Samuel N. Marcus M.D., Ph.D.




Upper GI Endoscopy

When you’re experiencing issues in your gastrointestinal (GI) tract, there is only so much information we can learn from the signs and symptoms. There is a point where we need to take a closer look. For this, we require special medical equipment that can access, illuminate and take pictures and/or videos of the tissues and parts that make up the GI tract.

One of these pieces of equipment is called an endoscope and it can be used for a procedure called an upper endoscopy, which provides images of your esophagus (the tube that leads from your mouth to your stomach), the stomach and the upper-portion of the small intestine (called the duodenum).

Preparation for an Upper Endoscopic Procedure

In order for the procedure to be 100% effective, your stomach needs to be as empty as possible. Therefore, we ask that patients abstain from eating and drinking anything for at least six hours prior to the appointment time – and that includes water. Avoiding salty food prior to the recommended fasting period, and hydrating well beforehand will help to prevent uncomfortable thirst levels. Failure to respect this rule can result in faulty results, or may require us to reschedule your appointment for a later date.

Your doctor will need to know about any medications you’re currently taking – including over-the-counter medications and supplements. This list includes:

  • Aspirin products, antiplatelet agents or any anti-coagulants/blood thinners (heparin or warfarin)
  • Clopidogrel
  • Insulin
  • Iron

Dr. Marcus also needs to know about any allergic reactions you’ve had to medications in the past. The doctor will let you know which of your  medications are fine to continue with up until your upper endoscopy and which ones will should be avoided before the procedure.

For example, we typically ask patients on blood thinners or asprin to stop taking them as long as 14-days before the procedure, and to remain off them for a few days or more afterwards.

Why Have an Upper Endoscopy?

If you are scheduled for an upper endoscopy, odds are you’re experiencing one or more of the following symptoms:

  • Difficulty swallowing
  • Persistent nausea
  • Vomiting
  • Persistent abdominal pain
  • Bleeding that seems to be coming from the upper GI

Because your GI organs are soft tissues, rather than bone, they don’t show up well on X-rays. Plus, X-rays use radiation. With an upper endoscopy, we can get a much clearer image of the tissues and organs in question – without any radiation required. We can see even the barest hint of inflammation, a small ulcer, punctures or tears that may be causing discomfort, abnormal cells or tumors.

In addition to providing an image, the endoscope is also equipped to remove cell and tissue samples for biopsy. Don’t be alarmed if you find out something needs to be biopsied. Most of the time, these tests come back normal – or with a diagnosis of a condition that is easily treated. Serious or life threatening results are more rare.

Wielding the endoscope, Dr. Marcus also has the ability to treat certain conditions, such as the quick and efficient removal of a polyp or the immediate treatment of visible bleeding. These procedures are only mildly discomforting at most, and some patients don’t feel anything at all.

What Happens During an Upper Endoscopy?

The procedure for an upper endoscopy is fairly straightforward. We will spray your throat a few times with a numbing agent. This helps to stop your gag reflex, so you can relax as the doctor inserts the endoscope. In most cases, we administer a mild sedative to further relax the patient.

Patients are often relieved to learn that because the esophagus and trachea (the tube that connects from your throat to your lungs) are separate, breathing is completely unaffected by your endoscopy. You will be able to breathe in a relaxed fashion the entire time.

Once the tube is successfully inserted in the mouth and down the throat, and we’ve verified that you’re doing okay, the doctor will continue feeding the scope down into and past the stomach, and into the duodenum. At certain points, the endoscope will express air into the cavity to inflate the area a bit for better viewing. All the while, he will be viewing the images transmitted on the screen, looking to make sure that all is well – and expertly identifying any areas of concern for diagnosis, treatment and/or further examination.

The entire procedure will only take about 10 or 15 minutes.

At worst, our patients find the procedure to be mildly uncomfortable. At best, our patients fall sound asleep during the scope and are surprised when we wake them up to let them know it’s over!

After the Procedure

Once the upper endoscopy is complete, we will remove the tube and relocate you to an area where you can relax while the majority of the sedative effects wear off. You may notice that your throat feels a little sore –this is completely normal. You may also feel a bit bloated from the air that was used to inflate different parts of the upper GI during the procedure.

In almost all cases, you will be allowed to get a drink of water, and you can get something to eat once you leave the office unless the doctor informs you otherwise.

Dr. Marcus will take a moment to tell you what he saw, and discuss anything that was unusual or required removal or samples for biopsy. When the biopsy results are in, our office will give you a call to discuss the results.

If you were given a sedative, someone must be available to take you home. Even though you may feel perfectly fine, the effects of the sedatives can last for the rest of the day so you are not safe to drive or operate a car, truck or heavy machinery. We recommend you give yourself a break and take the rest of the day off!

Complications from an upper endoscopy are incredibly rare. However, you should contact our office immediately if you experience bleeding, a worsening sore throat, trouble swallowing, abdominal pain, fever or blood in the stool in the days following your procedure. Contact the office of Dr. Marcus to learn more about upper endoscopy or to schedule your appointment.


When a colonoscopy is performed by Dr Marcus, his patients are free of pain or discomfort. And, that’s how it should be since the procedure plays a vital role in both preventative medicine – as well as in diagnosis and treatment. Did you know that having a colonoscopy as a routine part of your adult wellness plans (typically for adults 50-years and over) saves lives?

