Endoscopic Procedures: Colonoscopy, Endoscopy, ERCP, BARRX, Enteroscopy, Endoscopic Ultrasound, Sphincter of Oddi Manometry

Advanced Endoscopy and Gastroenterology

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.

The Unit, according to Stephen K. Heier, MD, director of Phelps' Advanced Endoscopy and Gastroenterology, has the most advanced technology available and offers a broader range of endoscopic procedures than any other hospital in the Hudson Valley region, including those that are considered academic teaching hospitals. (Stephen K. Heier, 914-366-1190).

Below is a list of conditions that Phelps is equipped to diagnose and treat.

Gastrointestinal Conditions & Endoscopic procedures:

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 who are diagnosed with pancreatitis or have gallbladder pain after the gallbladder has been removed, actually have undiagnosed SOD. Endoscopic retrograde cholangiopancreatography (ERCP), using X-ray fluoroscopy, can reveal the sphincter and ERCP with sphpincter 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 stomache 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. Enteroscopy can reveal the more than 20 feet of small intestine beyond the reach of the standard uppeer 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.Enteroscopy helps determine the cause of anemia and can be used to 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.

Endoscopic ultrasound (EUS) is a procedure used to assess digestive diseases anddetect 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.

Endoscopic ultrasound 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.

Zenker's Diverticulum 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 new minimally invasive surgical treatment for Zenker's was developed by Dr. Stephen Heier at Phelps.

The office of Stephen K. Heier, MD, director of Phelps' Advanced Endoscopy and Gastroenterology, is on the Phelps campus at 755 North Broadway, Suite 530. (914- 366-1190)

The physicians of Westchester Gastroenterology Associates at Phelps also diagnose and treat patients in the Hales Endoscopy Unit. To learn more about WGI's physicians, Barry E. Field, MD, Floyd C. Byfield, MD, FACP, and Christopher A. Martin, MD, visit the practice website: www.westchestergastro.com. (914) 366-6120

In the Endoscopy Unit's new Gastrointestinal Motility Center, David Kauvar, MD uses procedures such as esophageal manometry, anorectal manometry and biofeedback therapy to treat gastrointestinal problems including bloating, constipation, GERD and persistent heartburn. (914) 631-7727

Other gastroenterologists who treat patients in the Phelps Endoscopy Unit include: Richard Findling, MD, with offices in Croton, Ossining and Dobbs Ferry (914-827-7424), Malene Galizi, MD, with an office in Hartsdale (914-713-3228), Michael Gerdis, MD, with offices in Hartsdale and Yonkers (914-948-3627), and Julie Torman, MD, with offices in Croton and Sleepy Hollow (914-271-4212).

Two patient rooms in the Hales Endoscopy Unit. All rooms have sliding glass doors and curtains for privacy and are equipped with telephone and tv.	One of four procedure rooms, fully equipped with state-of-the-art technology.

All endoscopic procedures are performed by board-certified gastroenterologists, with the assistance of specially trained Registered Nurses and endoscopy technicians. Three anesthesiologists who are dedicated to the Endoscopy Unit spend time with patients before a procedure is performed, monitor them during the procedure and stay with them during the recovery period.

The fourth treatment room was added in 2010 featuring specialized equipment, including cardiac monitors and high-density TVs.

Patients also appreciate the comfort of the patient rooms. All nine of them have sliding glass doors with curtains for privacy and are equipped with telephone and TV.