Dr. Christopher DuCoin leads an informative discussion on what surgical options are available to those who have difficulty swallowing.
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ACCME
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USF Health designates this live activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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USF Health is an approved provider of continuing education for physicians through the Florida Board of Medicine. This activity has been reviewed and approved for up to 0.25 continuing education credits.
Target Audience: Gastroenterologists
Release Date: June 14th, 2022
Expiration Date: June 14th, 2023
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Relevant Financial Relationships
All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.
Christopher DuCoin, MD: Consultant for Intuitive, Medtronic, Boston Scientific and Ethicon.
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Difficulty Swallowing and Surgical Options
Featuring:
Christopher DuCoin, MD, MPH, FACS
Dr. Christopher DuCoin, MD, MPH, FACS is a board-certified general surgeon. His surgical interests include: Robotic Surgery of the Foregut (esophagus and stomach). The foregut surgery which he specializes in is both benign and malignant esophageal diseases requiring esophagectomy, paraesophageal hernias, anti-reflux surgery, and esophageal motility disorders such as achalasia. His endoscopy area of expertise is also that of the foregut nature and includes both diagnostic and therapeutic procedures, such as Peri-Oral Endoscopic Myotomy (POEM).
Transcription:
Caitlin Whyte (Host): Difficulty swallowing can dramatically affect a person's quality of life. But plenty of surgical options are available. To walk us through our choices and get you back on the path to easy and effortless swallowing, is Dr. Christopher DuCoin, Chief of the Division of GI Surgery at the University of South Florida.
Welcome to the Tampa Generally Speaking podcast, a go-to listening location for specialized physician to physician content and a valuable learning tool for world-class healthcare. I'm your host, Caitlin Whyte. So Doctor, what an interesting topic we have today. To start us off, tell us some reasons why a person would have a hard time swallowing.
Christopher DuCoin, MD, MPH, FACS (Guest): So, there's so many different reasons someone can have trouble swallowing from just the mechanics of how you eat and chew to actual physiological pathology, such as hiatal hernia is where the stomach jumped up into the chest or diverticula, which are outpouchings, even strictures can cause difficulty swallowing or eating.
And the strictures can be multiple things from benign strictures, which, you know, sometimes there's just an old scar tissue to even cancer. So, there's a whole bunch of reasons. And I think part of our job is to figure out why that stricture's there or why that pathology is there, then to be able to treat it. The goal is to be able to treat everything and get people back to eating and swallowing normal.
Host: Beautiful. So, we're going to dive into some of those you just mentioned right now. Let's start off with a stricture. Why would one of those form?
Dr. DuCoin: Yes the strictures can form for multiple reasons. The can be anything from a decreased blood supply to just kind of abnormal pathology, something you're born with, which is like a web or a, or kind of like the way the mucosa of the esophagus comes together.
And then they can be related to cancer too. They can be related to previous surgery. Strictures can even come from when pills get stuck and they kind of get stuck chronically. And then the stricture forms over time.
Host: You also mentioned diverticula what does that mean?
Dr. DuCoin: Yeah, diverticula. We usually think about things like diverticulitis and diverticulosis, that's diseases of the colon. When you get a diverticula of your esophagus, it's like an outpouching, but instead of a whole bunch of them, there's usually just a small little outpouching, usually in the upper or lower portion of the esophagus. Sometimes we get them in the middle, but they're usually just one diverticula, one outpouching and they can be caused again for multiple reasons. But usually it's when the muscles of the esophagus are too tight and don't allow food to pass.
Host: And how about achalasia. I've never heard about that. Can you tell us what that is?
Dr. DuCoin: Yeah. So achalasia is the same thing. It's when the muscle's too tight. Now so when the muscle's too tight at the bottom of the esophagus, it won't relax and achalasia starts to happen. We don't really know the why, why we get achalasia. We know what happens, the nerves to the esophagus stop working. So, usually when you eat something, your food will kind of move from your mouth to your stomach in a very controlled manner through the esophagus. Then there's the muscle at the bottom of the esophagus called the lower esophageal sphincter. It stays tight all the time, so that the acid in the stomach doesn't reflux back up. When you eat something in a very controlled manner, it goes from your mouth to your stomach and that muscle relaxes, and then allows the food to bolus to go by. With achalasia, when those nerves aren't working, there's no controlled peristalsis, no controlled movement of that food from the mouth to the stomach and that muscle at the base of the stomach fails to relax. So it's tight all the time. So, achalasia is really like the failed workings of your esophagus. And again, we've got multiple ways we can treat that too.
