Dr Juan C. Gregory
Pediatric Gastroenterologist

Dr. Gregory received his medical degree at Texas Tech University Health Sciences Center in Lubbock, Texas. He did his pediatric residency training at the University of California-San Diego. Dr Gregory did his fellowship training at Children’s National Medical Center in Washington, DC. He has practiced at Blank Children’s Hospital in Des Moines, Iowa from 2000-2004. Dr. Gregory joined GI Consultants in July of 2004. Dr. Gregory’s speciality areas include gastroesophageal reflux, inflammatory bowel disease and feeding problems.

Our Philosophy
Dr. Gregory cares for newborn through teens with problems and diseases that effect the digestive system and liver. We strive to provide the highest level of care to each patient that comes through our door. Dr. Gregory will work to identify and understand the problems the child is having and then put together a plan for that child and family to help them on the road to a healthy, normal life.

We respect the confidence you have placed in GI Consultants and will at all times regard our relationship with the utmost trust, respect, and confidentiality. Should you at anytime have comments regarding the care provided by our doctors or staff, please feel free to contact our Executive Director at (775) 329-4600.

Your Child’s First Visit
Appointments may be scheduled by calling the office during regular office hours, Monday through Friday from 8:00 a.m. to 5:00 p.m.

Your child’s first visit with Dr. Gregory will probably be the longest. Please plan to be at our office for at least one hour. We ask that you arrive 30 minutes ahead of your child’s appointment to complete medical history and insurance information. You will need to bring the following information along to your child’s first appointment–unless our office has already received it:

• Referral from your child’s primary care provider for an office visit.
• Medical records from your child’s primary care provider.
• Results of any previous evaluations, including x-rays (bring films not just the reports.)
• Any information pertaining to prior pediatric GI evaluations, i.e., lab tests, procedures, procedure notes, biopsy results, etc.

Due to limited space and the ability to maximize your time with the doctor, please plan on bringing only the scheduled child to the appointment.

After Hours Care
If your child has an urgent GI health care need outside of our regular hours, please contact your primary care physician, and your call will be referred to us as necessary. You can feel confident your child will receive the highest level of care no matter when you need it. If it is a medical emergency, call 911 or go immediately to the Emergency Department of your local hospital.

Waiting
Dr Gregory will make every attempt to stay on schedule. It is difficult, however, to guarantee you will not have to wait past your appointment time. Occasionally emergencies do occur which may further affect the timeliness of the schedule. We will attempt to inform you of such delays. If waiting will be an inconvenience to you, we will reschedule your appointment to another time.

Esophagogastroduodenoscopy - EGD
Examination of the upper gastrointestinal tract.

Colonoscopy
Examination of the colon or large bowel.

Flexible Sigmoidoscopy
An examination of the lower portion of the large intestine.

Endoscopic Retrograde Cholangiopancreatography-ERCP
An examination of the bile and pancreatic ducts using xrays and radiographic dye injected via a thin tube which is passed through a special side-viewing endoscope.

Esophageal Manometry
Evaluation of the function of the esophagus by taking pressure measurements within the esophagus during swallowing.

Ambulatory Esophageal pH Probe
24 hour measurement of the acidity within the esophagus using a thin sensor
catheter attached to a mini-computer worn on a
belt.

EUS Imaging
EUS is a state-of-the art technology that combines endoscopy with ultrasound. By combining these two technologies, EUS is capable of detailed examinations of the lining and walls of the gastrointestinal tract and internal organs that lie next to the gastrointestinal tract such as the pancreas, bile duct and gallbladder.

Given Capsule
Is a first-line tool in the detection of abnormalities of the small bowel.
Capsule Endoscopy is utilized to diagnose diseases of the small intestine including Crohn's Disease, Celiac disease and other malabsorption disorders, benign and malignant tumors of the small intestine, vascular disorders and medication related small bowel injury.

Hemorrhoid BandingThe CRH O’Regan SystemTM

The “gold standard” for hemorrhoid banding, is a non-surgical hemorrhoid removal procedure that utilizes a small, single-use and disposable suction device. The procedure is quick, painless and highly effective (99.1%) with an average procedure time of 1 minute.  Typically there is no recovery time and pre/post medication is not needed.

