Gastroenterology & Hepatology

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Division of Gastroenterology & Hepatology
GI Cancer Surveillance Program

Each year, about 15,000 Americans find out they have esophageal cancer. Unfortunately, most patients are diagnosed at a late stage with symptoms of difficulty swallowing or severe anemia. At this stage, cancer of the esophagus usually cannot be cured.

The best chance for curing the disease is through early detection. Recent studies have shown a markedly increased risk for esophageal cancer in patients with long-standing heartburn or Barrett's esophagus. Unfortunately, traditional screening methods, such as conventional endoscopy, are costly and require patients to miss work because they must be sedated during the exam.

Transnasal Ultrathin Unsedated Upper Endoscopy
This procedure has been extensively developed and validated by researchers and clinicians at the Medical College of Wisconsin.  It provides the potential for "same day" evaluation of patients with various upper intestinal complaints, without the associated costs and risks of sedated endoscopy.  Particular applications include screening for Barrett's esophagus, screening for esophageal varices in patients with cirrhosis, evaluation of upper abdominal discomfort, and evaluation for evidence of H. pylori infection.

Open Access Diagnostic Upper and Lower Endoscopy
We offer routine screening and surveillance of patients referred by their physician for upper endoscopy and colonoscopy.  Often, a referring physician does not need intensive consultation for a procedure, as in the case of colorectal cancer screening or surveillance of Barrett's esophagus.  In this way, we can expedite the requested procedure with minimal patient cost and inconvenience.

Palliative and/or Curative Treatment of Gastrointestinal Malignancy
We provide expert care in virtually every area of endoscopic treatment and with close collaboration with our colleagues / team members from Surgery, Radiology, Oncology and Radiation Therapy can provide expeditious evaluation and treatment to optimize patient care.  Our technical expertise includes laser / argon plasma therapy including photodynamic therapy for benign and malignant conditions, endoluminal stent placement of the entire gastrointestinal tract including an anti-reflux esophageal stent designed at the Medical College of Wisconsin, diagnostic and therapeutic ERCP and endoscopic ultrasound.

Consultative care in the evaluation and treatment of Gastrointestinal malignancies
For those patients who require more extensive evaluation, we offer extensive clinical  support in the evaluation and management of virtually all GI disorders, including referral for Genetic Testing and Counseling.

In an attempt to screen those at risk, the GI Cancer Surveillance Center uses a new form of ultra-thin endoscopy. This small, thin camera is used to view the esophagus and stomach. The new procedure does not require sedation and can be performed in less than 20 minutes.

For patients with late-stage esophageal cancer, therapy is based on relieving patient symptoms, with difficulty in feeding being the most common. Traditionally, feeding tubes are placed directly into the stomach through the skin, allowing patients to receive nutrition.

Dua Stent Prevents Reflux                                                         
In the past several years, tubes or stents have been developed that can be placed in the esophagus, bypassing the tumor and therefore allowing patients to eat. The drawback of these stents is that in some patients material can reflux or flow from the stomach back into the throat and lungs, causing pneumonia. To prevent this problem, Kulwinder Dua, MD has developed a stent with a pressure-sensitive valve that prevents reflux. The Dua Stent is FDA-approved. Patients can now enjoy their food without the problems of reflux. Another benefit of this stent is that it allows patients to belch or vomit if necessary. Dr. Dua notes that the benefits of this stent may extend well beyond patients with esophageal cancer, but currently it is approved only for cancer-related swallowing difficulty.
© 2014 Medical College of Wisconsin
Page Updated 10/02/2014