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Ochsner’s Dr. Mainor Antillon Pioneers ESD as an Alternative to Major Surgery
Tim Ragusa was having trouble swallowing. Even liquids were difficult to get down—even painful. Tim thought he was having esophageal muscle spasms and figured the condition could be alleviated with medication, so he was shocked when an endoscopy showed he had a small tumor in his esophagus.
Tim’s doctor referred him to Ochsner’s Mainor Antillon, MD, for evaluation. Dr. Antillon confirmed the presence of the tumor and scheduled Tim for an endoscopic submucosal dissection (ESD).
The standard of care for managing tumors like Tim’s is an esophagectomy, the surgical removal of all or part of the esophagus. Recognizing that esophagectomy is a major surgery with many serious risks and a lifelong impact on quality of life, Dr. Antillon is pioneering ESD an alternative to the traditional surgical route. ESD has proven to have far fewer complications than surgery, patients recover in less than 24 hours, and their quality of life postprocedure is not impaired.
ESD was developed in Japan in the 1980s initially to treat early gastric cancer, but the procedure is now used to remove tumors and lesions in other areas of the body, including the esophagus, stomach, and colon. Using a modified electrosurgical needle knife, a highly trained physician excises the lesion and the tissue under the lesion after injecting fluid into the submucosa to separate the lesion from the underlying tissue.
ESD is a technically demanding procedure that requires a high skill level achieved through rigorous training. Currently, there are no ESD training programs in the United States. Dr. Antillon trained in Japan and is one of only a very few physicians in the United States who can perform the procedure. He has performed more than 240 ESDs at Ochsner over the past 3 years, far more than practitioners at any other hospital in the country.
Most of Dr. Antillon’s procedures have been excisions of lesions in the colon, the most difficult of the ESD procedures because of the many bends in the colon and the thinness of the colon wall. A successful ESD of a colonic lesion, however, means the patient does not leave the hospital with a colostomy.
“ESD is an amazing technique that keeps the body intact,” Dr. Antillon said.
The primary complications of ESD include perforation and bleeding, but the incidence of these complications in Dr. Antillon’s colon patients is <4% for perforation and <3% for bleeding. In his gastrointestinal tract and esophageal patients, Dr. Antillon’s complication rate is <3%.
Tim didn’t have any complications, but his ESD took 3 times longer than Dr. Antillon expected because of the size of his tumor. Instead of the 1-2 cm the initial endoscopist estimated, Tim’s tumor was actually 10 cm, and the subsequent pathology report confirmed its malignancy.
With Dr. Antillon’s encouragement, Tim scheduled follow-up appointments with surgery and oncology specialists. Because the recurrence rate of esophageal cancer is about 25%, a surgeon Tim consulted after the ESD recommended an esophagectomy to ensure the cancer did not return. Tim asked how the removal of his esophagus would affect his life.
“He told me I’d have to sleep at a 20-degree angle,” Tim said, “and that I would go from eating like a lion to grazing like a cow.”
That prospect didn’t appeal to Tim—“I want to be able to eat a steak,” he said—so he passed on the surgery, but he wanted some peace of mind about whether or not he was cancer free after the procedure.
After Tim made 4 trips to M. D. Anderson in Houston and underwent countless tests, the Anderson oncologist confirmed that Tim’s cancer was gone.
“They showed me a picture of my esophagus at Anderson,” Tim said. “It looks like a brand-new esophagus.”
Today, he follows up regularly with Dr. Antillon for surveillance endoscopies. So far, those endoscopies have been negative.
“This has changed my life on how I look at things,” Tim said. “I just don’t take things for granted. I’m thankful for everything Dr. Antillon did for me. He is passionate about his work and cares about his patients. He’s going to save a lot of people.”
Figure legend: Dr. Mainor Antillon (right) and clinical research coordinator Chad Eriksen.
I am truly grateful
“I was admitted to the hospital for treatment of cellulitis and I received 2 antibiotics, Ciprofloxacin and Clindamycin, which killed my normal flora and allowed C diff (a bacteria) to ravage my colon. Then I began a long bout with a vile and vicious diarrhea. I was having silent seizures from dehydration and twice found on the floor unresponsive after falling out of bed during a mild seizure. I was hospitalized for treatment each time, and not improving.
My Nurse Practitioner in the Gastroenterology Department at Ochsner Medical Center was following my admissions, especially the last one. She told Dr. Arnab Ray about my condition, and he offered me the procedure of a fecal transplant. This allowed normal flora from a healthy person to colonize my colon immediately!
I am truly grateful Dr. Ray was able to do this for me as the many treatments were not helping and patients who need this procedure will have it available also. After 2 weeks, when I was improving I lived in a higher consciousness where I could use positive energy to help myself, my doctors, & anyone needing divine help.”
Dr. Arnab Ray, gastroenterologist, has performed over 20 Fecal Microbiota Transplantations (FMT) to treat Clostridium difficile and is currently enrolling patients in the clinical trials. Read Dr. Ray's article about a doctor's perspective on fecal transplants, click here.