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Endoscopic Treatment of Rectal Tumor Eliminates Need for Major Surgery

Endoscopic Treatment of Rectal Tumor Eliminates Need for Major Surgery Laura Moreno and her son, Pete Moreno, play a card game called "31," one of Laura's favorite card games.

Laura Moreno acknowledges, a little ruefully, that she's "a little old lady."

It's true she relies on a walker -- at age 82, many people do. But her good humor and spirits are those of a young woman, and she doesn't let age interfere with the things she loves: spending time with her children and grandchildren, weekly bingo outings, doing puzzles.

So when a serious illness threatened in 2013, Moreno and her family looked for the best, most advanced treatment they could find.

"I enjoy my life," she said simply, "and I'm not ready to go. It's not my time, not yet."

The first signs that something was wrong appeared in late summer, with stomach pain that wouldn't go away. "I thought my ulcers had come back," remembered Moreno, "so I tried being more careful about what I ate." But the pain only grew worse. By October, it was bad enough that her son, Pete, insisted that she visit the local hospital in their hometown of Hobart, Indiana.

The first signs that something was wrong appeared in late summer, with stomach pain that wouldn't go away. "I thought my ulcers had come back," remembered Moreno, "so I tried being more careful about what I ate." But the pain only grew worse. By October, it was bad enough that her son, Pete, insisted that she visit the local hospital in their hometown of Hobart, Indiana. Irving Waxman, MD

What doctors found were not ulcers but a low-lying mass in her rectum. They recommended that she be evaluated at a major medical center, and referred her to Irving Waxman, MD, an expert in interventional endoscopy and director of the Center for Endoscopic Research and Therapeutics (CERT) at the University of Chicago Medicine. In November, accompanied by her son and daughter-in-law, Moreno made the trip to Chicago.

After performing an endoscopic ultrasound and doing biopsies of the mass, Waxman was able to give Moreno what she calls "the best news of my life": the mass wasn't cancerous. "It was such a relief," she said.

"Everyone was so nice, so caring. And Dr. Waxman's Spanish is excellent -- it really helped to be able to talk to him in my own language."

But the news wasn't all good. The mass was large, covering 75 percent of the rectal circumference and extending a full 10 cm from the outermost end of the anal canal -- roughly half the length of the rectum itself. The location was particularly worrisome: low rectal tumors, those lying less than three centimeters above the anal opening, usually require a permanent colostomy and complete removal of the rectum and anus.

"Given Mrs. Moreno's age and overall health, we had to weigh the options carefully," Waxman said. "A colostomy itself is life-altering, and such a surgery could have been life threatening. In fact, when our colorectal surgical team evaluated Mrs. Moreno, they were concerned that any surgery, even one that was minimally invasive, might be too risky for the patient."

After discussing the options with Moreno and her family, Waxman and his team decided to attempt endoscopic treatment, performed on an outpatient basis in one of CERT's state-of the art surgical suites.

"I was worried," Moreno admitted. "The alternatives weren't good. But everyone was so nice, so caring. And Dr. Waxman's Spanish is excellent -- it really helped to be able to talk to him in my own language. You just feel more comfortable. It gives you confidence."

"I was worried," Moreno admitted. "The alternatives weren't good. But everyone was so nice, so caring. And Dr. Waxman's Spanish is excellent -- it really helped to be able to talk to him in my own language. You just feel more comfortable. It gives you confidence."

The confidence was well placed. Taking advantage of high-definition imaging that allowed him to see the entire affected area in detail, Waxman began a procedure known as wide-field endoscopic mucosal resection. Working in one small zone at a time, he first elevated a tiny portion of the lesion from the underlying bed of healthy mucosal tissue. Then, placing a thin wire loop, or snare, around the section, he tightened the loop and sent an electrical current through the wire to both snip off the abnormal tissue and seal the resulting wound.

It was a painstaking process: all told, the procedure took four hours and required 250 separate resections. "Very few centers in the country, and probably none in Chicago, would have offered an endoscopic approach to a lesion of this size and extent," Waxman said.

Still, the results -- complete removal of the tumor without the potentially dangerous complications of surgery -- more than justified the effort. And although the recovery itself wasn't without setbacks, Moreno is doing well.

"The first thing I asked Dr. Waxman was whether I could eat chili," she laughs. "He said yes!" Turning serious, she added, "Dr. Waxman is an excellent doctor, very attentive and very skilled. The nurses, the people in the office -- it's an excellent team. They're good people, and I'm very thankful."

September 2014


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