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.
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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