Host: Got ya. Now looking at GERD, that's often associated with stomach issues, but how does GERD affect swallowing as well?
Dr. DuCoin: Great question. So, GERD is reflux disease or gastroesophageal reflux disease. And usually GERD in the world I live in, which is the surgical world is related to some sort of defect or issue at that lower esophageal sphincter where it's too loose. Most common cause is because that stomach's been sucked up into the chest that hiatal hernia. So, again, it can lead to like a fair amount of acid creating from the stomach up into the esophagus.
It can kind of burn that lower part of the esophagus and you can get things like Barrett's disease or even cancer, when the cells start to change. The way it would really affect one's eating is again, what we'd call up a benign peptic stricture, or benign stricture of the esophagus. It's just a whole bunch of scar tissue and inflammation in that distal esophagus that forms secondary to all the reflux disease.
Host: And wrapping up here, Doctor, can you tell us a bit about esophageal cancer and those treatment options?
Dr. DuCoin: Yeah. So esophageal cancer's a tough one. It's a usually a glandular disease of the lower part of the esophagus called adenocarcinoma or more like a, a squamous cell, like a skin at the top part. It's a, it's a pretty intense cancer. So it's usually treated with staging first, CT scans and ultrasounds to see how much it's progressed. Almost always when we're talking surgery, it's first treated with chemotherapy and radiation and then a surgical resection, but we're getting so good at early detection and, and kind of screening mechanisms for esophageal cancer, that now we're even able to treat it sometimes in very, I'd say unique and special instances with ,endoscopic or trans oral surgery to remove, resect or ablate that tumor. But most of the time it requires chemotherapy, radiation, and then a large operation where we actually remove part of the esophagus and rebuild it with the stomach.
I usually describe it as not just a big oncologic cancer resection, but almost like a transplant case too, because we're going to now rebuild the stomach in the shape of the esophagus and transplant it into its old place.
Host: Well doctor, thank you so much for your time today and for your work in this field. And thank you for listening to the Tampa Generally Speaking podcast, which is available on all major streaming services for free. You can also check out our website, tgh.org/cme. This has been the Tampa Generally Speaking podcast. I'm your host, Caitlin Whyte. We hope you join us next time.
Caitlin Whyte (Host): Difficulty swallowing can dramatically affect a person's quality of life. But plenty of surgical options are available. To walk us through our choices and get you back on the path to easy and effortless swallowing, is Dr. Christopher DuCoin, Chief of the Division of GI Surgery at the University of South Florida.
Welcome to the Tampa Generally Speaking podcast, a go-to listening location for specialized physician to physician content and a valuable learning tool for world-class healthcare. I'm your host, Caitlin Whyte. So Doctor, what an interesting topic we have today. To start us off, tell us some reasons why a person would have a hard time swallowing.
Christopher DuCoin, MD, MPH, FACS (Guest): So, there's so many different reasons someone can have trouble swallowing from just the mechanics of how you eat and chew to actual physiological pathology, such as hiatal hernia is where the stomach jumped up into the chest or diverticula, which are outpouchings, even strictures can cause difficulty swallowing or eating.
And the strictures can be multiple things from benign strictures, which, you know, sometimes there's just an old scar tissue to even cancer. So, there's a whole bunch of reasons. And I think part of our job is to figure out why that stricture's there or why that pathology is there, then to be able to treat it. The goal is to be able to treat everything and get people back to eating and swallowing normal.
Host: Beautiful. So, we're going to dive into some of those you just mentioned right now. Let's start off with a stricture. Why would one of those form?
