August 26, 2013
Endoscopic gastroenterologist Anu Mathew, MD, shows Donald Cook an area of concern on an image of his esophagus.
When Donald Cook, 77, ate a meal, he felt full very quickly.
Diagnosed with a hiatal hernia years ago, the retired engineer was accustomed to having the occasional digestive issue. When his symptoms — including a 25-pound weight loss — became too severe to ignore, he visited gastroenterologist Joseph Fares, MD.
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This article appears in the September - October 2013 edition of HealthBeat, John C. Lincoln's free health newsletter.
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The specialist confirmed the hiatal hernia during an endoscopy — a procedure using a thin, flexible tube with a small camera inserted through the mouth and into the esophagus. Biopsy of a suspicious nodule confirmed stage 1 (the earliest) cancer.
Donald's general surgeon, Sam Durrani, MD, wanted more information. He called on the expertise of gastrointestinal endosonographer Anu K. Mathew, MD.
"We needed to see if the cancer had spread into the wall of the esophagus," Dr. Durrani said. "If it had, we would need to remove the esophagus. In a way, Donald was fortunate to have the hiatal hernia because it led us to the early stage cancer, which had no symptoms."
Dr. Mathew performed an endoscopic ultrasound — endoscopy with a miniature ultrasound probe. "Fortunately, the cancer had not spread deep into the esophageal wall; we could remove it," she said. In a procedure a week later, she scraped away the top two layers of the affected part of Donald's esophagus. "We left behind a very thin muscle layer."
Fast Facts About Barrett's Esophagus
- Barrett's esophagus has no symptoms other than the typical ones of acid reflux (or gastroesophageal reflux disease — GERD).
- Barrett's esophagus occurs in approximately 13 percent of Caucasian men over the age of 50.
- The incidence of esophageal cancer is rising faster than breast cancer, prostate cancer or melanoma.
- Men develop Barrett's esophagus twice as often as women, and Caucasian men are affected more often than men of other races.
Donald then had laparoscopic hiatal hernia surgery at John C. Lincoln Deer Valley Hospital. Dr. Durrani used only a few small incisions that caused Donald little pain.
But his challenges weren't over yet. A follow-up endoscopy revealed one more issue: Barrett's esophagus with dysplasia — abnormal cell development — where the initial cancer started.
With Barrett's esophagus, parts of the esophageal lining change into intestinal lining due to damage from chronic stomach acid.
Patients with Barrett's esophagus may develop this dysplasia and a higher risk of esophageal cancer.
Over the last several months, Dr. Mathew has performed three procedures to remove Donald's Barrett's cells at John C. Lincoln North Mountain Hospital. She uses sophisticated new radiofrequency ablation (RFA) equipment that eradicates a thin layer of diseased tissue, allowing new healthy tissue to grow.
"It looks much better," Dr. Mathew said. "Mr. Cook still has reflux and will need to take medication to prevent more Barrett's cells from forming." A couple of islands of Barrett's cells remain and will be removed during follow-up RFA procedures.
"It's been challenging," Donald said of his journey back to good health. "But I'm gaining back the weight. I'm happy to be back in the gym and feeling much better."
For more information, please visit JCL.com/endoscopy.
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