Rare Surgery on Intestinal Cancer performed at MedIndia Hospitals, Chennai (First time in India)
(L-R) Dr. M.S.
Prasad, M.S, Dr. B.J. Gokul, MD., DM,
Dr. T.S. Chandrasekar,
MD., DM, D.Sc, FRCP, FASGE, FICP, FIMSA) |
Medical Team with Patient (2nd from Left)
|
Rare Surgery on Intestinal Cancer performed at
MedIndia Hospitals, Chennai (First time in India)
Chennai, 4th January 2019: For a sole bread winner of the family, nothing is more
tragic than to be afflicted with an advanced cancer of the intestine at the
prime age of 41. The silver lining in an otherwise hopeless situation is ending
up in the right hands to get the latest treatment for successful palliation and
also become part of making a record as the first to have received such a
treatment in India.
We at the Medindia Hospitals, Nungambakkam, Chennai, a
tertiary specialty centre of Excellence for Digestive Diseases, affiliated to
the Tamil Nadu Dr. MGR Medical University, happened to receive a young
gentleman employed in Malaysia with advanced cancer of the duodenum with
symptoms of incessant vomiting, severe weight loss and jaundice due to blockage
of both the biliary tree and duodenum, the first part of small intestine. He
was just skin and bones due to his progressive illness and poor nutrition.
He could not retain the food he ate. He was referred to us from his native
place Kumbakonam.
At this advanced stage,the tumour infiltration was
such that a surgery was not feasible and conventional endoscopy treatment would
not be successful. There was obstruction in both the biliary system as
well as proximal small bowel causing severe jaundice and unrelenting vomiting
due to total obstructionto the outflow of food. This was the challenge that
needed to be addressed.
Thus, a team doctors under the leadership of Dr.
T.S. Chandrasekar, a renowned Gastroenterologist , carried out
choledochoduodenostomy, an advanced endoscopic procedure to relieve the
obstruction to the flow of bile, using Endoscopic Ultra Sound (EUS), a state of
the art medical equipment, which combines both ultrasound as well as endoscope
to access the site of operation for delivering a stent for
palliative care, effectively.
By skillful maneuvers, the bile duct was identified by
EUS endoscope passed through the patient’s mouth, and a self-expanding metallic
stent (an artificial tube) was deployed connecting the bile duct and the
duodenum, to provide free flow to the passage of bile obstructed by the
cancerous growth. Subsequently jaundice came down as became evident from the
fallof bilirubin level from 20 mg to 3 mg% in just few days.
Now came the challenge of providing relief from
vomiting due to obstruction to the gastric outflow. With a growth in the
duodenum that was too tight and too long, the prospect of standard stenting
looked bleak and not feasible. The relief could come only by apalliative
gastrojejunostomy-creating of a shortcut passage from the stomach to intestine.
But the patient was unwilling either for open or laparoscopic surgery in the
backdrop of family history of cancer and the tragic outcomes he witnessed.
The only option left was a state of the art
procedure, namely, EUS guided Gastro Jejunostomy (GJ). This
anastomos is between the stomach and the proximal small intestine called
jejunum,though a straight forward and established procedure in open surgery, is
not yet available in the regular therapeutic repertoire of the endoscopist
because it is writ with innumerable challenges and demand extraordinary skills
in endoscopy, endo-ultrasound anatomical orientation and of course the logistics
of availability of complex instrumentation.
The recent introduction of the state of the art
‘HOT AXIOS- Lumen Apposing Self-expanding Metallic Stent (LAMS)’, from Boston
Scientific Co., USA, came in handy. It gave hope that the endoscopic GJ was
possible to bypass the obstruction caused by the malignant growth in the
duodenum. The GJ was meticulously planned to the last detail and executed
successfully on 26th Dec 2018.
The highlight was that the procedure was transmitted
live to the learned audience of surgeons attending the then ongoing 78thannual
conference of the Association of Surgeons of India (ASI) at the Chennai Trade
Centre.
These two endoscopic procedures added a new lease of
hope and comfort to the patient by reducing jaundice and provided relief
from vomiting. He could start taking food orally which he was unable for over
few weeks. The sight of he taking food and retaining it was the most gratifying
scene for the endoscopist.
These procedures qualify as minimally invasive
endoscopic surgical procedures since they were carried out through mouth
without opening the abdomen under minimal intravenous sedation,
without blood loss and any blood transfusion.
These procedures are likely to herald a new era in the
treatment of advanced small intestine cancer, which will prove a
great boon to the suffering patients unfit for surgery. It promises
improved quality of life.
To the best of our knowledge and as per our internet
search, this is for the first time in India that both the above cited
procedures were done on the same patient simultaneously.
MedIndia Hospitals
#83, Valluvar Kottam High Road,
Nungambakkam,
Chennai – 600 034.
India
#83, Valluvar Kottam High Road,
Nungambakkam,
Chennai – 600 034.
India
Mobile: +91
98409 93131.
Phone: +91 044 28312345, +91 044 28311001
Toll Free Digestive Diseases Helpline No. : 12789 (Free for BSNL Subscribers)
E-Mail: medindiacare@gmail.com
Phone: +91 044 28312345, +91 044 28311001
Toll Free Digestive Diseases Helpline No. : 12789 (Free for BSNL Subscribers)
E-Mail: medindiacare@gmail.com