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Dr. Crespin

News & Medical Updates

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A stomach doctor is referred to as an gastroenterologist, or “GI” doctor. Others think of them as an “Endoscopy Doctor” because of the procedure. Stomach doctors in New York City specialize in caring for patients who are experiencing issues with their throat, stomach, intestines and colon. But endoscopy doctors also provide recommendations for overall improvements to health and will evaluate the total health of the patient.

Procedures performed by stomach doctors include endoscopic procedures including a colonoscopy, upper endoscopy or sigmoidoscopy. The most common procedure is an endoscopy to diagnose diseases of the stomach, joints, urinary tract, heart, throat, nose and diseases of the ear.

Stomach doctors in New York City

What is an endoscopy procedure?

The doctor will insert a tool called an endoscope into a person’s mouth when evaluating the throat and stomach. These endoscopes are equipped with a light and miniature camera at the end with several types of specialized instruments that can take biopsies or perform other tasks. The doctor is evaluating the patient in real-time but also taking pictures of the patient for later analysis. The comfort of the patient is important, so doctors will often provide anesthesia to maintain the comfort of patients during the procedure.

Other tools the doctor may use during the procedure may include forceps for taking tissue samples, biopsy forceps and a cytology brush for removing tissue samples, and other tools. A dedicated medical facility such as Upper Westside GI will provide all the safety and professional resources for doctors to perform this procedure.

Why get an endoscopy?

Most patients want to see a stomach doctor in New York City because they are having discomfort or pain in their digestive system. Doctors may also provide treatment while performing an endoscopy, including minor incisions in the skin, called laparoscopic surgery, which can allow for various tasks. Laser therapy is also an option as is photodynamic therapy where a light-sensitive substance is injected into a tumor to destroy it. The purpose of an endoscopy is to provide a diagnosis and address the comfort of the patient. In some cases, cancer or pre-cancer can be a concern, so doctors are looking for an early diagnoses and treatment option to maintain the health of patients.

What is a colonoscopy?

A stomach doctor may also screen for colorectal cancer. The evaluative procedure can provide more information on the area of the body with discomfort or at risk of cancer. Sometimes, the doctor will remove growths called polyps which sometimes develop into cancer. The colonoscopy is a procedure where the doctor will explore the large intestines for the purpose of evaluating the rectum and colon. The tube used is a colonoscope for the purpose of locating any blood, cuts, ulcers, polyps, cancer or other issues that may exist. Similar to an endoscopy, the colonoscopy allows doctors to take samples while photographing the area being investigated.

What medicines do stomach doctors use?

There are a variety of medicines available to address issues with the digestive system, too many to list on this page but would typically include medicines to address discomfort, pain, cancer and healing of affected areas. You may visit http://www.medindia.net/drugs/medical-condition/abdominal-pain.htm to find out more information on drugs prescribed by stomach doctors to treat gastrointestinal issues.


New York City offers a number of options for getting colonoscopy screenings, including the hospital where Dr. Crespin currently examines patients (Upper Westside GI).

Schedule your appointment today for a colon checkup: CLICK HERE


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Colon cancer is the second deadliest cancer among men and third among women but a report has found that people who receive colonoscopies to remove growths lower their mortality rate by a staggering 53 percent. Screening for colon cancer can drastically reduce one’s risk of developing this disease because, during a colonoscopy, colon polyps can be found and removed before they have a chance to develop into cancer. Colonoscopies are recommended for men and women in their fifties but your family’s health history should be a consideration to receiving an earlier screening.

Flexible SigmoidoscopyAmong cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it.

The risk of getting colon cancer increases with age. More than 90% of cases occur in people who are 50 years old or older. Colorectal cancer screening saves lives, but many people are not being screened according to national guidelines.

Precancerous polyps and colon cancer don’t always cause symptoms, especially at first. You could have polyps or colon cancer and not know it. That is why having a screening test is so important.

You should begin screening for colorectal cancer soon after turning 50, then keep getting screened regularly until the age of 75. Ask your doctor if you should be screened if you’re older than 75.

Don’t put off getting a colonoscopy. Because early detection decreases the likelihood of cancer you should talk to your doctor today about regular screenings. Regular screenings are performed in out-patient facilities and do not typically require overnight stays.

New York City offers a number of options for getting colonoscopy screenings, including the hospital where Dr. Crespin currently examines patients (Upper Westside GI).

