While the digestive tract is sometimes evaluated as an independent organ, it is viewed in relation to the body's other systems. For this reason, our gastroenterologists are board certified in both internal medicine and gastroenterology. They specialize in the diagnosis and treatment of medical conditions within any part of the digestive system.
If you suffer from gastrointestinal issues, you know that going through diagnostic procedures can sometimes be inconvenient. Fortunately, minimally invasive endoscopic procedures can often spare patients with digestive disorders from having to undergo major surgeries.
Many of these new methods can minimize trauma and reduce blood loss, resulting in shorter hospital stays and faster recovery times.
Listen in as Hemant Chatrath MD explains the new advanced interventional gastroenterology procedures at Meritus Health.
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New Advanced Interventional Gastroenterology Procedures
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Learn more about Dr. Hemant Chatrath
Hemant Chatrath, MD
Dr. Hemant Chatrath earned his medical degree from University of Delhi, Maulana Azad Medical College and completed his residency at Cook County (Stroger) Hospital in Chicago, Illinois. He recently completed a fellowship in Gastroenterology and Hepatology at University of Arizona School of Medicine and a fellowship in Advanced Interventional Endoscopy at University of California, Los Angeles. Dr. Chatrath is board certified in internal medicine and gastroenterology with the American Board of Internal Medicine.Learn more about Dr. Hemant Chatrath
Transcription:
New Advanced Interventional Gastroenterology Procedures
Melanie Cole (Host): Today minimally invasive endoscopic procedures can often spare patients with digestive disorders from having to undergo major surgeries. These new methods can minimize trauma and reduce blood loss, resulting in shorter hospital stays and faster recovery times. My guest today is Dr. Hemant Chatrath. He is a gastroenterologist with Meritus Health. Welcome to the show, Dr. Chatrath. When it comes to the GI system, what has typically been done to explore this system?
Dr. Hemant Chatrath (Guest): Gastroenterology, as a new specialty, has expanded tremendously from what we were able to do a few years from today versus what we can do now. It’s a very exciting time in gastroenterology and the world of interventional endoscopy with a lot of new developments, a lot of new procedures and a lot of new techniques coming in, which helps us look at the GI tract more carefully, do a lot of procedures which were previously done by surgeons and required hospitalization and incisions and multiple other things which can be now done in a minimally-invasive way with endoscopy and in much shorter time and less discomfort to patients.
Melanie: What is interventional endoscopy? People hear that word “interventional” and they’re not sure what that means.
Dr. Chatrath: Interventional, in layman’s words, we can say something which you do an intervention on. Previously, endoscopy was mostly diagnostic where you would go with an endoscope and look at the GI tract from the mouth or from below, and you could do some interventions, but now with interventional endoscopy it’s a whole new world. You can do surgeries inside the GI tract without even opening the patient. So, this is exactly what the word “interventional” means.
Melanie: What type of procedures are you doing interventionally for endoscopy to look for issues?
Dr. Chatrath: There are numerous new procedures which come under the umbrella of interventional endoscopy. I would like to tell you about some of the ones which we do very routinely. These include endoscopic ultrasound, ERCP, endoscopic mucosal resection, and I’ll go over them one by one. Let’s start with endoscopic ultrasound. This is a new technique which no one was doing in the Washington County area before, and all our patients who needed this procedure had to go to Baltimore or DC to get these procedures done. There was a lot of difficulty for patients who were elderly to leave their homes, go out of their comfort zone and go to these hospitals, and many of these procedures require multiple sessions, so they would have to go multiple times. This was a barrier in many patients even seeking care, because they would not be either physically or, for some other reasons, not be able to go all the way to Baltimore and Washington, DC, and their disease would progress and they would not get the right management for their conditions. Endoscopic ultrasound is a way in which we do ultrasound with an endoscope. So, many of our patients may have seen what a routine ultrasound is, when they are in a dark room and the technician puts a probe on their stomach or the region of the body which needs examination, and they look at the ultrasound machine where sound waves make certain images of body organs. Endoscopic ultrasound is a similar concept. The great thing about endoscopic ultrasound is that organs, like the pancreas, which are very deeply seated in the body and cannot be accessed easily with an ultrasound done on the abdomen, what I do is go with an endoscope inside the patient’s esophagus and stomach through the mouth, so there are no incisions or any surgical need. And once I am in the stomach and the small bowel, the pancreas is very close or almost next to it, and then I use the ultrasound which is on the tip of the endoscope to look at the entire pancreas very carefully, to look for any cyst, any masses, any cancer, or any other signs of chronic pancreatitis.
