Cnrstn 09.10 - Winthrop University Hospital

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Summer/Fall • 2010Institute for Digestive DisordersMultidisciplinary Collaboration ProvidesNovel Therapy for Swallowing DisorderEating, chewing, swallowing, digesting– it’s a process that most peopletake for granted. Yet for the thousandsof Americans who suffer dailywith achalasia – a disorder of thenerves and muscles of the esophagusthat hinders the passage of swallowedfood and liquids into stomach – thecondition can be debilitating.“Achalasia disrupts the organizedcontractions of the muscle in theesophagus that propels food into thestomach, preventing the muscularvalve between the esophagus and thestomach – known as the loweresophageal sphincter (LES) – fromrelaxing. As a result, patients rely ondrinking copious amounts of waterand eating upright in order to facilitatethe movement of food down theesophagus and into the stomach,”said Stavros Stavropoulos, MD,Director of GastrointestinalEndoscopy and the AdvancedEndoscopy Program at Winthrop.“If left untreated, achalasia canresult in significant complications.”For more than a decade, a laparoscopicsurgical procedure known asHeller myotomy has been the primarytreatment of achalasia in patients atlow surgical risk. However, an emergingfield known as natural orificetransluminal endoscopic surgery(NOTES) is changing the landscape forsurgical interventions. The approachinvolves passing an endoscope – athin tube with a built-in camera, lightand miniscule tools – through the naturalorifices of the body in order toperform surgery non-invasively, withoutany external wounds or scars.Determined to provide select achalasiapatients with a non invasiveversion of surgical Heller myotomy,Dr. Stavropoulos joined forces with8 CornerstoneStavros Stavropoulos, MD, Director ofGastrointestinal Endoscopy and theAdvanced Endoscopy Program at Winthrop(left) and Collin E. Brathwaite, MD, Chiefof the Division of Minimally Invasive andBariatric Surgery and Director of theBariatric Surgery Center at Winthrop.Board certified surgeon and criticalcare specialist Collin E. Brathwaite,MD, Chief of the Division of MinimallyInvasive and Bariatric Surgery andDirector of the Bariatric Surgery Centerat Winthrop, to launch a clinical trial ofan investigational technique known asendoscopic submucosal myotomy.This unique approach involvespassing an endoscope through themouth into the esophagus, where asmall incision is made on the lining ofthe esophagus, known as the mucosa.A balloon is then inserted and dilatedin the submucosa – the layer betweenthe inner lining of the esophagus andthe outer wall consisting of the muscleof the esophagus. Dilation of theballoon in the submucosa creates atunnel that allows insertion of theendoscope and access to the muscleof the LES. A long incision is thencarefully made on the posterior portionof the muscular ring that formsthe LES. The incision divides themuscle fibers of the LES, whichweakens the muscle, allowing for theeasier passage of food while preservingsome valve function to preventreflux of acid from the stomach intothe esophagus.As a result of Dr. Stavropoulosand Dr. Brathwaite’s unique multidisciplinarycollaboration, the firstclinical application of this novel techniquein a patient in the United Statestook place at Winthrop. To-date, thetrial has delivered promising resultsfor three patients, with two additionalpatients scheduled to undergo treatmentin the coming weeks.“Our research was accepted forpublication in the prestigious peerreviewedmedical journal GastrointestinalEndoscopy. It was also presentedat the 2010 Digestive DiseaseWeek – the world’s largest gathering ofphysicians and researchers in the fieldsof gastroenterology, hepatology,endoscopy and gastrointestinal surgery,”said Dr. Stavropoulos, noting that thetechnique was initially developed in animalmodels by researchers at the MayoClinic, first performed in a porcinemodel in 2007, and first performed ina human patient in Japan in 2009.“Winthrop is the first and onlyCenter in the area performing thiscutting-edge intervention,” notedDr. Brathwaite. “The strong multidisciplinarycollaboration amongWinthrop’s GI Division and theDepartment of Surgery enable apatient’s care to be seamlessly coordinatedthroughout the entire process.”(continued on page 9)
Summer/Fall • 2010Therapy for Swallowing Disorder(continued from page 8)Upon an initial consultation withDr. Stavropoulos, where all treatmentoptions are discussed, patients undergoa comprehensive evaluation involving abarium swallow, CT scan, endoscopyand a high resolution manometry studySeveral volunteers and adoptedchildren gathered at Winthrop’sFirst Annual InternationalAdoption Party.– a state-of-the-art functional assessmentof the physiology of theesophagus. The study is conducted andinterpreted by Winthrop’s BhawnaHalwan, MD, who possesses specializedtraining in this technique.First AnnualInternational Adoption PartyUnites FamiliesWinthrop-University Hospital held its First Annual International AdoptionParty on April 23 at Winthrop’s Community Outreach Center. The event wasa terrific success, with 12 families and 22 children in attendance. Specialbonds were formed as children played together and parents shared theiradoption experiences with each other.The party was sponsored by Winthrop’s International Adoption Program,which also offers an extensive support group for parents of adopted childrenand their families. Each month, experts educate parents about common postadoptionconcerns and provide networking opportunities for parents andfamilies. The support group also sponsors special events geared to helpadopted children get to know each other.For more information about Winthrop’s International Adoption Program,call 1-866-WINTHROP.Patients also receive a comprehensiveconsultation with Dr. Brathwaite.In cases where endoscopic myotomy ischosen, the procedure is performed byDr. Stavropoulos. If there is a need toassess the incision (or exclude a smallperforation), Dr. Brathwaite uses asmall laparoscopic instrument to makea very small key-hole incision in thepatient’s abdominal wall. Using a smallscope equipped with a camera, hechecks for leakages from the esophaguswhile Dr. Stavropoulos fills theesophagus with a special dye thatmakes leaks more readily visible.The entire procedure takes justover an hour. Patients are generallydischarged within 24 hours with littleor no pain. Six weeks after the procedure,patients are prompted to returnto Winthrop to undergo a follow upmanometry study to examine the pressurelevels in the LES and esophagus.As the Winthrop pilot study continuesto gather data on the effectivenessof endoscopic submucosal myotomy inselect achalasia patients, it is the hopeof these Winthrop physicians that thiswill in turn lead to future multi-centertrials of its efficacy when compared tosurgical treatment.For more information on interventionalendoscopic services atWinthrop, call 1-866-WINTHROP. ■What’s New@ WinthropAre you interested inreceiving news andevent-related updatesfrom Winthrop –delivered straight toyour e-mail inbox?Log on to www.winthrop.orgor email KSenecal@winthrop.org tosign up today for electronic alerts!Cornerstone9
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Cnrstn 09.10 - Winthrop University Hospital

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