Gastroenterology and gastroenterological procedures.


Gastroenterology is a branch that deals with the illnesses of the digestive system: esophagus, stomach, intestines, liver, pancreas. The digestive system illnesses cover for a major part of the population’s medical problems. The diet, everyday pace of life, stress, work and environment, together with the genetics are important factors in the appearance and development of the gastrointestinal illnesses.

Our check-ups do not aim at discovery and treatment only, but mostly at prevention of the illnesses and their early detection. We pay special attention to gastrointestinal endoscopy. We offer the following check-ups, investigations and services on a regular basis:

  • гастроентеролошки субспецијалистички преглед
  • ехо преглед на стомачните органи
  • горна и долна ендоскопија (гастроскопија, колоноскопија, ректоскопија, аноскопија)
  • консултации, советување, давање терапија, превентивни прегледи, второ мислење

Gastroneterological subspecialist check-up

The check-ups in this department are performed by a doctor, specialist, subspecialist
gastroenterologist. After an interview about the existing illnesses and the current complaints, the
doctor does a physical check-up, and asks for blood analyses if necessary.
If, based on the interview and the physical check-up, the doctor defines the reasons for the disorder,
the doctor suggests diet regime and a suitable treatment. However, if that is not the case, and the
reason for the disorder still remains vague, then the patient is advised to carry out further
investigations like: abdominal endoscopy, colonoscopy, ultrasound of the abdomen etc.
Sometimes it happens that the health problems are not of abdominal origin, so the patient is
suggested to consult another specialist doctor.
The patient is recommended to take along any previous medical reports, especially if s/he has already
seen other specialists or has had therapy due to the fact that s/he has had the health problem for a
longer period of time.

The ultrasound machine emits sound waves that reflect from the organs in the abdomen and create
an image on the screen. The frequency of the sound waves is beyond our hearing and that is why it is
called ultrasound.
This procedure is very accurate when examining the liver, gall, pancreas, spleen, kidneys, bladder and
prostate for men, large blood vessels and lymph nodes in the abdomen.
The check-up is completely painless and harmless for the patient or for pregnant women. It lasts
several minutes, there are no pains and no special preparation is needed.

Gastroscopy – endocopical examination of the esophagus, the sopmach and the duodenum.

Esophago – gastro – duodenoscopy (gastroscopy, for short) gives a direct insight in the upper part of
the digestive tract. It is performed with a thin, flexible optical instrument (gastroscope) which is
applied in the mouth to enter the esophagus, the stomach and finally the duodenum. Endoscopy of
the upper part of the digestive tract is more detailed and accurate procedure than the X-ray barium.
Trained doctor, subspecialist, gastroenterologist performs the gastroscopy.

The patient is given local anesthetic for the mouth and the throat, and a sedative to feel relaxed
during the procedure, whereas the lips are protected with a special tube. The patient is lying on the
left side during the procedure. Since air is insufflated for a better view in the channel, the patient
might feel a bit tense in the stomach. The patient can breathe freely during the procedure, without a
feeling of pain, the only discomfort being a possible light irritation of the throat and a gag reflex. The
entire procedure lasts 5 to 15 minutes. Many patients find it lightly uncomfortable, yet some others
even fall asleep during the procedure.

Gastroscopy allows your doctor to evaluate the symptoms for permanent pain in the upper abdomen,
nausea, vomiting and/or difficulties in swallowing. Gastroscopy is an excellent method for detecting
the reasons for bleeding in the upper digestive tract, and is a more precise method than x-rays in
discovering ulcers and tumors of the esophagus, stomach and duodenum.
During the procedure the doctor might collect tissue sample (biopsy), that can help differentiate
between benign or malign tissue changes.
We must bear in mind that biopsy is taken for many reasons, even without a suspected cancer, for
example, testing the presence of Helicobacter pylori, a bacteria that causes ulcer. This procedure is
not only diagnostic, but also therapeutic in the treatment of certain diseases.

