Advanced technology aids treatment of gastrointestinal cancer, pre-cancer

July 16, 2019 | by Edward-Elmhurst Health

“I had developed a fear about the prep for the colonoscopy and had avoided the procedure,” says Holly Lindstrom, 75, who had experienced gastrointestinal symptoms for a year without relief after making dietary changes.

“When I took a friend to his colonoscopy, I talked with a nurse there who calmed my concerns about the prep and strongly urged me to get my colonoscopy done.” Lindstrom moved forward with the test.

Lindstrom's exam showed two polyps, one of which was removed during the procedure. However, the second polyp was too large and required consultation with Edward-Elmhurst Health gastroenterologist Gonzalo Pandolfi, M.D., a specialist in advanced therapeutic endoscopy, to discuss a procedure called endoscopic submucosal dissection (ESD).

In ESD, gastroenterologists use flexible, tube-like imaging tools called endoscopes. High definition imaging and special instruments allow for improved visibility and precise dissection.

Dr. Pandolfi is one of only a few advanced therapeutic endoscopists in the Chicago area with the specialized training needed to perform ESD.

“ESD is designed to remove early cancer and large premalignant lesions in the esophagus, stomach and large intestine in one piece,” says Dr. Pandolfi. “This allows for a complete resection, a better pathological exam and also helps with staging of cancers.”

The ESD procedure was originally developed in Japan for the removal of gastric tumors. However, in the U.S., it’s used more commonly for colon cancers, which are more prevalent here. Prior to the availability of ESD, removal of a large, premalignant lesion or early stage neoplasm in the intestinal tract would have required traditional piecemeal removal via endoscopic mucosal resection (EMR). EMR is associated with higher rates of recurrent neoplasm and/or the need for invasive surgery with increased cost, hospitalization days, risk (morbidity and mortality) and longer recovery.

“In Ms. Lindstrom’s case, we removed a 3.5 centimeter rectal tumor with a small area of superficial high-grade dysplasia and early cancer,” says Dr. Pandolfi. “This was a complete curative resection for something that would have previously required large radical resection of the rectum with temporary or permanent colostomy.”

Instead, Lindstrom went home the same day, took it easy for a few days and returned to normal activities.

Jim Stevens, 54, had his first colonoscopy 10 years ago as recommended by his physician without any significant findings. Ten years later, his next screening exam showed five polyps, one of which required Dr. Pandolfi’s expertise.

“Mr. Stevens had a 5 centimeter tumor on his rectum, which showed high-grade dysplasia, the most advanced changes you can see before the tissue turns into cancer,” says Dr. Pandolfi. “We removed the polyp in one piece and he went home that day.”

“I felt a little pressure while in recovery, just after the procedure,” says Stevens. “Other than that, I haven’t experienced any symptoms or effects. I’m 100 percent back to normal.”

“My wife and I went in for consultation with Dr. Pandolfi and he described everything,” says Stevens. “He explained why this polyp couldn’t be removed during the initial colonoscopy and what we could do with better tools. He prepared me for everything.”

“The man is a born teacher,” says Lindstrom. “He spent as much time with us as we needed engaging, explaining, even drawing pictures on a whiteboard. He thoroughly explained the procedure to us and told us what we were dealing with. We left feeling like we had something to take care of, but not as though it was the end of the world.”

Lindstrom and Stevens both share a desire to encourage everyone to have their doctor-recommended colonoscopies on time.

“How different my life could have been if I hadn’t done that colonoscopy,” says Lindstrom.

Stevens sums up his experience with early detection and ESD simply, “For my life, I’m grateful.”

The American Cancer Society recommends beginning regular colonoscopy screening at age 45 for people with average risk for colorectal cancer. Discuss your risk factors and what’s best for you with your physician.

Learn more about Edward-Elmhurst Health’s gastrointestinal care.

Learn more from Healthy Driven Chicago:

Eight tips for better digestive health

Colonoscopy: What to expect before, during and after

GERD may be to blame for frequent heartburn

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