Schedule your appointment today for a colon checkup: CLICK HERE


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Outpatient services are something that patients count on to be safe and easy. That’s why it’s so important for patients to choose carefully where they go to get an Upper Endoscopy, Colonoscopy, Flexible Sigmoidoscopy or HET System (Hemorrhoid Treatment). Outpatient services are medical procedures or tests that can be performed without requiring patients to stay overnight. Most of these procedures are done in only a couple of hours, and patients typically walk out the door to continue their day.

What are the benefits of choosing endoscopy outpatient procedures?

Benefits include the ability to quickly leave following your procedure while ensuring you have a minimally invasive experience.

Staff members and doctors who specialize in the procedures you need means that you are dealing with the most advanced medical facility in New York City. Our patients choose Westside GI instead of a hospital because the procedure has been streamlined in a way that can be safe and easy. When choosing an outpatient center, here are a few reasons why our patients choose Westside GI Center’s outpatient procedures:

– We take most types of health insurance.
– We provide instructions leading up to and following the procedure.
– We offer a clean, organized and private environment.
– Our staff is experienced and top-notch.
– We have multiple doctors on site.

Westside GI prides itself on being the leader in providing quality outpatient GI procedures in New York City. In addition to handling most major insurance claims, our office will work with individuals to reduce costs and receive the best care possible.

Meet one of our Doctors

Dr. Jeffrey S. Crespin is typical of our doctors who deliver Westside GI Center’s outpatient procedures. Practicing gastroenterologist in Manhattan for more than 15 years, Dr Crespin is a board certified gastroenterologist provides the highest quality medical care and services in a compassionate, professional and personalized manner.

Dr. Crespin attended Harvard University and has experience leading Clinical Medicine studies at Columbia University in addition to practicing endoscopic procedures. He’s affiliated with NYU Lenox Hill Hospital, located in the Upper East Side of Manhattan , St.Lukes-Roosevelt and Beth Israel Hospitals. His expertise is the evaluation and testing of the intestinal tract for optimal diagnosis, treatment, and prevention of gastrointestinal diseases.

Dr. Crespin is expertly trained in endoscopic procedures, which allow direct visualization of the intestinal tract for optimal diagnosis, treatment, and prevention of gastrointestinal diseases.

Upper EndoscopyUpper Endoscopy

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee). Esophagogastroduodenoscopy (also spelled oesophagogastroduodenoscopy) or panendoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). However, a sore throat is common.

ColonoscopyColonoscopy

Colonoscopy lets the physician look inside your entire large intestine (another name for the colon), from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine, the terminal ileum.

Dr. Crespin also treats a wide variety of conditions, including:

– Screening for Colon Cancer
– Reflux Disease (Heartburn)
– Abdominal Pain Constipation
– Diarrhea
– Irritable Bowel Syndrome
– Swallowing Disorders
– Bloating
– Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)
– Hepatitis B
– Hepatitis C
– Other Diseases of the Liver
– Celiac Disease

You can feel secure in knowing Westside GI Center’s outpatient procedures utilize the most advanced health care technology available to help meet your needs. We are proud to be your digestive specialist here in the Greater New York Area.


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The esophagus is a muscular tube that connects your throat to your stomach. With each swallow, the esophagus muscle contracts and pushes food into the stomach. At the lower end of the esophagus, a valve (a special sphincter muscle) remains closed except when food or liquid is swallowed or when you belch or vomit.

Esophageal testing or manometry measures the pressures and the pattern of muscle contractions in your esophagus. Abnormalities in the contractions and strength of the muscle or in the sphincter at the lower end of the esophagus can result in pain, heartburn, and/or difficulty swallowing. Esophageal manometry is used to diagnose the conditions that can cause these symptoms.

An empty stomach allows for the best and safest examination, so do not eat or drink anything for 6 hours before the test. Since many medications can affect esophageal pressure and the natural muscle contractions required for swallowing, be sure to discuss with your healthcare professional each medication you are taking. Your doctor may ask that you temporarily stop taking one or more medications before your test.

A healthcare professional will apply a cream to numb the inside of your nostrils. Then a thin, flexible, lubricated tube will be passed through your nose and advanced into your stomach while you swallow sips of water. Mild, brief gagging may occur while the tube is passed through the throat. When the tube is in position, you will be sitting upright or lying on your back while the tube is connected to a computer. Once the test begins it is important to breathe slowly and smoothly, remain as quiet as possible and avoid swallowing unless instructed to do so. As the tube is slowly pulled out of your esophagus, the computer measures and records the pressures in different parts of your esophagus.

