Category Archives: Patient Care

Push to Screen, Treat Baby Boomers for Hepatitis C Virus

In 2012, the U.S. Centers for Disease Control (CDC) recommended one-time screening for hepatitis C virus (HCV) for all adults born from 1945 to 1965 – the “baby boomers.”1 Pennsylvania and New York state legislatures have passed laws making it mandatory for health care providers to offer HCV screening or diagnostic testing for all baby boomer patients.2,3 According to Thomas R. Riley, III, MD, gastroenterology and hepatology, Penn State Health Milton S. Hershey Medical Center, “We just aren’t seeing the numbers of HCV cases that we know are out there in this population; this tells us that it isn’t being detected.” Continue reading

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Exercise as Medicine for Gastro-Intestinal Cancer Surgery Patients

Photo of man in a gym ssetting, holding a towel around his neck.Exercise interventions that increase physical activity prior to a patient undergoing surgery or during chemo/radiotherapy for colorectal cancer and other types of cancer have demonstrated improvements in daily activities, social activity, and fatigue, anxiety and depression.1 “If exercise were a drug, it would have no trouble getting FDA approval,” says Niraj J. Gusani, MD, associate professor of surgery, medicine and public health sciences, Penn State Health Milton S. Hershey Medical Center. Dr. Gusani and Amanda B. Cooper, MD, assistant professor of surgery, have launched rigorous research programs for patients with upper GI cancers, studying the effects of physical activity as it relates to recovery from surgery and long-term survival.

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Advances in Living Donor Liver Transplantation

To better meet the increasing need for liver transplantation in the U.S. and expand the potential donor pool, living donor liver transplantation (LDLT) is an increasingly viable option.1-3 According to Karen Krok, MD, transplant hepatologist at Penn State Health Milton S. Hershey Medical Center, “Advances in the surgical procedure and donor selection have made the process safer. Overall, donors fare remarkably well afterward. We have had donors who run a marathon within a year after donation!” Dr. Krok directs the LDLT program, where a total of 12 LDLT procedures have been performed since its inception in 2008, with no donor deaths. 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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Providing Hope to Patients with Carcinomatosis: Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Mucin covering the liver

Mucin covering the liver

For patients with peritoneal dissemination of an abdominal malignancy (e.g., carcinomatosis), cytoreductive surgery (CRS) paired with hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly increase survival time.1 According to Colette Pameijer, M.D., FACS, associate professor of surgery, “The CRS/HIPEC technique offers hope to these patients. It adds a significant amount of time to their lives, which would otherwise be counted in months, rather than years.” Metastatic cancer cells implanted within the peritoneal cavity or its surfaces are not detectable by CAT scan, and do not respond well to standard resection and systemic chemotherapy. Patients with carcinomatosis who receive palliative treatment have a median survival time of six months.1 Continue reading

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Large Colorectal Polyp Morphology Predicts Endoscopic Management Patterns

As techniques and technology have rapidly advanced over the past decade, endoscopy has had a large impact on how many gastrointestinal (GI) conditions are treated. “One of the biggest shifts we have made clinically in terms of the number of patients treated is endoscopic resection of large colorectal polyps,” says John Levenick, M.D., Penn State Hershey Gastroenterology and Hepatology. In the past, these would have been automatically referred for open or laparoscopic resection. However, not all large polyps exhibit the same clinical features and some pose relatively greater challenges and risks during resection. Levenick and colleagues determined how well an endoscopic approach performed for management across polyp types based on gross morphology. Continue reading

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