Dr. Jerry Evans of Agnesian HealthCare discusses the importance of getting a colonoscopy and other lifesaving cancer screenings.

1. Know & Go Friday
Colon Cancer Screenings
Are Real Lifesavers!
Jerry Evans, MD
Agnesian HealthCare
Gastroenterology

2. Our Team
• Three gastroenterologists
– Jerry Evans, MD
– Sujatha Kailas, MD
– Nathan Slinde, MD
• Surgeons (6)
• Pulmonologist (2)
• RN (17)
• LPN (2)
• CNA (4)
• HUC (1)

3. Our Team
Jerry Evans, MD Sujatha Kailas, MD Nathan Slinde, MD

4. Welcome
to GI

6. Primary Procedures
• Colonoscopy
• Esophagogastroduodenoscopy (EGD)
• Radiofrequency Ablation
• Endoscopic Retrograde Cholangiopancreatography
(ERCP)
• Capsule Endoscopy
• Endoscopic Ultrasound
• Esophageal Motility
• BRAVO pH Studies
• Hydrogen Breath Testing

7. 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=play
er_detailpage&v=fZkAHDf8WsA

8. 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

9. 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.

10. 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

11. 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.

12. Would you rather drive on a snowy day or a
clear, sunny day?
It is easier to visualize details in the colon if it is
clear of all waste.

13. 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.

14. 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 placement
http://www.youtube.com/watch?feature=play
er_detailpage&v=jhO-aEVFDOg

15. 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.

16. 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.

17. 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.

19. 19

20. ERCP
• Test designed to diagnose and treat diseases
of the pancreas, bile ducts, liver and
gallbladder
• Therapeutic techniques
– Open bile ducts
– Extract stones
– Place stents

21. Capsule Endoscopy
• Examination of the small intestine
– Ingestion of video capsule
– Lasts eight hours
– Capsule takes 60,000 images over eight-hour
period
– Doctor views images on video monitor

22. Capsule Video

23. Endoscopic Ultrasound
• Endoscope which contains built-in ultrasonic
capabilities that allows for highly accurate
staging of cancers and complex
gastrointestinal diseases.

24. 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

25. 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

26. Positioning the capsule in the esophagus Recording pH and transmitting data to receiver

27. Questions?
Colonoscopy Training Device
Play time!