Melanie: Dr. Chatrath, what other disorders, when you’re doing the endoscopic ultrasound, are you looking for?
Dr. Chatrath: We are looking for disorders of the pancreas, disorders of the bile duct and gallbladder, and any masses or any lumps or bumps, if you will, of the GI tract can be looked at with an endoscopic ultrasound in great details. It gives us information as to which layer of the intestinal wall is the lesion arising from, meaning how deep is it penetrating, is this something which can be taken care of endoscopically or if this needs surgical management. And, then, when you look at the pancreas, this is actually a very useful tool for pancreatic cancer detection. As we all know, pancreatic cancer is one of the GI cancers which, unfortunately, is still on the rise and, given the trend, it would become the second-largest mortality cancer in the entire country after lung cancer in the next few years. Unfortunately, we have not been able to come up with any good screening modalities or even treatment for this cancer, because once someone is diagnosed it, the prognosis is not very encouraging at this time.
Melanie: And are you also looking for GERD or Barrett’s Esophagus when you do the endoscopic ultrasound?
Dr. Chatrath: Barrett’s Esophagus has some application when doing endoscopic ultrasound, but I am also performing a new procedure which is called “radio frequency ablation”, which is an ablation procedure for Barrett’s Esophagus. Barrett’s Esophagus is actually a pre-cancerous lesion of the esophagus and, if nothing is done about this lesion, slowly changes of cancer start to develop in these abnormal cells, which is called “dysplasia”, and dysplasia over time leads to esophageal cancer. So, patients who have long-standing GERD and there are certain risk factors for Barrett’s Esophagus besides GERD, in these patients, if they do develop Barrett’s Esophagus and have some changes of dysplasia, then radio frequency ablation is a very neat procedure which, in layman’s language, destroys or it toasts or burns the abnormal epithelium and lets the body change it to a normal epithelium and regenerate itself.
Melanie: And why would somebody need one of these procedures? Would they have some symptoms that you would then say that they needed one of these new advanced interventional gastroenterology procedures? What would send them to see you?
Dr. Chatrath: This could be certain diseases present with symptoms which, as we discussed, like Barrett’s Esophagus, patients may have long-standing reflux symptoms, or they may even have difficulty swallowing. So, every disease has its own symptoms. Again, pancreatic cancer patients will present with weight loss, abdominal pain. Similarly, chronic pancreatitis will be abdominal pain. What I would say is if someone has unexplained abdominal pain, that they go to the emergency room, nothing is found, then this is where endoscopic ultrasound comes into play, because it looks inside the abdominal organs from very close and is able to pick up things which conventional imaging may not pick up every time. And the other advantage of endoscopic ultrasound is that if I do see a lesion-- I would like to give an example. Many times patients undergoes CT scan of the abdomen for reasons like abdominal pain, nausea, vomiting, and the CT scan picks up certain suspicious lesions which could be in the pancreas or liver, and this causes a lot of anxiety to the patient. They don’t know what this lesion is; if this is a cyst which may turn into cancer, or this is something which is just a benign cyst and they don’t have to worry about it. So, that the number of CT scans that we have these days once patients go to emergency room, we see a lot more lesions being detected, and sometimes it’s good that advanced lesions are detected early, but at other times, it causes a lot of anxiety to patients as to what they are. With endoscopic ultrasound, I can only look at these lesions from very close, I can also do a biopsy of these lesions, again from inside, so there is no needle which goes from the skin or any pain that these patients have when biopsies of these suspicious lesions are done.
Melanie: So, it’s a real benefit for the patients. In just the last few minutes, Dr. Chatrath, please wrap it up for us about some of these new exciting interventional endoscopic procedures for the GI system, and why they should come to Meritus health for their care?
Dr. Chatrath: Meritus Health is the only hospital here which is offering these endoscopic procedures in the entire Washington County area. As we discussed, we are able to perform endoscopic ultrasound, ERCP, radio frequency ablation for Barrett’s Esophagus, luminal stents, which I did not talk about before, but stents are devices which can help in relieving obstruction in different parts of the GI tract, be it in the esophagus, stomach, or in colon, when patients have obstruction from tumor or from other reasons where their body is not able to handle food as it should, that’s when stents come in and help relieve the obstruction. And, lastly, a procedure I want to talk about is EMR, which is endoscopic mucosal resection, which is a very promising procedure in which superficial cancers of the colon, esophagus or stomach can be removed endoscopically. So, before patients had to have surgery for any kind of cancer to get rid of that cancer, if they were surgical candidates. And that entails staying in the hospital, sometimes blood transfusion, sometimes drains placed in their abdomen, and, in cases of colectomy, patients may even have a colostomy that they have to have, which makes their social life and the quality of life very poor. In EMR, the exciting thing is that superficial cancers need not undergo this entire surgical procedure and can be handled with an endoscopy. So, this is another procedure that we’re offering at Meritus.
