by Frances J. Jones, MD, FACG
The American Cancer Society has estimated that in 2021, over 20,000 people will be diagnosed with gastrointestinal cancer. Early detection is the key to cancer treatment.
Thanks to advanced technology on the rise, physicians now have many effective tools to combat gastrointestinal cancers – colon cancer, esophageal cancer, gastric cancer, and pancreatic and biliary tumors. Gastrointestinal technological advances benefit patients by offering less invasive methods to diagnose and treat precancerous and cancerous lesions.
Colon cancer remains the second leading cause of cancer-related deaths in the United States. The past decade has seen mechanical and optical advancements in the colonoscope. The Olympus 190 colonoscope is equipped with response insertion technology with passive bending, high-force transmission, and variable stiffness, allowing for faster insertion times. The optics have improved with high-definition white light, providing brighter images and higher contrast. Narrow Band Imaging (NBI) is a special filter that illuminates abnormal tissue, enhances the margins and highlights mucosal features.
Artificial Intelligence (AI) technology is rapidly evolving. Convolutional neural network computer programming can help endoscopists identify colon polyps.
Barrett’s mucosa is a precancerous mucosal change that can result in esophageal cancer. NBI highlights mucosa with dysplasia, abnormal cell changes. Endoscopic mucosal resection (EMR) removes and stages nodular mucosal areas. EMR is a technique where tissue is lifted by saline injection and then resected by snare cautery. Snare cautery can be performed with or without a cap on the end of the scope.
Radiofrequency ablation (RFA) and cryotherapy are also utilized to treat dysplastic areas. RFA uses a focal or circumferential balloon catheter through the scope to deliver high-frequency electrical currents to the tissue, creating heat and destroying the tissue. Cryotherapy uses a catheter to deliver liquid nitrogen oxide to freeze the tissue, creating tissue death and normal mucosa regeneration.
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are currently in-use for early-stage gastric cancer. ESD is a technique where endoscopic needle knives dissect down to the submucosa and remove the lesion “en bloc.” ESD requires specialized training, longer procedural time and has an increased risk of complications. However, it offers a lower recurrence rate.
Pancreatic and biliary tumors require endoscopic retrograde pancreatography (ERCP). ERCP is a procedure where a specifically-designed endoscope and wire create access to the biliary and pancreatic ducts. Olympus has designed a new ERCP scope with a single-use, detachable, disposable distal cap, eliminating the source of bacterial contamination.
An endoscopic ultrasound (EUS) also diagnoses and treats pancreatic and biliary tumors. The EUS is a specialized scope with an ultrasound at the tip. A working channel allows diagnostics with fine needle aspiration for cysts and larger needles for biopsies of tissue. Evolving and investigational EUS therapies use RFA and photodynamic therapy to treat neoplastic pancreatic cysts and solid tumors.
As gastrointestinal technology continues to advance, consider the improved patient outcomes.
Frances J. Jones, MD, FACG, is a board certified, fellowship trained gastroenterologist at TPMG Gastroenterology – Williamsburg. She has a special interest in cancer prevention. mytpmg.com
