disease is already proceed to late stage. Regular screening can help early diagnosis before it is too late to cure. There may be cases of bleeding occur if people are suffering from colorectal polyps, tumors or inflammation and other abnormalities and the blood may be mixed with stool and passed out. However, due to a very small amount of bleeding, patients are difficult to aware. Fecal occult blood test is capable of detecting if there is visually undetectable blood in stool and so it is called "occult blood" test. Research indicates that regular annual fecal occult blood tests can detect if there is any abnormal bleeding (positive result) happened in colon, as a result, incidence and mortality of colorectal cancer can be reduced effectively. Our center provides new type of fecal occult blood test which requires just a stool sample and no need to restrict diet beforehand. Subject have to follow the instructions to collect a small amount of stool sample and then return it to the center for testing. The process is simple and convenient.
- Colon Capsule Endoscopy
Colon Capsule Endoscopy
The colon capsule endoscopy is a new endoscopic technique. Through a pill-sized capsule with cameras on both ends and a small data recorder, medical staff can view the inner wall of the colon This examination time is usually within 9 hours, it will then be naturally passed out during bowel opening. This examination is accurate, simple, safe, low-invasive and also require no sedatives. Subjects’ discomfort and inconvenience can be effectively minimized.
In order to ensure a clear image of the inner wall of colon, subjects have to follow the instructions to have bowel preparation in advance.
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Esophagus and Stomach - Magnet-Controlled Capsule Endoscopy
Magnet-Controlled Capsule Endoscopy
1. What is magnet-controlled capsule endoscopy?
This is a sedation-free and minimally invasive endoscopic modality for examining oesophagus, stomach and small bowel. Patients will swallow a magnetic capsule with a build-in camera for gastrointestinal examination. During the stomach examination, the capsule can be guided precisely through the external magnetic controller in five dimensions. It takes about 10 to 20 minutes for stomach examination. Then capsule will transit into duodenum, jejunum, ileum with gastrointestinal peristalsis and will be naturally passed out during bowel opening. Images are captured and recorded at 2 frames per second. The battery life is up to 12 hours.
2. Who can undergo magnet-controlled capsule endoscopy?
- Those who intend to have health check
- Those who are indicated for conventional endoscopy, but are unwilling to have or cannot tolerate this procedure. For example, upper abdominal pain, bloating, acid reflux, gastrointestinal bleeding (e.g. melena, hematemesis), allergy to sedatives or anaesthetics.
- Those who are suspected of small bowel disease without stenosis or obstruction, especially those with negative findings in oesophagogastroduodenoscopy (OGD) and colonoscopy.
Magnet-controlled capsule endoscopy is mainly used for screening and diagnosis. If there is a need for biopsy or therapeutic intervention, doctors will arrange conventional endoscopy for further management. A previous study found magnet-controlled capsule endoscopy detected gastric focal lesions in the whole stomach with 90.4% sensitivity and 94.7% specificity. It did not miss any lesions of significance (including tumors or large ulcers). [1]
3. Who is not suitable for magnet-controlled capsule endoscopy?
- Patients who have a pacemaker, electronic cochlear implant or other metal implants that are contraindicated to MRI scans.
- Pregnant women
- Children
- Gastrointestinal obstruction, stenosis, perforation, or fistula
- Dysphagia
- Patients who have undergone gastric bypass or bariatric surgery and who are expected with high risk of capsule retention.
4. The risk of magnet-controlled capsule endoscopy
The major risk is capsule retention in the body (rare scenario).
5. Differences between magnet-controlled capsule endoscopy and OGD
OGD Magnet-controlled capsule endoscopy If there is a need to use anaesthetics or sedatives Yes No Pain Yes No If it can induce gastrointestinal bleeding or perforation Yes No Cross infection Yes No (Disposable capsule) The coverage of examination Esophagus, stomach, duodenum Esophagus, stomach, whole small bowel Should discontinue anticoagulants before the procedure? Yes No Can you work during the examination? No Yes (After completion of the stomach examination) Purpose Diagnosis, biopsy and therapeutic intervention Screening and diagnosis 6. The differences between magnet-controlled capsule endoscopy and conventional capsule endoscopy
Magnet-controlled capsule endoscopy allows active navigation by the operator during the stomach examination, while the conventional capsule endoscopy scans the stomach by passive transiting resulting in large blind areas.
7. The process of magnet-controlled capsule endoscopy examination
- The examinee should fast for 8 hours and follow instructions to drink defoamer and 800ml water 40 minutes before the examination.
- Wear a wireless data recorder, lay on the examination bed and swallow the capsule.
- The examinee will be instructed to change position to facilitate the stomach examination when an operator in the control console navigate the capsule in the body.
