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Saving the esophagus while preventing cancer

April 26, 2016 | UC Irvine Health
Samuel Davila and Dr. Jason Samarasena
Samuel Davila and Dr. Jason Samarasena

Precancerous cells covered the lining of almost half of Samuel Davila’s esophagus. If they stayed, they represented near-certainty that he would develop cancer within 10 years.

But the treatment he was offered at a Los Angeles hospital — removing the lower half of the food tube, and stretching the stomach vertically to attach it to what remained — was associated with long and difficult recovery, plus health problems that would plague him for the rest of his life.

“I told the doctor, ‘I run, I do martial arts. Will I still be able to do these after the surgery?’” Davila recalls. “The doctor’s mouth just hung open for 20 seconds.”

Finding a nonsurgical option

Life after the surgery typically includes nausea, gas, acid reflux and difficulty digesting. As bad as that sounded, Davila was ready to go ahead. But then a close friend started searching the Internet and discovered a far more attractive option offered at the UC Irvine Health H.H. Chao Comprehensive Digestive Disease Center (CDDC).

A year and a half later, Davila’s esophagus is intact — and free of abnormal cells. The endoscopic procedure that made this possible, radiofrequency ablation, is far less invasive than surgery, and more than 95 percent effective, says Davila’s UC Irvine Health gastroenterologist, Dr. Jason Samarasena.

Davila had the most severe form of a condition called Barrett’s esophagus, in which abnormal cells line the esophagus, usually as a result of gastroesophageal reflux disease or GERD. Although most people with Barrett’s don’t go on to develop cancer, their risk is steeply elevated if it is moderate or severe.

April is Esophageal Cancer Awareness Month. The American Cancer Association estimates that nearly 17,000 new esophageal cancer cases will be diagnosed in 2016. Esophageal cancer — which is more likely to strike smokers and men older than 55 — tends to be aggressive and difficult to detect early, with a five-year survival rate of 5 percent to 30 percent, according to the National Cancer Institute.

Zapping away abnormal cells

Davila’s case was complicated by the formation of nodules in his esophagus that had to be surgically shaved off first using the endoscope, Samarasena says.  It’s a delicate procedure in which Samarasena is highly experienced. Once Davila had his nodules removed in this outpatient procedure, he was ready for the ablation.

Radiofrequency ablation is an outpatient procedure that uses a high-definition endoscope to locate the precancerous cells, which look pink. When there are large numbers of those abnormal cells, as in Davila’s case, Samarasena says, the first treatment involves a balloon catheter placed alongside the endoscope. It’s inflated against the wall of the esophagus to reach the entire circumference, then it zaps the precancerous cells with a band of electrodes.

After a few months, the esophagus is rechecked, after which the remaining precancerous cells are treated with a more targeted approach, using an electrode fitted to the tip of the endoscope. It takes two to four treatments to eliminate the cells and restore healthy tissue to the esophagus.

Best of all, the treatment requires no surgical removal of part of the esophagus and produces none of the surgery’s resulting health and quality-of-life complications.

“It’s like turning the clock back 10 or 15 years,” Samarasena says. The lining looks white again, the color of healthy tissue.

Recovery takes a few days, and a soft diet is required for a week or so.

Moving to OC to continue treatment

Since seeking treatment at the CDDC, Davila has become ardent proponent of preventive medicine. He tells people of the importance of regular check-ups and tests to detect gastrointestinal conditions before they transform into full-blown, life-altering disease. People need, he says, “to catch their disease in time, cure their disease and avoid going through pain and agony.”

Davila’s case was an exceptionally bad one, but his response was exceptionally good. After his first procedure in early 2014, more than 95 percent of the precancerous cells were gone.

Davila was so dedicated to his treatment that when his insurance would not cover medical care outside the county in which he lived, Davila moved from the Los Angeles area to Laguna Hills, to continue treatment with his UC Irvine Health doctor. After follow-up treatment in late 2014, the rest of the abnormal cells were gone. They could come back, but he’ll be checked regularly to catch them early if they do.

He vividly remembers waking up after the endoscopy to find that most of his abnormal cells were gone. “Dr. Samarasena looked into my eyes and said, “’We did it!’”

Comments

Mark O
May 04, 2016

I'm an esophageal cancer survivor but my younger brother was not. We both had adenocarcinomas at the GI junction & I also had squamous cell carcinomas. I underwent a esophajectomy and recovered well. First comment: whatever the patient and the medical team finds as the best long-term treatment is the one you go with. If it should be the full esophajectomy life restrictions this article suggests are exaggerated. The only physical activity limitations I experience are those of my imagination and will.

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