Colorectal cancer is one of the most common cancers in both men and women, and a recent study published in the New England Journal of Medicine, found that removing benign colon and rectal polyps – a routine part of colonoscopies –lowers the risk for the development of cancer. Similarly, colonoscopy help us to identify abnormal cells – potential cancer starters – so we can take action swiftly before any cancer can develop or progress.

What is a Colonoscopy?

Your gastrointestinal (GI) tract is divided into three major sections: upper, mid- and lower. Colonoscopies are designed to get a more detailed view of the lower-GI, composed of the rectum and colon – which is also called the large intestine or the bowel.
It can be important to get a look at the inside of your colon when you experience:

  • Blood in the stool
  • Significant changes in bowel habits
  • Inexplicable abdominal pain
  • After an abnormality is found on a colonic X-ray or computerized axial tomography (CT)
  • A personal history of polyps, some types of non-colonic cancer, or symptoms that are considered precursors for colon cancer.
  • Your 50th birthday (or sooner, depending on your family’s colon history).

  • If any of these situations sound familiar, contact our office and schedule an appointment. A conversation and a brief examination and part one; a colonoscopy or other investigatory procedure may or may not be required as part two.
    To obtain images of the colon we use a four-foot long flexible tube equipped with four LEDs for illumination, three video-chips, channels for air, irrigation and suction and to pass accessories such as biopsy forceps and even a small, electrified wire loop – used as needed to remove polyps, growths and/or to obtain tissue samples. The tube is only about as wide as the average finger.

    Once you are sedated (most patients feel very relaxed and drowsy, and often  fall  completely asleep!), comfortably positioned on your left side and covered with a blanket, the doctor will perform a brief rectal exam, using a lubricated gloved finger.

    After that, the lubricated colonoscope is inserted into your anus, through the rectum and then up into the colon. Moving very slowly and gently, the doctor will move the scope up the descending colon, around the splenic flexure, across and through the transverse colon and then down the ascending colon, into the cecum (the first portion of your colon, where it connects to the small intestine). This is where the colonoscope stops.

    Along the way, the doctor may need to activate the air channel, which inflates the colon a bit, creating space to gain a better view. You may also feel a bit of suction if the scope needs to remove liquid stools or blood. If the doctor sees any polyps, growths or abnormalities, he may choose to remove them there and/or take samples for biopsy. This typically does not cause the patient any pain or discomfort.

    ELUXEO® Endoscopic Imaging System

    Today’s gastroenterologists face increasing challenges and opportunities to drive practice growth and advance patient care. Fujifilm’s ELUXEO® Endoscopic Imaging System and full portfolio of colonoscopes and gastroscopes for GI physicians are unparalleled in delivering a unique combination of clarity, versatility, and accessibility to enhance practice performance in high volume settings, backed by industry-proven technology service and support.
    A powerful video imaging system is the foundation of any advanced endoscopic platform. Fujifilm’s long-standing experience in medical image engineering led to the pioneering of LED Multi-Light technology in Endoscopy in 2018 with the introduction of the ELUXEO® Endoscopic Imaging System. With ELUXEO, Fujifilm is the first to achieve optimal illumination that enhances endoscopic visualization and image clarity. The ideal output combination of individual LEDs has been developed to achieve optimal results in White Light as well as clinically proven special light observation modes: Linked Color Imaging (LCI®) to enhance adenoma detection and Blue Light Imaging (BLI) to enhance characterization of lesions. Since then, Fujifilm has introduced a comprehensive line of 700 Series colonoscopes and gastroscopes that, when used in combination with the ELUXEO Endoscopic Imaging System, provide endoscopists with an unmatched combination of image clarity and visualization with exceptional scope control, maneuverability, precision, and ergonomics.

    Preparation For Your Colonoscopy

    The colon is the final stop in the digestive system; it’s the place where the last of the water and salt is removed from the liquidized undigested food residue deposited there by the small intestine. FYI: your small intestine moves about two-pints of this  liquidized residue into the colon each day. By the time the colon has done its work, there is only about a pint of solid matter left.

    • This solid matter (aka “stool”) makes it impossible to get a clear image of your colon. Thus, preparing for a colonoscopy requires:
      • Liquid Diet. Usually the day before your appointment, you need to take a liquid diet. No solid food is allowed. Our office will provide plenty of detailed instructions, including suggested food items. This diet gives you enough calories to live your daily life, but begins to cleanse your G.I. tract, minimizing the amount of stool that will accumulate before the colonoscopy.
      • Bowel Preparation. The evening before and the morning of your appointment you need to drink the special cleansing liquid that will flush out the stool from your colon. This liquid is very effective so you won’t want to be too far away from the bathroom from this point on.
      • Fasting. No solid food for 24 hours prior to your examination and no liquids for 3 hours prior to your examination.
    • Enema(s). In some cases, we’ll also provide you with an enema solution, perhaps two. Following the instructions on the bottle, you can easily administer the enema to yourself two-hours before the procedure. After this, we’ll be able to have a free and clear view of your colon’s delicate tissues.

    Colonoscopy Preps

    Because you will be given a sedative, it is also important that you have someone on hand to drive you home from your appointment. While you may “feel” like you’re okay, the sedative effect of your medication takes longer than you think too wear off completely  and will remain in your system until the next day.  So no driving that day and you will need to arrange in advance that a responsible person picks you up and drives you home. We recommend not to go to work  and to avoid attending important meetings and making important decisions until the next day.

