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
Historically, the worst part of having a colonoscopy is the preparation of clearing the colon of stool. This is by far the most important step as the cleaner the colon at the time of the preparation, the more polyps are found. Most Gastroenterologist have adopted the split dose prep, which involves placing the patient on clear liquids the day before, and giving the prep solution ( laxatives) the evening before and the morning before the procedure. While this achieves a cleaner prep then in the past when the entire prep was given the night before, it is extremely difficult for the patient. Generally started in the evening, patients are usually up most of the night running to and from the bathroom. This can in many cases lead to dehydration. Just when you think you are finished , the second part of the prep is given causing more trips to the bathroom. In the morning food and liquid are not allowed to be consumed prior to the colonoscopy. By then most patients are dehydrated and wiped out, and migraines from not being allowed to have your morning dose of caffeine are a frequent occurrence.
The literature has clearly shown that this grueling process is unnecessary. There are multiple studies which have proven that a clear liquid diet the day before not only is not required, but can actually reduce the tolerance of a bowel prep. Studies have shown that eating a low residue diet ( any food except nuts, seeds, fruits and vegetables) improve both the tolerance and efficacy of a bowel prep. In addition, 20 years ago the Japanese proved that a full morning prep achieves the same if not better results than a night time or split dose prep.
At Monmouth Digestive health, Dr Gorcey has taken the literature to heart. Three full meals the day before are encouraged, and no laxatives are given before sleep. The only dietary restrictions are no nuts, seeds, fruits or vegetables for 3 days prior to the procedure. The clean out process begins in the morning, between 4 - 6 hours before the time of the colonoscopy. Prior to starting the prep, patients are allowed to have coffee or tea without milk or cream. The entire prep time takes 2 hours , during which time the patients drink 2 liters over 2 hours. Half of this liquid is water or any clear liquid, the other half is the prep solution. We encourage the "shot glass method" pioneered by Dr Gorcey, where 2.5 ounces are swallowed every five minutes. This minimizes nausea due to the fact that by the second "shot", the first has already emptied out of the stomach. A minimum of 2 hours NPO (no food or liquids) is required leading up to the procedure. There is no time for dehydration to occur, and caffeine deprivation migraines are eliminated.
But the advances utilized by Dr Gorcey Don't end with the preparation ! During the colonoscopy it is important to inflate the colon with gas so the creases in the colon flatten out. This allows polyps to be found. The majority of Gastroenterologists accomplish this using plain air. The problem with air is that it has to come out the same way it goes in, namely from the rectum. Air can be trapped in the intestines causing discomfort , bloating, and in some cases severe pain. Dr Gorcey exclusively use carbon dioxide (CO2) for colon inflation. The benefit is that CO2 is absorbed by the lining of the colon, enters the blood stream , and is taken to the lungs where it is exhaled. Trapped gas and post procedure bloating is a thing of the past when CO2 is used.
Of course the most important aspect of the colonoscopy is finding polyps. This is done as the colonoscope is slowly withdrawn. Most gastroenterologist perform the withdrawal with regular white light. Dr Gorcey utilizes new technology called Narrow Band Imaging for his withdrawals. This allows faster and more accurate appreciation of even the most subtle polyps.
Why don't all gastroenterologists use these techniques ? Simple. Most doctor's are resistant to change, or ignorant of the literature. They do what is comfortable for them and generally are under concerned with the comfort of the patient. It's easier to do what you have always done than to adopt new technology and techniques. Having been a patient and having undergone 5 colonoscopies himself, Dr Gorcey has constantly striven to improve the process. There is no easier or better way to have a colonoscopy than what is offered at Monmouth Digestive health, where the patient always comes first.