During the test, you may experience some discomfort in your nose and/or throat. The test will take approximately 30 minutes to complete and the results will be sent to your doctor’s office.

After the test, you may experience mild sore throat, stuffy nose, or a minor nosebleed; all typically improve within hours. Unless your physician has given you other instructions, you may resume normal meals, activities, and any interrupted medications.

As with any medical procedure, there are certain risks. While serious side effects of this procedure are extremely rare, it is possible that you could experience irregular heartbeats, aspiration (when stomach contents flow back into the esophagus and are breathed into the lung), or perforation (a hole in the esophagus). During insertion, the tube may be misdirected into the windpipe before being repositioned. Precautions are taken to prevent such risks, and your physician believes the risks are outweighed by the benefits of this test.

In some situations, correct placement of the tube may require passage through the mouth or passing the tube using endoscopy (a procedure that uses a thin, flexible lighted tube). Your physician will determine the best approach.

Important Reminder:
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition. Please visit http://www.asge.org/patients/patients.aspx?id=6818 for more information.


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Upper endoscopy lets your doctor examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). Your doctor will use a thin, flexible tube called an endoscope, which has its own lens and light source, and will view the images on a video monitor. You might hear your doctor or other medical staff refer to upper endoscopy as upper GI endoscopy, esophagogastroduodenoscopy (EGD) or panendoscopy.

Upper endoscopy helps your doctor evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It’s the best test for finding the cause of bleeding from the upper gastrointestinal tract. It’s also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.

Your doctor might use upper endoscopy to obtain a biopsy (small tissue samples). A biopsy helps your doctor distinguish between benign and malignant (cancerous) tissues. Remember, biopsies are taken for many reasons, and your doctor might order one even if he or she does not suspect cancer. For example, your doctor might use a biopsy to test for Helicobacter pylori, the bacterium that causes ulcers.

Your doctor might also use upper endoscopy to perform a cytology test, where he or she will introduce a small brush to collect cells for analysis.

Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract. Your doctor can pass instruments through the endoscope to directly treat many abnormalities – this will cause you little or no discomfort. For example, your doctor might stretch (dilate) a narrowed area, remove polyps (usually benign growths) or treat bleeding.

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test. Bleeding can occur at a biopsy site or where a polyp was removed, but it’s usually minimal and rarely requires follow-up. Perforation (a hole or tear in the gastrointestinal tract lining) may require surgery but this is a very uncommon complication. Some patients might have a reaction to the sedatives or complications from heart or lung disease.

Although complications after upper endoscopy are very uncommon, it’s important to recognize early signs of possible complications. Contact your doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Note that bleeding can occur several days after the procedure.

If you have any concerns about a possible complication, it is always best to contact your doctor right away.

NOTE: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition. Please find out more at http://www.asge.org/patients/patients.aspx?id=378


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Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. These pockets occur when the inner layer of the digestive tract pushes through weak spots in the outer layer. A single pouch is called a diverticulum. The pouches associated with diverticulosis are most often located in the lower part of the large intestine (the colon). Some people may have only several small pouches on the left side of the colon, while others may have involvement in most of the colon.

Diverticulosis is a common condition in the United States that affects half of all people over 60 years of age and nearly everyone by the age of 80. As a person gets older, the pouches in the digestive tract become more prominent. Diverticulosis is unusual in people under 40 years of age. In addition, it is uncommon in certain parts of the world, such as Asia and Africa.

Because diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure within the digestive tract with straining during bowel movements. The combination of pressure and straining over many years likely leads to diverticulosis.

Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. It is possible that some people with diverticulosis experience bloating, abdominal cramps, or constipation due to difficulty in stool passage through the affected region of the colon.

Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen by other imaging tests, for example, computed tomography (CT) scan or barium x-rays.

Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms, and therefore do not need treatment. When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables or grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose or polycarbophil. These products come in various forms including pills, powders, and wafers. Supplemental fiber products help to bulk up and soften stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort.

Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer. Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation. Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess. Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum. Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. In this case, surgery may be necessary to remove the involved area of the colon.

Important Reminder:
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition. Please visit http://www.asge.org/patients/patients.aspx?id=6818 for more information.