- After the stomach examination, the examinee can wear data recorder to leave the room. The capsule will passively transit to the rest of the gastrointestinal tract and transmit captured images to the data recorder on the way until the battery is used up (battery life >10 hours).
- Return the data recorder.
FAQ:
- Is the capsule difficult to swallow?
It is a pill-sized (about 27mm X 18mm) capsule with a smooth surface. Except those with dysphagia, most patients have no difficulties in swallowing the capsule.
- Can I choose the examination coverage? How long does the examination last?
The examinee can choose:
- Esophagus and stomach The examination is usually completed within 30 minutes.
- Esophagus, stomach and the whole small bowel examination. The examination requires bowel preparation. The whole examination usually needs 10-12 hours.
- Can I drink and eat during the examination?
Yes. Examinee can drink water or any colourless liquid during examination and resume a normal diet after the examination. Examinee who chooses whole small bowel examination can eat solid food (e.g. sandwich) 4-6 hours after stomach examination.
Reference:
1. Liao Z, Hou X, et al. Accuracy of Magnetically Controlled Capsule Endoscopy, Compared With Conventional Gastroscopy, in Detection of Gastric Diseases. Clin Gastroenterol Hepatol. 2016 Sep;14(9):1266-1273.e1. doi: 10.1016/j.cgh.2016.05.013. Epub 2016 May 20. PMID: 27211503.
- Urea Breath Test (UBT)
Urea Breath Test (UBT)
The urea breath test (UBT) is a non-invasive test for diagnosing the presence of a bacterium, Helicobacter pylori (H. pylori) in the stomach. H. pylori causes inflammation, ulcers, and atrophy of the stomach. The test also may be used for follow-up exam of H. pylori eradication treatment regime.
Comparing to OGD, urea breath test gives equally accurate result in terms of Helicobacter detection, while OGD provides additional information such as presence of inflammation or ulcer in the stomach.
LiverLiver ExaminationLiver Examination
HBV DNA Test
HBV DNA quantification is an essential tool to assess the level viral replication in chronic hepatitis B. It is the standard investigation in patient selection for treatment as well as monitoring of treatment response and development of drug resistance. In our laboratory, we employ the TaqMan real-time polymerase chain reaction technology with the state-of-the-art ABI Prism system for measurement of HBV DNA. We use the Eurohep HBV standard to set the standard curve, which has a correlation coefficient routinely greater than 0.99. The linear range of HBV DNA measurement is from 100 to 109 copies/ml (20 to 2.0 x 108 IU/ml).
In order to ensure proper follow-up of the test results, all the requests require referral letters from doctors. To arrange an appointment for the test, please contact the Center for Liver Health during office hours to with a completed request form and a referral letter.
Drug-resistant variants of virus test
Use of anti-viral agents is associated with drug resistant mutations at the HBV polymerase gene. The emergence of drug resistance will lead to failure of treatment and worsening of liver disease. Early detection and confirmation of the drug resistant mutations will aid the clinical decision to modify the anti-viral regimes. In our laboratory, we perform polymerase chain reaction amplification and direct sequencing of the HBV polymerase gene to detect drug resistance. This assay has the advantage of detecting the key drug resistant mutations of different anti-viral drugs at the same time. In addition, compensatory mutations that may affect cross-resistance and viral replication fitness can also be detected.
In order to ensure proper follow-up of the test results, all the requests require referral letters from doctors. To arrange an appointment for the test, please contact the Center for Liver Health during office hours to with a completed request form and a referral letter.
FibroScan
Apart from liver stiffness measurement, Fibroscan has a new function to measure the controlled attenuation parameter (CAP). It is more convenient and bears a zero risk than the traditional assessment of liver fibrosis by liver biopsy. Technically, the operator will place a probe at the position of the liver where shear wave is emitted through the skin into the liver. At the same time, the probe will trace the velocity of the shear wave. The higher the velocity, the stiffness the liver. A stiffer liver usually reflects more severe liver fibrosis.
There are no obvious symptoms for fatty liver, liver fibrosis, liver cirrhosis and early stage hepatocellular carcinoma. Regular monitoring of liver fibrosis and cancer surveillance is recommended for early detection and treatment of these conditions, particularly among high risk patients.
To arrange an appointment for the investigation, please contact the Center for Liver Health during office hours.
Small BowelSmall Bowel Capsule EndoscopySmall Bowel Capsule Endoscopy
The small bowel capsule endoscopy is a new endoscopic technology. Through a pill-sized capsule with cameras on one end and a small data recorder, medical staff can view the inner wall of the small bowel Examination usually lasted for eight hours and it will then be naturally passed out during bowel opening. This examination is accurate, simple, safe, low-invasive and also require no sedatives. Subjects’ discomfort and inconvenience can be effectively minimized.
