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    CPMC Experts at Digestive Diseases Week

    New Research on Gastrointestinal Disorders Being Presented by CPMC’s Experts at Digestive Diseases Week

    March 27, 2014

    Researchers in CPMC’s interventional endoscopy team will present new findings next month at the Digestive Diseases Week (DDW) congress, the world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

    Interventional endoscopy allows gastroenterologists to diagnose gastrointestinal (GI) disorders and perform surgical procedures. Drs. Kenneth Binmoeller, Janak Shah, Yasser Bhat and Chris Hamerski are at the forefront of clinical research as the first endoscopists to investigate and clinically utilize many of the new micro-instruments for detecting and treating GI disorders.

    New treatments for Barrett’s esophagus

    At the DDW meeting, CPMC’s GI team will lead a video presentation on a new treatment for long-segment Barrett’s esophagus, a condition in which the tissue lining the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach—is replaced by tissue that is similar to the intestinal lining.

    Currently, most endoscopists who treat Barrett's esophagus remove nodular lesions with endoscopic mucosal resection (EMR) followed by radio frequency ablation—a medical procedure that uses heat generated from high frequency alternating current. However, this strategy samples only a small portion of the Barrett’s segment. Additionally, there is concern for "buried Barrett's glands" hidden beneath the ablated lining.

    A new method—circumferential EMR with temporary metal stent placement—not only provides a more accurate pathologic diagnosis, as the entire Barrett's segment is theoretically removed and sent to pathology, it may also improve the chances for long-term eradication of Barrett's esophagus.

    Managing patients with surgically altered GI anatomy

    In a subsequent oral presentation at the DDW meeting, the GI team will compare two interventions in patients with surgically altered GI anatomy. Dr. Bhat and his colleagues found that endoscopic ultrasound (EUS)-guided interventions were significantly more successful than standard ERCP (endoscopic retrograde cholangiopancreatography), especially in certain types of gastric bypass patients.

    These findings are based on a retrospective study that included patients with surgically altered anatomy who had already undergone either EUS or ERCP biliary intervention. The decision of which method to use was at the discretion of the attending endoscopist, however the findings of this study demonstrate the advantages of “on demand EUS” in centers performing ERCP (like CPMC).

    Additional research updates among the GI team

    Three other projects will be described at the DDW meeting, as poster presentations:

    Feasibility of EUS-directed biliary stone removal without fluoroscopy in patients with uncomplicated choledocholithiasis: A technique that could help minimize patients’ and providers’ exposure to radiation during bile duct stone removal.

    Underwater Endoscopic Mucosal Resection (UEMR) without submucosal injection of polyps with prior resection attempts: An overview of the CPMC interventional endoscopy team’s method of resection of colon polyps that have been incompletely removed at outside facilities. Patients in this study had their polyps removed endoscopically by CPMC’s experts, and were spared from surgery.

    EUS-guided interventions decrease the rate of therapeutic biliary ERCP failures: Comparison of ERCP outcomes at centers with and without interventional EUS. This abstract compared the outcomes of ERCP in centers with and without EUS capability, and found that the availability of interventional EUS significantly decreased ERCP failures. These findings further demonstrate the importance of EUS in centers performing ERCP.