I'm Dr.
Walid Chalhoub, and I am one of the advanced endoscopists here
on MedStar Georgetown University Hospital.
Advanced Endoscopy is a field in GI
that deals with procedures that are not basic endoscopies.
Basic endoscopies are upper endoscopies,
such as an EGD, which is something that just goes into the esophagus,
stomach, and small intestines and deals with just basic GI
diseases, and colonoscopies are endoscopies
that go into the colon and deal with basic colon diseases.
Advanced endoscopy has more advanced
procedures such as ERCP's, EUS's,
and Endoscopic Submucosal Dissections.
It needs a whole level of extra training.
And this extra training
helps us go into minimally
invasive techniques
that deal with bile duct diseases that deal
with pancreatic diseases, that deal with pancreatic duct diseases. And
these procedures
help patients go into a minimally invasive way of dealing
with both malignant and benign diseases.
ERCP is a technique which is an endoscopic technique.
We can actually go inside the bile duct and try to deal with diseases of the bile
duct itself, that being benign diseases such as stones or strictures
or even malignant diseases such as cancers of the bile duct
and an ERCP has no cutting from the outside of the body.
That's why these procedures are very
helpful with patients and
they go more with the nonsurgical route, and patients
like them more in a way where they are
minimally invasive versus a more surgical, more invasive technique.
I'm not saying that they take over surgery,
but they are primarily the first mechanism of dealing with biliary disease,
it being
benign or malignant
initially.
Colon cancer is very prevalent and
when somebody has a family history of colon cancer, they have
to be very aware that they are
at an increased risk of developing it.
Other conditions that increase the risk of developing it is if they have
genetic disorders that actually put them at that higher risk as well.
And those disorders are usually either things
that they have known since they were born or
things that they have passed on in their family too.
Smoking actually increases their risk as well.
Their race increases the risk as well.
All these are factors that put
patients in certain categories of having increased risk of colon cancer,
and that needs to be discussed with a primary care physician.
Screening for colon cancer is imperative and very, very important.
The new
guidelines for screening have changed recently
and the age for screening has changed
for all races dropping down the screening age to 45 most recently
It was 50 for everybody and now we're going with 45. So, this is something that I would like
all my patients to be very aware of that they need to start screening earlier.
We are seeing a lot of pathology in much younger patients these days
and that's why screening, again, I cannot stress on how much imperative
screening for colon cancer is these days.
Yes, we do
specifically in patients that are very young.
So, depending on if somebody is, for example, 55
and they do have a cancer, then probably not.
But if it's somebody who's 19 and has it, then yes, then there's something
obviously very evidently wrong or in somebody
who's younger than 45, usually there's something going on that's not
usually normal.
So, those are the patients that we always do refer to genetic counseling.
Pancreatic cancer is a very evolving field
and it's research is very evolving as well.
What was known five years ago is very different, than what was known
ten years ago is very different than what was known two weeks ago.
And it's more of a consensus, more than a guideline.
And with the most recent consensus, pancreatic cancer
screening has changed recently.
So, the most recent consensus is,
in patients with a family history
of somebody who in their immediate
family was less than 50 who had it,
and they have high
risk as well, high risk predisposition for them to develop it,
are now being deemed eligible for screening.
There's no really one screening technique to do this.
So, endoscopic ultrasound, which is something we do here at Georgetown,
is a technique for actually screening them,
which is also an endoscopic technique, is just like a regular endoscopy,
but the endoscope itself has an an ultrasound potential,
which is very easy just to take a look at the pancreas and see if there's
any lesions within the pancreas that are possibly cancerous.
And we're trying to actually create a registry
of these patients who are at high risk for pancreatic cancer development.
So, these patients have a higher risk of developing pancreatic cancer
if they are genetically predisposed, number one, or
if they have specific lesions in their pancreas
at a young age, such as pancreatic cysts as well.
When you're at high risk, it depends on age, number one,
family history, number two, and what types of lesions
in the pancreas you have, number three, going on.
And here at Georgetown, we're trying to develop registries
where we categorize these patients and try to put them into into different
categories, really,
so that we can follow them and develop more guidelines into screening them.
The screening criteria for colon cancer would be age for
45, family history, history of polyps in your family
and then any genetic predisposition in the family as well.
These are like the major things that we do look for, for screening in
colon cancer.
Not getting screened is just putting yourself at risk
because humans, at the end of they make polyps, and polyps,
if left in place long enough, do progress to cancer.
So, the whole point of colonoscopy is saving lives, and they do.
Because, just like we make hair and nails on the outside of our bodies,
we make polyps on the inside of our colons.
So, we need to go in and give our colon that hair cut
it needs every time on a schedule.
Blood thinners are some of the medications that we do
advise our patients to stop prior to colonoscopies.
Really instantaneously.
Once you wake up, I tell you exactly what I found just because
colonoscopies are visual exams. I examine your colon visually.
I take a look, I see polyps, I take them out.
If I see cancer, I tell you, I think this looks malignant or not.
Just because we removed polyps during colonoscopy,
it's not like you have a quota in your life that you made these three polyps
and that's it.
Once a polyp maker, always a polyp maker.
That's what I tell my patients.
And that's why you have to come back and the time interval
for you to come back is catered or tailored
to how many and to what size of polyps I took out during your colonoscopy.
So, let's say I took out one very small polyp,
then you come back in seven to ten years.
If I took out a larger polyp, then you come back in about three years.
So, depending on what size and how many polyps I took out
during a colonoscopy, is the time that you have to come back.
It's what your genetics are composed of is what puts you to that risk
and for that risk.
So really, that's why you have to get these done
MedStar Georgetown
University Hospital is one of the pretty much first
university hospitals here in the region to establish a fellowship
in GI. I think
that educating fellows and residents
in a program and teaching them keeps a program on its toes and
on its cutting edge of excellence and education.
And I think that is what puts us... this is one of the things that puts us
at a higher bar
of being one of the more superior programs probably
on the East Coast, if not the nation, number one.
Number two is our multidisciplinary approach to patients.
So, it's not just a GI program,
it's a GI program that's married to a surgical program,
that's married to a radiology program, that's married to an I.R.
program. We all work together for a patient.
It's not just a GI person doing a procedure for one patient.
So, this is what's very nice about the MedStar team, is not just a GI team.
The MedStar team is a GI team and a surgical team and again, an I.R. team.
And we all come together to make sure that our patient gets exactly what they need.