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ADVANCING PATIENT CARE
CENTER FOR
ENDOSCOPIC
RESEARCH AND
THERAPEUTICS
2014 ANNUAL REPORT
LEADING
02
INNOVATING
06
EXCELLING
14
COLLABORATING
18
EDUCATING
24
ON THE COVER
A close up image of an occult buried gland in
the esophagus of a patient previously treated for
Barrett’s esophagus. This image was obtained with
an optical coherence tomography based technology
called volumetric laser endomicroscopy which
provides high-resolution cross sectional imaging of
superficial layers of the esophagus.
DISCOVERING
26
ADVANCING
PATIENT CARE
The Center for Endoscopic Research and Therapeutics (CERT)
at the University of Chicago Medicine was created to be a oneof-a-kind program with a single focus: Advancing patient care
through endoscopic discovery and innovation.
We know that you want the best care for your patients who
have challenging gastrointestinal conditions. Diagnostic and
interventional endoscopy is the only thing we do – and we do
it very well. Our dedicated, multidisciplinary team performs
more than 2,500 highly specialized procedures each year,
making our program one of the largest and most experienced
in the region. These include leading-edge treatments available
at only a handful of other hospitals nationwide.
We value your partnership. When you refer a patient to us, we
will collaborate with you to develop a personalized treatment
plan and keep you informed about your patient’s care.
Along with our team’s deep experience, state-of-the-art
technology and robust research, we offer you and your patients
the collaborative expertise of our University of Chicago
Medicine colleagues in a wide variety of specialties, including
surgery, oncology and genetics.
01
IRVING WAXMAN, MD, FASGE
Sara and Harold Lincoln Thompson
Professor, Medicine and Surgery
Director, Center for Endoscopic
Research and Therapeutics
LEADING
With deep experience and
commitment to innovation
02
Dr. Waxman is an international
authority in endoscopic ultrasound
(EUS), endoscopic retrograde
cholangiopancreatography (ERCP),
and endoscopic mucosal resection
(EMR). Dr. Waxman’s work focuses
on state-of-the-art endoscopic
procedures for esophageal, gastric,
pancreatic, lung, and rectal tumors.
His clinical research interests
include minimally invasive therapy
for esophageal and colon cancers
and therapeutic applications of
endosonography.
UZMA D. SIDDIQUI, MD, FASGE
Associate Professor of Medicine
Associate Director, Center for
Endoscopic Research and Therapeutics
Director, Endoscopic Ultrasound
and Advanced Endoscopy Training
Dr. Siddiqui uses endoscopic
ultrasound (EUS) and other
therapeutic procedures to
diagnose and treat a wide range
of gastrointestinal cancers and
precancerous lesions. In 2014,
she began a new CERT program
focused on endoscopic treatment of
unresectable cholangiocarcinoma
using photodynamic therapy
(PDT) and radiofrequency ablation
(RFA) with endoscopic retrograde
cholangiopancreatography (ERCP).
Other therapeutic endoscopic
procedures she performs include
drainage of pancreatic cysts, nerve
block for pain related to pancreatic
cancer, RFA of Barrett’s esophagus,
endoscopic mucosal resection (EMR)
of large polyps or small tumors in the
GI tract and endoscopic suturing.
03
VANI J. KONDA, MD
Assistant Professor of Medicine
Director, Endoscopic Research
and Education Programs
Dr. Konda uses advanced imaging
techniques to diagnose and treat
Barrett’s esophagus, gastroesophageal
reflux disease, and other esophageal
conditions. She is also interested
in colorectal cancer prevention,
detection, and treatment. Her
research focuses on the use of
advanced endoscopic imaging
techniques for improved screening,
surveillance, and detection
of precancerous tissue in the
gastrointestinal tract. Under Dr.
Konda’s direction, the CERT team
has participated in multiple trials
examining new endoscopic tools and
techniques and developing promising
new minimally invasive treatments.
LEADING
04
ANDRES GELRUD, MD,
MMSc, FASGE
Associate Professor of Medicine
Director, Pancreatic Disease Center
and Advanced Endoscopy
A clinical and interventional
pancreatologist, Dr. Gelrud treats
adult and pediatric patients with
acute, recurrent acute, and chronic
pancreatitis as well as complications
of pancreatitis. He uses endoscopic
retrograde cholangiopancreatography
(ERCP) to diagnose and treat diseases
of the bile duct and pancreas, and
he is highly skilled in transgastric
pancreatic necrosectomy, a procedure
to remove necrotic pancreatic tissue
through the mouth using endoscopes.