    Once the procedure is complete, you will be transferred to the recovery area  where  the sedative  effects of the medication will wear off enough to allow you to get dressed and for  Dr. Marcus to come and talk to you about how the procedure went as well as what he saw or found. If tissue was removed or biopsied an appointment will be made for you  to come back to Dr Marcus’ office to discuss the results.

    Are you due for a colonoscopy? Contact us here at the office and we will start the process for you.


    For doctors who specialize in the gastrointestinal (GI) tract, examinations are not as easy as those performed on the exterior portions of the body. Not only do we need to get a look deep into your body’s interior recesses and cavities, our examinations involve moving through tight sphincters, soft tissues and persistent valves – which require the use of highly specialized instruments.

    A sigmoidoscope, used for sigmoidoscopies, is one of several innovative medical instruments that allows us to get an image of the lowest portion of your intestinal tract, with minimal discomfort on your end.

    Sigmoidoscopy Provides Partial Views of the Sigmoid Colon

    Your colon is the last section of the large intestine, and it connects directly to your rectum. The last third of the colon is called the sigmoid colon. It forms a curvy S-shape and it about 40 cm in length (just under 16-inches).

    When we need to get a good look at the interior of the sigmoid colon, typically for colon cancer screening, there is an option between a colonoscopy or a flexible sigmoidoscopy. Unlike a colonoscopy, which can view the entire interior of the colon, a sigmoidoscopy can only see the left-hand portion of the colon, which has its pros and cons.

    Sigmoidoscopies are becoming increasingly popular because they are simpler than a colonoscopy, and work well in combination with a fecal occult blood test (FOBT), preventing the need for all of the prep and sedation required for a colonoscopy.

    When is a Sigmoidoscopy Performed?

    Typically, a sigmoidoscopy is used to screen for:

    • Colon cancer
    • Polyps
    • Ulcers
    • Abnormal cells

    Sometimes, these abnormalities are completely asymptomatic, meaning you won’t have any symptoms. This is especially true when progressive cell abnormalities are in their beginning stages. In other cases, you may experience signs or symptoms of colon disease, such as:

    • Changes in bowel movements
    • Rectal bleeding
    • Inexplicable weight loss
    • Abdominal or rectal pain

    If any of these symptoms sound familiar, contact our office and schedule an appointment so we can look into the matter further. It’s much better to be given the “all clear” then to hope something will go away, only to find out later that your latent colon disease has progressed to a point where you require more dramatic treatment. Sooner is always better when it comes to diagnosis and treatment of any medical condition.

    If we notice anything unusual during your sigmoidoscopy, we may take small tissue samples so the lab can analyze them. The results will tell us what, if any, treatment or further testing is required.

    Preparing For the Procedure

    In order to get a good image of your sigmoid colon, we need the tissue to be as clean as possible. To achieve this, we ask that patients:
    • Enjoy a Clear Liquid Diet. You’ll be asked to follow a clear, liquid diet for one to three days prior to the sigmoidoscopy (cleanses are all the rage these days, right?). Ideas of what you can consume during your 1-3 day cleanse will be clearly outlined in your pre-procedural paperwork.
    • Use a laxative. To further ensure you colon has evacuated stored contents, you’ll be provided with a laxative. It’s recommended that you stay close to a restroom from this point onward.
    • Administer an enema. Finally, you’ll be provided with an enema solution (possibly two) that you administer roughly two hours before your scheduled appointment.

    After these steps are complete, your sigmoid colon will be the cleanest it has been in years (or at least since your most recent colonoscopy, cleanse or sigmoidoscopy) and we can get an unobstructed view of the tissue inside.

    What Does a Sigmoidoscopy Entail?

    First, you will be asked to lay on your left-hand side. Because flexible sigmoidoscopes are very thin, and the procedure is so gentle, sedatives are rarely necessary.

    The doctor will insert the sigmoidoscope slowly into your rectum, and then continue to feed it along the sigmoid colon. This instrument is equipped with a light and a camera, and a view of your lower-colon is projected on a screen as it moves along its way.

    The sigmoidoscope also adds a little air into the colon, which inflates it for easier viewing. This part of the procedure can cause a little bit of discomfort – but shouldn’t be painful. If necessary, you may need to shift a little this way, or that way, at the doctor’s instruction – to help the scope move forward and to give the doctor a better view.

    If there are any visible polyps or growths, the scope is equipped with a small sharp blade and these growths can be removed immediately and painlessly. If the doctor notices any abnormal tissue, a small sample will be taken for biopsy at the lab.

    The entire process takes between 10 and 20 minutes, after which, you may experience a little abdominal cramping and/or bloating. This is totally normal. You should be able to drive yourself to and from the office. If any biopsies were required, you will be contacted with their results as soon as we have them.

    If you experience pain, dizziness, bloody stool or fever – you should call our office immediately. Fortunately, those types of post-procedure reactions are incredibly rare.

    Contact Dr. Marcus to schedule your sigmoidoscopy. Remember that preventative checkups are the best way to catch cancer and other colon diseases before they develop into more serious issues.

    CapsoCam Capsule Endoscopy

    Have you seen a diagram of the small intestine lately? If not, take a peek at the one below and you’ll see why modern endoscopic procedures have had a difficult time getting a good look at the interior of the small intestine.

    It’s a long and winding road to say the least, which makes the small intestine more challenging to view via standard endoscopy technology. For decades, GI doctors wished there was a magic pill patients could swallow so we could see the interior of this vast organ (about 23 feet in total length!!).

