Tag Archives: research

Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection: Minimally Invasive Techniques for Resecting GI Mucosal Tumors

Major advances in the development of endoscopic devices and techniques over the past fifteen years have introduced endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) as standard of care for the safe and effective removal and/or definitive staging of mucosal lesions of the esophagus, stomach, duodenum and colon, often eliminating major surgery as first-line management. Gastroenterologists at Penn State Hershey Medical Center including Abraham Mathew, M.D., Matthew Moyer, M.D., and Charles Dye, M.D., have become leading clinicians and active researchers in these techniques, performing several hundred EMR procedures annually. Mathew explains, “EMR is the more widely used of these techniques for removal of smaller tumors or lesions [<2.5 cm]. With EMR, normal saline or hydroxy propyl methylcellulose, dilute epinephrine and methylene blue are injected into key areas of the submucosal space beneath the tumor, strategically positioning the tumor and separating it from the bowel wall; the tumor can then be resected with less risk of thermal or mechanical damage to the muscularis propria. With ESD, a more aggressive technique for removal of larger, more invasive tumors, the surgeon uses specialized devices to tunnel into the submucosal plane to dissect the tumor en block. Incisions are closed endoscopically with sutures or clips.”

A colon mass lesion in the process of being resected by ESD.

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Addressing Patient Nutritional Needs in Complex Abdominal Surgery and Intestinal Failure

The pre-treatment nutritional status of patients with acute abdominal injury, or chronic gastrointestinal (GI) illness plays a large role in post-surgical course of recovery. Likewise, their ability to obtain nutrition after treatment significantly impacts long-term health outcomes and quality of life.

David Soybel, M.D.

Physicians at Penn State Hershey Medical Center and Penn State College of Medicine are investigating how to better detect and address nutritional needs before and after major complex GI surgery. According to David Soybel, M.D., “A significant proportion of patients with complex medical histories have pre-existing deficiencies in specific micronutrients such as zinc, copper, selenium, and magnesium. Major procedures place high demands on already compromised micronutrient stores, and often put these patients into a state of ‘micronutrient distress’ that may be associated with longer and more complicated recovery.”

Soybel’s research aims to establish methods to routinely detect and treat these deficiencies in high-risk patients, both before and after surgery. “Pre-surgical recognition of micronutrient deficiencies would provide the opportunity for micronutrient repletion and other interventions, and better prepare patients to get well post-surgery,” says Soybel. “Likewise, in acute situations, recognition of such deficiencies and rapid intervention could help patients better recover after emergency procedures.”

Gordon Lee Jensen, M.D., Ph.D.

Based in State College and one of few physicians in the country who specializes in management of intestinal failure, Gordon Lee Jensen, M.D., Ph.D., explains, “In the past, many of these intestinal failure patients would have died or become indefinitely dependent on intravenous, total parenteral nutrition (TPN). But now, because of new medications and advances in medical nutrition therapy, some can eventually come off of TPN and lead more normal lives. Today, TPN is more often a temporary supportive measure. Successful transition off of TPN depends on a number of factors. If a patient has at least 100 cm of small bowel length and a portion of intact colon (or at least 150 cm of small bowel and no functional or intact colon), and residual disease is controlled, then the odds are favorable for them to eventually adapt to enteral or oral nutrition.” Continue reading

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Identifying Gene Expression Profiles Linked to Cancer Development in Barrett’s Esophagus

Douglas B. Stairs, Ph.D.

Douglas B. Stairs, Ph.D.

The rising incidence of Barrett’s esophagus (BE) over the past two decades, coincident with increases in obesity, chronic heartburn, and gastroesophageal reflux disease, has focused attention on questions about how to monitor and treat these patients. About four in 1,000 BE patients annually develop esophageal adenocarcinoma (EAC), a 30- to 40-fold greater risk than in the general public. EAC, in turn, is linked to five-year survival rates of only about 20 percent. While early identification of high-risk BE patients is critical to improve EAC survival, factors predictive of cancer progression have not been identified. Continue reading

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IBD Center Advances Toward Official Announcement

Inflammatory bowel disease (IBD), has increasingly been a focus of clinical attention at Penn State Hershey Medical Center. The multidisciplinary care needed by these patients has brought together surgeons, gastroenterologists, radiologists, nutritionists, and other sub-specialists to foster the creation of an IBD center focused on providing excellence in IBD patient care and promoting access to cutting-edge research and treatments. This initiative has been directed by Walter Koltun, M.D., F.A.C.S., F.A.S.C.R.S., chief, Division of Colon and Rectal Surgery, and Emmanuelle Williams, M.D., assistant professor of medicine. Koltun explains, “The Penn State Hershey IBD Center has three major components that include a multidisciplinary patient care clinic where surgeons and gastroenterologists see patients together; educational and training programs for both medical professionals and patients; and, an IBD research program that includes benchtop basic science and clinical trials of new, investigative treatments.”
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