Utilizing a combination of EMR (endoscopic mucosal resection), ESD (endoscopic submucosal dissection) , and in the most difficult cases Laparoscopic assisted endoscopic resection, extremely large precancerous polyps can be removed obviating the need for a surgical resection which carries a 14% morbidity . Dr Gorcey has removed hundreds of large complex polyps from the GI tract including colonic, gastric and duodenal saving these patients from unnecessary surgery.
With over 30 years of experience, and over 20,000 colonoscopies performed, Dr Gorcey possesses the expertise necessary for even the most difficult colonoscopies and polyp resections. Due to his advanced training in lesion resection including ESD (Endoscopic Submucosal Dissection) and EMR (Endoscopic Mucosal resection) , Dr Gorcey is also an expert in repairing complications such as bleeding or perforation, preventing the need for emergency surgery in most cases.
Dr Gorcey reaches the end of the colon in over 99% of his procedures, insuring a complete exam in the majority of cases. In addition, his adenoma detection rate or ADR, which is the percentage of patients he finds pre cancerous polyps in patients over 50 years of age, is greater than 50%. National average runs between 25 and 30 % This is a truly objective criteria which as it increases has been shown to reduce the incidence of colon cancers missed in between interval surveillance colonoscopies. Dr Gorcey uses NBI (narrow band imaging) technology to enhance his polyp detection rate during all his exams.
After having many colonoscopies performed on himself, Dr Gorcey has made the process of bowel preparation as easy as possible. Patients are allowed to eat low residue foods such as pasta, rice, potatoes, eggs, meat, chicken fish and shellfish up to and including the dinner the night before. In most cases the actual bowel prep does not start until the morning of the procedure. Utilizing the lowest volume possible, most patients can drink 2 liters over 2 hours utilizing the "shot glass technique" drinking 2-3 ounces every 5 minutes.
Dr Gorcey uses carbon dioxide instead of air during the procedure. What does this mean for the patient? Air is what most gastroenterologists use to inflate the colon during a colonoscopy. Air is not absorbed in the GI tract and has to be passed after the procedure. If too much air is used, or the procedure is long, and in many other circumstances, the patient may not be able to pass the gas and severe abdominal bloating and pain can occur. CO2 gets rapidly absorbed by the lining of the colon so patients don't have to pass the gas. Recovery is faster and there is no gas bloat syndrome. Dr Gorcey introduced CO2 colonoscopy to Monmouth county in 2014. Even though it has become more available many doctors still prefer to use air
While complications like perforation (making a hole in the colon) or bleeding ( after removing a polyp) are infrequent, many are referred for emergency surgery. Due to Dr Gorceys training and experience with advanced lesion resection and other advanced interventional procedures, he is proficient in endoscopically closing these holes if they occur, and treating large bleeding blood vessels successfully. In the majority of cases emergency surgery can be averted by these techniques
Dr Gorcey only uses state of the art, colonoscopes which are high definition, macro zoom/ High focus capable, and can visualize with standard white light as well as Narrow Band Imaging (NBI) which enhances mucosal features . For large polyp resection he uses the most advanced cautery systems which translates to increased safety for the patient. For difficult colons Dr Gorcey uses, and was one of the principal investigators for the Olympus Scope Guide system which with the use of magnets shows real time position of the colonoscope on the screen, eliminating guess work about where the colonoscope is forming loops. CO2 is available for all colonoscopies as mentioned above.
Image of the colonoscope on the Olympus Scope guide system
Different looping patterns of the colonoscope that can be seen withe the Olympus scope guide system
Polyps that may be missed with white light stand out with NBI. Dr Gorcey is one the few gastroenterologists to perform withdrawel during colon cancer screening fully under NBI visualization. More polyps are found faster like this which shortens procedure time without sacrificing adenoma detection rate
NBI is also used to better delineate the borders of large flat polyps during EMR (endoscopic mucosal resection)
The most advanced ERBE electrical generators are used during advanced lesion resections