    CapsoCam Capsule Endoscopy Allows Visual Access to the Small Intestine

    Now, with new CapsoCam Capsule endoscopy, our wish has been granted. CapsoCam offers several advantages like:
    • Being able to access regions of the GI tract that are difficult or impossible to access via endoscopy, as well as the esophagus, stomach and colon.
    • The ability for patients to participate in GI imaging without the need for sedation or invasive procedures
    • Detecting inflammation and/or digestive disorders more accurately.

    What is the CapsoCam?

    Capsule endoscopy uses a vitamin-sized pill containing video chips (these are one or two cameras inside, depending on the procedure), a light bulb, a battery and a transmitter. As the pill makes its way through your esophagus, stomach, small intestine and colon, it takes a continuous stream of pictures. These pictures are transmitted wirelessly to a receiver worn by you for the duration of the capsule’s journey – typically about eight hours. Eventually, the capsule is passed, via your stool, and into the toilet. There is no need to retrieve it as it can be safely flushed away. In the meantime, the images captured by the receiver will be downloaded in your doctor’s office for review. We use the information to detect digestive issues in the esophagus, stomach and small intestine. Although we will gain images of the colon, CapsoCam technology is not yet approved by the FDA for direct visualization of the colon mucosa.

    What Will the Capsule Endoscopy Procedure Find?

    There are all kinds of things we can see by reviewing the images provided during your capsule endoscopy. These include things like:
    • The cause of intestinal bleeding. If you have unexplained bleeding in your intestinal tract, often detected via blood in your school, imaging technology can help us detect the source so we can apply the best method of treatment.

    • Diagnosis of inflammatory diseases. Inflammatory diseases, like Crohn’s disease, used to be diagnosed via a process of exclusion. Now, technology like the capsule endoscopy allows us to make a more concrete assessment of chronic GI inflammation.

    • Cancer detection. Any tumors or potential cancerous lesions or growths in the GI tract may show up in the pictures. If so, we can go from there to schedule a biopsy and/or removal of the tissue in question if that seems necessary.

    • Celiac disease diagnosis. Because the pill is traveling via the same path as potentially offending gluten, we can use the PillCam to see how gluten affects your digestive tract, which can lead to more accurate diagnosis of celiac disease. It can also prevent the misdiagnosis of celiac disease, freeing us up to seek the true cause of existing digestive complaints or food sensitivities.

    • Polyp screening. Many studies have shown a link between polyps and eventual cancer growth. If you have a medical history of polyps or an inherited syndrome that causes polyps, we may choose to use capsule endoscopy to keep a better eye on things.

    • Get a second look. Sometimes, the results from a previous test or endoscopic procedure are “unclear” or “inconclusive.” Rather than scheduling another round of invasive endoscopy, we can use capsule endoscopy to get a more comfortable second look.

    While capsule endoscopy doesn’t require sedation, it still requires the same cleansing preparations required for other endoscopic procedures – including fasts and purging.

    The Limitations to Capsule Endoscopy

    Due to the nature of the technology, there are some limitations of capsule endoscopy. Sometimes we aren’t able to see the images very clearly, depending on the speed the capsule is traveling when it takes the pictures. On the flip side, if the capsule moves more slowly than normal, the battery can run out at the 8-hour mark – leaving us with incomplete images. Also, we can’t always tell exactly where in the small intestine a particular issue lives, so that can make it difficult to locate if we need to perform more invasive or surgical procedures for treatment.

    If the GI tract has obstructions and/or scar tissue (strictures), the capsule can potentially get stuck, requiring surgical removal. This is very rare, however. If we suspect you have strictures or obstructions that will limit capsule movement, we give you a dissolvable, dummy capsule first. If the dummy capsule gets stuck, we can locate it via X-ray and note the location of the stricture without any complications. It will dissolve and be absorbed by the body within a few days.

    In the big picture, the continuing development of capsule endoscopy technology will continue to improve our ability to accurately diagnose and treat gastrointestinal disorders using the least invasive methods possible.

    Contact Dr. Marcus’s office to learn more or to see whether you’re a good candidate for PillCam capsule endoscopy.

    Bravo® pH Monitoring Means Accurate GERD Diagnosis

    Prior to the innovative Bravo® pH Monitoring system, doctors had to either make an educated guess or use fairly invasive procedures – like a full upper endoscopy – to determine whether or not a patient suffered from gastro-esophageal reflux disease, or GERD.

    The last thing we want to do is to prescribe unnecessary medicines or procedures, or not prescribe them when they’re needed, because this interferes with patient health and comfort. Bravo® pH monitoring allows us to get real-time readings of the acid levels in your esophagus over a 48-hour period. This information is crucial in making an accurate diagnosis so we can get you the treatment you need.

    Here’s How Bravo® pH Monitoring Works

    The Bravo® Monitoring systems uses a small, pH capsule (just a little larger than a standard pencil eraser) that is attached painlessly to esophageal tissue using an endoscope. You’ll be mildly sedated to remain relaxed during the procedure.

    The capsule is wirelessly connected to a receiver, that dutifully records the acid levels in your esophagus. Within about four to five days, the gel capsule will simply dissolve and the contents will pass through your digestive tract, so there is no need to have it removed.

    You will, however, return to the office with the receiver so we can upload its findings into the Bravo® software program, where the results are analyzed and Dr. Marcus can make an accurate diagnosis. For the most accurate readings, we recommend that you:

    • Stop taking reflux meds. If you currently take prescription meds for acid reflux, we ask that you stop taking them at least two weeks prior to Bravo® Monitoring. In most cases, this means being more uncomfortable than normal, so you can take Tums or Rolaids for the time being since they don’t interfere with the test results.

