Colon cancer is the 3rd highest cause of cancer related death in the United States. Rates of colon cancer cancer have been decreasing due to the ability to remove polyps before transformation to colon cancer, and much of that is due to early colon cancer screening.

Who should get it?

• Guidelines recommend scheduling regular colonoscopy evaluation at the age of 50.
• African American patients are at a slightly increased risk of colon cancer, thus we recommend screening start at age 45.
• If you have no polyps found on routine colonoscopy and do not have a family history of colon cancer, you do not need another colonoscopy for 10 years.
• If you have a family history or genetic predisposition for colon cancer, your first colonoscopy may be before age 50 and your screening interval may be shorter than 10 years.
• If you have inflammatory bowel disease such as Crohn’s disease or Ulcerative colitis, the age of your first colonoscopy may be earlier than 50 and your screening interval will be shorter than 10 years.

An upper endoscopy is performed to evaluate the upper gastrointestinal system (esophagus, stomach, small intestine). This examination is used to diagnose and treat multiple disease processes including ulcer disease, bleeding vessels, reflux disease (GERD), Barrett’s esophagus, Celiac disease, esophageal and gastric varices, placement of luminal stents due to cancer or strictures, and for the evaluation of abdominal pain, unintentional weight loss, nausea/vomiting, diarrhea and decreased appetite. This procedure is also used to insert feeding tubes for those patients who need it.

Potential procedure risks:

• Bleeding
• Perforation requiring surgery
• Complications with anesthesia

Signs or symptoms of a complication:

• Very firm abdomen
• Severe or persistent abdominal pain
• Fever
• Chest pain
• Shortness of breath
• Vomiting of blood or passing blood through rectum

If you have any of the above signs or symptoms after a procedure, call me immediately or go to an emergency room.

A colonoscopy is performed to visualize the inner aspect of the colon (large intestine). This exam is useful for multiple purposes such as colon cancer screening, evaluation of abdominal pain, rectal bleeding, bowel movement irregularities and other intestinal problems.

Potential procedure risks:

• Bleeding
• Perforation requiring surgery
• Complications with anesthesia

Signs or symptoms of a complication:

• Very firm abdomen
• Severe or persistent abdominal pain
• Fever
• Chest pain
• Shortness of breath
• Vomiting of blood or passing blood through rectum

If you have any of the above signs or symptoms after a procedure, call me immediately or go to an emergency room.

Endoscopic ultrasound (EUS) is a specialized endoscopic procedure that is used for the evaluation of many disease processes such as pancreatic cysts, bile duct stones, pancreatic or bile duct abnormalities, masses (pancreas, liver, esophagus, stomach, small intestine, lymph nodes, colon) and staging of cancers. EUS guided biopsies can be performed to obtain tissue samples to make a diagnosis. Lastly, EUS is also used to drain cysts internally and get access to a ductal system that is obstructed.

Potential procedure risks:

• Pancreatitis
• Infection
• Bleeding
• Perforation requiring surgery
• Complications with anesthesia

Signs or sypmtoms of a complication:

• A very firm abdomen
• Severe or persistent abdominal pain
• Fever
• Chest pain
• Shortness of breath
• Vomiting of blood or passing blood through rectum

If you have any of the above signs or symptoms after a procedure, call me immediately or go to an emergency room.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialized endoscopic procedure that is used for the evaluation and treatment of biliary and pancreatic ductal stones, strictures and the stenting of cancers causing obstruction.

Potential procedure risks:

• Pancreatitis
• Infection
• Bleeding
• Perforation requiring surgery
• Complications with anesthesia

Signs or symptoms of a complication:

• Very firm abdomen
• Severe or persistent abdominal pain
• Fever
• Chest pain
• Shortness of breath
• Vomiting of blood or passing blood through rectum

If you have any of the above signs or symptoms after a procedure, call me immediately or go to an emergency room.

Ductoscopy is the direct visualization of the bile (cholangioscopy) or pancreatic (pancreatoscopy) ducts from inside using an ERCP technique. Targeted biopsies can be performed and treatment of stones can be performed.

Signs or symptoms of a complication:

• A very firm abdomen
• Severe or persistent abdominal pain
• Fever
• Chest pain
• Shortness of breath
• Vomiting of blood or passing blood through rectum

If you have any of the above signs or symptoms after a procedure, call me immediately or go to an emergency room.

When hemorrhoids persist despite dietary and lifestyle modifications, it may be appropriate to try hemorrhoidal banding. The banding procedure is performed in the office and takes less than 3 minutes.

There is no sedation necessary and the patient may go back to work right away. The band applies pressure to the hemorrhoid vessel and eventually the banded vessel is depleted of blood flow. The overlying tissue scars down and the band falls out without intervention. Often, multiple sessions are required.

Complications of banding include:

• Anal pain
• Bleeding and stricture formation

However, the risks are very low compared to the benefits.

Now offering the CHR O’Reagon System

Before endoscopic equipment became more refined, large colon polyps were treated by surgical removal of a segment of the colon. Now, the majority of large colon polyps can be removed during a colonoscopy. When removing large colon polyps, risks of bleeding and perforation are increased compared to a standard colonoscopy procedure when removing large colon polyps. However, the benefits of a successful endoscopic resection are still much greater than the risks.

Signs or symptoms of a complication:

• A very firm abdomen
• Severe or persistent abdominal pain
• Fever
• Chest pain
• Shortness of breath
• Vomiting of blood or passing blood through rectum

If you have any of the above signs or symptoms after a procedure, call me immediately or go to an emergency room.

Barrett’s esophagus is a precursor to esophageal cancer. The risk for transformation to cancer is low, but treatment is recommended by performing endoscopic therapy along with lifestyle and pharmacologic interventions.

The average small intestine is approximately 20 feet long, so an upper endoscopy and colonoscopy may not be able to find the source of the disease process. In this situation, a capsule endoscopy is performed.

The preparation is the same as that of a colonoscopy. Next, the patient comes to the procedure center where the patient will swallow a large ‘pill’ that has a camera inside of it. The patient will wear a video recording device for the next 24-48 hours. As the camera travels through the small intestine, the video recording captures video and images of the small intestine. The camera will then pass out of the body during a bowel movement. The video recorder is brought back to the procedure center, where Dr. Kim will review the video recording to identify any abnormalities.

Potential procedure complications:

• If you have a stricture or narrowing of the small intestine, sometimes the camera pill can get stuck. In this situation, the patient may need an endoscopy with dilation and removal or surgery.