Procedure Statistics • Colonoscopy - 3,829 performed each year • EGD - 2,272 performed each year • On average, 30 procedures are performed daily!http://www.youtube.com/watch?feature=player_detailpage&v=fZkAHDf8WsA
Colonoscopy • Screening starting at age 50 or younger with positive family history for cancer • Screening every five to 10 years thereafter if polyps are found • Outpatient procedure • Moderate sedation/general anesthesia • Pathology results in five to seven days
Did You Know?• Dr. Hiromi Shinya pioneered modern colonoscopic techniques in 1970 in New York.• St. Agnes Hospital started performing colonoscopies in 1985.• In 1997, St. Agnes Hospital had two procedures rooms. Six colonoscopies were performed each day.• Currently, St. Agnes Hospital boasts six procedure rooms and 20 pre- and post-operative rooms. Thirty procedures are performed each day.
Will It Be Uncomfortable Or Will I Remember the Procedure?• Moderate sedation – Fast acting, short duration, amnesiac side effects – Able to return to regular activities the next day• Deep sedation/general anesthesia – For patients with more complex medication conditions
Bowel Preparation• The bowel preparation – do it right! – Choosing the right preparation for you – Limit your diet to low residue several days before starting preparation – Be sure you understand the preparation instructions – call for clarification if unsure – Maximize clear liquid intake! Before, during and after the preparation.
Would you rather drive on a snowy day or aclear, sunny day?It is easier to visualize details in the colon if it isclear of all waste.
Preventing Colon Cancer• With widespread routine screening, nearly 30,000 lives in the United States could be saved each year.• Despite the fact that colonoscopy is the gold standard screening method for colon cancer, it is underused compared to screening methods for breast and cervical cancers.
Upper Endoscopy • Examination of the esophagus, stomach and duodenum (first part of small bowel) • Screening for complaints of heart burn (reflux) • Difficulty swallowing • Abdominal pain • Feeling of fullness • Loss of appetite • Esophageal stent placementhttp://www.youtube.com/watch?feature=player_detailpage&v=jhO-aEVFDOg
Barrett’s Esophagus• Barrett’s esophagus is a serious complication of gastroesophageal reflux (GERD).• Barrett’s esophagus does not have specific symptoms.• Individuals with Barrett’s esophagus may have symptoms related to GERD.• Individuals with symptoms related to GERD have an increased risk of developing esophageal adenocarcinoma – a serous cancer of the esophagus.
Barrett’s Esophagus• About 10 to 15 percent of people with chronic symptoms of GERD develop Barrett’s esophagus.• Average age at diagnosis is 50.• 30 percent of patients over the age of 50 with reflux are diagnosed with Barrett’s esophagus.• Many patients over the age of 50 with Barrett’s esophagus have no symptoms of reflux.
Barrett’s Esophagus Diagnosis & Treatment• Can only be diagnosed with an upper endoscopy and biopsy.• Physicians recommend that people with a long- standing history of reflux be screened for Barrett’s esophagus.• Family history of esophageal cancer.• Gastroenterologists foresee that endoscopic radiofrequency ablation or cryotherapy of Barrett’s esophagus will shift current management from surveillance to cancer prevention.
Endoscopic Ultrasound• Endoscope which contains built-in ultrasonic capabilities that allows for highly accurate staging of cancers and complex gastrointestinal diseases.
Esophageal Motility• Procedure to determine esophageal peristaltic action in the esophagus and lower and upper esophageal sphincter function• Difficulty swallowing• Complaints of reflux• Prior to surgical treatment of reflux
BRAVO pH Monitoring• Monitoring device implanted during an EGD• Identifies the cause of heartburn• Recording device worn on belt for 48 hours• Patient keeps diary of reflux symptoms• Physician analyzes downloaded information
Positioning the capsule in the esophagus Recording pH and transmitting data to receiver
Questions?Colonoscopy Training Device Play time!