1. Know & Go FridayColon Cancer ScreeningsAre Real Lifesavers!Jerry Evans, MDAgnesian 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 TeamJerry Evans, MD Sujatha Kailas, MD Nathan Slinde, MD 4. Welcome to GI 5. Primary Procedures Colonoscopy Esophagogastroduodenoscopy (EGD) Radiofrequency Ablation Endoscopic Retrograde Cholangiopancreatography(ERCP) Capsule Endoscopy Endoscopic Ultrasound Esophageal Motility BRAVO pH Studies Hydrogen Breath Testing 6. 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 7. Colonoscopy Screening starting at age 50 oryounger with positive familyhistory for cancer Screening every five to 10 yearsthereafter if polyps are found Outpatient procedure Moderate sedation/generalanesthesia Pathology results in five to sevendays 8. Did You Know? Dr. Hiromi Shinya pioneered moderncolonoscopic techniques in 1970 in New York. St. Agnes Hospital started performing colonoscopiesin 1985. In 1997, St. Agnes Hospital had two proceduresrooms. Six colonoscopies were performed each day. Currently, St. Agnes Hospital boasts six procedurerooms and 20 pre- and post-operative rooms. Thirtyprocedures are performed each day. 9. 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 medicationconditions 10. Bowel Preparation The bowel preparation do it right! Choosing the right preparation foryou Limit your diet to low residue severaldays before starting preparation Be sure you understand thepreparation instructions call forclarification if unsure Maximize clear liquid intake!Before, during and after thepreparation. 11. 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. 12. Preventing Colon Cancer With widespread routine screening, nearly30,000 lives in the United States could besaved each year. Despite the fact that colonoscopy is the goldstandard screening method for colon cancer, itis underused compared to screening methodsfor breast and cervical cancers. 13. Upper Endoscopy Examination of theesophagus, stomach andduodenum(first part ofsmall bowel) Screening for complaints ofheart 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 14. Barretts Esophagus Barretts esophagus is a seriouscomplication of gastroesophageal reflux(GERD). Barretts esophagus does not havespecific symptoms. Individuals with Barretts esophagus mayhave symptoms related to GERD. Individuals with symptoms related toGERD have an increased risk ofdeveloping esophageal adenocarcinoma a serous cancer of the esophagus. 15. Barretts Esophagus About 10 to 15 percent of people with chronicsymptoms of GERD develop Barrettsesophagus. Average age at diagnosis is 50. 30 percent of patients over the age of 50 withreflux are diagnosed with Barretts esophagus. Many patients over the age of 50 with Barrettsesophagus have no symptoms of reflux. 16. Barretts EsophagusDiagnosis & Treatment Can only be diagnosed with an upper endoscopy andbiopsy. Physicians recommend that people with a long-standing history of reflux be screened for Barrettsesophagus. Family history of esophageal cancer. Gastroenterologists foresee that endoscopicradiofrequency ablation or cryotherapy of Barrettsesophagus will shift current management fromsurveillance to cancer prevention. 17. 19 18. ERCP Test designed to diagnose and treat diseasesof the pancreas, bile ducts, liver andgallbladder Therapeutic techniques Open bile ducts Extract stones Place stents 19. Capsule Endoscopy Examination of the small intestine Ingestion of video capsule Lasts eight hours Capsule takes 60,000 images over eight-hourperiod Doctor views images on video monitor 20. Capsule Video 21. Endoscopic Ultrasound Endoscope which contains built-in ultrasoniccapabilities that allows for highly accuratestaging of cancers and complexgastrointestinal diseases. 22. Esophageal Motility Procedure to determine esophageal peristalticaction in the esophagus and lower and upperesophageal sphincter function Difficulty swallowing Complaints of reflux Prior to surgical treatment of reflux 23. 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 24. Positioning the capsule in the esophagus Recording pH and transmitting data to receiver 25. Questions?Colonoscopy Training DevicePlay time!