While colon cancer is the second leading cause of cancer deaths in the United States, there is some positive news. First, the death rate from colon cancer has declined over the past 20 years. Second, experts believe that this is due in part to the availability of very effective screening tools that identify colon cancer early, when treatment is the most effective. Unfortunately, only two out of 10 eligible people take advantage of this important screening tool.

Georgetown GI offers a comprehensive screening program designed to find polyps (noncancerous growths) and cancer before symptoms develop. The most common screening techniques used are:

fecal occult blood test, which looks for blood in the stool
digital rectal exam, during which a physician or health care provider inserts a gloved finger into the rectum to feel for anything unusual
flexible sigmoidoscopy, which uses an endoscope to examine the inside of the rectum and sigmoid colon
colonoscopy, which uses a longer endoscope than the sigmoidoscope to examine the enitire colon lining.

Current American Cancer Society guidelines for colorectal cancer screening are described below.

Beginning at age 50, both men and women should follow one of these five screening options:

Yearly fecal occult blood test; all positive tests should be followed by a colonoscopy,
Flexible sigmoidoscopy every 5 years
Yearly fecal occult blood test plus sigmoidoscopy every 5 years
Double-contrast barium enema every 5 years
Colonoscopy every 7-10 years.

People should begin screening earlier or have screening more often if they have any of the following colon cancer risk factors:

A strong family history of colorectal cancer or polyps, meaning a parent, sibling or child who developed cancer or polyps younger than age 60
Families with hereditary colorectal cancer syndromes
A personal history of colorectal cancer or polyps, or
A personal history of chronic inflammatory bowel disease

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ERCP

The diagnostic capability of ERCP, (endoscopic retrograde cholangiopancreatography), is described in the section on the Center for Pancreatic and Biliary Disease. In addition to its diagnostic importance, ERCP can also be used to treat certain conditions immediately. These treatments, however, require the experience of experts in this procedure. Georgetown GI specializes in the use of ERCP, both for diagnosis and treatment.

During the ERCP, if a blockage is found in any of the ducts, the physician may be able to use one of the following tools to remove or relieve the obstruction:

Sphincterotomy, cutting the muscle sphincter of the bile or pancreatic duct, allowing the physician to remove stones.
Duct dilation and stenting, during which the physician uses a balloon catheter to stretch a narrowed opening. Stents are then often placed in the opening to maintain the stretch.
Cholangioscopy

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Esophageal and Colonic Stent Placement

In the hands of Georgetown’s experts, endoscopes are used to place stents in the esophagus, duodenum and colon, as well as bile duct systems, to prop open areas blocked by tumors or other obstructions.

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Enteroscopy

The small intestine is long and twisted, requiring longer instruments and specialized techniques to reach with an endoscope. An enteroscopy allows the physician to visualize the lining of the 1/3 of the small intestine, identify the cause of internal bleeding, remove a piece of the lining for further examination, and remove growths such as polyps. Additional evaluation is available using the "capsule" wireless endoscopy.

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Endoscopic Ultrasound and Fine Needle Aspiration

The combination of endoscopy and ultrasound, which uses sound waves to generate an image on a monitor, has become an extremely valuable GI diagnostic tool. A tiny ultrasound transducer is mounted on the tip of the endoscope, allowing the physician to obtain high-quality ultrasound images from inside the body. Not only does the test generate unique images of the different layers of the walls of the digestive tract, it can obtain pictures of the blood vessels, lymph nodes, pancreas, liver, gallbladder and bile duct in ways that no other noninvasive examination can match.

Georgetown GI offers extensive expertise in endoscopic ultrasound, which can be used to:

detect small pancreatic tumors
staging esophageal, gastric, pancreatic and rectal cancers
detect common bile duct stones.

In addition, under ultrasound guidance, a fine needle can be passed down the endoscope into an enlarged lymph node or suspicious mass. The needle removes tissue from these sites, which a pathologist can evaluate for diagnosis.

Contact: John Carroll, MD
Phone: (202) 444-6649

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Interventional Endoscopic Ultrasound

cyst drainage
placement of fiducials for radiation treatment

Contact: Nadim Haddad , MD
Phone: (202) 444-6649

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Wireless Capsule Endoscopy for Evaluation of Obscure GI Bleeding

Georgetown GI is one of only a few centers in the nation studying wireless "capsule" endoscopy to help identify the cause of unexplained bleeding in the small intestine. Using this new technology, the patient Endoscopy Procedure - Link to Video swallows swallows a vitamin-sized capsule that contains a camera, a light, batteries and a transmitter. The capsule passes through the small intestine via the same contractions that carry food, snapping two photos per second and transmitting them to a cellular-phone-sized receiver the patient wears around the waist.

This new technology allows physicians to see 15 to 20 feet of the small intestine that cannot be visualized using the traditional endoscopic approach. The study, which will involve 80 patients, will help to determine whether or not capsule endoscopy improves physicians’ ability to diagnose the causes of intestinal bleeding, including tumors and abnormal blood vessels.

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