Peripheral Nerve Evaluation (PNE) for Fecal Incontinence

Do the following sound familiar?

• Frequent bowel accidents

• Monitoring what and how much you eat

• Using pads or protective garments

• Planning activities around the bathroom

These are symptoms of fecal incontinence. Unfortunately, many people experience problems with bowel and bladder continence — about 1 in 12 adults in the US has fecal incontinence, and 21 million adults in the US are affected by fecal incontinence. These symptoms can cause problems emotionally, physically, and even socially.  Although discussing the problem can be embarrassing, there are a variety of treatment options that the providers at IGIC can offer you.  These options can range from simple solutions such as fiber supplementation and optimization of your medications to more nuanced and individualized approaches including physical therapy and neurostimulation. 

Our on staff physical therapists have extensive training and expertise in the specific treatment of pelvic floor problems.  These are private sessions that focus on your comfort and gradual improvement. 

Neurostimulation is an approach to bowel continence problems that focuses on improving the communication that your lower body has with your brain and nervous system. 

Our doctors can offer a treatment called Peripheral Nerve Evaluation, or PNE.  This is a simple, in-office procedure done with the help of local anesthesia.  It requires no preparation and can be done in the order of minutes.  During this evaluation, a provider will use a small needle to numb the skin on your back and insert a very thin caliber lead into the tissue under the skin. This lead is then left in place for about one week along with an external stimulator that the patient wears on a belt.  During this week, we monitor your symptoms and compare them to the symptoms you had prior to the stimulation.  

If the test is successful, which it is in about 70-80% of the appropriately selected patients, we can discuss having a more permanent treatment that can deliver a similar level of stimulation. 

Please let your IGIC provider know if you have ever had any problems with bowel continence, such as leakage of stool, frank stool related accidents, or even severe urgency that limits your social interactions and life. Fecal Incontinence (FI) is a treatable condition. It’s not a normal part of aging. And you shouldn’t have to deal with it on your own.

Are Colonoscopies Effective?

A study recently published in the New England Journal of Medicine about the effectiveness of colonoscopy is making the news!

This study, the NordICC trial, which was performed in Norway, Poland, and Sweden, claims that it found that colonoscopy is not as effective at preventing colon cancer and death as previously thought. However, there are several issues with the study that may not make it applicable to colonoscopies in the United States:

The Study is Not Representative of Colorectal Cancer Screening in the United States

• This study was conducted in Norway, Poland, and Sweden which has a population very different than in the United States and may have different rates of polyps and colon cancer, especially among communities of color.

• In the United States, guidelines state that gastroenterologists should be detecting adenomas (pre-cancerous polyps) in at least 25% of screening colonoscopies. This number makes sure that gastroenterologists are performing high-quality exams and finding enough adenomas. A recent study actually found the average adenoma detection rate in the United States is 39%. In contrast, in the NordICC trial, almost 1/3 of the endoscopists had an adenoma detection rate below 25%. This means that the gastroenterologists in the study may have been missing polyps.

Half of the Patients in the “Colonoscopy” Group of the Trial Did Not Have a Colonoscopy

• In the NordICC trial, only 42% of people invited to have a colonoscopy actually had a colonoscopy. But even the people who did not go through with a colonoscopy were still included in the “Colonoscopy” group when calculating the results. This likely brought down the calculated effectiveness of colonoscopy.

• In the people who did get a colonoscopy, colonoscopy was effective — their risk of colorectal cancer was reduced by 31% and the risk of dying from colorectal cancer was reduced by 50%.

• Prior studies have shown that colonoscopy reduces the risk of colorectal cancer by more than 50% and reduces the risk of dying from colorectal cancer by almost 70%.

Colonoscopy is Still the Gold Standard

• Colonoscopy remains the only test that screens, detects, and prevents colorectal cancer.

• The U.S. Preventative Services Task Force recommends that Americans begin colorectal cancer screening at age 45.

See the original study here.