Melanie: Thank you so much for being with us today, Dr. Chatrath. It’s fascinating information. You’re listening to Your Health Matters with Meritus Health. For more information you can go to www.MeritusHealth.com/MMG. This is Melanie Cole. Thanks so much for listening.
New Advanced Interventional Gastroenterology Procedures
Melanie Cole (Host): Today minimally invasive endoscopic procedures can often spare patients with digestive disorders from having to undergo major surgeries. These new methods can minimize trauma and reduce blood loss, resulting in shorter hospital stays and faster recovery times. My guest today is Dr. Hemant Chatrath. He is a gastroenterologist with Meritus Health. Welcome to the show, Dr. Chatrath. When it comes to the GI system, what has typically been done to explore this system?
Dr. Hemant Chatrath (Guest): Gastroenterology, as a new specialty, has expanded tremendously from what we were able to do a few years from today versus what we can do now. It’s a very exciting time in gastroenterology and the world of interventional endoscopy with a lot of new developments, a lot of new procedures and a lot of new techniques coming in, which helps us look at the GI tract more carefully, do a lot of procedures which were previously done by surgeons and required hospitalization and incisions and multiple other things which can be now done in a minimally-invasive way with endoscopy and in much shorter time and less discomfort to patients.
Melanie: What is interventional endoscopy? People hear that word “interventional” and they’re not sure what that means.
Dr. Chatrath: Interventional, in layman’s words, we can say something which you do an intervention on. Previously, endoscopy was mostly diagnostic where you would go with an endoscope and look at the GI tract from the mouth or from below, and you could do some interventions, but now with interventional endoscopy it’s a whole new world. You can do surgeries inside the GI tract without even opening the patient. So, this is exactly what the word “interventional” means.
Melanie: What type of procedures are you doing interventionally for endoscopy to look for issues?
Dr. Chatrath: There are numerous new procedures which come under the umbrella of interventional endoscopy. I would like to tell you about some of the ones which we do very routinely. These include endoscopic ultrasound, ERCP, endoscopic mucosal resection, and I’ll go over them one by one. Let’s start with endoscopic ultrasound. This is a new technique which no one was doing in the Washington County area before, and all our patients who needed this procedure had to go to Baltimore or DC to get these procedures done. There was a lot of difficulty for patients who were elderly to leave their homes, go out of their comfort zone and go to these hospitals, and many of these procedures require multiple sessions, so they would have to go multiple times. This was a barrier in many patients even seeking care, because they would not be either physically or, for some other reasons, not be able to go all the way to Baltimore and Washington, DC, and their disease would progress and they would not get the right management for their conditions. Endoscopic ultrasound is a way in which we do ultrasound with an endoscope. So, many of our patients may have seen what a routine ultrasound is, when they are in a dark room and the technician puts a probe on their stomach or the region of the body which needs examination, and they look at the ultrasound machine where sound waves make certain images of body organs. Endoscopic ultrasound is a similar concept. The great thing about endoscopic ultrasound is that organs, like the pancreas, which are very deeply seated in the body and cannot be accessed easily with an ultrasound done on the abdomen, what I do is go with an endoscope inside the patient’s esophagus and stomach through the mouth, so there are no incisions or any surgical need. And once I am in the stomach and the small bowel, the pancreas is very close or almost next to it, and then I use the ultrasound which is on the tip of the endoscope to look at the entire pancreas very carefully, to look for any cyst, any masses, any cancer, or any other signs of chronic pancreatitis.
Melanie: Dr. Chatrath, what other disorders, when you’re doing the endoscopic ultrasound, are you looking for?
Dr. Chatrath: We are looking for disorders of the pancreas, disorders of the bile duct and gallbladder, and any masses or any lumps or bumps, if you will, of the GI tract can be looked at with an endoscopic ultrasound in great details. It gives us information as to which layer of the intestinal wall is the lesion arising from, meaning how deep is it penetrating, is this something which can be taken care of endoscopically or if this needs surgical management. And, then, when you look at the pancreas, this is actually a very useful tool for pancreatic cancer detection. As we all know, pancreatic cancer is one of the GI cancers which, unfortunately, is still on the rise and, given the trend, it would become the second-largest mortality cancer in the entire country after lung cancer in the next few years. Unfortunately, we have not been able to come up with any good screening modalities or even treatment for this cancer, because once someone is diagnosed it, the prognosis is not very encouraging at this time.
