ASST HOSPITAL OF CREMONA PANCREAS CANCER, GASTROINTESTINAL BYPASS
SOPHISTICATED AND MINIMALLY INVASIVE ENDOSCOPIC TECHNIQUE USED FOR THE FIRST TIME THE PATIENT STARTS EATING AND CAN GET CHEMOTHERAPY
The Gastroenterology of Cremona among the Italian centers specialized in minimally invasive endoscopy thanks to the collaboration with surgeons and anesthetists
A minimally invasive operation to “override” the tumor and allow the patient to start eating again, without suspending chemotherapy. It was first performed in Cremona by Gastroenterology and digestive endoscopy on a 55-year-old man with an inoperable pancreatic tumor. The diagnosis dates back to about three years ago: despite oncological treatments, in the last period the disease has developed further to the point of occluding the duodenum – i.e. the first intestinal tract – compromising the passage of food coming from the stomach.
The gastrointestinal anastomosis operation – this is the technical definition – allows the stomach to be connected to an intestinal loop downstream of the narrowing, all endoscopically and guided by ultrasound. In this way, the use of more invasive surgical interventions is avoidedreducing hospitalization times and improving the person’s quality of life.
The patient is well and will be able to continue treatment in oncology, where he will continue the therapeutic process to treat pancreatic cancer. The operation carried out will pave the way for new cases of this type, which place the Gastroenterology of Cremona among the Italian centers specialized for minimally invasive endoscopic interventions.
A “BRIDGE” BETWEEN STOMACH AND INTESTINE
“Until now, this type of problem has been solved with the implantation of duodenal prostheses,” he explains Roberto Grassiadirector of Gastroenterology and Digestive Endoscopy at the Hospital of Cremona. «It is a small metal or plastic tube that is inserted inside the intestine to resolve blockages and restore the transit of food. In the case discussed these days, it was important guarantee the patient a good quality of life in the long term, which is why we opted for the ultrasound-guided gastroenterostomy. The clinical literature demonstrates how this type of operation performed only endoscopically is more effective compared to the simple duodenal prosthesis and less invasive than traditional surgery.”
Once the best point to connect the two organs has been identified, a special prosthesis is inserted which acts as a bridge, excluding the occlusion caused by the tumor. «It is a kind of bypass – continues Grassia – which not only allows the stomach to be emptied but also prevents the development of the pathology from rendering the operation ineffective, while the patient can continue the course of oncological treatment».
MULTIDISCIPLINARY COLLABORATION TO REDUCE RISKS
Also in this case, the multidisciplinary collaboration with General Surgery (directed by Gian Luca Baiocchi), Anesthesia and Resuscitation (directed by Enrico Storti) and Oncology (directed by Matteo Brighenti) allowed us to set the most appropriate treatment path for the patient: «The discussion with colleagues from the other departments involved allowed us to intervene by minimizing the risks for the patient, being able to count on the support of surgeons and anesthetists if – in case of complications during the endoscopic procedure – it was necessary to intervene surgically».