BARRX Radiofrequency Ablation for Barrett's Esophagus

"Ablation" is a technique where tissue is heated until it is no longer viable or alive. Various forms of ablation have been used for nearly a century to treat a number of cancerous and precancerous conditions, as well as to control bleeding. The HALO ablation technology is a very specific type of ablation, in which heat energy is delivered in a precise and highly-controlled manner.

Ablation therapy is performed in conjunction with upper endoscopy and the treatment is performed in an outpatient setting.

For more information on Barrx, call our office at (775) 329-4600 or go to: www.barrx.com

Ascites

When fluid accumulates in the abdominal cavity, it is called ascites. Cirrhosis of the liver is the most common cause of ascites but other conditions such as heart failure, kidney failure, infection or cancer can also cause ascites.

Most patients who develop ascites notice abdominal distension and rapid weight gain. Some people also develop swelling of ankles and shortness of breath.

Depending on how much fluid is present in the abdomen, ascites may be diagnosed by your doctor on physical examination but is usually confirmed by tests such as ultrasound or CT scan of the abdomen. In the majority of patients, your doctor will recommend that a small needle be inserted through the abdominal wall (after local anesthesia) to remove fluid to be examined in the laboratory. This test is called a paracentesis. The fluid removed will be examined for signs of infection or cancer and to determine the cause for the fluid accumulation.

For more information on Ascites call our office at (775) 329-4600 or click here: 

     http://www.acg.gi.org/patients/gihealth/ascites.asp

Barrett's Esophagus

The esophagus is normally lined with squamous cells. When these cells are replaced by intestinal cells it is called Barrett's esophagus. This is a precancerous condition caused by repetitive damage to the esophagus lining.  The exact cause of Barrett's is not known, but the condition usually develops in people who have gastroesophageal reflux disease (GERD). Heartburn and acid reflux are the most common symptoms of GERD and result from stomach contents washing back into the esophagus. Risk factors for Barrett's esophagus also include an age greater than 55, male gender, Caucasian and Hispanic backgrounds and smokers.  Barrett's esophagus itself does not produce symptoms, but most people seek help because of symptoms related to GERD such as heartburn, and less commonly, difficulty swallowing.  Barrett's esophagus is diagnosed by performing an upper endoscopy or EDG procedure. During this procedure the doctor takes small samples (biopsies) of tissue from the esophagus. The biopsies are sent to the pathology laboratory where the pathologist (a physician who specializes in looking at specimens through a microscope) determines if the tissue shows changes at the cellular level in the area of the lower esophagus.  Treatment for Barrett's esophagus may start with controlling GERD by making a number of lifestyle changes. These actions include losing weight, avoiding foods that aggravate heartburn, smoking cessation if you smoke, taking antacids or stronger acid-blocking medications, and elevating the head of your bed to prevent reflux during sleep. The treatment of Barrett's esophagus also involves surveillance of the area by repeating an EGD according to national guidelines.

For more information on Barrett's call our office at (775) 329-4600

Chronic Hepatitis C

Hepatitis C is the most common blood-borne infection in the U.S. Approximately 2.7 million Americans are infected. Transmission of the virus occurs through contaminated blood through such activities as blood transfusion before 1991, intravenous drug use, occupational exposure, sexual contact, and possibly intranasal drug use, tattoos or body piercings. Most people have no symptoms and are surprised when they are informed of the diagnosis. Abnormal lab tests during routine physical examination, insurance applications or blood donations often prompt the hepatitis C investigation. People with symptoms most commonly have fatigue, muscle and joint pains, and right upper quadrant discomfort. The virus is diagnosed by blood tests. The most common screening test detects the hepatitis C antibody. If this test is positive, it means there has been past exposure to the virus (only rarely is the test falsely positive). Most people exposed to the virus have a chronic infection, as our body does not eradicate the virus by its own defenses very well. For more information on treating and living with Hepatitis C call our office at (775) 329-4600 or go to:

     National Institute of Health consensus paper on hepatitis C 2002.

