Study Examines Effectiveness Of Minimally Invasive Endoscopic Procedure For Removing Esophagus

Better outcomes reported from high-volume providers of complex endoscopic procedure

The research, published in Clinical Gastroenterology and Hepatology, examined national outcomes from endoscopic treatment compared to esophagectomy, surgical removal of the esophagus. It found that endoscopic therapy offered long-term survival rates similar to those for esophagectomy, says lead author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic in Florida. "Endoscopic resection in the esophagus is similar to how we remove polyps in the colon, although it is much more technically complex. Esophagectomy is a major surgical procedure that cuts out the entire esophagus, and pulls the stomach into the neck to create a new food tube," Dr. Wallace says. "Our study on national outcomes, as well as our own experience with the procedure at Mayo Clinic in Florida, suggests that both offer the similar changes for cure and long-term survival," he says. "Patients now have the option to preserve their esophagus when only early stage cancer is present." The research looked at national outcomes from the two procedures in patients with esophageal adenocarcinoma, the most common type of esophageal cancer in the United States. The research team examined data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. They identified 1,619 patients with superficial, early stage esophageal adenocarcinoma who had endoscopic therapy (19 percent) or surgery (81 percent) from 1998 through 2009. Many of these patients were treated for cancers that arose from Barrett's esophagus, a condition in which the cells in the lower part of the esophagus morph into a precancerous state. The researchers collected survival data through the end of 2009, and found that endoscopy therapy increased progressively - from 3 percent in 1998 to 29 percent in 2009 - and was more often used in older patients. After adjusting for patient and tumor factors, the researchers concluded that patients treated by endoscopy had similar overall survival times compared to surgery. article

The Endoscopists Influence on Endoscopic Test Characteristics

ERCP is the most complex endoscopic procedure performed by gastroenterologists, with about 500,000 performed in the United States each year. According to the article "Lower Provider Volume Is Associated with Higher Failure Rates for Endoscopic Retrograde Cholangiopancreatography," physicians who performed fewer than 117 ERCPs each year were grouped as low providers, and those who performed more were classified as high providers, based on the authors' analysis. Nearly 90 percent of ERCP providers perform fewer than two ERCPs each week. ERCP is performed to diagnose and treat conditions of the bile duct and pancreatic duct. Conditions that could necessitate the use of ERCP include gallstones, acute and chronic pancreatitis with a blockage, or an obstruction from a malignant tumor such as pancreatic cancer. The procedure is usually performed under general anesthesia. Failure rates following the procedure were defined as patients who required a second ERCP or a related procedure, including surgery, within seven days of the first procedure. Other than failure or a complication from the first ERCP, it is exceedingly unlikely that a patient should require a second procedure in such a short time frame. "Risks of the procedure are essentially doubled with a second ERCP," said Gregory A. Cote, M.D., M.S., the paper's first author and an assistant professor of medicine at the Indiana University School of Medicine Division of Gastroenterology and Hepatology. Those risks include tearing of the intestinal wall, pancreatitis, internal hemorrhage, complications from anesthesia, and infections. "Having two interventions in such a short time span induces substantial anxiety for patients and their loved ones, and the implications on health care costs are clear. In a fee-for-service reimbursement structure, there is little incentive to minimize or eliminate these repeat procedures." Using data collected by the Regenstrief Institute, Dr. Cote and colleagues found that 116 of the 130 doctors surveyed did two or fewer ERCPs a week, or fewer than 117 ERCPs per year. more bonuses

Various kinds of endoscopy include laparoscopy for the abdomen, colonoscopy for the large intestine, bronchoscopy for the lungs and cystoscopy for the urinary system. Enteroscopy An enteroscopy is a procedure using a thin, flexible tube to visually examine and take biopsies of the small intestine. Preparation for the exam includes having nothing to eat after midnight on the day of the procedure and having only clear liquids until four hours prior to the procedure, notes MedlinePlus. Diseases of the small intestine diagnosed using an enteroscopy procedure include polyps, ulcers, Crohn's disease and lymphoma. Endoscopic Retrograde Cholangiopancreatography An endoscopic retrograde cholangiopancreatography, or ERCP, is a diagnostic procedure that allows the physician to observe problems within the gallbladder, pancreas, liver and bile ducts, according to the National Digestive Diseases Information Clearinghouse. An ERCP procedure requires the swallowing of the endoscope as the physician guides it through the esophagus, stomach and duodenum. Dye inserted through the scope into the ducts allows visualization of abnormalities such as a gallstone or cancer. Preparations for an ERCP include nothing to eat or drink for six to eight hours prior to the procedure. You Might Also Like The Best Diet Pre-Colonoscopy Endoscopic Ultrasound The endoscopic ultrasound evaluates gastrointestinal and lung diseases. A small ultrasound transducer passed through the anus or the mouth provides images of the surrounding organs and tissues. Images of the esophagus, pancreas, gallbladder, liver and intestinal lining provide diagnostic evaluation for masses, bile duct stones and chronic pancreatitis, as well as for staging cancers, such as pancreatic, lung, rectal and esophageal cancers. Endoscopic Treatments Uses for the endoscope go beyond diagnostic procedures to include several types of endoscopic therapies. Transoral flexible endoscopic suturing enables the placement of stitches to increase lower esophageal sphincter pressure in the treatment of gastroesophageal reflux disease, or GERD. Dilation procedures to open abnormally narrowed passageways include inflating a balloon passed through the region using endoscopy. conversational tone

Endoscopy Procedures

Because this article serves to illustrate a principle, we do not dwell on any particular type of endoscopy, and we chose general illustrative data for the sensitivity and specificity of the two matrices. The analysis illustrates that the endoscopists contribution always decreases the overall test performance. The amount of decrease depends on the endoscopists skill set in eliciting a diagnostic sign and interpreting the sign correctly. As a diagnostician, the endoscopist cannot measure beyond his or her own level of competence. The overall test performance may decrease even further if more than one physician is involved in the diagnostic process. Multiple factors influence the diagnosticians performance as captured by the endoscopists (ES) matrix, such as experience, knowledge, dexterity, quality of instrumentation and technical support, procedural time, diligence, intelligence, and other innate talents. Fortunately, most of these contributing factors are amenable to training and can be improved through outside influences. The analysis also highlights the importance of non-endoscopist care providers (e.g., referring physicians, primary-care providers) who must interpret the findings and recommendations communicated to them in endoscopy reports. Fortunately, this too may be improved through training, education, and effective communication via complete and unambiguous endoscopy records. Most analyses that study the characteristics of endoscopic tests tend to focus on the general performance measures of the endoscopic procedure and ignore the contribution of the individual endoscopist to a successful test outcome. In many situations of testing, however, there may exist a very sensitive and specific relationship between the underlying endoscopic sign and a given disease, yet the diagnosis of the endoscopic sign itself is fraught with errors, which render the endoscopic test less suitable for clinical practice. We also tend to confuse an excellent test with our personal ability to actually perform the test, and we fail to account for the fact that our own level of competence affects the test outcome. We cannot elicit a diagnostic sign that we do not know. you can try these out