Endoscope Offers Smart Fixes for Your Serious Digestive Problems

Works for achalasia, some gastric and esophageal cancers
abdominal pain

Today, many GI tract diseases that once required surgery can be treated without incisions. Two such conditions include achalasia, a swallowing disorder, and early-stage gastric and esophageal cancers.

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The techniques use specially equipped endoscopes, instruments that allow doctors to perform procedures by going through the patient’s mouth. The doctors then use surgical tools attached to the end of the scope.

“The endoscope is expanding the type of procedures we’re doing,” says Matthew Kroh, MD, Director of Surgical Endoscopy at the Cleveland Clinic’s Digestive Disease Institute.

“Now, we can treat diseases that once required open surgeries by using an endoscope without an incision,” says gastroenterologist Amit Bhatt, MD.

How POEM can help swallowing disorders

Known as a peroral endoscopic myotomy (POEM), the minimally invasive procedure is used to treat the swallowing disorder known as achalasia. The disease affects the lower esophageal sphincter, the muscle that allows food to pass from the esophagus into the stomach. When there is no food present, the muscle keeps the opening closed to prevent any stomach acid reflux from coming up into the esophagus.

With achalasia, the muscle is too tight, so when people swallow, it fails to loosen enough to allow food to pass into the stomach from the esophagus. Patients then have difficulty swallowing.

According to Dr. Kroh, people can experience chest pain and feel the food stuck in their throat. In severe cases, it can lead to malnutrition, vomiting and even aspiration of food particles into the lungs, which can cause pneumonia.

If the condition is not treated medically or surgically, over time the esophagus can stop working. A surgeon may have to remove it entirely. The cause of achalasia remains unknown.

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POEM, an endoscopic procedure that takes between one and three hours to complete, can effectively relieve the swallowing disorder without need surgery.

ESD: Getting to gastric tumors early

Originally developed in Japan, the ESD (endoscopic submucosal dissection) technique is a minimally invasive procedure used to remove early stage tumors of the esophagus, stomach and colon with an endoscope while avoiding surgery.

According to Dr. Bhatt, “ESD allows for complete, one-piece resection of cancers. This is a great benefit because this minimally invasive procedure can allow a pathologist to verify that it was curative – similar to a surgically removed tumor.

Dr. Kroh explains, “In the past, when we found these early cancers, typically it required removal of that organ, so if you had stomach cancer, for example, the stomach would have to come out.”

Now, doctors have the option to use the endoscope to cut out these tumors. “We can cut out these layers within the GI tract as long as the cancer is confined to the innermost surface layer called the mucosa,” Dr. Kroh says.

Doctors perform the procedures in the operating room with general anesthesia. However, they can remove the cancerous tumor completely without ever making an incision.

The goal of ESD is to be curative. But, Dr. Kroh adds, if it is not possible to remove all the cancer this way, it still gives the team a better idea of how advanced the disease is prior to surgery.

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Another important aspect of these cases is the collaboration between gastroenterologists and general surgeons. “For instance, when a surgeon and a gastroenterologist do a gastric case together, the beauty of it is that even if it doesn’t come out endoscopically, the patient can still get the next less invasive technique,” Dr. Kroh says.

Dr. Bhatt agrees. “Having an advanced endoscopist and a surgeon work side by side allows us to combine our expertise, ideas and innovations to develop novel approaches to problems,” he says.

Minimally invasive, quicker recovery

When using endoscopic techniques, surgeons don’t have to remove as much as they would when performing a larger, open surgery. These minimally invasive procedures also significantly reduce the patient’s recovery time.

A total stomach removal, for example, requires the patient to stay in the hospital for between five and seven days. A laparoscopic procedure results in a stay of between three and five days. Patients need only stay overnight after an endoscopic procedure. Generally, they can return to work within a day or two, experts say.

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