    • Live your life as usual. We want to get accurate readings that reflect pH levels during your typical, day-to-day life. Go about your daily routine – work, exercise, etc. – as if nothing is different. This isn’t a chance to put on your best eating habits, just eat normally. In fact, we want to see what the readings are after a few meals, a couple of snacks and a fatty meal each day if that is your norm. If you typically drink beer, wine or cocktails, we want to see the readings after you drink those beverages as well.

    • Maintain your Patient Diary. You’ll be given a Patient Diary in which you can record eating and sleeping habits as well as any acid reflux symptoms you might have. You will also document stop/start times for any periods spent lying down and/or sleeping.

    • Keep the wireless receiver close. The receiver can be connected to your waistband or to your waist by an elastic band that is provided. While showering, the receiver should remain no more than three feet away from your body. Failure to keep the receiver close means it can’t accurately record consistent pH levels – and that means we can’t make an accurate diagnosis. The receiver is easy to use – you press the meal button once when you start and once again when the meal is complete. You’ll also use coded buttons to record certain symptoms. The bed button is pressed before and after you lie down.

    • Show up to your follow up appointment. Return the receiver and your Patient Diary when scheduled, typically two days after the Bravo® Monitoring begins.

    It’s that simple!

    A few things to note:
    • Bravo® capsules rarely cause any problems, but patients may feel like there is a little something in their throat – since there is. This sensation will fade within five days, as soon as the capsule falls off.

    • The capsule contains a small piece of metal. This will be shed by your body through the digestive tract without issue. However, this means that you should avoid having an MRI for 30 days after the procedure, just to make sure the metal has exited your body.

    • We’ll want to see you one more time to discuss the monitoring results, so schedule a follow-up appointment with our office staff as soon as possible.

    Interested in taking advantage of Bravo® pH Monitoring to learn more about what’s going on in your esophagus? Contact us here in Dr. Marcus’s office to schedule an appointment.

    Hemorrhoidal Banding

    Hemorrhoids may be a standing joke, but they’re no laughing matter when you have them. From mild discomfort and itching, to chronic pain and rectal bleeding – they can make everyday life miserable.

    Fortunately, you do not have to suffer indefinitely. There are multiple paths to permanent hemorroid treatment, depending on the severity of your particular case as well as your personal preference. Some of our patients find that the use of garden-variety apple cider vinegar or over-the-counter remedies, like Preparation-H® , are enough to do the trick. However, these rarely work for long if hemorrhoids when stubborn hemorrhoids refuse to heal on their own.

    Hemorrhoidal Banding — Non-Surgical Relief for Internal Hemorrhoids

    When hemorrhoids (sometimes mistakenly written as “hemroids”) become a chronic issue – more powerful remedies are required for patients to experience relief.

    A fear of surgery, or the inconveniences associated with surgical treatment of hemorrhoids, can be enough to prevent people from seeking much-needed treatment. Fortunately, there is a fast, simple and non-surgical treatment that can put a permanent end to existing hemorrhoids. It’s called hemorrhoidal banding, or rubber band ligation.

    This outpatient treatment requires zero to minimal days off, depending on the number and degree of the hemorrhoids in question. Best of all, hemorrhoidal banding is performed right in the comfort of Dr. Marcus’s office so there’s no need to deal with referrals, hospital O.R.s or a new team of medical staff.

    Rubber band ligation works by cutting off the blood flow to the isolated, banded tissue. Once it lacks a blood supply, the hemorrhoid begins to shrink and then – within two days to a week – it dies off. A small patch of scar tissue forms where the hemorrhoid used to be, and this scar tissue helps to hold existing veins in place, preventing them from bulging into the anus

    This is an added bonus of hemorrhoidal banding; it’s like a treatment and a preventative therapy in one.

    What Happens During a Hemorrhoidal Banding Procedure?

    There are slightly different techniques used for hemorrhoidal banding, so the specifics might vary from doctor to doctor. However, the general procedure remains the same:

    • The initial consultation. Of course, before any treatment can be administered, your doctor will need to do a physical exam to determine the quantity and degree of the hemorrhoids in question. Dr. Marcus uses proctosigmoidoscopy or anoscopy to get a picture of the affected area to make the best diagnosis for your situation. Hemorrhoidal banding works best on first- and second-degree hemorrhoids. It is often recommended for third-degree hemorrhoids if patients are experiencing bleeding and/or prolapse. In most cases, only one to two hemorrhoids can be treated at a time; addition hemorrhoid banding can be scheduled at 4- to 6-week intervals. There have been circumstances where patients had as many as four hemorrhoids banded at once, but that typically requires general anesthesia – which requires more complicated procedure prep.

    • The banding. To perform the banding, the doctor uses a sterile instrument to grasp the hemorrhoid tissue, and then a separate device places a tight rubber band around the base. In most cases, this is all there is to it. If a particular hemorrhoid feels exceedingly painful, Dr. Marcus can inject it with a numbing solution.

    Please Note: Patients on any type of anticoagulant therapy are not candidates for hemorrhoidal banding because it puts you at risk for excessive bleeding. Patients who take aspirin are asked to stop taking it for at least 14-days prior to the procedure.

    Enjoy a Quick Recovery From Hemorrhoidal Band Ligation

    You will feel mild to moderate pain or discomfort for the first day or two after the procedure is over. Some people prefer to take these days off, or schedule their recovery over a weekend – but it’s not necessary. You may also experience a feeling of abdominal fullness or the feeling that they have to have  bowel movement.

