Transcription:
Advanced Treatment Options for Stomach and Digestive Issues

Bill Klaproth (Host): So if you've got a stomach or digestive issue, you'll be seeing a gastroenterologist most likely who will use a minimally invasive advanced procedure such as an endoscopic ultrasound to help diagnose the issue. So what do you need to know about these advanced procedures? Let’s find out with Dr. Gurtej Malhi, a gastroenterologist with Dignity Health Medical group. Dr. Malhi, thank you for your time.

Gurtej Malhi, MD (Guest): Hey, Bill. Thank you for having me here. It’s great to be here.

Host: You bet. So let’s jump into this. What is an endoscopic ultrasound?

Dr. Malhi: Endoscopic ultrasound is like an endoscopy procedure where we use a camera which has an ultrasound probe in front of it and we do the ultrasound from inside the gastrointestinal system. So what we do is it’s like the endoscopy. We go through the mouth into the stomach and the first portion of the small intestine. Then we do ultrasound of your internal organs. There are various utilities of this procedure because we can see the organs very closely because when we do ultrasound from the outside, there is a lot of artifact from the air in the bowel. So we cannot see certain organs very well from outside. So it has a lot of great benefit from doing endoscopic ultrasound to see those organs.

Host: So doctor, what are some of the common conditions then this is used to screen for and treat?

Dr. Malhi: So endoscopic ultrasound over the last several years has come up with greater utility in different diagnostic and therapeutic interventions. Common conditions are the cancer staging, mainly for the esophageal, pancreas, rectal cancer staging to see how deep the tumor is going into the wall of intestine. It helps us with the staging so that we can manage the tumors better. Also through the ultrasound camera, we can even do biopsy of the tumor. Some of the tumor where traditionally we used to biopsy under the CT guidance or even during the open surgery or laparoscopy to do the biopsy. But with endoscopic ultrasound, we can see those lesions very well from inside and have a better access to do the biopsy. One thing is decreased the seeding of the tumor when we do the biopsy. Another thing is we can see those organs better and have a better accessibility with less complications.

Host: You really do get an inside view. I think I already know the answer, but what are some of the benefits of this compared to traditional open surgical techniques.

Dr. Malhi: So traditionally a lot of biopsies we were doing under CT guidance. Once of the concern with the CT guidance was that we were not able to access certain lesions because of the prevalence of blood vessels. Or when they biopsied the lesion, then there was risk of seeding the tumor or spreading the tumor outside of the main area. With endoscopic ultrasound, one thing is that when we access these kinds of lesions, we can see where the blood vessels are and try to avoid those blood vessels. Also the tumor seeding is way less than other methods. Also it is very minimally invasive. So it does not require any laparoscopy or any other surgical procedures.

Host: So is everyone a good candidate for these advanced GI techniques?

Dr. Malhi: Most of the patients are a very good candidate. Most of our patients are done under deep sedation. We do not require general anesthesia. As long as they don’t have major cardiovascular symptoms or any recent cardiovascular event, patients are able to tolerate procedure very well without any complications.

Host: So is there anything patients need to do in advance of a procedure like this?

Dr. Malhi: Mainly if we need to do the biopsy on a lesion, if the patients are on blood thinner, we stop the blood thinner at least two to five days depending on what kind of blood thinner they are on. They have to be fasting for eight hours prior to the procedure. Besides that, nothing else is required.

Host: What about recovery? Are there any after effects at all?

Dr. Malhi: Most of my patients are able to go home the same day and they recover very well. The complication risk is very, very low. Next day they are able to go back to work.

Host: So what are some of the common procedures, then, you perform with this? Such as the ECRP, the complex polyp removal, and the radiofrequency ablation. Can you touch on each of those for us?

Dr. Malhi: Yes. We do perform ERCP where we do intervention in the pancreas and the bile duct, especially for bile duct stone. When they are complex stone, we do lithotripsy where we can go into the bile ducts and break the stone down and remove the large stones. For bile duct stricture or narrowing in the bile duct, which can happen from various conditions, we can provide a stenting of the bile duct to help drainage of the bile into the intestine, especially when patients are jaundiced or their liver enzymes are very high because of the obstruction. Certain patients with chronic pancreatitis or chronic inflammation of the pancreas, they can have stones or blockage in the pancreas where we can offer treatment for that, for the removal of stones, and for stents in the pancreas to help with the drainage procedure.

Also we do perform cyst drainage around the pancreas, especially when patients have bad attack of pancreatitis. They can form a big cyst around the pancreas, which can be symptomatic. Previously it was being treated with putting percutaneous or drainage from the outside by intervention radiology or required surgical drainage. But we offer endoscopic drainage of those cysts into the stomach by very minimally invasive technique and has a very good success rate.

Other things we offer is removing large complex polyps in the colon, which previously required surgical resection. Most of the polyps we are able to remove with colonoscopy with very minimally invasive technique. Also we perform radiofrequency ablation for Barrett’s esophagus. The Barrett’s esophagus condition which can happen from chronic acid reflux and it can lead to change in the lining of the cells of the lower esophagus, which can very readily be a precancerous condition and can over years can progress into cancer in very few patients. So those patients require very close observance. If we think the condition is progressing, then we can do radiofrequency ablation or burn that area so that it does not progress into cancer.

Host: These advanced GI screening techniques are amazing. If you could wrap it up for us doctor, is there anything else we should know about some of these new advanced screening techniques?

Dr. Malhi: For these advanced, like endoscopic ultrasound is developing day by day. Now there are more and more procedures happening with endoscopic ultrasound. We do liver biopsy, we do biopsy of the tumors and the chest cavity, which are close to the esophagus. We biopsy the lesions in the stomach, which is arising from the wall of the stomach which previously we were not able to biopsy with the traditional endoscopy. We can look at those lesions under ultrasound and do a needle biopsy on that. Also for staging of various cancer, it helps with the management of the tumor how we should approach those kinds of tumors.

Host: Right. Well thanks Dr. Malhi. We appreciate it. For more information about GI screenings or to get hooked up with one of our providers, please visit stjosephscares.org. That’s stjosephscares.org. If you want to hear more, make sure you subscribe to Hello Healthy in Apple podcasts, Google Play, or wherever you listen to your podcasts. This is Hello Healthy, a Dignity Health podcast. I'm Bill Klaproth. Thanks for listening.