Gastroenterology patients no longer have to travel to Charlotte, Winston-Salem or Durham to benefit from endoscopic ultrasound (EUS) – the most modern and minimally invasive technique used to assess digestive issues. The imaging-guided procedure is now performed locally by Dr. Vinay Patel, a specially trained gastroenterologist who joined Northeast Digestive Health Center in 2013.
“We wanted to provide a service to our patients and the community that wasn’t there before,” Dr. Patel said. “Now, patients don’t have to travel elsewhere to have their advanced therapeutic procedure done. We have the technology and expertise to do it locally.”
As one of only five physicians in the region trained in EUS technology, Dr. Patel has performed more than 500 procedures during his fellowship at the University of Louisville and through his role as EUS director at Carolinas HealthCare System NorthEast, which purchased and houses the equipment.
EUS technology is far-reaching and used for a variety of treatments, including assessing tumors, determining the stage of cancer and if it has spread, identifying stones and masses in the bile duct, draining pseudocysts or other abnormal collections of fluid, evaluating abnormal imaging studies and guiding treatment.
Dr. Patel noted that EUS does not take the place of imaging modalities such as a CT or MRI, but rather it provides a more dynamic and refined view with the opportunity to provide tissue diagnosis and therapeutic intervention immediately.
“If someone has cancer in the esophagus, rectum, stomach, small bowel, pancreas or biliary tree, we can stage it locally, identify it, provide immediate tissue diagnosis and direct therapy,” he said. “Before the patients leave – more often than not – they know exactly what kind of cancer it is, what stage it is and what the next plan of treatment is.”
Additionally, Dr. Patel is using EUS technology for pain intervention and relief through precise targeting of medication. “If a Stage 3 pancreatic cancer patient has pain, we’re able to use EUS to affect the nerves with a neurolysis or a block and help control severe pain and reduce the patient’s narcotic requirement.”
EUS procedures can take as little as 20 minutes or as long as 90 minutes, Dr. Patel said, and there is very low risk of complication. “With this procedure, I never tell a patient how long it’s going to take because I want to be thorough. We are done only when I am satisfied that all the information needed has been gathered.”
In the recent case of a 34-year-old woman, the EUS findings and subsequent treatment was swift and may have helped prevent a longer hospital stay and worsening infection. Just eight weeks after giving birth, the patient developed acute upper abdominal pain and fever. When she arrived at the hospital, she was septic with cholangitis. A CT scan indicated the bile duct was enlarged, but didn’t show the reason why.
“We did an EUS, and in just a few seconds, we were able to tell that there was a stone obstructing the bile duct. We switched her over to an ERCP, took out the stone and relieved the obstruction, thereby treating the infection,” Dr. Patel said. “EUS helped direct the patient’s therapy and likely shortened the course of an infection-related hospitalization.”
Staying on the forefront of new technology is important to the physicians at Northeast Digestive Health Center, but only if the technology helps patients. “There are so many new things coming out – different types of needles, balloons, techniques and technologies – but we have to see what best works for our patients,” Dr. Patel said. “Just because we know how to do something doesn’t mean we should do it, especially if it’s not beneficial or if the risk far outweighs the benefit.”
With EUS, all signs point to continuing advancements. “Although endoscopic ultrasound technology has been around for more than 30 years, it’s only recently become interventional,” he said. “It will continue to evolve and we’re excited to see where this technology takes us to help our patients and improve their outcomes.”
For those of us who suffer from acid reflux, which is worse: enduring the painful and uncomfortable symptoms of the condition, or taking a chance on the potential health risks associated with long-term PPI usage? It’s the burning question I address in this blog, but not one that has a clear-cut answer.
Back in 1991, the Food and Drug Administration approved proton pump inhibitors (PPI). Marketed under the brand name Prilosec, the medication (omeprazole) was revolutionary and very effective in treating reflux, as well as other problems such as peptic ulcer disease. Since then, a number of PPIs have been approved and are generally well tolerated and have few side effects.
Over time, however, there have been many worries raised about the safety of PPIs. Initially, Prilosec was only given for 1-2 months at a time because there were theoretical concerns the medication could increase the risk of stomach cancer – a theory that was never confirmed. In more recent years, there have been periodic concerns about the safety of PPIs, including:
While these issues have been raised, admittedly, many of the studies might have been influenced by confounding variables. For example, patients who are obese are more likely to have reflux and more likely to be treated with a PPI. Patients who are obese also are more likely to have cardiovascular disease and more likely to have heart attacks. If a study shows an association between PPI usage and heart attacks, is it due to the medication or due to the obesity? Subsequently, most of these studies concluded that more research needs to be done to further assess whether the medication is causing a particular problem.
