April is Esophageal Cancer Awareness Month, a good time to shed some light on this uncommon but growing cancer.
P.O.E.M. has come to Seattle at Swedish Medical Center. No, not the kind that rhymes but one that is elegant in its own way. Per Oral Endoscopic Myotomy or POEM is relatively new procedure used in the treatment of achalasia, which is a disorder of the esophagus due to degeneration of the nerve network within the walls of the esophagus. The diseases leaves patients with little propulsive power to push food toward and into the stomach as well as causing the “valve” at the top of the stomach to remain closed. This makes it difficult for patients to eat or drink. Patients may need to drink a lot of fluid to get food to pass into the stomach whereas others may feel pain or discomfort after eating and still others may have undigested food come up many hours after eating or when lying down.
The Swedish Thoracic Surgery team recently had results from a study published in Annals of Thoracic Surgery, "Short-Term Outcomes Using Magnetic Sphincter Augmentation Versus Nissen Fundoplication for Medically Resistant Gastroesophageal Reflux Disease", in which a retrospective case-control study was performed of consecutive patients undergoing either procedure who had chronic gastrointestinal esophageal disease (GERD) and a hiatal hernia of less than 3 cm. Based on the study, the LINX device appears to restore the sphincter barrier function and preserve normal physiology which enables belching and vomiting.
Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD. Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them. I thank the patients who have taken time to share their thoughts on the blog.
When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.
There are some exc...
Dysphagia. This is the technical medical term for difficulty swallowing which is a common complaint. Most people have experienced this sensation in their lives. It can occur when you’re eating something doughy like a bagel or French bread and then take few extra bites before swallowing. If you immediately swallow several times in a row you may get the sensation that the food is slowly passing toward your stomach. Your mouth may salivate; you might get a pressure sensation behind your breastbone; you might experience some pain, burning or discomfort. And, then you will feel instant relief the second the food you swallowed passes from the esophagus into the stomach. This is dysphagia.
For most people, this experience occurs very occasionally and usually when we are trying to eat too much, too quickly.
However, for some patients this symptom may occur more frequently such as daily and sometimes as often as every bite of food. It may also occur with solid food alone or with both sol...
LINX has arrived at Swedish! After several months of preparation, we will be implanting the first 3 LINX devices on September 21, 2012. For our 3 adventurous patients, we are excited to see them have their GERD controlled with the LINX and also hope that it meets their expectations.
To learn more about this procedure and others options for managing GERD, you may wish to come and hear my partners Dr. Ralph Aye and Dr. Alex Farivar talk at Swedish Issaquah on September 26th, 2012.
Update on 9/23: I am happy to report that our patients who have received the LINX device are all doing well.
Acid reflux, heartburn and indigestion are all forms of gastroesophageal reflux disease or GERD. This common problem afflicts over 20 million people in the United States on a daily basis. As a surgeon who treats patients with some of the most severe symptoms of GERD, I was recently struck by the fact that very little has changed in the treatment of the debilitating problem over the last several decades.
Medications have always been the primary treatment for patients with GERD. TUMS, Rolaids, alka seltzer are easy over the counter remedies that could provide instant but only short-term relief. More potent medications called H2 receptor antagonists (commonly known as Zantac, Pepcid AC) brought about longer lasting relief. These medications were great but many patients experienced a relapse of symptoms.
The newest medications for GERD...
New technologies have the potential to improve patient outcomes but need to be carefully studied so that patients will maximally benefit. Robotic thymectomy for myasthenia gravis and thymomas was introduced at Swedish in May of 2009 after careful evaluation of our outcomes with traditional sternotomy and VATS thymectomy.
One of the more challenging aspects of being a surgeon is to understand how new technologies can benefit your patients and how those technologies might become part of your practice. If you’ve watched Grey’s Anatomy, read Time magazine or the Wall Street Journal or surfed the web recently, you’ll be aware of the da Vinci surgical robot. The robot has allowed many different surgical specialties to operate in confined areas of the body with tiny instruments placed through equally small incisions thereby avoiding a larger incision. In thoracic surgery, one of the confined spaces is an area in front of the heart where a gland called the thymus reside...
November is associated with two significant cancer awareness efforts that have meaning to all of the staff at Swedish Thoracic Surgery.
First, and most important to us, November is Lung Cancer Awareness month. Each year for the last 6 years we have suported this important cancer with an event for the public. Lung cancer is the most common cancer and remains the deadliest of all cancers. Yet, is is always shrouded in secrecy because of its association with smoking. But, many of the patients quit smoking some time ago or were never smokers and must still face this deadly disease.
This year, a public event - Shine a Light on Lung Cancer - will be held on Tuesday, November 7, 2001 at 5:30 pm at Gilda's Club on 1400 Broadway. Anyone who has been touched by lung cancer is encouraged to attend.
Second, November is also becoming known as Movember. This movement has been to support men's cancer initiatives and prostate cancer with the...
April is esophageal cancer awareness month and I was stimulated by two patients I saw recently to highlight the association of esophageal cancer with chronic GERD (heartburn, acid reflux) and the over the counter treatments people take for GERD.
Why am I writing about this? To highlight three common issues I hear everyday:
Click here for a full list of Dr. Louie's publications. A subset of his citations is summarized below.
Brian E. Louie, Xiaopan Yao, Alberto Antonicelli, Eric Vallières, Zhitao Gu, Frank Detterbeck, James Huang, Yue Shang, Ralph W. Aye, Alexander S. Farivar and Wentao Fang. Partial Thymectomy Results In Similar Outcomes To Total Thymectomy In Masaoka-Koga Stages I And II Thymoma. Submitted to Journal of Thoracic and Cardiovascular Surgery. (2016)
Brian E. Louie, Andreas M. Schneider, Drew B. Schembre, Ralph W. Aye. Impact of Prior Interventions on outcomes during per oral endoscopic myotomy. Surgical Endoscopy (2016) In press.
Brian E. Louie, Jennifer L. Wilson, Sunghee Kim, Robert J. Cerfolio, Bernard J. Park, Alexander S. Farivar, Eric Vallières, Ralph W. Aye, William R. Burfeind Jr., and Mark I. Block. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Annals of Thoracic Surgery (2016). doi.org/10.1016/j.athoracsur.2016.03.032
Brian E. Louie, Alexander S. Farivar, Dale Shultz, Christina Brennan, Eric Vallières, and Ralph W. Aye. Short Term Outcomes Comparing Magnetic Sphincter Augmentation Versus Nissen Fundoplication for Chronic GERD. Annals of Thoracic Surgery - (2014) 98;498-505.
Brian E. Louie, Alexander S. Farivar, Ralph W. Aye and Eric Vallières. Early Experiences with Robotic Lung Resection Result in Similar Operative Outcomes and Morbidity When Compared to Matched VATS Cases. Annals of Thoracic Surgery (2012) 93(5):1598-1605.
The Patient Rating score is based on responses given during the CAHPS Patient Experience Survey.Responses are measured on a 10 - point scale, with 10 being the best score. These scores are then translated to a 5 - point scale in order to display results in a 5 - star rating.Comments are also gathered from the same survey and displayed in their entirety with the exception of any language that may be considered slander, libel or contain private health information, which will be removed prior to publishing the comments.