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Polyps are benign growths (noncancerous tumors or neoplasms) involving the lining of the bowel. They can occur in several locations in the gastrointestinal tract but are most common in the colon. They vary in size from less than a quarter of an inch to several inches in diameter. They look like small bumps growing from the lining of the bowel and protruding into the lumen (bowel cavity). They sometimes grow on a “stalk” and look like mushrooms. Some polyps can also be flat. Many patients have several polyps scattered in different parts of the colon. Some polyps can contain small areas of cancer, although the vast majority of polyps do not.

Polyps are very common in adults, who have an increased chance of acquiring them, especially as we get older. While quite rare in 20-year-olds, it’s estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp. We don’t know what causes polyps. Some experts believe a high-fat, low-fiber diet can be a predisposition to polyp formation. There may be a genetic risk to develop polyps as well.

The biggest risk factor for developing polyps is being older than 50. A family history of colon polyps or colon cancer increases the risk of polyps. Also, patients with a personal history of polyps or colon cancer are at risk of developing new polyps. In addition, there are some rare polyp or cancer syndromes that run in families and increase the risk of polyps occurring at younger ages.

There are two common types: hyperplastic polyp and adenoma. The hyperplastic polyp is not at risk for cancer. The adenoma, however, is thought to be the precursor (origin) for almost all colon cancers, although most adenomas never become cancers. Histology 9examination of tissue under a microscope) is the best way to differentiate between hyperplastic and adenomatous polyps. Although it’s impossible to tell which adenomatous polyps will become cancers, larger polyps are more likely to become cancers and some of the largest ones (those larger than 1 inch) can already contain small areas of cancer. Because your doctor cannot be certain of the tissue type by the polyp’s appearance, doctors generally recommend removing all polyps found during a colonoscopy.

Most polyps cause no symptoms. Larger ones can cause blood in the stools, but even they are usually asymptomatic. Therefore, the best way to detect polyps is by screening individuals with no symptoms. Several other screening techniques are available: testing stool specimens for traces of blood, performing sigmoidoscopy to look into the lower third of the colon, or using a radiology test such as a barium enema or CT colonography. If one of these tests finds or suspects polyps, your doctor will generally recommend colonoscopy to remove them. Because colonoscopy is the most accurate way to detect polyps, many experts now recommend colonoscopy as a screening method so that any polyps found or suspected can be removed during the same procedure.

Most polyps found during colonoscopy can be completely removed during the procedure. Various removal techniques are available; most involve removing them with a wire loop biopsy forceps and/or burning the polyp base with an electric current. This is called polyp resection. Because the bowel’s lining isn’t sensitive to cutting or burning, polyp resection doesn’t cause discomfort. Resected polyps are then examined under a microscope by a pathologist to determine the tissue type and to detect any cancer. If a large or unusual looking polyp is removed or left for possible surgical management, the endoscopist may mark the site by injecting small amounts of sterile India ink or carbon black into the bowel wall. this is called endoscopic tattooing.

Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure. Possible complications, which are uncommon, include bleeding from the polypectomy site and perforation (a hole or tear) of the colon. Bleeding from the polypectomy site can be immediate or delayed for several days; persistent bleeding can almost always be stopped by treatment during colonoscopy. Perforations rarely occur and may require surgery to repair.

Your doctor will decide when your next colonoscopy is necessary. The timing depends on several factors, including the number and size of polyps removed, the polyps’ tissue type and the quality of the colon cleansing for your previous procedure. The quality of cleansing affects your doctor’s ability to see the surface of the colon.

If the polyps were small and the entire colon was well seen during your colonoscopy, doctors generally recommend a repeat colonoscopy in three to five years. If your repeat colonoscopy doesn’t show any indication of polyps, you might not need another procedure for an additional five years.
However, if the polyps were large and flat, your doctor might recommend an interval of only months before a repeat colonoscopy to assure complete polyp removal. Your doctor will discuss those options with you.

IMPORTANT REMINDER: The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition. For more information, please visit http://www.asge.org/patients/patients.aspx?id=396


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Your bowel must be clean so that your doctor can thoroughly examine your colon. Many patients feel that the bowel prep is the most difficult part of a colonoscopy. But it is important that you try your best to fully complete the prep.

Several types of bowel prep medications are available; the two medications used most often in bowel prep are described in the box on this page. Your physician may recommend one of these or other preps which are available. You will need to carefully follow your doctor’s instructions about the exact dose and timing of your prep. Some types of prep may be covered by your medical insurance. You’ll want to find out if you have any out-of-pocket costs.