Dr. Gelrud leads the multidisciplinary
team at the new University of
Chicago Medicine Pancreatic Diseases
Center, the first of its kind in Illinois.
05
PHYSICIAN ASSISTANTS
NURSE COORDINATORS
Megan Meiklejohn
PA-C, MPAS
Mallory Geschke
PA-C, MPAS
Megan is a new member of the
CERT team, specializing in
the inpatient and outpatient
care of patients with pancreatic
disorders. She received her
bachelor’s degree from the
University of WisconsinMadison, and then received
her master’s degree in physician
assistant studies in 2012 from
Marquette University.
Mallory earned both
her bachelor’s degree in
neuroscience and her master’s
degree in physician assistant
studies from the University
of Wisconsin-Madison.
She joined the CERT team
in May 2014 and excels
at patient education and
perioperative care.
Operations Manager
Marilu Andrade (center)
Administrative Assistants
Breonda Bradie (left)
Nina Miller (right)
LEADING
06
Lynne Stearns, MSN, RN
A member of the CERT team
since 2001, Lynne Stearns
graduated from Northern
Illinois University and
obtained her master’s degree
in Nursing Education from
Olivet Nazarene University.
As a patient care coordinator,
her long experience at CERT
is an asset to patients in both
scheduling procedures in
and out of the Center and
navigating the larger healthcare system.
Ada I. Turner, RN,
BSN, CGRN
Ada Turner graduated from
Indiana University and has
been with the University
of Chicago Medicine
since February 2003. A
Spanish speaker, she uses
her knowledge of the many
components of an academic
medical center to efficiently
coordinate patients’ care
and manage their experience
within and beyond CERT.
Senior Research
Project Professional
Ann Koons
From left to right, nurses Milena Vunjak, Sharon Pedrido, Jennifer Wang, Kelly Bryan,
Jennine Regan, and Johnny Webb.
Our dedicated team of physicians, advance practice nurses, and administrative support staff have
a single focus: providing you and your patients with the best possible outcomes and the highest
standards of care, communication, comfort, and convenience.
07
08
INNOVATING
Realizing the promise of
endoscopic technologies
The Center for Endoscopic Research and Therapeutics uses the most innovative
endoscopic techniques to provide minimally invasive solutions for a range
of gastrointestinal problems. Many of the advanced techniques we use were
developed or perfected by our physicians, who strive constantly to push the
boundaries of endoscopic technology for the benefit of patients.
Our international reputation is based on consistent excellence at the leading
edge of endoscopic practice:
Advanced imaging techniques to identify precancerous conditions,
sometimes even before they can be found with standard endoscopy.
Endoscopic treatment of malignancies and obstruction of the GI tract
and other complicated conditions, sparing patients from the risk of
surgery.
Precise endoscopic diagnosis and staging of cancer, enabling referring
physicians to plan the most appropriate and effective surgical and
oncological care.
We are one of the only hospitals in the country to provide a comprehensive
approach to treating benign pancreatic disease and our collective experience
in complete endoscopic mucosectomy of Barrett’s esophagus is unmatched
in the U.S. Many of the procedures we offer are available at only a select few
institutions. These major differentiating procedures include include endoscopic
submucosal dissection (ESD); extracorporeal shock wave lithotripsy (ESWL)
for biliary pancreatic stones, and photodynamic therapy (PDT) for palliation
of cholangiocarcinoma.
09
Endoscopic
Submucosal
Dissection
Endoscopic submucosal dissection (ESD) can be considered
minimally invasive intraluminal endoscopic surgery. ESD
was developed in Japan as an alternative to standard surgical
procedures to obtain en bloc removal of gastrointestinal (GI)
neoplasias. En bloc resection is vital because it allows detailed
histopathological evaluation of the entire resected neoplasm, and
is associated with lower recurrence rates when compared to the
loop-snare piecemeal technique, including traditional endoscopic
mucosal resection.
The ESD technique utilizes an electrosurgical knife to mark
the margins of the lesion, mucosally incise around it, and cut
through the submucosal layer underneath the lesion.
Due to its increased technical difficulty, ESD is available only at
a few selected quaternary care centers in the United States.
Endoluminal resection is one of our main areas of research
focus at CERT. We were one of the first groups in the nation to
perform endoscopic mucosal resection (EMR). Our experience
performing EMR spans 15 years and thousands of cases.
Therefore, it is a natural evolution for us to now perform ESD.
Indications for ESD include:
Superficial esophageal cancer
(both squamous or adenocarcinoma)
Early gastric cancer
Early colorectal cancer
(limited to the superficial submucosa)
Non-lifting colorectal lesions.
