Gastroenterology

Overview

In the Thomas E. and Alice M. Hales Endoscopy Unit, Phelps gastroenterologists use specialized tools to view, diagnose and treat conditions of the digestive tract with most advanced technology available and a broader range of endoscopic procedures than anywhere else in the Hudson Valley region.

The unit features 9 private rooms with telephone and TV.

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Conditions

• Abdominal Pain
• Acid Reflux and Barrett’s Esophagus
• Bleeding in the Small Intestine
• Colorectal Cancer
• Other Digestive Diseases
• Zenker’s Diverticulum

Abdominal Pain:
Abdominal Pain is sometimes caused by too-tight pressure of the muscle at the bottom of the bile and pancreatic ducts. This condition is called sphincter of Oddi dysfunction (SOD). Often, people are misdiagnosed with pancreatitis or have gallbladder pain after the gallbladder has been removed, when they actually have undiagnosed SOD. Endoscopic retrograde cholangiopancreatography (ERCP), using X-ray fluoroscopy, can reveal the sphincter, and ERCP with sphincter of Oddi manometry can analyze the muscle. If it is too tight, the SOD can be cured simply by a sphincterotomy that is performed in less than a minute during ERCP.

Acid Reflux and Barrett’s Esophagus:
Barrett’s Esophagus occurs when there are changes in the cells that line the esophagus, which can sometimes lead to esophageal cancer. Acid reflux is the main risk factor for Barrett’s. About 10% of people with chronic reflux disease (when stomach contents backflow into the esophagus) develop Barrett’s Esophagus and one out of 200 with the earliest form of Barrett’s develops esophageal cancer. A screening endoscopy to diagnose Barrett’s takes only a few minutes. Radiofrequency ablation (RFA) can eliminate Barrett’s by burning away layers of the abnormal cells. The procedure involves a balloon-like device covered with electrodes (called HALO 360 by BARRX). When the balloon is inserted and inflated, the electrodes deliver energy to the esophagus lining for one or two seconds and the diseased tissue is eliminated.

Bleeding in the Small Intestine:
Anemia can be caused by bleeding in the digestive tract. Enteroscopy can reveal the more than 20 feet of small intestine beyond the reach of the standard upper endoscope or colonoscope. The enterescope allows evaluation and treatment of the small bowel without a need for invasive surgery. Dr. Stephen Heier brought one of the first commercially available single-balloon enteroscopes in the United States to Phelps. In addition to determining the cause of anemia, enteroscopy can be used to diagnose and treat patients with familial polyp syndromes and those who have abnormal X-ray imaging of the small intestine.

Colorectal Cancer:
Colorectal cancer is the 3rd most commonly diagnosed cancer and the 3rd leading cause of cancer death in men and women in the US. Polyps in the colon or rectum, which are usually benign, may become cancerous over time. When screening detects colon or rectal polyps at an early stage, they can be removed, and colorectal cancer can be prevented. Screening for colorectal cancer should begin at age 50, or earlier if there is a family history of colorectal cancer or other high-risk factors. Colonoscopy is the preferred procedure to detect colorectal cancer in its early stages.

Other Digestive Diseases and Cancer:
Other areas where digestive diseases or cancer may occur include the linings of the upper and middle digestive tract (esophagus and stomach) as well as nearby organs such as the pancreas, liver and gallbladder.

Zenker’s Diverticulum:
Zenker’s is a pouch in the wall of the throat that results when a muscle in the upper esophagus doesn’t relax. When swallowing, bits of food can get trapped in the pouch and may cause irritation. If the pouch is very large, food may spill into the throat hours after eating. The traditional treatment is to cut the muscle that won’t relax. A minimally invasive surgical treatment was developed by Dr. Stephen Heier at Phelps.

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Treatment

In the Endoscopy Unit, board-certified gastroenterologists are assisted by specially trained Registered Nurses and endoscopy technicians, as well as dedicated anesthesiologists. An anesthesiologist spends time with each patient before a procedure is performed, monitors them during the procedure and during recovery.

Procedures used to detect, diagnose and treat conditions of the digestive tract include:

Endoscopic ultrasound (EUS) is a procedure used to assess digestive diseases and detect cancer. The endoscope allows visualization, and ultrasound (high frequency sound waves) produces detailed images of the linings of the upper and lower digestive tract (esophagus, rectum and stomach) as well as nearby organs, such as the pancreas, liver and gallbladder. Extremely small lesions can be detected, allowing diagnosis and treatment at an early stage when the prognosis is better. During EUS, tissue samples can be obtained with a thin needle in a process called fine needle aspiration. The tissue is then examined by a pathologist. EUS is also considered the “gold standard,” for the staging of esophageal or rectal cancer prior to surgery or chemotherapy.

EUS is also used to evaluate the gallbladder and bile duct. Its superior resolution results in an ability to detect stones in the bile duct in 95% of patients. Abdominal sonography, on the other hand, which is traditionally used for this purpose, detects stones in the bile duct only 50-60% of the time. Undetected stones in the bile duct can cause persistent abdominal pain and/or fever.

ERCP (Endoscopic Retrograde Cholangiopancreatography) uses X-ray fluoroscopy, to reveal the sphincter and ERCP with sphincter of Oddi manometry to analyze the muscle.

Radio Frequency Ablation or RFA (BARRX) is used to burn away layers of abnormal cells to eliminate Barrett’s Esophagus.

Balloon Enteroscopy reveals the small intestine, which is beyond the reach of standard upper endoscopes or colonoscopies.

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