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Michael E. DeBakey VA Medical Center - Houston, Texas

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Houston VA Leads Fight against Esophageal Cancer

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Dr. Shaib and Vet Joseph Armiak

“The main purpose of the ablation procedure is to remove the abnormal lining of the esophageal,” said Yasser Shaib, M.D., M.P.H., Therapeutic Endoscopy chief at the Michael E. DeBakey VA Medical Center with Veteran Joseph Armiak during a follow-up appointment. “The tissue then regenerates and normal tissue grows back. This eliminates or markedly reduces the chances of cancer developing.” Photo by: Fran Burke, Public Affairs Specialist

Thursday, July 21, 2011

HOUSTON - An outpatient treatment that destroys pre-cancerous tissue in the lining of the esophagus is now widely available for Veterans at Michael E. DeBakey VA Medical Center.

Endoscopic radiofrequency ablation therapy has been in pilot use at the DeBakey VA for more than four years and was recently featured in the New England Journal of Medicine as a highly effective treatment for complete eradication of Barrett’s esophagus, a pre-cancerous condition that affects one to two million adults in the United States each year.

According to Yasser Shaib, M.D., M.P.H., Therapeutic Endoscopy chief at the DeBakey VA who is specially trained in the ablation therapy, Barrett’s disease occurs when the esophagus is chronically exposed to gastric contents of the stomach caused by gastroesophageal reflux disease (GERD). With prolonged acid exposure, normal cells in the esophagus can undergo a genetic change and are then vulnerable to further changes that can lead to cancer

Individuals with Barrett’s esophagus have a 40 to 130 times higher incidence of developing esophageal cancer than those without the condition. Esophageal is presently the fastest growing form of cancer in the United States.

“The main purpose of the ablation procedure is to ablate, or remove the abnormal lining of the esophageal,” said Shaib, who led the pilot program at the DeBakey VA and is also an associate professor of Medicine at Baylor College of Medicine. “The tissue then regenerates and normal tissue grows back. This eliminates or markedly reduces the chances of cancer developing. Data from studies shows that the treatment is highly effective. In fact, it looks very promising.”

During the procedure, an ablation catheter is positioned on the abnormal esophageal tissue. The physician then delivers a rapid burst of ablative energy which removes a very thin layer of the disease esophagus. The procedure is performed in an outpatient setting, without incisions, and takes less than 30 minutes on average.

For a person with Barrett’s disease, David Y. Graham, M.D., Digestive Disease Section chief says the risk of developing esophageal cancer is similar to the risk of developing colon cancer for patients who have a colon polyp. However, unlike a colon polyp which is removed immediately upon diagnosis through a colonoscopy, the standard treatment for Barrett’s disease was “watchful waiting” or surveillance to monitor the progression of the disease.

Esophageal cancer is often incurable because the disease is frequently discovered in the advanced stages. Former Texas Governor Ann Richards, Baseball Hall of Famer Harmon Killebrew, and legendary actor Humphrey Bogart all died of this fatal disease. Esophageal cancer has a five-year patient survival rate of just 16 percent.

“It usually starts with GERD, which can cause Barrett’s disease, which can lead to esophageal cancer,” said Graham, who is also a professor of Medicine at Baylor College of Medicine. “That’s why it’s important to seek medical treatment for symptoms of GERD, the most common being heartburn.”

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Awarded re-designation for Magnet Recognition for Excellence in Nursing Services in 2008, the Michael E. DeBakey VA Medical Center serves as the primary health care provider for more than 120,000 veterans in southeast Texas. Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases. The MEDVAMC is home to a Post Traumatic Stress Disorder Clinic; Network Polytrauma Center; an award-winning Cardiac and General Surgery Program; Liver Transplant Center; VA Epilepsy and Cancer Centers of Excellence; VA Substance Abuse Disorder Quality Enhancement Research Initiative; Health Services Research & Development Center of Excellence; VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; Mental Illness Research, Education and Clinical Center; and one of the VA’s six Parkinson’s Disease Research, Education, and Clinical Centers. Including the outpatient clinics in Beaumont, Conroe, Galveston, Houston, Lufkin, and Richmond, MEDVAMC outpatient clinics logged more than one million outpatient visits in fiscal year 2010. For the latest news releases and information about the MEDVAMC, visit www.houston.va.gov