Melanie: And are you also looking for GERD or Barrett’s Esophagus when you do the endoscopic ultrasound?
Dr. Chatrath: Barrett’s Esophagus has some application when doing endoscopic ultrasound, but I am also performing a new procedure which is called “radio frequency ablation”, which is an ablation procedure for Barrett’s Esophagus. Barrett’s Esophagus is actually a pre-cancerous lesion of the esophagus and, if nothing is done about this lesion, slowly changes of cancer start to develop in these abnormal cells, which is called “dysplasia”, and dysplasia over time leads to esophageal cancer. So, patients who have long-standing GERD and there are certain risk factors for Barrett’s Esophagus besides GERD, in these patients, if they do develop Barrett’s Esophagus and have some changes of dysplasia, then radio frequency ablation is a very neat procedure which, in layman’s language, destroys or it toasts or burns the abnormal epithelium and lets the body change it to a normal epithelium and regenerate itself.
Melanie: And why would somebody need one of these procedures? Would they have some symptoms that you would then say that they needed one of these new advanced interventional gastroenterology procedures? What would send them to see you?
Dr. Chatrath: This could be certain diseases present with symptoms which, as we discussed, like Barrett’s Esophagus, patients may have long-standing reflux symptoms, or they may even have difficulty swallowing. So, every disease has its own symptoms. Again, pancreatic cancer patients will present with weight loss, abdominal pain. Similarly, chronic pancreatitis will be abdominal pain. What I would say is if someone has unexplained abdominal pain, that they go to the emergency room, nothing is found, then this is where endoscopic ultrasound comes into play, because it looks inside the abdominal organs from very close and is able to pick up things which conventional imaging may not pick up every time. And the other advantage of endoscopic ultrasound is that if I do see a lesion-- I would like to give an example. Many times patients undergoes CT scan of the abdomen for reasons like abdominal pain, nausea, vomiting, and the CT scan picks up certain suspicious lesions which could be in the pancreas or liver, and this causes a lot of anxiety to the patient. They don’t know what this lesion is; if this is a cyst which may turn into cancer, or this is something which is just a benign cyst and they don’t have to worry about it. So, that the number of CT scans that we have these days once patients go to emergency room, we see a lot more lesions being detected, and sometimes it’s good that advanced lesions are detected early, but at other times, it causes a lot of anxiety to patients as to what they are. With endoscopic ultrasound, I can only look at these lesions from very close, I can also do a biopsy of these lesions, again from inside, so there is no needle which goes from the skin or any pain that these patients have when biopsies of these suspicious lesions are done.
Melanie: So, it’s a real benefit for the patients. In just the last few minutes, Dr. Chatrath, please wrap it up for us about some of these new exciting interventional endoscopic procedures for the GI system, and why they should come to Meritus health for their care?
Dr. Chatrath: Meritus Health is the only hospital here which is offering these endoscopic procedures in the entire Washington County area. As we discussed, we are able to perform endoscopic ultrasound, ERCP, radio frequency ablation for Barrett’s Esophagus, luminal stents, which I did not talk about before, but stents are devices which can help in relieving obstruction in different parts of the GI tract, be it in the esophagus, stomach, or in colon, when patients have obstruction from tumor or from other reasons where their body is not able to handle food as it should, that’s when stents come in and help relieve the obstruction. And, lastly, a procedure I want to talk about is EMR, which is endoscopic mucosal resection, which is a very promising procedure in which superficial cancers of the colon, esophagus or stomach can be removed endoscopically. So, before patients had to have surgery for any kind of cancer to get rid of that cancer, if they were surgical candidates. And that entails staying in the hospital, sometimes blood transfusion, sometimes drains placed in their abdomen, and, in cases of colectomy, patients may even have a colostomy that they have to have, which makes their social life and the quality of life very poor. In EMR, the exciting thing is that superficial cancers need not undergo this entire surgical procedure and can be handled with an endoscopy. So, this is another procedure that we’re offering at Meritus.
Melanie: Thank you so much for being with us today, Dr. Chatrath. It’s fascinating information. You’re listening to Your Health Matters with Meritus Health. For more information you can go to www.MeritusHealth.com/MMG. This is Melanie Cole. Thanks so much for listening.