Some of the safety concerns noted above make sense. PPIs reduce stomach acid, but we have stomach acid for a reason. One reason is that it protects us if we inadvertently swallow harmful bacteria (such as salmonella). If someone takes a PPI, does not have acid in their stomach and gets exposed to salmonella, they are more likely to get symptoms from that exposure than someone who has stomach acid. Similarly, it is proposed that gastric acid may prevent colonization of harmful bacteria that could lead to pneumonia. There are questions of whether the lack of acid leads to impaired absorption of nutrients, such as calcium, magnesium and vitamin B12.
What guidance should be given to patients with concerns over long-term PPI usage? At this point, it is clear there may be safety concerns; however, the true magnitude and scope is not clear. There are some patients with reflux who are at risk for stopping PPIs, including patients with gastroesophageal reflux disease (proven by endoscopy), Barrett’s esophagus, esophageal stricture or eosinophilic esophagitis.
In addition, there may be other reasons patients are on a long-term PPI where stopping the medication may be hazardous. This would include:
It is widely believed that reflux patients who are not in these categories may discontinue their PPI medication safely and there are several alternatives and recommendations that may be helpful:
Ultimately, the decision of whether to stop a PPI is one you will need to make for yourself; however, I encourage you to first speak with your physician(s). There is no reason to immediately stop the medicine, as there doesn’t appear to be any type of critical peril. Remember, these medications have now been available for 25 years and we have vast experience in their usage.
From my standpoint as a gastroenterologist, more research needs to be done before altering clinical practice. As a reflux patient who takes PPI chronically, I have made the decision to continue my medication. I would rather accept the risk of long-term PPI use rather than having nightly heartburn and regurgitation. Meanwhile, I will attempt to lose weight in hopes that, perhaps, I can stop the medication at some point and not have to suffer from the symptoms.
One would be hard-pressed to come up with something positive to say about hemorrhoids. Despite being a common medical condition, it is fraught with negative connotations and is a topic that many people are embarrassed to discuss.
As painful as hemorrhoids are to have – and talk about – there is a remedy that is simple and painless. Hemorrhoid banding is the most widely used and effective treatment for internal hemorrhoids. The minimally invasive procedure helps remove or destroy internal hemorrhoids by tying them off at the base with rubber bands, cutting off the blood flow.
It works like this: The physician inserts a viewing instrument into the anus and uses a special syringe-like device to place a tiny rubber band (about 1/25th of an inch) around the base of the hemorrhoid. With no more blood flow, the hemorrhoid shrinks and falls off in about a week. A scar eventually forms in place of the hemorrhoid, holding in nearby veins so they don’t bulge into the anal canal.
All of the physicians at Northeast Digestive are certified to perform hemorrhoid banding using the CRH O’Regan System – an FDA-approved technology that was invented in 1997 by laparoscopic surgeon Dr. Patrick J. O’Regan. Dr. Geanina Anghel is the most recent physician at Northeast Digestive to undergo the training, which involves working with a board-certified surgeon trainer and hands-on patient banding sessions.
The procedure takes place at the Northeast Digestive office and lasts about a minute. Patients can expect their total visit to last between 15 and 30 minutes as there is no prep or sedation required. Some may experience mild discomfort during the treatment, whereas other patients have very little discomfort at all.
The procedure is more than 99-percent effective and is used to treat about 95 percent of internal hemorrhoid patients. Another benefit of the single-use, disposable technology is that it protects against cross-patient infection.
“More than half of adults will get hemorrhoids before the age of 50, yet many people are hesitant to get treatment or talk about them with their doctor,” Dr. Anghel said. “There’s no reason for that because banding is a great option for those who suffer from hemorrhoids. Not only is it safe with a very low complication rate, there’s also a low likelihood of recurrence. We can treat them painlessly in a matter of seconds right in our office.”
Upper Endoscopy vs. Colonoscopy
An Upper Endoscopy or esophagogastroduodenoscopy or EGD is a procedure performed by a trained gastroenterologist or surgeon passes a flexible tube with light and camera through the mouth with direct visualization and assessment of oropharynx, esophagus, stomach, and proximal duodenum.
Indications: Dysphagia, foreign body, nausea and vomiting, bleeding, IBD, obtain tissue biopsy, abdominal pain, iron deficiency anemia
What to expect before, during, and after procedure?
A colonoscopy is a procedure performed by a trained gastroenterologist or surgeon inserting a long flexible tube through rectum while the patient is sedated. The tube is attached with light and a camera that will assess and interpret findings from the exam.
Indications: screening, history of colon polyps, positive cologuard, heme positive stool, lower bleeding, iron deficiency anemia, abnormal imaging, IBD (ulcerative or Crohn’s).
What to expect before, during, and after procedure?
Call us today to talk to one our providers about whether you need an upper endoscopy or colonoscopy, (704) 783-1840!