Screening versus Diagnostic Colonoscopy: What’s the Difference?

Perhaps the first time you heard the terms “screening colonoscopy” and “diagnostic colonoscopy” was when you called your insurance company to ask about your coverage.

You were probably told a screening colonoscopy was covered 100%, while a diagnostic colonoscopy had a copay or coinsurance.

Understanding the difference between them can make life a little easier – and help you know what to expect for your out-of-pocket costs.

What’s The Difference?
Screening colonoscopies and diagnostic colonoscopies are performed similarly using the same equipment. The difference is how the procedure is billed to your insurance. Billing will depend on your symptoms (or lack of symptoms) and what your doctor finds during the procedure.

A colonoscopy is considered preventive screening if the patient doesn’t have any gastrointestinal symptoms and no polyps or masses are found during the colonoscopy.

The Affordable Care Act (ACA) considers preventive services “essential health benefits” and requires insurance companies to pay all associated costs. That also means you won’t have to pay a copay or coinsurance for a screening colonoscopy.

Since a diagnostic colonoscopy isn’t considered preventive, your insurance may require you to pay a copay or coinsurance.

Screening Colonoscopy
A screening colonoscopy is a preventive procedure to examine the colon to ensure it’s healthy. All adults 45 and older need screening because colon cancer is one of the most common and deadly cancers. It is also typically treatable when it’s caught early. Better yet, colon cancer can be prevented by finding and removing polyps before they can develop into cancer.

According to the American Cancer Society, people with an average risk of developing colon cancer should have a screening colonoscopy every ten years.

A colonoscopy is considered screening when:
You’ve had no lower gastrointestinal signs or symptoms before the colonoscopy
No polyps or masses are found during the colonoscopy
There’s no family history of polyps or colon cancer
You have no history of polyps or colon cancer

Diagnostic Colonoscopy
Unlike a screening colonoscopy, you may be required to pay a deductible or coinsurance for a diagnostic colonoscopy, according to your insurance policy.

A colonoscopy is considered diagnostic when you’ve had:
Signs or symptoms in the lower gastrointestinal tract noted in your medical record before the procedure, including:
Abdominal pain that doesn’t improve
Anemia
Change in bowel habits
Constipation
Diarrhea
Rectal bleeding
Blood in the stool
Polyps within the past 10 years
A positive stool-based test or CT colonography and require a follow-up colonoscopy
Can Screening Become Diagnostic?

It’s true that you may go in for a screening colonoscopy and come out with a diagnostic colonoscopy. If your doctor finds a mass needing biopsy or finds a polyp, your colonoscopy is considered diagnostic at that point. That’s why it’s essential to understand your insurance coverage before your procedure.

What You Need to Know About Insurance Coverage for Colonoscopies
Medicare and most private insurance companies fully cover screening colonoscopies, including the deductible or coinsurance. Medicare coverage is often slightly different than private insurance plans.

Medicare Coverage
Medicare covers a screening colonoscopy:

Every 10 years, if you’re not high risk
Every 2 years, if you’re high risk, or have:
A history of polyps or colon cancer
A family history of polyps or colon cancer
A personal history of inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s Disease
Medicare covers a diagnostic colonoscopy without a deductible, but you will be required to pay 20% coinsurance.

Private Insurance Coverage
Private insurance coverage for diagnostic colonoscopies varies. Always ask your insurance company about out-of-pocket costs, including copays, coinsurance, deductibles, limits, or exclusions.

Grandfathered Plans
The ACA was passed in 2010 and any plans that were established before then are considered “grandfathered”. That means they are exempt from the coverage requirements for colonoscopy. People who have one of these plans may pay more (co-pay, co-insurance) for a screening colonoscopy.

Some states have their own laws that may still require insurance plans to provide coverage, even if the plan is older.


Knowing whether or not a colonoscopy is considered a screening or diagnostic is not always simple. It’s important to call your insurance provider before your colonoscopy appointment to have the best idea of what your out-of-pocket cost will be.