Your doctor will prescribe the type of bowel prep that is best for you. You will receive specific instructions. In general, here is what you can expect:

  • Your doctor will prescribe the type of bowel prep that is best for you. You will receive specific instructions. In general, here is what you can expect:
  • Your doctor will tell you to change your diet at least one day before your colonoscopy. Usually you will need to limit your diet to clear broth, tea, gelatin desserts, ginger ale, sherbet, and clear fruit juices (the ones you can see through), such as apple juice.
  • You need to avoid gelatin desserts and liquids that are red or purple.
  • It is important to avoid dehydration during bowel prep. Drink more fluids than you usually do.
  • Your doctor will tell you exactly when to stop eating and drinking before your
    colonoscopy.
  • Follow carefully all the steps your doctor prescribes. Can I continue to take my current medications? Tell your doctor what medications you’re taking, especially aspirin products, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Most medications can be continued. Some can interfere with either the prep or the colonoscopy.

 

Your medical condition is the most important factor in deciding which type of bowel prep is best for you. Tell your doctor if you are pregnant or breast feeding, or if you have a history of bowel obstruction. Let the doctor know if you have high blood pressure. Also, mention if you have any heart, kidney or liver disease, or if you have had any of these diseases in the past. You need to mention any allergies you have to medications to the doctor. If you have had difficulty with a bowel prep in the past, be sure to mention this as well. Other factors in choosing the type of prep are the time of the colonoscopy appointment, individual preferences (taste and amount of medication), and out-of pocket costs.

The type and severity of side effects differ among patients. They also vary with the product used. Some patients have nausea, vomiting, bloating (swelling in the abdomen) or abdominal pain. A prep can cause kidney failure, heart failure or seizures, but this is rare. Your doctor will explain the possible side effects of the prep selected for you.

It is extremely important that your colon be thoroughly cleaned before your colonoscopy. This will let the doctor see any abnormalities, such as colon polyps, during the procedure. Polyps are small growths in the colon that could later turn into cancer. Cleansing the colon before a colonoscopy is called bowel preparation, or “prep.” It involves taking medication that causes diarrhea, emptying the colon. The medication is taken by mouth, and comes in liquid or tablet form. You will also need to change what you eat during the day or two before the colonoscopy.

NOTE: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition. Please find out more at http://www.asge.org/publications/publications.aspx?id=10094


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Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus. This occurs in the area where the esophagus is joined to the stomach.

It is believed that the main reason that Barrett’s esophagus develops is because of chronic inflammation resulting from Gastroesophageal Reflux Disease (GERD). Barrett’s esophagus is more common in people who have had GERD for a long period of time or who developed it at a young age. It is interesting that the frequency or the intensity of GERD symptoms, such as heartburn, does not affect the likelihood that someone will develop Barrett’s esophagus.

Most patients with Barrett’s esophagus will not develop cancer. In some patients, however, a precancerous change in the tissue, called dysplasia, will develop. That precancerous change is more likely to develop into esophageal cancer.

At the current time, a diagnosis of Barrett’s esophagus can only be made using endoscopy and detecting a change in the lining of the esophagus that can be confirmed by a biopsy of the tissue. The definitive diagnosis of Barrett’s esophagus requires biopsy confirmation of the change in the lining of the esophagus.

There are two main types of esophageal cancer: squamous cell cancer and adenocarcinoma of the esophagus. Squamous cell cancers occur most commonly in individuals who smoke cigarettes,use tobacco products and drink alcohol. In addition, African Americans are also at increased risk of developing this type of cancer. This cancer is also very common in many areas in Asia. The frequency of squamous cell cancer of the esophagus in the United States has remained the same. Another cancer, adenocarcinoma of the esophagus, occurs most commonly in people with GERD. It is also very common in Caucasian males with increased body weight. Adenocarcinoma of the esophagus is increasing in frequency in the United States.

The most common symptom of GERD is heartburn, a condition that 20 percent of American adults experience at least twice a week. Although these individuals are at increased risk of developing esophageal cancer, the vast majority of them will never develop it. In a few patients with GERD (about 10 to 15 percent of patients), a change in the lining of the esophagus develops near the area where the esophagus and stomach join. When this happens, the condition is called Barrett’s esophagus. Doctors believe that most cases of adenocarcinoma of the esophagus begin in Barrett’s esophagus.