     http://www.ncbi.nlm.nih.gov/pubmed/14768714

Colon Cancer

Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. The colon is part of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).  Colon and rectal cancers begin in the digestive system, also called the GI (gastrointestinal) system. The digestive system processes food for energy and the last part of it absorbs fluid to form solid waste (stool) that then passes from the body. In order to understand colorectal cancer, it helps to know something about the structure of the digestive system and how it works. After food is chewed and swallowed, it travels to the stomach. There it is partly broken down and sent to the small intestine. The word "small" refers to the width of the small intestine. In fact, the small intestine is the longest part of the digestive system -- about 20 feet. The small intestine also breaks down the food and absorbs most of the nutrients. It leads to the large intestine (also called the large bowel or colon), a muscular tube about 5 feet long. The colon absorbs water and nutrients from the food and also serves as a storage place for waste matter. The waste matter (stool) moves from the colon into the rectum, the last 6 inches of the digestive system. From there the waste passes out of the body through the opening called the anus. The wall of the colon and rectum is made up of layers of tissues. Colorectal cancer starts in the inner layer and can grow through some or all of the other layers. The stage (extent of spread) of a cancer depends to a great degree on how deep the cancer goes into these layers.
Abnormal growths in the colon or rectum
Cancer that starts in these different areas may cause different symptoms. But colon cancer and rectal cancer have many things in common. In most cases, colorectal cancers develop slowly over many years. We now know that most of these cancers start as a polyp -- a growth of tissue that starts in the lining and grows into the center of the colon or rectum. This tissue may or may not be cancer. A type of polyp known as an adenoma can become cancer. Removing a polyp early may keep it from becoming cancer.  Over 95% of colon and rectal cancers are adenocarcinomas. These are cancers that start in the cells that line the inside of the colon and rectum. There are some other, more rare, types of tumors of the colon and rectum, but the facts given here refer only to adenocarcinomas.

For more information on Colon Cancer call our office at (775) 329-4600 or go to:

     American Cancer Society www.cancer.org

Constipation 

Constipation is defined as infrequent bowel movements, hard to pass stools or straining during bowel movements that is troubling to the individual.  Frequency of bowel movements among healthy people varies widely from three bowel movements each day to three bowel movements a week.

Many factors can lead to constipation including a diet that is low in fiber, inadequate fluid intake, low levels of physical activity, medications, and poor bowel habits.  Medical problems that can cause constipation include diabetes, hypothyroidism, neurologic and connective tissue disorders, and colorectal cancer.  Alterations in bowel motility or the coordination of the muscles involved in having a bowel movement can also cause constipation.

Common signs/sypmtoms of constipation include:  passing stool fewer than 3 times a week, abdominal bloating, straining frequently during bowel movements, incomplete bowel movements, or having to apply manual pressure to have a bowel movement.

Treatment options include:  taking fiber supplements(Metamucil, Citrucel, etc), taking laxatives as well as various medical tests(Colonoscopy, Motility Study, etc).

For more information on Constipation call our office at (775) 329-4600

Diarrhea

Diarrhea, is derived from the Greek word "to flow through", and is a common problem for many people.  Because the range of normal stools is broad, it is not defined by the number of stools a person passes per day.  In general, acute diarrhea is defined as less than 14 days in duration and chronic diarrhea is defined as more than 30 days in duration.

Symptoms may be mild, such as painless and watery bowel movements, or more severe.  "Alarm" symptoms which generally require medical evaluation are severe abdominal pain, high fever, bloody stools, or symptoms of dehydration (dizziness, dry mouth and tongue, rapid pulse, dark urine).

The treatment of your diarrhea depends on its cause.  Mild symptoms can often be treated at home.  More severe symptoms may warrant a medical evaluation and occasionally hospitalization.

For more information on Diarrhea call our office at (775) 329-4600

Diverticulosis and Diverticulitis

Many people have small pouches that bulge outward through weak spots in their colon, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticula. The condition of having diverticula is called diverticulosis. About half of all Americans age 60 to 80, and almost everyone over age 80, has diverticulosis. Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. When the pouches become infected or inflamed, the condition is called diverticulitis. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning. The most common symptom of diverticulitis is abdominal pain. Fever, nausea, vomiting, chills, cramping, and constipation may occur as well. Diverticulosis and diverticulitis are also called diverticular disease. Rarely, complications such as infections, perforations or tears, blockages, or bleeding may occur as a result of diverticulosis. Increasing the amount of fiber in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends 20 to 35 grams of fiber each day. The doctor may recommend g a fiber product such as Citrucel® or Metamucil® once a day. These products are mixed with water and provide about 4 to 6 grams of fiber for an 8-ounce glass. Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An acute attack with severe pain or severe infection may require a hospital stay, bed rest, a restricted diet, and antibiotics given into a vein. In some cases, however, surgery may be necessary.

