Category Archives: Treatments

Multi-Gene Panels—Changing Our Approach to Hereditary GI Cancers

Multi-gene panels can have a significant impact on the successful identification of patients with or at-risk for hereditary gastrointestinal cancers, such as those associated with Lynch syndrome. According to Maria J. Baker, Ph.D., professor of medicine and genetic counselor, medical geneticist, hematology and oncology, “Multi-gene panels can screen for up to 72 different genes or more, depending on the laboratory, using a single blood sample and eliminating the need for a time-consuming sequence of tests. This can reduce overall costs and shorten the ‘diagnostic odyssey,’ potentially reducing stress for the patient than with traditional sequential genetic testing.” Continue reading

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Prophylactic Total Gastrectomy to Manage Hereditary Gastric Cancer Risk

Roux-Y reconstruction with esophagojejunostomy. ©Steinemann et. al.; licensee BioMed Central Ltd. 2011.

Roux-Y reconstruction with esophagojejunostomy. ©Steinemann et. al.; licensee BioMed Central Ltd. 2011.

Minimally invasive surgical treatment options are helping to revolutionize surgical care for patients with many upper gastrointestinal cancers and pre-cancerous syndromes at Penn State Health.  Hereditary Diffuse Gastric Cancer (HDGC) is an inherited, autosomal dominant syndrome with high (80%) penetrance which results in invasive stomach cancers (often multifocal) at a relatively young age (30-50 years old)1.  Mutations in the E-cadherin (CDH1) are usually the cause of HDGC and patients often have a strong family history of stomach cancer and breast cancer (lobular breast cancer is also associated with CDH1 mutations)2. Continue reading

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Endoscopic Suturing Device Allows for More Reliable Repair of Duodenal Perforations and Potentially Safer NOTES

Endoscopic suturing device technology has improved in recent years. In addition, it has brought improved success in the immediate repair of selected GI perforations and the potential to allow natural orifice transluminal endoscopic surgery (NOTES) to be performed in a safer and more effective way.1 Marking the first documented use of the Overstitch™ endoscopic suturing device (Apollo Endosurgery, Austin, Texas) for the repair of a duodenal perforation in conjunction with a NOTES abdominal washout, the Penn State Health Milton S. Hershey Medical Center team of Abraham Mathew, M.D., Matthew T. Moyer, M.D., M.S., and fellow, Ryan Gaffney, D.O., presented their success with this technique at the third annual American College of Gastroenterology international endoscopy video competition in October 2015, Honolulu, Hawaii.2 The video presented two cases in which surgery-sparing endoscopic repair of a duodenal perforation was successfully employed. As Dr. Gaffney explains, “In both cases, the risks of morbidity or mortality with open or laparoscopic surgery were considered very high and an endoscopic approach was regarded as a potentially safer, life-saving option.”

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History of Pneumonia Presents Major Risk Factor for Aspiration or Pneumonia Following Routine Ambulatory Endoscopy

As the number of ambulatory endoscopies increases, it is imperative to identify and work to prevent complications. Respiratory complications are considered the most common associated with such procedures (including coughing, fever and shortness of breath) and are documented for an estimated 5.3 percent of patients following an ambulatory endoscopy where propofol was administered.1 Abraham Mathew, M.D., and Lisa Yoo, D.O., Gastroenterology and Hepatology, found that 1.1 percent of adults who underwent a routine ambulatory endoscopy experienced pneumonia or aspiration within 30 days after the procedure. The vast majority of cases involved pneumonia, while cases of aspiration were very low (0.07 percent).

Clinical Characteristics Chart

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Diabetes Mellitus and Metabolic Syndrome—Independent Risk Factors for Hepatocellular Carcinoma

At the annual American College of Gastroenterology (ACG) meeting in 2015, Allison Kasmari, M.D., internal medicine resident, Penn State Health Milton S. Hershey Medical Center, presented findings on behalf of a group of researchers, including Amy Welch, M.D., Thomas Riley, M.D., and Thomas McGarrity, M.D., demonstrating a significantly increased risk (35 percent) of hepatocellular carcinoma (HCC) among individuals with type II diabetes mellitus (DM) and hypertension (23 percent). Based on a retrospective review (2008-2012) of 7,473 patients with HCC using MarketScan, a U.S. insurance claims database, the largest increase in HCC risk (458 percent) was seen among patients with the triple combination of DM, hypertension and hepatitis C virus (HCV), compared to age-matched controls without such diseases (Table). The abstract findings were ranked among the top 10 from a total of more than 2,500 abstracts presented at the ACG meeting and were also featured on Medscape and in an ACG SmartBrief. Continue reading

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Providing Hope to Patients with Carcinomatosis: Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Mucin covering the liver

Mucin covering the liver

For patients with peritoneal dissemination of an abdominal malignancy (e.g., carcinomatosis), cytoreductive surgery (CRS) paired with hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly increase survival time.1 According to Colette Pameijer, M.D., FACS, associate professor of surgery, “The CRS/HIPEC technique offers hope to these patients. It adds a significant amount of time to their lives, which would otherwise be counted in months, rather than years.” Metastatic cancer cells implanted within the peritoneal cavity or its surfaces are not detectable by CAT scan, and do not respond well to standard resection and systemic chemotherapy. Patients with carcinomatosis who receive palliative treatment have a median survival time of six months.1 Continue reading

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Large Colorectal Polyp Morphology Predicts Endoscopic Management Patterns

As techniques and technology have rapidly advanced over the past decade, endoscopy has had a large impact on how many gastrointestinal (GI) conditions are treated. “One of the biggest shifts we have made clinically in terms of the number of patients treated is endoscopic resection of large colorectal polyps,” says John Levenick, M.D., Penn State Hershey Gastroenterology and Hepatology. In the past, these would have been automatically referred for open or laparoscopic resection. However, not all large polyps exhibit the same clinical features and some pose relatively greater challenges and risks during resection. Levenick and colleagues determined how well an endoscopic approach performed for management across polyp types based on gross morphology. Continue reading

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