It is best if the procedure is performed on an empty stomach, so the patient should not eat or drink
(except for water) 6 hours prior to the procedure. Your doctor will tell you when to restrain from
food. You should inform the doctor about the possible therapies you take, (so that the doctor can
modify the doses if necessary), possible drug allergies, heart or lung problems. You should also inform
the doctor if you are bound to take antibiotics when performing dental procedures, because in that
case you will have to take antibiotic treatment for the gastroscopy as well.

After the procedure the patient remains under control until the drugs’ effects fade away. The patient
might feel a slight discomfort in the throat or bloating, because of the air in the stomach. The patient
is allowed to eat immediately after the procedure, provided the doctor does not recommend
differently. Generally speaking, the results are available immediately after the procedure, except for
some cases when it might take several days due to further examinations.
If the patient has taken sedative prior to the procedure, s/he is not recommended to drive even if
s/he does not feel fatigue at all. For this reason, it is good to be accompanied home after the
procedure, since the sedative can influence reasoning and reflexes for the rest of the day.

Complications are possible, yet very rare, especially when the procedure is performed by an
experienced doctor, especially trained for this kind of examination. Light bleeding at the place of
biopsy or when removing a polyp is possible, but it is usually really minor and there is seldom need
for further steps. Other potential complications are: reaction to the medicaments that were used,
heart and lung complications, and perforation of the area being examined. It is very important to
recognize the signs of possible complications as soon as possible, so if the patient feels fever, high
temperature, difficulties in swallowing or swallowed throat, chest or stomach pain, s/he should
immediately inform the doctor.

endoscopic examination of the large bowel and a distal part of the small bowel.
Examination of the large bowel is necessary in cases of occult bleeding and/or presence of blood in
the stool, unexplained anemia, irregular stool, sudden constipation, periodic constipation and
diarrhea, unexplained stomach pain, bloating, weight loss, family history of colorectal cancer.

The doctor will give you detailed instructions regarding diet restrictions and cleaning the colon, which
is essential before the procedure. Generally speaking, the preparations are based on consuming
laxatives a day or two before preforming the procedure. The colon must be completely clean so that
the procedure can be accurate and thorough, therefore you must follow the doctor’s instructions
carefully and precisely.

Colonoscopy is not complicated and it rarely causes heavy pains. The patient might feel pressure,
bloating, or cramps in the stomach. Therefore the patient is given pain killers and sedatives before
the procedure, to feel more relaxed and cope possible discomfort. The patient lies on the back, or on
the side, while the doctor slowly examines the colon. The procedure usually lasts 15 to 60 minutes.

The patient is given and explained the examination results. However, in case of possible biopsy, it will
take several days for a final interpretation of the results.
If the patient has taken sedative prior to the procedure, s/he is not recommended to drive even if
s/he does not feel fatigue at all. For this reason it is good to be accompanied home after the
procedure, since the sedative can influence reasoning and reflexes for the rest of the day. The patient
might feel cramps in the stomach due to the air insufflated during the procedure. The discomfort
disappears after letting the gases out. Generally, the patient can eat after the procedure, however
possible reductions might be suggested, especially after a polypectomy.
Ви бидат објаснети резулатите и наодот од прегледот, иако понекогаш можно е да има потреба
да се почекаат резулатите од евентуалната биопсија за целосно да биде интерпретиран наодот.

Complications are possible, yet very rare when performed by an experienced doctor, especially
trained to perform the procedure. Light bleeding after biopsy or polyps removal may appear, but it is
usually minor, and there is no need for further monitoring.
Colon perforation is possible, but very seldom complication, which takes surgery to be resolved.
Other possible complications might be: intolerance of the therapy (the drugs prescribed), heart and
lungs complications.

Although the complications are rare cases, it is extremely important to recognize the signs of possible
complications as early as possible. The patients should contact the doctor if they feel sharp
stomachache, fever and high temperature, notice rectal bleeding, which can sometimes appear
several days after the procedure.