Your doctor will first perform an imaging procedure of the esophagus using endoscopy to see if there are sufficient changes for Barrett’s esophagus. In an upper endoscopy, the physician passes a thin, flexible tube called an endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope has a camera lens and a light source and projects images onto a video monitor. This allows the physician to see if there is a change in the lining of the esophagus. If your doctor suspects Barrett’s esophagus, a sample of tissue (a biopsy) will be taken to make a definitive diagnosis.

Capsule Endoscopy is another test that has been used to examine the esophagus. In capsule endoscopy, the patient swallows a pill-sized video capsule that passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt. With capsule endoscopy, the physician is not able to take a sample of the tissue (a biopsy).

Both of these techniques allow the physician to view the end of the esophagus and determine whether or not the normal lining has changed. Only an upper endoscopy procedure can allow the doctor to take a sample of the tissue from the esophagus to confirm this diagnosis, as well as to look for changes of potential dysplasia that cannot be determined on endoscopic appearance alone. Barrett’s tissue has a different appearance than the normal lining of the esophagus and is visible during endoscopy.

Taking a sample of the tissue from the esophagus through an endoscope only slightly lengthens the procedure time, causes no discomfort and rarely causes complications. Your doctor can usually tell you the results of your endoscopy after the procedure, but you will have to wait a few days for the biopsy results.

Barrett’s esophagus is twice as common in men as women. It tends to occur in middleaged Caucasian men who have had heartburn for many years. There is no agreement among experts on who should be screened. Even in patients with heartburn, Barrett’s esophagus is uncommon and esophageal cancer is rare. One recommendation is to screen patients older than 50 years of age who have had significant heartburn or who have required regular use of medications to control heartburn for several years. If that first screening is negative for Barrett’s tissue, there is no need to repeat it. There is a great deal of ongoing research in this area and so recommendations may change. You should check with your doctor on the latest recommendations.

Medicines and/or surgery can effectively control the symptoms of GERD. However, neither medications nor surgery for GERD can reverse the presence of Barrett’s esophagus or eliminate the risk of cancer. There are some treatments available that can destroy the Barrett’s tissue. These treatments may decrease the development of cancer in some patients and include heat (radiofrequency ablation, thermal ablation with argon plasma coagulation and multipolar coagulation), cold energy (cryotherapy) or the use of light and special chemicals (photodynamic therapy).

It is necessary to discuss the availability and the effectiveness of these treatments with your gastroenterologist to be certain that you are a candidate. There are potential risks from these treatments and they may not benefit the majority of patients with Barrett’s esophagus. There is much research being conducted in this area; you should talk with your doctor about recommendations and guidelines.

Dysplasia is a precancerous condition that doctors can only diagnose by examining tissue samples under a microscope. When dysplasia is seen in the tissue sample, it is usually described as being “high-grade,” “low-grade” or “indefinite for dysplasia.”

In high-grade dysplasia, abnormal changes are seen in many of the cells and there is an abnormal growth pattern of the cells. Low-grade dysplasia means that there are some abnormal changes seen in the tissue sample but the changes do not involve most of the cells, and the growth pattern of the cells is still normal. “Indefinite for dysplasia” simply means that the pathologist is not certain whether changes seen in the tissue are caused by dysplasia. Other conditions, such as inflammation or swelling of the esophageal lining, can make cells appear dysplastic when they may not be.

It is advisable to have any diagnosis of dysplasia confirmed by two different pathologists to ensure that this condition is present in the biopsy. If dysplasia is confirmed, your doctor might recommend more frequent endoscopies, or a procedure that attempts to destroy the Barrett’s tissue or esophageal surgery. Your doctor will recommend an option based on how advanced the dysplasia is and your overall medical condition.

The risk of esophageal cancer developing in patients with Barrett’s esophagus is quite low, approximately 0.5 percent per year (or 1 out of 200 per year). Therefore, the diagnosis of Barrett’s esophagus should not be a reason for alarm. It is, however, a reason to have periodic upper endoscopy examinations with biopsy of the Barrett’s tissue. If your initial biopsies don’t show dysplasia, endoscopy with biopsy should be repeated about every three years. If your biopsy shows dysplasia, your doctor will make further recommendations regarding the next steps.

NOTE: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition. Please find out more at http://www.asge.org/patients/patients.aspx?id=8954


Dr. Jeffrey Crespin, MD

Dr. Crespin has been a practicing gastroenterologist in Manhattan for over ten years. Dr Crespin is a board certified gastroenterologist, who strives to provide the highest quality medical care and services in a compassionate, professional and personalized manner.

© 2016 Copyright by Jeffrey Crespin, MD. All rights reserved.