Our GI Oncology Program offers advanced staging and minimally invasive management techniques for many patients with cancers or precancerous states in the esophagus, stomach, small intestine, colon, pancreas, bile duct, and liver.
For patients with Barrett’s Esophagus, we have been providing Radiofrequency Ablation (Barrx) with excellent success. This endoscopic procedure is over 90% successful in eradicating Barrett’s, and 5-year data demonstrate no evidence of recurrences following treatment in over 92%. We are one of the busiest and experienced centers in the Northeast and one of the top 35 in the country.
For patient with early esophageal cancer, we are able to provide curative resection via endoscopy via Endoscopic mucosal resection (EMR) for smaller lesions and Endoscopic Submucosal Dissection (ESD) for larger lesions. These are endoscopic techniques that can be curative, thus preventing what would formerly have required surgical removal of a large part of the esophagus. ESD, developed in Japan and largely practiced in Asia, is available in only 20-25 centers in the United States. As of this writing*, we are the only center performing ESD in the State of CT and have had excellent results. Following successful endoscopic resection patients in whom cancer arose in the setting of Barrett’s are enrolled in our Radiofrequency Ablation Program to eliminate the risk of future esophageal cancers. We have also used EMR and ESD to provide curative resection for early stomach and colon cancers as well as for patients with tumors residing under the surface of the stomach lining.
Endoscopic Ultrasound (EUS) is an important tool to determine how advanced of GI cancers are (staging). We are one of the busiest and most experienced EUS centers in the country. In addition to assisting with determination of whether a GI tumor may be treated by endoscopy alone, EUS is also extremely important in determining the best treatment approach when more advanced tumor stages preclude endoscopic therapy. EUS tumor staging assists surgeons and oncologists to determine if a patient’s tumor is best managed by surgical resection alone, chemotherapy and/or radiation therapy followed by resection, resection followed by chemotherapy and/or radiation therapy, or chemotherapy and/or radiation therapy without surgery. EUS findings are an important part of the discussion that regularly takes place at our multi-disciplinary (GI-Surgery-Oncology) meetings at which difficult patient problems are fully discussed and cooperative plans made. EUS staging thus maximizes benefit while minimizing risk, reduces the likelihood of a patient undergoing unsuccessful surgery, and expedites the delivery of the latest and most appropriate care.
At our center, we are actively studying pancreatic cystic neoplasm, a pre-cancerous condition of the pancreas. We are actively participating in a multicenter study (10 centers across the country) studying pancreatic cyst management. The study is looking at how to better determine which patients with precancerous cysts can safely be watched and which are best managed by pancreatic surgical resection. The results appear likely to change the recommended management of cysts and should allow for greater avoidance of unnecessary surgery. For non-surgical candidates in whom cyst fluid analysis suggests a high risk of progression to pancreatic cancer, endoscopic (EUS-guided) intra-cystic alcohol injection can be employed to assist in the destruction of such lesions.
We also routinely perform endoscopic (minimally invasive) palliation techniques for patients with complications of cancer. Abdominal pain can be improved by EUS-guided celiac plexus neurolysis (injection of alcohol into the pain-sensing nerves around a tumor) in patients with incurable cancer. This reduces the need for narcotics. Endoscopic radiofrequency ablation can also be used to control rectal bleeding from radiation proctitis following treatment of prostate cancer.