Much to his surprise,
Mr. N., who had been completely symptom-free,
was diagnosed with colon cancer. He underwent
surgery followed by chemotherapy, and his prognosis
is good.
The early stage at which his cancer was diagnosed
played a significant role in the outcome. Mr.
N.’s case is fairly common, according
to Barry Glanzman, MD, Former Chief of Gastroenterology
at Huntington, who said that diagnoses of early
stage colon cancers in patients without symptoms
are routinely made in Huntington Hospital’s
Endoscopy Suite.
Screening colonoscopy is just one of the procedures
that is performed in the Endoscopy Suite. Every
week, between 75 and 80 patients are seen in
the unit for screening, diagnosis, or treatment
of a wide range of diseases of the gastrointestinal
tract.
Colonoscopy
During colonoscopy, a miniature camera mounted
on a flexible tube projects high-resolution
images of the lower intestines onto a video
screen. Gastroenterologists not only visualize
the colon, but they can also insert instruments
into the tube to painlessly remove common growths,
called polyps, for biopsy. Since colon cancer
almost always starts as a benign polyp, polyp
removal is essential to cancer prevention.
A biopsy determines the type of polyp and whether
any cancer is present. Further follow-up is
then determined.
“Once you find polyps, it is often not
a one-time thing,” Dr. Glanzman commented.
“Patients need to undergo routine surveillance
for the rest of their lives on a schedule determined
by their doctor.” By following these patients
over the years, the risk of developing colon
cancer is significantly reduced.
In addition to colon cancer, colonoscopy may
also be used to assess diseases such as ulcerative
colitis and diverticulitis, and is useful to
the work-up of rectal bleeding and disease.
(click here for
Colon Cancer - Silent Killer)
Upper Endoscopy
Gastroenterologists also send patients to the
Endoscopy Suite for upper endoscopy studies
to diagnose and treat conditions affecting
the esophagus and stomach. Symptoms that may
necessitate an upper endoscopy include severe,
recurrent heartburn, known as reflux, as well
as unexplained or unintended weight loss, or
difficulty swallowing.
“Gastroesophageal Reflux Disease, known
as GERD, is an extremely common problem and it
is often under-treated,” explained Dr.
Glanzman. “If left untreated for long periods
of time, it can result in ulcerations, narrowing
of the esophagus, damage to the larynx and hoarseness,
asthma-like symptoms, and even an increased risk
for esophageal cancer.”
Dr. Glanzman noted that there are many effective
therapies for GERD. Physicians begin by recommending
lifestyle changes such as weight loss, eliminating
caffeine, adopting a low-fat diet, avoiding food
before bedtime, and elevating the head of the
bed.
“Patients who continue to experience symptoms
might benefit from powerful medications called
proton pump inhibitors, which reduce the amount
of acid dramatically and allow the esophagus
to heal,” said Dr. Glanzman.
Hiatal hernias are also diagnosed by gastroenterologists
in the Endoscopy Unit. This is a common problem,
occurring in about 25% of patients over the age
of 50. A hiatal hernia occurs when part of the
stomach protrudes up into the chest cavity through
a weakened area in the diaphragm. Small hiatal
hernias may cause no symptoms at all. Some patients
may experience heartburn when the hiatal hernia
allows food and stomach acids to back up into
the esophagus. Medication may be used to treat
these symptoms, but in severe cases, surgery
is an option.
Dr. Fried noted that endoscopy may also be used
to diagnose stomach ulcers, which he pointed
out, are not caused by stress as was once believed.
“We now know that ulcers are associated
with bacteria,” he explained. “Symptoms
of ulcers include a gnawing hunger-like pain
that wakes you up at night. It often improves
with food. Treatment consists of medication to
suppress acid and an antibiotic.”
According to Dr. Fried, the recurrence rate drops
dramatically once the bacteria are eradicated.
A Commitment to Patient Safety
Although endoscopy is not a surgical procedure,
it is invasive and does carry some risks. That
is why Huntington Hospital has made a major commitment
to ensuring patient safety before, during, and
after the procedure.
Hospital staff members are well-trained in maintaining
a sterile environment, and all endoscopic equipment
is thoroughly cleaned and sterilized using the
most up-to-date sterilization techniques.
Because sedation is administered, the hospital
has begun to include Board-certified anesthesiologists
as part of the endoscopy team. Patients who are
at risk for complications, including the elderly
and those in frail health, are scheduled for
their procedures on days when an anesthesiologist
will be present to administer sedation and assist
with monitoring vital signs throughout the procedure.
A registered nurse assists the gastroenterologist
during every procedure and reviews post-procedure
instructions before the patient is discharged.
Once patients have returned home, nurses make
follow-up telephone calls to check on their recovery
and answer any questions.
For all patients, but especially those at high
risk, the comprehensive resources of the entire
hospital are available in the unlikely event
of a complication.
For additional information on endoscopy at Huntington
Hospital, or a referral to a gastroenterologist,
call (631) 351-2236 or click
here to see a list of our physicians.
MARCH 2002 (updated Nov 2006)
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