    Some patients experience minimal pain and discomfort while others find they need to use acetaminophen and sitz baths for the first 24- to 48-hours to minimize discomfort. Patients should avoid taking aspirin or non-steroidal anti-inflammatory medications for at least four days after the procedure. Light bleeding is completely normal for the first week to 10-days.

    Consuming a high-fiber diet and plenty of water is the best way to prevent future hemorrhoids from developing and to naturally heal any other hemorrhoids you might have.

    Interested in learning whether this simple, non-surgical hemorrhoid treatment is right for you? Contact the office of Dr. Samuel N. Marcus and we’ll schedule a consultation. 650-988-7488.

    Bacterial Overgrowth Testing

    What is Bacterial Overgrowth Testing?

    There is only one reason why your breath would test positive for higher-than-normal levels of hydrogen; the presence of very specific, anaerobic bacteria that produce hydrogen as a byproduct of eating sugar/carbs. These bacteria live in the colon. When they are exposed to unabsorbed food particles – primarily sugars and carbohydrates – they eat on them and excrete hydrogen gas.


    This hydrogen, which can be tested via the breath, is a sign that something is wrong with your digestive tract – specifically the small intestine, where the bulk of nutrient absorption occurs. If your small intestine was healthy, those unabsorbed particles wouldn’t make it all the way down to the colon in the first place.


    Over a period of time, as the bacteria and their hydrogen byproduct increases in number, they can actually back up into the small intestine. When this happens, the hydrogen will eventually be absorbed into the blood stream, make its way into your lungs, and is expelled when you exhale.


    The result is measurable hydrogen levels, read by our hydrogen breath test, causing us to do further exploration and diagnosis so we can select the right treatment for your particular digestive issue.

    When is Bacterial Overgrowth Testing Used?

    There are three different conditions that are diagnosed using hydrogen breath testing:

    • Certain sugar intolerances. If those aforementioned bacteria have access to unabsorbed sugar, we can assume that your body has a particular sugar intolerance. The most common version of this is lactose intolerance (the sugar found in milk), however people can also have difficulty digesting other sugars, like fructose, sorbitol or sucrose.

    • Bacteria overgrowth. Your body relies on a balance of flora and fauna. If the bacteria colonizing the small intestine are overpopulated, it causes digestive issues.

    • Rapid passage of food. Sometimes, food simply moves too fast through the gastrointestinal (GI) tract, which causes its own share or problems, ranging from abdominal pain, and excess gas to bloating, distension and diarrhea.

    Each of these things can be tested for as monitor the levels of hydrogen in your breath as your body processes (or doesn’t process, more likely) certain sugars.

    What Happens During the Test?

    You will feel mild to moderate pain or discomfort for the first day or two after the procedure is over. Some people prefer to take these days off, or schedule their recovery over a weekend – but it’s not necessary. You may also experience a feeling of abdominal fullness or the feeling that they have to have  bowel movement.

    Some patients experience minimal pain and discomfort while others find they need to use acetaminophen and sitz baths for the first 24- to 48-hours to minimize discomfort. Patients should avoid taking aspirin or non-steroidal anti-inflammatory medications for at least four days after the procedure. Light bleeding is completely normal for the first week to 10-days.

    Consuming a high-fiber diet and plenty of water is the best way to prevent future hemorrhoids from developing and to naturally heal any other hemorrhoids you might have.

    Interested in learning whether this simple, non-surgical hemorrhoid treatment is right for you? Contact the office of Dr. Samuel N. Marcus and we’ll schedule a consultation. 650-988-7488.

    Treat Barrett’s Esophagus With Radiofrequency Ablation

    Often, a seemingly small issue in the gastrointestinal tract can lead to progressively complex problems. Heartburn is a prime example of this. Occasional heartburn is one thing, chronic heartburn (acid reflux) is another – and it can lead to GERD, which can lead to Barrett’s Esophagus; all of these diagnoses put you at higher risk for developing esophageal cancer.

    This is why accurate diagnosis and immediate treatment of these GI disorders is so critical.

    Barrett’s esophagus is typically diagnosed using an upper endoscopy. It is thought that about 13% of all patients with GERD have Barrett’s Esophagus, evident when healthy esophageal tissue begins to change into intestinal tissue – the result of continuous contact with digestive acid and enzymes.

    What is Radiofrequency Ablation (RFA)?

    Some of the methods for treating Barrett’s Esophagus are more invasive than others. Our office always tries to use the least invasive method possible to start, only moving to more invasive methods if we have to.  Unlike surgical treatments of Barrett’s, which often require the removal of entire sections of the esophagus, radiofrequency ablation (RFA) uses a form of heat therapy to remove irregular cells, and it has been very useful for treating Barrett’s Esophagus – even cases where large sections of the esophagus were affected.

    The RFA procedure uses radiofrequency (energy) waves that are delivered directly to the tissue via a catheter. This way, we have acute control of the waves, minimizing contact with healthy tissue as much as possible. That’s the RF of the RFA. When the RF waves make contact with the diseased tissue cells, it removes a thin layer. This is called ablation.

    If you have only small areas of tissue affected by Barrett’s Esophagus, we will use the combination of an endoscope armed with a small catheter. If larger sections require ablation, we’ll use a special balloon-mounted catheter so we can treat larger areas at one time. Once the diseased tissue is removed, the body typically regenerates the affected area with healthy tissue cells, leaving you Barrett’s Esophagus free – or significantly reducing the damage.

