Advances in Gastroenterology – The Future is Exciting
By Josh George, MD, Gastroenterology Associates of North Texas, LIVING WELL Magazine
Technological advances are all around us. We are constantly bombarded with advertisements for faster technology, better imaging and state of the art equipment. We have seen these changes in the field of gastroenterology. New endoscopic equipment has allowed us to better manage patients with several different digestive disorders from reflux disease to gastrointestinal (GI) cancers. We are able to diagnose cancers earlier and help in the comprehensive management of these patients. New technology allows us to treat precancerous conditions before they have a chance to become cancer.
One major advance in gastroenterology has been the development of endoscopic ultrasound (EUS). EUS combines two modalities for better imaging. One facet of EUS is the traditional endoscopic portion, which allows us to visualize the GI tract with a thin, flexible scope. The scope is inserted via the mouth, in cases of upper endoscopy, or via the rectum, in cases of a colonoscopy. The second facet of EUS involves the ultrasound transducer on the end of the scope. With the ultrasound component we can be in the GI tract endoscopically, but also visualize the surrounding organs including the pancreas, gallbladder and liver. This ability to see beyond the traditional endoscopic realm is important for cancer staging. The depth of cancer penetration is a crucial component in decision making. With EUS, the layer of cancer origination as well as the depth of local spread can be determined with over 90% sensitivity.
In addition, EUS can allow the early detection and management of cancers such as pancreatic cancer. As we know, pancreatic cancer is one of the most lethal cancers and unfortunately it is diagnosed late due to vague symptoms. EUS has become the gold standard in staging several GI cancers, including esophageal, pancreatic, stomach and rectal cancer. EUS is also being used in cases of suspected gallbladder disease. As stated, the endoscope is advanced into the stomach and from the stomach we can visualize the gallbladder with great accuracy to rule out gallbladder sludge or even small gallstones.
Another common disorder seen is gastroesophageal reflux disease (GERD). Reflux affects close to 25 – 40% of individuals at some point in their lives. Chronic reflux can lead to acid related complications such as ulcers and Barrett’s esophagus. Barrett’s is when the lining of the esophagus changes from its normal flat appearance on a microscope to a precancerous change which looks like tall columns on the microscope. Barrett’s is important is because of its risk of esophageal cancer. Esophageal cancer is rapidly rising in incidence and it has a poor prognosis with only a 15% five-year survival. Therefore, early detection and treatment is important.
Close to 6 – 20% of patients with reflux have evidence of Barrett’s at the time of endoscopy. There are risk factors for Barrett’s including reflux symptoms for over 10 years, age greater than 50 with reflux, white males and reflux symptoms despite reflux medications. Individuals with such symptoms and characteristics should seek medical care to assess their risk of Barrett’s esophagus. Historically, Barrett’s esophagus was monitored for progression and if signs of cancer or near cancer were seen, then surgery was the next step in management. Unfortunately the surgery, called esophagectomy, can be a very morbid procedure.
Early detection is important and there are now treatment options, which were not readily available a few years ago. One such therapy is radiofrequency ablation. In its simplistic form, it is the process of burning off the bad, Barrett’s tissue and allowing the new, normal tissue to develop in its place. Ablation therapy uses a heat that is transmitted via a catheter, which is placed through the endoscope directly onto the Barrett’s tissues. The advantage of ablation is that there is controlled depth of treatment, which limits complications allowing us to aggressively treat the bad, precancerous area. The results have been outstanding with over 95% eradication of the Barrett’s esophagus. This response is amazing and the ability to remove a precancerous condition in a safe manner is just another exciting advancement in the field of gastroenterology.
If you have questions about GERD, endoscopic ultrasound, or Barrett’s esophagus, we would be happy to meet with you. Staying abreast of technologic advances is important to us in order to provide the best care for our patients. We have 17 board certified gastroenterologists to provide quality and compassionate care for you and your family.
For more information about us you can also visit our website at gantgi.com.