Endoscopic mucosal resection helps patient avoid surgery

In 2015, after 25 years of traversing the globe for an airline, Catherine Arellano was enjoying her retirement traveling for fun with her husband, Solon.

But in May of that year, an endoscopy at another hospital revealed a large benign mass in her colon. Catherine was told that her only treatment option was surgery to remove 10 inches of her colon.

Avoiding surgery and a possible colostomy was important to Catherine.

“I thought it would take away from my quality of life,” she says. “It didn’t feel right that I wasn’t presented with other, less invasive options.”

A second opinion yields another polyp removal option

Catherine’s story isn’t uncommon. Most patients with complex colon polyps like hers are referred for surgical polyp removal. The colon wall typically is only 4-to-5 millimeters thick, and many providers believe these large or flat lesions are too difficult to remove endoscopically, and surgery is the only option.

While endoscopic surgery has advanced since the first polyp was removed in 1973, there’s still risk involved. And despite the best efforts of the surgical team, there are complications during surgery that can lead to death.

Catherine’s husband encouraged her to seek a second opinion. He’s a patient at MD Anderson’s Endoscopic Center receiving treatment for Barrett’s Esophagus – a pre-cancerous condition.

Catherine met with his physician, Marta Davila, M.D., chair ad interim of Gastroenterology, Hepatology and Nutrition, who felt surgery for her case wasn’t medically necessary.

“There have been great advances in endoscopic techniques over the past 10 years that allow us to treat patients,” Davila says. “It used to be that endoscopy was mostly for diagnosis and screening, but now we’re using endoscopy to treat patients. We can treat superficial cancers and get rid of them without surgery.”

Davila connected Catherine with Gottumukkala Raju, M.D., who specializes in endoscopic mucosal resection (EMR), one of several endoscopic techniques performed at MD Anderson.

“Dr. Raju laid out all of the possible scenarios of the procedure,” Catherine says. “I fully trusted him and had great confidence in his ability to do the right thing for me.”

Endoscopic mucosal resection provides safe alterative

The endoscopic mucosal resection procedure allows providers to remove polyps with an endoscope instead of having to make surgical incisions in the abdominal wall. First, fluid is injected into the colon wall underneath the polyps. Then, the polyps are carefully shaved off, along with superficial layers of the colon to help prevent regrowth.

Findings of a recent MD Anderson study showed that more than 75% of patients with complex colon polyps could avoid surgery for their polyp removal, as well as its associated risks and costs. Many patients don’t have access to procedures like endoscopic mucosal resection because few providers perform it. Providers don’t learn about this technique in their regular training and instead become proficient in it through specialized training.

“My research and development of techniques for endoscopic closure of colon perforations has helped me take care of these patients with large and complex colon polyps safely,” Raju says.

The right infrastructure

But an endoscopic mucosal resection isn’t possible without the right support and people, Raju says.

“At MD Anderson, we have physicians who are trained to cut these polyps, technicians who provide quality support during procedures, nurses who educate our patients, anesthesiologists who manage the cases, pathologists who can confirm the type of tumor removed doesn’t require surgery and a surgical team who can help our patient if something can’t be removed safely and completely,” he says.

Most centers don’t have this support system. So Raju and our other providers are partnering with the American Society of Gastrointestinal Endoscopy to develop educational materials to share their knowledge and treatment techniques with their peers at other hospitals, as well as patients.

In September, Catherine underwent an endoscopic mucosal resection procedure with Raju, who successfully removed her polyp. One month later, she and her husband traveled to Edinburgh, Scotland, her birthplace. They haven’t slowed their travel plans since – adding more and more destinations to their passports.

A longer version of this story originally appeared in Messenger, MD Anderson’s bimonthly employee publication.