    To date, RFA has been used effectively to treat more than 60,000 patients suffering from Barrett’s Esophagus and is approved by the FDA.

    What Happens During an RFA Procedure?

    Because RFA is only minimally invasive, the prep is very straightforward. Depending on your situation, you may need to stop taking or alter the doses of any prescription or over the counter meds you’re currently taking – including meds to control acid reflux. Your doctor will discuss these points with you in detail before procedure day.

    You’ll be asked to abstain from eating or drinking anything (including water) after midnight of the evening before the RFA. While you are welcome to drive yourself to our office, we ask that someone else be available to pick you up because you will be under mild sedation and unable to drive.

    Once you arrive, you will be positioned on the table and mildly sedated for your comfort. General anesthesia will be administered, so you don’t feel any pain. Typically, a radiofrequency ablation procedure takes between 30 and 50 minutes. When it’s over, the doctor will report how it all went, and you will be sent home with some pain meds. We recommend taking it easy for the rest of the procedure day.

    Most patients experience only mild discomfort in their throat and chest for two to four days afterward, but this is managed by prescribed pain medication and anti-inflammatories. You can return to work and your normal daily activities the day after the procedure. To help the area heal as completely as possible, with minimal risk of infection or complications, we recommend adhering to a liquid diet for the first 24 to 48 hours after the procedure and focusing on a soft diet for a week after that.

    Would you like to learn more about Barrett’s Esophagus, its diagnosis and treatment via radiofrequency ablation? Contact the office of Dr. Marcus to schedule a consultation.

    Argon Plasma Coagulation (APC) Offers a Safer and More Efficient Treatment Option

    Argon plasma coagulation (APC) is a relatively new procedure that effectively treats multiple conditions affecting the gastrointestinal tract, including:

    • Angiodysplasia, which can cause unexplained GI bleeding as well as anemia.

    • Gastric antral vascular ectasia (GAVE) or watermelon stomach, a less common cause of GI bleeding and/or anemia.

    • Colonic polyps.

    • Radiation colitis, severe inflammation or damage to the colon after radiation treatment

    • Esophageal cancer.

    APC is an encouraging alternative to existing treatments for these conditions, such as contact thermal coagulation (heater probe and bipolar cautery) and laser treatments. In addition to its more straightforward application, APC is also more effective at treating multiple lesions during the same procedure, requires lesser depth of penetration (increasing safety), is associated with faster recovery times. It is also more cost-effective than other alternatives.

    What is Argon Plasma Coagulation (APC)?

    Many people mistakenly believe that APC is another type of laser treatment. It is not. Instead, APC uses the combination of argon gas and a high-voltage spark. Like lightening, this activated gas spark wants to find a ground in the nearest tissue. Thus, we use a very targeted probe to deliver the spark to the adjacent lesion or area of concern.

    The spark penetrates the affected tissue to between two- to three-millimeters (2mm to 3mm) deep. This technology makes it possible for us to treat lesions that occur in a fold of the GI tract or that are located in positions that are inaccessible to the tip of the endoscope.

    What Can I Expect During the Procedure?

    In many ways, your APC isn’t all that different from the patient perspective than a typical endoscopic procedure. If it is the upper-GI area being treated, you may only need to fast and refrain from drinking liquids after midnight the evening before the procedure. If the lower GI will be treated, you will probably need to fast and cleanse as per your doctor’s instructions. If you have diabetes, we will work with you to keep your blood sugar in check throughout the fasting, procedure and post-op period.

    We will require a list of both prescription and over-the-counter medications – including acid reflux meds and anticoagulants – so we can discuss whether or not you’ll need to abstain or adjust the dosage for the weeks or days leading up the procedure.

    The procedure will involve a local anesthetic to reduce discomfort and the gag reflex. You will also be sedated, which means someone needs to be available to drive you home after the procedure.

    In most cases, the APC treatment will be completed in under an hour, but there are exceptions – depending on the number and severity of the lesions. Once the APC is complete, the doctor will report on how things went and send you home with instructions for the next week.

    Most patients experience only mild, if any, discomfort, manageable with mild pain medications. For the first 24 to 48 hours, you should adhere to a liquid diet, and you may also be instructed to observe a soft diet for the following week. This aids the healing process and minimizes the chance of infection or complications at the treatment sites.

    Are you interested in learning more about argon plasma coagulation and its potential for treating your GI issue? Contact the office of Dr. Samuel Marcus to schedule a consultation.

    Anorectal Manometry

    Anorectal manometry is a test we can use here in our office in order to assess the muscle tone and pressures, sensation and neural reflexes of the anal sphincter. This test is used for patients who are suffering from rectal incontinence (the inability to control bowel movements, which leads to embarrassing anal leakage) or severe constipation (the inability to have a bowel movement even when you have the urge).

    Healthy bowel movements are dependent on very specialized muscles in the anal sphincter and colon. These muscles help to control the movement of fecal matter through the bowels. In a healthy colon and rectum, anal muscles tighten when fecal matter moves into the bowels to prevent it from perpetually leaking. On the flip side, when you when you feel the urge to have a bowel movement, your rectal muscles will begin to relax – paradoxically, they relax even more when you’re bearing down – so the fecal matter can exit the colon in a controlled fashion.