For more information on Diverticulosis/Diverticulitis call our office at (775) 329-4600

 Esophageal Cancer

The esophagus is a muscular tube that connects the mouth with the stomach. It carries food and liquids to the stomach. There are two main types of cancer that occur in the esophagus. Squamous cell carcinoma is more common in the upper part of the esophagus and adenocarcinoma is more common the lower part of the esophagus. Esophageal cancer affects men more often than women, affects African Americans more often than Caucasians and is more common in people over age 55.

The exact cause of esophageal cancer is unknown, but risk factors include alcohol use, smoking and obesity. The risk of esophageal cancer also increases with acid reflux. Over time, acid reflux can cause changes in the lining of the esophagus. This condition is known as Barrett's esophagus. Those with Barrett's esophagus have a higher risk of developing esophageal cancer.

For more information on Esophageal Cancer  call our office at (775) 329-4600 or go to:

     American Cancer Society www.cancer.org

Esophagitis

Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach.

Esophagitis is frequently caused by the backflow of acid-containing fluid from the stomach to the esophagus, a condition called gastroesophageal reflux disease (GERD).  An autoimmune disorder called eosinophilic esophagitis also causes this condition.

For more information on Esophagitis call our office at (775) 329-4600

Gastritis

Gastritis is an inflammation of the stomach lining. Many things can cause gastritis. Most often the cause is infection with the same bacteria -- Helicobacter pylori -- that causes stomach ulcers. An autoimmune disorder, a backup of bile into the stomach, or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can also cause gastritis. In some cases, the stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining.

The most common symptoms of gastritis are stomach upset and pain.

Gastritis can be caused by infection, irritation, autoimmune disorders (where the body' s immune system mistakenly attacks the stomach), or backflow of bile into the stomach (bile reflux).

Endoscopy of the stomach is the most common way to diagnose gastritis.  This is where a thin tube with a light and a camera on the end is inserted down your throat to your stomach. This allows the doctor to see into your stomach and take samples (called a biopsy) from the lining if needed. The laboratory tests you may need will depend on the cause of your gastritis. A stool test may be used to check for the presence of blood, or a biopsy may be taken of the tissues of your esophagus or stomach.

For more information on Gastritis call our office at (775) 329-4600

GERD (Gastroesophageal Reflux Disease)

Near the top of our esophagus is an area of muscle called the upper esophageal sphincter (UES). When we swallow, the UES relaxes and allows food to pass into the esophagus. The food then travels down the esophagus to another area of specialized muscle tissue called the lower esophageal sphincter (LES). The LES is located at the junction of the esophagus and the stomach. The job of the LES is to act as a one-way valve, allowing food to enter the stomach and prevent it from coming back up into the esophagus.

GERD occurs when the LES is too relaxed and does not prevent stomach fluids (stomach acid) and food from backing up into the esophagus. The lining of our esophagus is not protected from stomach acid, unlike the stomach's lining. The acid contact with the esophagus causes inflammation, and may cause irritation of the esophageal tissue. This leads to the symptoms of GERD.

Common GERD symptoms include:  Heartburn, Acid regurgitation, Hoarse or scratchy voice, or Difficulty swallowing.

Initial treatment of GERD involves lifestyle changes. Other treatments include: medications, endoscopic treatment of the esophagus, and surgery.

For more information on GERD call our office at (775) 329-4600.

Heartburn & Acid Reflux

An estimated 61 million Americans - or 44 percent of the U.S. adult population - have heartburn symptoms at least once a month. Of these, almost half have acid reflux disease, which is also known as gastroesophageal reflux disease (GERD).

Gastroesophageal reflux disease occurs when stomach acid backs up into the esophagus. Typical symptoms are heartburn and/or regurgitation. Less common GERD symptoms include persistent sore throat, hoarseness, chronic cough, asthma, the sensation of food or liquid in the throat, and even chest pain.

Factors which contribute to GERD symptoms include weight, smoking, age and pregnancy. Because of this, counseling, dietary support, patient education and lifestyle training are an important part of clinic services.

In addition, our state-of-the-art center provides specialized testing and treatment that is not widely available in the Northern Nevada area such as the GIVEN capsule and high resolution esophageal manometry.