Dr. DuCoin: Yes the strictures can form for multiple reasons. The can be anything from a decreased blood supply to just kind of abnormal pathology, something you're born with, which is like a web or a, or kind of like the way the mucosa of the esophagus comes together.
And then they can be related to cancer too. They can be related to previous surgery. Strictures can even come from when pills get stuck and they kind of get stuck chronically. And then the stricture forms over time.
Host: You also mentioned diverticula what does that mean?
Dr. DuCoin: Yeah, diverticula. We usually think about things like diverticulitis and diverticulosis, that's diseases of the colon. When you get a diverticula of your esophagus, it's like an outpouching, but instead of a whole bunch of them, there's usually just a small little outpouching, usually in the upper or lower portion of the esophagus. Sometimes we get them in the middle, but they're usually just one diverticula, one outpouching and they can be caused again for multiple reasons. But usually it's when the muscles of the esophagus are too tight and don't allow food to pass.
Host: And how about achalasia. I've never heard about that. Can you tell us what that is?
Dr. DuCoin: Yeah. So achalasia is the same thing. It's when the muscle's too tight. Now so when the muscle's too tight at the bottom of the esophagus, it won't relax and achalasia starts to happen. We don't really know the why, why we get achalasia. We know what happens, the nerves to the esophagus stop working. So, usually when you eat something, your food will kind of move from your mouth to your stomach in a very controlled manner through the esophagus. Then there's the muscle at the bottom of the esophagus called the lower esophageal sphincter. It stays tight all the time, so that the acid in the stomach doesn't reflux back up. When you eat something in a very controlled manner, it goes from your mouth to your stomach and that muscle relaxes, and then allows the food to bolus to go by. With achalasia, when those nerves aren't working, there's no controlled peristalsis, no controlled movement of that food from the mouth to the stomach and that muscle at the base of the stomach fails to relax. So it's tight all the time. So, achalasia is really like the failed workings of your esophagus. And again, we've got multiple ways we can treat that too.
Host: Got ya. Now looking at GERD, that's often associated with stomach issues, but how does GERD affect swallowing as well?
Dr. DuCoin: Great question. So, GERD is reflux disease or gastroesophageal reflux disease. And usually GERD in the world I live in, which is the surgical world is related to some sort of defect or issue at that lower esophageal sphincter where it's too loose. Most common cause is because that stomach's been sucked up into the chest that hiatal hernia. So, again, it can lead to like a fair amount of acid creating from the stomach up into the esophagus.
It can kind of burn that lower part of the esophagus and you can get things like Barrett's disease or even cancer, when the cells start to change. The way it would really affect one's eating is again, what we'd call up a benign peptic stricture, or benign stricture of the esophagus. It's just a whole bunch of scar tissue and inflammation in that distal esophagus that forms secondary to all the reflux disease.
Host: And wrapping up here, Doctor, can you tell us a bit about esophageal cancer and those treatment options?
Dr. DuCoin: Yeah. So esophageal cancer's a tough one. It's a usually a glandular disease of the lower part of the esophagus called adenocarcinoma or more like a, a squamous cell, like a skin at the top part. It's a, it's a pretty intense cancer. So it's usually treated with staging first, CT scans and ultrasounds to see how much it's progressed. Almost always when we're talking surgery, it's first treated with chemotherapy and radiation and then a surgical resection, but we're getting so good at early detection and, and kind of screening mechanisms for esophageal cancer, that now we're even able to treat it sometimes in very, I'd say unique and special instances with ,endoscopic or trans oral surgery to remove, resect or ablate that tumor. But most of the time it requires chemotherapy, radiation, and then a large operation where we actually remove part of the esophagus and rebuild it with the stomach.
I usually describe it as not just a big oncologic cancer resection, but almost like a transplant case too, because we're going to now rebuild the stomach in the shape of the esophagus and transplant it into its old place.
Host: Well doctor, thank you so much for your time today and for your work in this field. And thank you for listening to the Tampa Generally Speaking podcast, which is available on all major streaming services for free. You can also check out our website, tgh.org/cme. This has been the Tampa Generally Speaking podcast. I'm your host, Caitlin Whyte. We hope you join us next time.