    The results of the anorectal manometry procedure will help Dr. Marcus determine the best course of treatment for your particular issue. In some cases, exercises and/or biofeedback physical therapy can be sufficient to retrain pelvic floor and rectal muscles to correct sphincter dysfunction. In other cases, more invasive treatment may be required.

    What happens during the test?

    Before the test, you will be asked to fast for at least two hours, and we’ll ask that you cleanse the lower colon by performing two enemas, no more than two hours before the test time. This will ensure the lower colon is clean for the procedure. Anorectal manometry is a safe and pain-free procedure and there is very minimal risk involved.

    The total anorectal manometry procedure takes about 30 minutes from start to finish. There are two parts of the test: Anal sphincter electromyography (EMG) and the balloon expulsion test.

    • Anal sphincter electromyography (EMG): For this test, Dr. Marcus will insert a small plug electrode into the anal canal. He will then ask you to either squeeze, relax or bear down at different times, during which the electrode will transmit readings back to the computer. This part of the test will either confirm that the sphincter muscles are doing what they should, when they should – or it may indicate discrepancies – for example, muscles that contract when they should relax, or sphincter muscles that remain relaxed (often the case with rectal tears) when they should contract.

    • Balloon expulsion test. For the second part of the test, Dr. Marcus will insert a small, deflated balloon into the rectum and then he’ll gently inflate the balloon with water. If you have a latex allergy, please let our office know so we use a latex-free balloon for your procedure. Once the balloon is inflated, patients are asked to go to the restroom and expel the balloon. The length of time it takes for your body to expel the balloon is recorded. Anything longer than a normal expulsion time indicates some type of dysfunction in the anorectal muscles. When both parts of the procedure are complete, you will get dressed and the doctor will discuss his findings with you. Since no sedation is required for this procedure, you can drive yourself home and return immediately to your normal activities.

      Are you suffering from rectal incontinence or severe/chronic constipation? The sooner you are diagnosed the sooner you can be treated. Contact Dr. Marcus to schedule a consultation or to learn more about our practice. (650) 603-5436.

    Radiation Proctitis

    Proctitis refers to a condition where the lower colon and/or rectum are inflamed. This inflammation can be so severe that it causes pain and discomfort, and can also interrupt normal bowel functions. While a range of things can cause proctitis, one of the most common causes is the radiation used to treat colon, ovarian and rectal cancers. When this occurs, we refer to the condition as radiation proctitis.

    While radiation is often effective at treating the larger problem – cancer – the treatment itself can have negative side effects. Patients who experience radiation proctitis most typically experience rectal bleeding, which can begin as early as four to six-weeks after the initial treatment, for as long as nine-months after the radiation treatment has ended.

    Dr. Marcus provides diagnosis and effective treatment of radiation proctitis here in our Mountain View Endoscopy clinic.

    How is the Condition Diagnosed?

    In addition to rectal bleeding, patients with radiation proctitis may also experience:

    • Bloody bowel movements (one of most notable signs of rectal bleeding)
    • Pain in the anus or rectum
    • A feeling of fullness in the rectum
    • Abdominal pain, typically in the form of cramping
    • Rectal discharge, either mucous or pus
    • Chronic diarrhea or loose stools

    In most cases, your doctor will listen to your symptoms and record your medical history. If you’ve had radiation therapy, radiation proctitis would be the natural diagnosis. However, Dr. Marcus will need to do use diagnostic procedures to be sure –so you can determine the best method of treatment.

    Diagnostic measures for radiation proctitis include sigmoidoscopy (anoscopy), flexible sigmoidoscopy or colonoscopy (for cases where inflammation affects the greater colon). The results of these diagnostic tests will determine which form of relief and/or treatment will be the least invasive and the most effective.

    Can Radiation Proctitis be Treated or Healed?

    Yes, in most cases, we can provide some level of relief or treatment from radiation proctitis. The key is to come in as early as you notice symptoms. For patients whose tissues are already weakened from cancer and/or their cancer treatments, earlier treatment prevents a worsening of the proctitis. If you wait too long, there is a chance that treatment will be more difficult.

    In worst-case scenarios, untreated and sever cases of proctitis can lead to infections that compromise the rectum and lower colon, and can even require a re-sectioning of the lower bowel to remove inflamed tissue that is beyond repair. Getting your rectal proctitis in check will make you more comfortable and will allow your body to heal – rather than worsen.

    When radiation proctitis is mild or caught very early on, you may not require any treatment at all. Sometimes, prescription-strength anti-diarrheals and a modified diet will be enough to calm the inflammation such that the body can take over the natural healing process. You may also be instructed to take over-the-counter pain meds or anti-inflammatories until the symptoms have receded.

    More moderate cases of proctitis may require the addition of a topical anti-inflammatory – often prescribed in the form of a suppository or enema.

    If rectal bleeding is perpetual and/or severe, Dr. Marcus may recommend treating it using Argon Plasma Coagulation (APC). This is a newer, heat-based therapy that removes the affected tissue layers so new, healthy tissue can grow back in its place. APC is not quite involved as laser therapy and is more cost-effective.  In severe cases, you may require multiple APC treatments.

    Sometimes, severe inflammation can cause a rectal stricture, meaning the rectal passage becomes narrowed, impeding normal bowel functions. Mild rectal structures can usually be treated with stool softeners. If the stricture is more severe, it may require manual dilation.

    If you are experiencing the symptoms of rectal proctitis, contact Dr. Marcus and request a consultation. The sooner we can determine the source of your discomfort or bleeding, the sooner and more effectively it can be treated. (650) 603-5436.