Physicians at Roger Williams Medical Center Perform First-in-Rhode Island Surgical Procedure
Thursday, August 13, 2020
Physicians at Roger Williams Medical Center recently performed a first-in-Rhode Island surgical procedure that corrects a blockage of the digestive system that can occur in patients with advanced duodenal cancer.
Dr. Nabil Toubia, a gastroenterologist, Dr. Vince Armenio, a medical oncologist, and Dr. Abdul Saied Calvino, a surgical oncologist, worked together on this procedure using endoscopic ultrasound guidance to create a path between the blocked portion of the bowel and the stomach, using the new Lumen opposing stent technology that recently became available in the United States.
The procedure had no complications and improved the patient’s bowel obstruction symptoms and allow him to continue his chemotherapy which he needs to treat his extensive disease.
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About Procedure
Toubia spoke with GoLocalProv about the procedure.
"This was innovative because of the technology used and the multidisciplinary team approach to a difficult situation in a complex cancer patient," said Toubia. "The lumen apposing stent i.e. the device was designed and FDA-approved to drain pseudocyst surrounding the gut — now doctors have innovative ways to use it for other applications. Now we can go in and drain other obstructed structures without the need of potentially morbid surgery."
"In this case, the lumen apposing stent was used instead of large surgery — we were able to open up a channel between the obstructed small bowel and the stomach that allowed for drainage of the obstructed loop of bowel," said Toubia. "Major surgery was avoided but we were working in coordination with Dr. Calvino and his surgical oncology team in case of any complications such as a leak or bleeding which would require immediate surgical intervention."
Shorter Time -- and Recovery
"The procedure took only took 20 minutes and was done without incision," Toubia added. "If surgery had been performed — it would have required drainage of the obstructed loop of bowel rerouting his anatomy, this would have been a major undertaking since the patient had locally advanced recurrent cancer — and a hospitalization of up to a week. This was done on a Friday and he was released on Monday."
"The lumen apposing stent technology is being used more commonly around the nation," said Toubia. "It is used for instance to create a communication between the stomach and unobstructed loop small bowel in order to bypass an obstructed segment such as in the case of gastric outlet obstruction due to malignancy. It allows the opening of a pathway to bypass the area of obstruction.
"Other instances where this technology has been used is in patients who have high risk of morbidity and mortality for surgery and in need their gallbladder drainage — the traditional way would have drained gall bladder externally," he said. "What is being done is to drain it internally using the lumen apposing stent tool."
Impact in RI
"Having the experience of doing something like this — will allow us to offer it to other patients," said Calvino. "Every patient is different — we were able to help the symptoms and improve quality of life. Having this tool is an important tool in the tool box, and now we have more experience with the procedure."
"It’s important for Rhode Islanders to know — we have the more advanced techniques and they don’t have to travel out of state," he added.
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