For more information on Heartburn/Acid Reflux call our office at (775) 329-4600

Hemorrhoids

 
Hemorrhoids are swollen veins in the lower portion of the rectum or anus that may be internal (located inside the lower rectum) or external (under the skin around the anus). What causes hemorrhoids? Straining to move your bowels...Sitting too long on the toilet....Pregnancy and Childbirth What are the syptoms? Painless bleeding...Itching or pain in the anal region...Protrusion of internal hemorrhoid through the anus. Gastroenterology Consultants, Ltd., Removes the Need for Hemorrhoid Surgery with a Unique and Painless Procedure Performed in Less Than a Minute. Gastroenterology Consultants, Ltd., is now providing a treatment protocol that is clinically proven and utilizes the proprietary and patented CRH O'Regan SystemTM, which is effective, safe and painless. The CRH O'Regan SystemTM is only available to patients through specially trained and licensed medical providers. "Finally I have a safe and effective method to treat my patients with symptomatic hemorrhoids," said Dr. Craig Sande, President and CEO of Gastroenterology Consultants, Ltd. "The CRH O'Regan Hemorrhoid Banding Procedure has a 99.1% effectiveness rate and can be done in my office quickly and painlessly."

For more information on Hemorrhoid Banding call our office at (775) 329-4600

IBS (Irritable Bowel Syndrome)

Irritable bowel syndrome, or IBS is a condition associated with symptoms such as abdominal pain, bloating, and altered bowel function (constipation, diarrhea, or alternating pattern of constipation and diarrhea). Doctors call IBS a functional disorder. This means there is not a structural abnormality in bowel. Instead it is a problem with the way the bowels work. In IBS the nerves that control contractions in the bowels are extra sensitive to certain kinds of food, hormones, or stress.

There are defined criteria for the diagnosis of IBS. The diagnosis is based on a patient's symptoms and how long and how often the symptoms are present. The key clinical symptoms of IBS include abdominal pain that is associated with a change in frequency or consistency of the stool.

Your doctor will check to be sure that the symptoms are not due to other causes, if further work-up is needed. Various blood tests, x-rays, and examinations, such as sigmoidoscopy or colonoscopy may be done, but may not always be required.

Mild symptoms may be treated by eliminating food and drink that make the symptoms worse. Avoiding coffee/caffeine, alcohol, fatty foods, and dairy products may be helpful. If something seems to make it worse, eliminating it from the diet may be effective. Some medications may cause symptoms as well. Check with your doctor to help determine if medications may be a part of the problem.

Moderate symptoms that interfere sometimes with work, school, or social life may require keeping a diary. Keeping a list of your symptoms and associating what you are doing at the time of the symptoms can be very helpful in assessing the problem. Behavioral treatment for moderate to severe symptoms may include relaxation therapy, hypnosis, biofeedback, and cognitive-behavioral treatment. These kinds of treatment are recommended to help you cope better with your symptoms.

Severe symptoms may require treatment with antidepressants. These drugs act as pain relievers. They work by blocking or reducing pain sensations in your gut from reaching the brain.

For more information on IBS call our office at (775) 329-4600

 Ulcerative Colitis

Ulcerative colitis (UC) is a disease marked by inflammation of the lining of the colon and rectum, together known as the large intestine. This inflammation causes irritation in the lining of the large intestine which leads to the symptoms of UC. Though UC always affects the lowest part of the large intestine (the rectum), in some patients it can be present throughout the entire colon. UC belongs to a group of diseases called inflammatory bowel diseases which also includes Crohn's disease (CD).

The symptoms of ulcerative colitis depend on the severity of inflammation and the amount of the colon that is affected by the disease. In patients with mild to moderate inflammation, symptoms can include rectal bleeding, diarrhea, mild abdominal cramping, stool urgency, and tenesmus (discomfort and the feeling that you have not completely emptied your rectum after a bowel movement). When more severe inflammation is present, patients often develop fever, dehydration, severe abdominal pain, weight loss, loss of appetite or growth retardation (in children and adolescents with UC). Individuals with moderate or severe inflammation may also have to wake up at night to have bowel movements and may lose control of bowel movements.

All patients with symptoms consistent with UC should have a colonoscopy or flexible sigmoidoscopy to confirm the diagnosis assuming that they are healthy enough to undergo the procedure.

