IBD Center Opens at Penn State Health Milton S. Hershey Medical Center

Koltun-articleThe Inflammatory Bowel Disease (IBD) Center at Penn State Health Milton S. Hershey Medical Center is one of only a small handful of such centers in the U.S. providing nationally-recognized care to patients suffering from IBD and other related disorders, including Crohn’s disease and ulcerative colitis. Walter A. Koltun, M.D., FACS, FASCRS, chief, division of colon and rectal surgery, and director of the IBD Center, says, “This past spring, since the doors to the new IBD Center opened, physicians specializing in IBD treatment work collaboratively to bring the full spectrum of IBD care under one roof. This dramatically streamlines care for patients with IBD, so that all or most of their needs are coordinated and provided in a single setting.” Continue reading

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Routine Prophylactic Indomethacin for All ERCP Patients Called Into Question

Findings from a randomized, placebo-controlled, double-blind clinical trial raise doubts about the usefulness of indomethacin for prophylaxis of pancreatitis in all patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).1 Consecutive ERCP patients randomized to receive a single dose of indomethacin (100 mg, rectal) prior to ERCP failed to exhibit any statistically significant decrease in the occurrence of post- ERCP pancreatitis (PEP) (7.9 percent), compared to patients randomized to placebo (4.4 percent). The indomethacin and placebo groups were also similarly likely to experience hospital readmission within 30 days following ERCP (Figure). Continue reading

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Multi-Gene Panels—Changing Our Approach to Hereditary GI Cancers

Multi-gene panels can have a significant impact on the successful identification of patients with or at-risk for hereditary gastrointestinal cancers, such as those associated with Lynch syndrome. According to Maria J. Baker, Ph.D., professor of medicine and genetic counselor, medical geneticist, hematology and oncology, “Multi-gene panels can screen for up to 72 different genes or more, depending on the laboratory, using a single blood sample and eliminating the need for a time-consuming sequence of tests. This can reduce overall costs and shorten the ‘diagnostic odyssey,’ potentially reducing stress for the patient than with traditional sequential genetic testing.” Continue reading

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Variants of Unknown Significance (VUS) and Other Uncertain Findings

The majority of variants of uncertain significance (VUS) end up being normal polymorphisms that are not linked to increased cancer risk. Rarely, a VUS is later reclassified as a pathogenic variant that would then inform medical management recommendations. In these cases, patients with the reclassified VUS are contacted for follow-up consultation, sometimes years after the gene test was performed.

The presence of a newly identified pathogenic variant can also raise difficulties for advising patients. The result may be found in a gene for which we do not yet appreciate the full spectrum of cancers and the lifetime risks associated with these cancers, and screening recommendations are not necessarily developed. Continue reading

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Prophylactic Total Gastrectomy to Manage Hereditary Gastric Cancer Risk

Roux-Y reconstruction with esophagojejunostomy. ©Steinemann et. al.; licensee BioMed Central Ltd. 2011.

Roux-Y reconstruction with esophagojejunostomy. ©Steinemann et. al.; licensee BioMed Central Ltd. 2011.

CDH1 mutations encompass the majority of high-genetic risk stomach cancer cases, marked by onset at a relatively young age (30 to 50 years old) and a prominent family history of either gastric cancer or lobular breast cancer, also associated with CDH1 mutations. Joyce Wong, M.D., director of robotic surgical oncology, Program for Liver, Pancreas and Foregut Tumors, Penn State Cancer Institute, says, “Prophylactic total gastrectomy is recommended for patients with a CDH1 mutation, since more than 80 percent of these individuals would otherwise eventually develop gastric cancer.”1 Women often postpone prophylactic gastrectomy until after full development or childbearing, while men often undergo the procedure soon after a positive gene test. At Penn State Cancer Institute, total gastrectomies for such patients are routinely performed using a minimally-invasive robotic approach, which reduces recovery time and the risk for post-operative infection. Continue reading

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Endoscopic Suturing Device Allows for More Reliable Repair of Duodenal Perforations and Potentially Safer NOTES

Endoscopic suturing device technology has improved in recent years. In addition, it has brought improved success in the immediate repair of selected GI perforations and the potential to allow natural orifice transluminal endoscopic surgery (NOTES) to be performed in a safer and more effective way.1 Marking the first documented use of the Overstitch™ endoscopic suturing device (Apollo Endosurgery, Austin, Texas) for the repair of a duodenal perforation in conjunction with a NOTES abdominal washout, the Penn State Health Milton S. Hershey Medical Center team of Abraham Mathew, M.D., Matthew T. Moyer, M.D., M.S., and fellow, Ryan Gaffney, D.O., presented their success with this technique at the third annual American College of Gastroenterology international endoscopy video competition in October 2015, Honolulu, Hawaii.2 The video presented two cases in which surgery-sparing endoscopic repair of a duodenal perforation was successfully employed. As Dr. Gaffney explains, “In both cases, the risks of morbidity or mortality with open or laparoscopic surgery were considered very high and an endoscopic approach was regarded as a potentially safer, life-saving option.”

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History of Pneumonia Presents Major Risk Factor for Aspiration or Pneumonia Following Routine Ambulatory Endoscopy

As the number of ambulatory endoscopies increases, it is imperative to identify and work to prevent complications. Respiratory complications are considered the most common associated with such procedures (including coughing, fever and shortness of breath) and are documented for an estimated 5.3 percent of patients following an ambulatory endoscopy where propofol was administered.1 Abraham Mathew, M.D., and Lisa Yoo, D.O., Gastroenterology and Hepatology, found that 1.1 percent of adults who underwent a routine ambulatory endoscopy experienced pneumonia or aspiration within 30 days after the procedure. The vast majority of cases involved pneumonia, while cases of aspiration were very low (0.07 percent).

Clinical Characteristics Chart

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