Novel endoscopic procedure helps patient avoid surgery
UC Davis Health is the only hospital in the Sacramento region to use STER approach to remove GI tract tumors
(SACRAMENTO)
When Jeffrey Lipow went in for a routine endoscopy, it revealed a serious problem. A follow-up endoscopic ultrasound confirmed he had a tumor under the inner lining of his stomach. A biopsy revealed it was a gastrointestinal stromal tumor (GIST).
Jeffrey Lipow returned home less than 24 hours after a tumor was removed from his stomach’s muscle layer.
The GI tract contains four layers: the innermost layer is the mucosa, underneath is the submucosa, followed by the muscularis propria and finally, the outermost layer — the adventitia.
When tumors are in the mucosa or submucosa, they can be easily removed during an endoscopy as the lining of the stomach is examined using a camera-mounted flexible tube. However, for tumors that originate in the muscle layer, called GIST tumors, removal is not as straightforward. Surgery is usually needed.
“To be honest, I wasn’t thrilled with the idea of needing surgery,” shared Lipow. “So, the care team looked into the different treatment options available.”
A multidisciplinary approach
When patients like Lipow are diagnosed with GIST tumors, their complex case is studied by a multidisciplinary team of UC Davis Healthgastroenterologists, pathologists and oncology surgeons. This team of specialists, known as the “Tumor Board,” meets regularly to discuss treatment options for the patients.
Initially, the team focused on trying to shrink Lipow’s tumor with medication.
“Luckily, the medication worked, and the tumor did shrink,” Lipow recalled, “but not enough.”
After a lengthy discussion, the team recommended that the tumor be removed surgically. However, when Lipow met with the surgeon, he expressed interest in exploring other, less invasive options.
Mendoza-Ladd suggested removing the tumor with an endoscopy using a new technique called submucosal tunneling endoscopic resection (STER). UC Davis Health is the only facility in the Sacramento region to perform this type of procedure.
Surgery is usually required to remove tumors that originate in the stomach’s muscle layer, but the UC Davis Health GI endoscopy team has turned to a novel way to remove them without an operation.
What is a STER procedure?
Lipow was excited when Mendoza-Ladd told him about the STER procedure.
“I thought this was a much better alternative; they didn’t have to cut into me!” he exclaimed.
During a STER procedure, a small cut is made in the innermost layer (mucosa) just a few centimeters from the main tumor. The incision serves as an entrance to a tunnel that is created between the mucosa and the muscle layer. This tunnel allows the team to avoid creating a hole in the stomach that would otherwise be required to remove the tumor.
The tumor is then cut from the muscle layer and removed through the tunnel. Afterward, the entrance to the tunnel is closed and the procedure is finished.
“With this novel procedure, we were able to easily remove the tumor without any incisions in the skin, which speeds up the recovery time of patients and avoids potential post-surgical complications,” Mendoza-Ladd explained.
“With this novel procedure, we were able to easily remove the tumor without any incisions in the skin, which speeds up the recovery time of patients and avoids potential post-surgical complications.”—Antonio Mendoza-Ladd
Back to his normal routine
Less than 24 hours after Lipow’s STER procedure, he returned home to Placerville.
“I was on a liquid diet for a few days, but other than that I was back to my normal activities, like walking my dog, pretty quickly,” said Lipow.
Lipow credits the interventional endoscopy team for taking into consideration his wishes, and for his quick recovery.
“I appreciated the options they provided, allowing me to avoid surgery and be back to my normal routine so quickly,” he shared.