For more information on Ulcerative Colitis call our office at (775) 329-4600 or go to: 

    http://www.acg.gi.org/patients/gihealth/ulcerativecolitis.asp

Web Links for GI System and Illness

• American College of Gastroenterology 
• American Gastroenterological Association 
• American Liver Foundation
• American Association for the Study of Liver Diseases
• American Society for Gastrointestinal Endoscopy 
• Celiac Sprue Association 
• Northland Celiac Support Group NCSG
• Crohn's and Colitis Foundation of America  
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 
• National Center for Nutrition and Dietetics
• Hepatitis Foundation International 
• International Foundation for Functional Gastrointestinal Disorders
• Pediatic/Adolescent Gastroesophageal Reflux Association 
• United Ostomy Association 

(Click on images for larger view)

Endoscopic Ultrasound (EUS)
Endoscopy allows the visualization of the inner lining of the digestive system, such as the esophagus (feeding tube), stomach, small intestines and colon, with a flexible camera through the mouth or anus. Ultrasound uses high-frequency sound waves to image internal organs. EUS is a state-of-the art technology that combines endoscopy with ultrasound. By combining these two technologies, EUS is capable of detailed examinations of the lining and walls of the gastrointestinal tract and internal organs that lie next to the gastrointestinal tract such as the pancreas, bile duct and gallbladder.

When is EUS helpful?
EUS is a very sensitive test that may be helpful when other tests are inconclusive. There are numerous indications for EUS; here are some of the ways EUS can help:

• Evaluation of uncertain pancreas, bile duct or gastrointestinal wall/lining findings found on other tests (e.g. x-rays, CT scan, conventional ultrasound, MRI, upper endoscopy or colonoscopy)
• Checking for gallstones or common bile duct stones
• Determining the cause of pancreatitis
• Evaluation of pancreatic cysts
• Biopsy of lymph nodes close to the esophagus (swallowing tube), stomach, duodenum (first part of the small intestines) or rectum
• Biopsy of left adrenal gland lesions
• Biopsy of liver lesions that are close to the stomach
• Biopsy of spleen lesions
• Exclude esophageal or extrinsic cancers as the cause of swallowing difficulties
• Staging and diagnosis of the following cancers:
  

  
  

  	Esophagus (swallowing tube) cancer
  	Stomach (gastric) cancer
  	Rectum (rectal) cancer
  	Pancreas (pancreatic) cancer
  	Bile duct (cholangiocarcinoma) and ampullary cancers
  	Gallbladder cancer

• Lung cancer lymph node staging

What is cancer staging and why is staging important?
For cancer patients, staging describes the extent of a patient’s cancer, how early or advanced it is. Staging is important because it helps your doctors plan treatment (e.g. surgery, chemotherapy, radiation therapy, no treatment, etc.). EUS is the most accurate non-invasive way to determine the local extent of many gastrointestinal (GI) cancers (T stage), such as those listed above. In addition, EUS can be used to biopsy many tumors or lymph nodes close to the digestive tract.

What are some alternatives to EUS?
Prior to EUS, many digestive disorders and cancers were difficult to diagnosis or exclude because they can be hidden “deep” beneath organs and intestines. EUS can image or “see” beneath the surface of the digestive tract and into internal organs adjacent to the gastrointestinal tract. The close proximity of the EUS imaging probe allows very detailed images that can provide additional information when other tests are inconclusive.

In patients with suspected cancer, biopsies of cancer tissue (“tissue diagnosis”) are needed to confirm the diagnosis before any treatment can be started. CT scan (CAT scan) or conventional ultrasound-guided biopsies are good methods for “tissue diagnosis” in tumors close to the skin. However, EUS is safer and more accurate for “deep” tumors, such as those listed above. EUS can biopsy from across the digestive tract (esophagus, stomach, intestines and rectum) avoiding damage to overlying vital organs and blood vessels. Surgery for a diagnosis is an alternative to EUS but is much more invasive and requires general anesthesia.

Why should you choose to have your care with Gastroenterology Consultants?
Gastroenterology Consultants is currently the only and first practice to offer endoscopic ultrasound (EUS) in Northern Nevada and Reno. EUS requires highly sophisticated and advanced medical equipment that is available only at few highly specialized medical centers. With the support of Renown (Washoe) Regional Medical Center, the most current and best EUS technologies are available to Dr. Chen. The American Society for Gastrointestinal Endoscopy (ASGE) stated: “the limited availability of EUS is largely due to the lack of skilled endosonographers” [physicians with specialized training and expertise to perform EUS]. Dr. Chen trained at one of the few ASGE recognized EUS training institutions. He has published numerous medical articles on EUS in national peer-reviewed medical journals, and has been an invited speaker at national medical meetings.