There was a time when the only way to address disorders and diseases of the gastrointestinal tract was with invasive surgeries. Many of these surgeries required days of recovery in the hospital or left patients with a diminished quality of life. Fortunately, the evolution of technologies and techniques means that doctors are able to do more investigative and therapeutic procedures noninvasively, with the use of endoscopy.
“Advancing a scope through the mouth is less invasive than cutting the skin,” says gastroenterologist Tamir Ben-Menachem, MD, interventional endoscopy lead for Overlook Medical Center. “Our ability to detect tiny cancers is vastly improved with modern endoscopes or colonoscopes equipped with ultra-high-definition cameras, and the use of magnifying lasers that allow us to see almost at the cellular level. Some of these devices are small and flexible enough to enter tiny canals in the liver and pancreas so we can treat conditions such as gallstones and pancreatitis nonsurgically. Perhaps the biggest game changer has been the development of endoscopic ultrasound. This technology allows us to evaluate and treat a multitude of conditions through the wall of the intestine without requiring skin incisions.”
Here, we take a closer look at some of the newer endoscopic procedures and techniques that allow our physicians to cure many benign and malignant diseases of the digestive tract, and treat previously untreatable conditions.
Through interventional endoscopy at Overlook, doctors often are able to remove tumors of the stomach and esophagus that are too big to remove with standard endoscopes. With endoscopic submucosal dissection, these tumors can be removed without standard open surgery. With one technique, says Dr. Ben-Menachem, he is able to use endoscopic tools to “tent” the tumor, creating a little hill, and then slice it from the bottom. In another technique, he can create a cushion around the tumor and then “scoop out” the tumor; the cushion protects the surrounding area and isolates the tumor.
Sometimes, however, the tumor is too deep. In such an instance, the tumor can still be removed minimally invasively, though not completely endoscopically. “It becomes a combined approach,” says Dr. Ben-Menachem. “We remove the entire tumor with the endoscope, purposefully leaving a small defect in the wall of the stomach or intestine. The surgeon is with us in the operating room and then closes the small defect laparoscopically. Thus, we can completely resect a tumor of the stomach or intestine while preserving the majority of the organ.”
Barrett’s esophagus is a precancerous condition of the esophagus that occurs as a result of long-standing reflux disease (heartburn). In some cases, tissue damage from acid exposure can progress from simple Barrett’s esophagus to precancerous lesions known as high-grade dysplasia. “We used to send people for surgery and often had to remove the esophagus for high-grade dysplasia, which diminishes quality of life,” says Dr. Ben-Menachem, one of few physicians in the state with extensive experience in endoscopic treatment of Barrett’s esophagus. “Now we don’t have to do that.”
If there are nodules on the esophagus, these are removed with endoscopic submucosal dissection techniques. If no nodules are present, a magnifying laser is used to map the precancerous lesions and early stage cancers caused by Barrett’s esophagus; these are treated with heat, using radiofrequency ablation (RFA). For people with deeper lesions, or those for whom RFA has not been effective, cryotherapy – freezing the lesion, rather than heating it – is another option. Treatments are painless, says Dr. Ben-Menachem. “Our patients are back in business the next day.”
Refining Bariatric Surgery
Thousands of bariatric procedures are safely performed in New Jersey every year; unfortunately, on rare occasions, surgical follow-up may be required. This could include addressing leaks in the digestive tract where connections are made, or scarring that prevents patients from swallowing properly. Many leaks can be treated with specialized endoscopic suturing devices, endoscopic stenting, adhesives and other techniques. For significant scarring, doctors can perform a series of dilations to stretch the scar tissue and open it, then put a temporary stent in the GI tract to prevent recurrence.
“We try to make these fixes in the least invasive ways possible, in collaboration with Overlook’s team of gastroenterologists and bariatric surgeons,” says Dr. Ben-Menachem. “We couldn’t do a lot of what we do without good surgical backup. We make decisions together, not in a vacuum.”
Palliative Treatment for Advanced Cancers
With advanced cancers of the gastrointestinal tract, it’s not uncommon for blockages to develop. As a result, patients often wind up with feeding tubes because they cannot eat, or with external drains because secretions pool and cause additional complications. Fortunately, with the latest generation of lumen-apposing metal stents (LAMS), doctors are able to create new internal bypasses instead of having to rely on external drains. The stent is put in with the aid of endoscopic ultrasound. Shaped like a dumbbell, it creates a bridge between the blocked organ and the intestine.
“It makes such a difference in quality of life,” says Dr. Ben-Menachem. “It’s so gratifying to be able to help our patients in this way.”
Dr. Ben-Menachem can be reached at 908-277-8940.