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Polyps, or areas of dysplasia (precancerous tissue), can occur in the intestines. Until now, they have been hard to remove because they're flat.
By injecting carbon dioxide below the polyp, the area plumps up and is isolated from the deeper layers of the intestinal wall.
The endoscope is passed into the plumped up area and can remove a polyp or can sample the deepest layer of the gut wall.
Following a procedure during which the deepest layers of the gut wall have been sampled, the bubble collapses and the overlying tissue seals the deep sampling site safely.
Heartburn, gas, bloating, nausea, vomiting, constipation or diarrhea. Although these conditions make great material for clever advertising of products that promise to quell your fire, deflate your bubbles and settle your tummy, the remedies are a short-term solution to an ongoing problem if you have a gastrointestinal motility disorder.
Normally, the muscles of your intestines contract and relax in a synchronized manner to propel food through your digestive system. But if you have a motility disorder, these contractions are somewhat out of sync. Motility disorders can be caused by problems with your intestinal muscles or with the pacemaker cells that trigger intestinal muscles to contract. Or, these problems can be the result of a glitch in the nerves that line your intestinal tract. Regardless of the reason, when food doesn't move through your digestive system the way it should, the result is intestinal distress.
But help is on the way for the millions of Americans who have motility disorders. If you're among them, a new procedure called submucosal endoscopy, developed at Mayo Clinic, may quiet your internal rumblings.
In traditional endoscopy, a lighted scope is navigated down the passageway of your esophagus and into your intestines to view the lining of your intestinal tract. The submucosal endoscopy procedure follows that same path, but also gives doctors a way to enter and separate the layers of the intestinal wall — something never before possible. The procedure — developed by Christopher J. Gostout, M.D., director of endoscopy research and development at Mayo Clinic Rochester and his colleague, Elizabeth Rajan, M.D. — enables endoscopists to separate the individual layers of the intestinal tract and reach the deepest muscle layer in order to get a sample. This muscle layer contains nerve elements and pacemaker cells that can give clues to a person's motility disorder. "By applying endoscopy to better understand and anatomically classify motility-related disorders, we can develop more effective treatments," says Dr. Gostout.
In addition to using the submucosal endoscopy procedure to retrieve previously hard-to-reach muscle and nerve samples, Dr. Gostout and his team also are designing techniques and tools to safely remove, in one piece, polyps and early cancers from the intestinal tract. Removing these suspicious tissues — which grow as a result of heredity, diet, environment and aging — reduces the probability of cancer in high-risk people.
"For years, we've been trying to find a better way to remove large, flat polyps and areas of dysplasia (precancerous tissue) in the intestines, but they're hard to get at because they're flat. But back in 1998, we started thinking about this problem differently and decided a better way to get at these areas was to plump them up. This way we can isolate them from the deeper layers of the intestinal wall, where injury and problems can arise, using conventional methods to remove these tissues," says Dr. Gostout.
"This is really a paradigm shift in thinking. Instead of digging in to try to remove the tissue or trying to remove it by burning it away, we now inject the area with carbon dioxide just below the bad tissue to plump it up to form a bubble. We can open the bubble and place the endoscope directly into it. We then use a special instrument to remove the suspicious area. This method of removal is more efficient, safer for the patient and may be more cost-effective. Following the procedure, the bubble collapses and seals the space, which is very important for healing," says Dr. Gostout.
Due to its success, submucosal endoscopy is now being studied for more than motility disorders. Dr. Gostout and his team are planning to use it to identify and remove areas of dysplasia in Barrett's esophagus (a precancerous condition). Left untreated, these areas may lead to advanced cancer of the esophagus.
And, not too far down the road, Dr. Gostout and his colleagues can imagine using the submucosal endoscopy technique to gain access to the heart and the vessels surrounding the heart by way of the esophagus. "Blood clots commonly occur in the left atrial appendage. If we can get to the left atrial appendage through the esophagus, it would enable us to remove this potential site for clots to develop. This same access route may be used to plant electrodes in the heart to monitor heart rhythms in order to control abnormal heart rhythms. This would be a less invasive way of treating conditions such as atrial fibrillation," says Dr. Gostout.
In what he refers to as blue-sky thinking, Dr. Gostout envisions an environment in which he and his colleagues could take a step back from their usual routines to identify unmet needs and less invasive ways to resolve these needs. "This is where philanthropy could help. With philanthropists providing support, doctors could be freed to think innovatively about existing problems that need better solutions," says Dr. Gostout.
"We could use this kind of blue-sky thinking to develop a better tool set for use in the submucosal resection procedures. We could collaborate with colleagues on other ways our procedures might be used. And we could develop clinical trials to test our techniques and prove our theories all in an effort to improve patient care," says Dr. Gostout.
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