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Baystate Health Leads with Precision: One of Few Centers in the U.S. Offering Life-Saving Procedure to Remove Early Cancerous Digestive Tract Lesions

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a male doctor with a beard and glasses in blue scrubs and a male patient with white hair and a beard smiling after a procedure

A highly specialized procedure to remove precancerous and early cancerous lesions from the gastrointestinal (GI) tract, the part of the digestive system that food and liquids pass through, is now being offered at Baystate Health and saving patients’ lives.

Endoscopic submucosal dissection (ESD) is an advanced minimally invasive procedure to remove precancerous and cancerous tissue coming from the mucosa, the membrane that lines the digestive tract. An advanced gastroenterologist uses a flexible tube with a camera called an endoscope and inserts surgical tools through the endoscope to remove precancerous and cancerous areas in one single piece.

This technique allows the doctor to reach the GI tract without making any incisions, and compared to open surgery, it offers a quick, and pain-free recovery.

ESD was originally pioneered in Japan in 1995. Given the high prevalence of localized gastric cancers in Asian countries, select skilled endoscopists began to immediately apply this technique for colorectal lesions to treat early gastric cancer. Today, only a few centers in the United States perform ESD because the procedure requires a high degree of expertise and precision.

Berkshire County resident Tom Reid and his family are grateful Baystate Medical Center is one of them.

Critical Treatment

Berkshire County retired 72-year-old mailman and beloved grandfather and great-grandfather Tom Reid went to Berkshire Medical Center’s Emergency Department in critical need of care. “I was feeling awful – really out of it,” said Tom. While in the emergency room he vomited blood and doctors there discovered he had bleeding ulcers in his esophagus. Doctors at Berkshire Medical immediately referred Tom to specialists at Baystate Health.

“When Tom was referred to us and we examined him, we determined that he had Barrett's esophagus (a precancerous disease) with extensive cancer every two centimeters in his esophagus,” said Dr. Kais (Zak) Zakharia, a gastroenterologist and advanced endoscopist at Baystate Health, who has received additional training to perform the ESD procedure. “We needed to see how deep the cancer was. We confirmed it was an early cancer. Our multidisciplinary team met, and it was our recommendation to perform ESD to fully remove the cancer and minimize the risk of local cancer recurrence by performing en-bloc resection which removes a tumor in its entirety and provides an accurate staging of the tumor.”

“I was thinking just get the cancer out any way you can, but Dr. Zak and the team explained that this particular procedure was the right move for me,” remembered Tom. “I had faith that he could do it. He showed me graphs about it, explained everything that was involved, and what I would go through afterward. They didn’t sugarcoat it and said it would be worth it to me.”

Who is a Candidate for the ESD Procedure?

ESD can be used to treat the following tumors and lesions which can be difficult to remove completely with other methods:

  • Precancerous and early-stage (not advanced) cancerous tumors in the esophagus, stomach, and small bowel
  • Precancerous and early-stage (not advanced) cancerous polyps in the colon

ESD is a more effective option than the conventional endoscopic mucosal resection (EMR) for removing GI tract growths, especially those too large to remove in one piece or those with definite cancer. Using ESD in these cases can minimize the risk of cancer recurrence and can be curative. ESD can also help the physician determine the exact stage of GI cancer and help create a specific treatment plan.

What Happens in an ESD Procedure?

During the ESD procedure, the patient receives anesthesia, and the gastroenterologist inserts an endoscope through the mouth (for upper GI procedures) or anus (for lower GI procedures). A special fluid is injected beneath the tumor to help it separate and lift away from the muscle layer of the GI tract wall. The gastroenterologist then uses a high-frequency electrical knife to remove the tumor in a single piece.

“Depending on several factors, this procedure usually takes anywhere from two to four hours,” said Dr. Zakharia. “However, in Tom’s case, it took 10 hours to perform due to the fact he had an ultra-long segment of Barrett’s esophagus, which means an altered lining of his esophagus due to chronic acid reflux, with extensive early cancer throughout.”

Tom’s entire segment, 16 cm, was removed circumferentially in a single piece! This ESD is the longest resection in medical literature and won an award at the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting. After the procedure, the segment was sent to pathology to look at the margins and ensure the cancer was not extending beyond the resection — both laterally and in-depth. Results came back negative with no sign of cancer beyond the piece that was removed.

“This great outcome is an example of the wonderful teamwork we have at Baystate,” said Dr. Zakharia. “I had a lot of support from a variety of disciplines including administration, management in the operating room, endoscopy, nursing, gastroenterologists, anesthesiology, surgical techs, sterile processing team members, ambulatory nursing, contact services, patient service representatives, and so many others. It’s because of the team as a whole that this patient has such an excellent outcome.”

Recovery from the ESD Procedure

As part of the procedure, Tom had stents placed to reduce temporary narrowing from scar tissue which have since been removed. He said the recovery was a challenge, as he was told to expect, but today he is feeling back to his “old self”, is considered cancer-free, and will continue checkups in regular monthly and then yearly intervals.

Dr. Zakharia said it’s important for the community to know that this highly specialized procedure of ESD is available to patients locally and it can make all the difference in people’s lives. “It can make a huge difference for these patients,” he said. “Alternatives would be to have the esophagus removed surgically which has significant morbidity. Cancer would need to be in the early stage and with recommendations from a specialist, ESD is an option instead of complex surgery.”

“I have all my strength back,” said Tom. “I was weak from even climbing stairs, but I’ve increased from walking around the block to now where I can walk four miles, no problem. I can taste and enjoy food again and I can go out to eat. I’m back to normal and want to thank Dr. Zak and everyone who took care of me.”

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