Don’t delay your colonoscopy if you are 45 or older – schedule an appointment today!

OverStitch/TORe (transoral outlet reduction endoscopy)

The Transoral Outlet Reduction (TORe) procedure is a specialized endoscopic technique tailored for patients who have had gastric bypass surgery but are experiencing weight regain or less than expected weight loss. This advanced procedure is carried out using the OverStitch endoscopic suturing system. The primary focus of TORe is to reduce the size of the enlarged stomach pouch and the stoma, the opening to the small intestine, which can stretch after surgery. A significant advantage of this technique is its minimally invasive approach, as it is performed through the mouth using the OverStitch device, eliminating the need for external incisions. This approach not only minimizes the risk of complications but also facilitates a quicker recovery compared to traditional surgical methods.

TORe, performed by specialized gastroenterologists, marks a significant advancement in the field of gastrointestinal and bariatric care, particularly for post-gastric bypass patients looking for a less invasive method to address their weight loss challenges. The procedure is known for its balance of efficacy and safety, typically resulting in minimal discomfort and a swift return to daily activities. Each procedure is customized to the patient's specific needs by skilled gastroenterologists experienced in endoscopic techniques. As with any medical procedure, it's crucial for patients to consult with their healthcare provider to discuss the potential benefits and risks of TORe and determine its suitability for their unique health objectives and situation.

Intragastric Weight Loss Balloon: Orbera

The intragastric weight loss balloon is the only non-surgical weight loss strategy proven to help people lose weight. Your weight loss journey begins with a personalized evaluation. You’ll start receiving the education you need to prepare you for success. After that, the Orbera balloon is inserted into your stomach during an upper endoscopy. This is a non-surgical procedure where you will be completely asleep and comfortable. The balloon will remain in place for six months, helping to control portion size and curb appetite. With the help of the weight loss balloon and personalized coaching, you’ll focus on healthy eating, exercise, and lifestyle habits to maximize your success. The weight loss balloon is removed from your stomach at six months. After the weight loss balloon is removed, you’ll continue receiving support to help you achieve and maintain your optimal weight and healthy lifestyle.

Integrated Gastroenterology Consultants uses the Orbera Weight Loss System. Orbera is a year-long program for helping you lose weight by changing your habits. See more about the Orbera balloon, including FAQ videos, below.

Our advanced endoscopist, Dr. Allen Hwang, is the only doctor in the US north of New York who places intragastric weight loss balloons. Call (978) 459-6737 for a consultation on weight management and the weight loss balloon.

How the Orbera Weight Loss System Works

It’s a Tool, Not a Shortcut

How Much Weight Did You Lose?

What’s Life Like After It’s Out?

Does It Really Work?

Does It Require Surgery?

Is It Worth It?

What Does It Feel Like?

The First Thing That Works

More Than a Balloon

Intragastric Weight Loss Balloon: Spatz

The Spatz3 Adjustable Balloon System is the world’s first and only adjustable gastric balloon. This non-surgical weight loss solution offers patients a higher weight loss success rate than ever before. With the highest weight loss results and highest success rates of all 8-month gastric balloons, the Spatz3 has proven to have an 84% success rate and 15% weight loss, far exceeding every non-adjustable balloon in non-comparative studies. In addition, FDA Clinical Trials show that Spatz balloon patients lost five times as much weight as those on diet alone.Spatz Medical is committed to the patient’s journey, helping them achieve their weight loss goals, while learning to listen to body cues that ultimately contribute to long-term weight management success.

Integrated Gastroenterology Consultants now offers the Spatz3 Adjustable Balloon System as one option for intragastric balloons. See more about the Spatz3 balloon below.

Our advanced endoscopist, Dr. Allen Hwang, is one of the only doctors in the US north of New York who places intragastric weight loss balloons. Call (978) 459-6737 for a consultation on weight management and the weight loss balloon.