A new non-invasive procedure to treat early stomach and esophageal cancer offers improved quality of life according to physicians at the McGill University Health Centre (MUHC). This method, known as Endoscopic Submucosal Dissection (ESD), does not involve incisions or removal of organs and therefore reduces the risk of surgical complications. It also allows patients to return home within 24 hours. The MUHC is the first and only institution in Canada to offer this technique. The procedure and its positive outcomes were recently presented at an annual conference of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

“The incidence of esophageal cancer is increasing rapidly in Canada,” says lead physician Lorenzo Ferri, MUHC director of the Division of Thoracic Surgery and the Upper Gastrointestinal (GI) Cancer Program. “We are finding ways to detect it earlier and now our new procedure, which is ideal for early cancers, will ensure that the rise in rates doesn’t coincide with a rise in mortality.”

Traditionally, open surgical procedures have been used to treat patients with esophageal or stomach cancer. These involved making an incision in the abdomen or chest to access the affected organ, followed by removal of the diseased tissues. ESD uses a thin electric knife, inserted through a flexible tube called a gastroscope, to remove the inner lining of the stomach or esophagus harboring the cancer, while leaving the rest of the stomach or esophagus intact. This procedure is done without any incisions or scars in the patients body making recovery much easier.

“We remove the first lining of the organ rather than part of the organ itself,” says Dr. Ferri, who is also an Associate Professor in the department of oncology at McGill University and holds the David Mulder Chair in Surgery at the Montreal General Hospital. “This is partially why ESD is much safer for patients. The other reason is that there are no external incisions. Traditional surgical treatments for this disease carry mortality rates as high as 10 percent, so this new procedure is already saving lives”.

“The procedure was excellent,” says Alfred Petrauskais a patient who recently had ESD to treat his stomach cancer. “I was home the day after the procedure and the follow up was a piece of cake. If you have any family or friends with these cancers, tell them about this treatment.”

So far the MUHC has treated 15 patients using ESD and all are in remission. Chemotherapy or other surgeries have not been necessary. ESD only works for early stages of cancer, which represent about 10 percent of stomach and esophageal cancer patients seen at the MUHC.

About stomach and esophageal cancer

Stomach cancer, which initially develops in the cells of the stomach lining, is more likely to be diagnosed in men than in women. There is no single cause for stomach cancer. Risk factors include inflammation of the stomach, age, smoking and infection caused by a particular strain of bacteria.

Esophageal cancer starts in the cells of the esophagus, the hollow tube that carries food and drink from the back of the mouth to the stomach. Most people diagnosed with this cancer are over the age of 60 and men are more likely to be diagnosed than women. Risk factors include gastroesophageal reflux, smoking, alcohol consumption and obesity.

About the case-study presentations:

The case studies, Endoscopic Submucosal Dissection For Malignancies Of The Foregut: An Early North American Experience were presented by Lorenzo Ferri and Gerald Fried of the MUHC and McGill University.

Related links:

Cited case studies: www.sages2011.org/endoscopic-submucosal-dissection-for-malignancies-of-the-foregut-an-early-north-american-experience

MUHC: www.muhc.ca



April 23, 2012