INNOVATING
10
Photodynamic
Therapy for
Cholangiocarcinoma
Cholangiocarcinoma is a relatively rare cancer of the bile ducts
with approximately 5,000 cases annually in the United States.
Five-year survival rates average 5 to 10 percent.
For more than 80 percent of patients, the disease is unresectable.
Therapy options traditionally have been limited to chemotherapy
and palliative bile duct stenting to relieve jaundice.
In photodynamic therapy (PDT), the patient receives an IV
porphyrin sensitizer 48 hours prior to endoscopic application of
light to the tumor with the purpose of causing cell death. The
light is delivered via a flexible fiber during endoscopic retrograde
cholangiopancreatography (ERCP) at the time of biliary stent
stent placement or exchange.
Although data on the use of PDT in cholangiocarcinoma is
limited, initial studies in patients with unresectable disease have
suggested the treatment not only aids biliary decompression, but
also improves survival through actual tumor destruction. The
main side effect of this therapy is severe photosensitivity for 30
days for which the patient must be counseled.
CERT is the only center in the city to offer PDT for therapy of
unresectable cholangiocarcinoma and one of only a few centers
nationwide invited to participate in an international, Food and
Drug Administration approved PDT study.
11
Extracorporeal
Shock Wave
Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) is a critically
important tool in the endoscopic management of pancreatic
biliary stones.
Large stones in the main pancreatic duct can block the outflow
of pancreatic secretions and exacerbate pain in patients with
chronic pancreatitis, leading to poor quality of life, decreased
PO intake, malnutrition and frequently the development of
vitamin deficiency. Large stones can also contribute to additional
complications, such as pancreatic ductal disruption, pseudocyst
formation, pancreatic ascites, and pancreatic fistula.
The pancreatic duct measures 2 mm to 4 mm in diameter,
and stones in areas of stasis can grow to more than 1 cm.
Therefore, it is impossible to remove these stones endoscopically
without fragmenting them. Traditional therapies include
direct electrohydraulic lithotripsy or direct laser therapy, both
associated with significant complications; mechanical lithotripsy,
which often is unsuccessful technically; and open surgery.
ESWL targets shock waves to the large stones with the aid of
fluoroscopy. The stones are fragmented into little pieces that
can be extracted endoscopically or by a previous pancreatic
sphincterotomy. The procedure is most effective in patients
with head predominant disease. In one recent study (Tandan
M, et al. GIE 2013) of 636 patients with chronic calcific
pancreatitis who were treated with ESWL 60 percent were
pain free eight years later.
ESWL is contraindicated in patients with coagulation disorders,
calcified aneurysm or lung tissue within the shock wave path.
Severe complications such as acute pancreatitis are extremely
rare. Other procedure-related findings of unclear clinical
significance include elevated pancreatic enzymes, transient
hematuria, and petechial lesions on the skin.
The combination of ESWL and endoscopic therapy, which we
perform the same day, alleviates pain in up to 85 percent of
patients. In some cases, retreatment may be required.
INNOVATING
12
Endoscopic
Imaging
Our advanced imaging program and our experience in making
difficult diagnoses mean we can offer you and your patient
a more complete evaluation using multiple state-of-the-art
modalities.
We routinely integrate advanced imaging into our endoscopic
procedures. These tools go far beyond the capability of
traditional endoscopes to visualize the GI tract, providing
information about tissue architecture, vascular patterns, and even
microscopic-level detail.
We have the most advanced options for recognizing subtle
or occult precancerous changes in patients with diseases like
Barrett’s esophagus and high-grade dysplasia. We often use
two or three imaging modalities to examine the lining of the
esophagus, beginning with a high-definition endoscope that
produces images with a resolution in the range of a million
pixels. We also regularly use narrow-band imaging, which uses
filtered blue light that enables us to see and interpret mucosal
pit patterns and vascular patterns. Our optical coherence-based
technology allows us to see the superficial layers of the esophagus
down to 3 mm deep with a resolution of 7 microns.
We also can visualize cellular detail with a resolution down to
1 micron using probe-based confocal laser endomicroscopy
(pCLE). We use this real-time microscopic imaging to see
cellular detail throughout the entire GI tract, even in less
accessible organs such as the bile ducts and pancreas. By using
multiple advanced modalities, we reduce the chances of sampling
error or missed lesions.
We can perform an optical biopsy where we are able to
accurately pinpoint cancerous and noncancerous cells in organ
tissue without removing a tissue sample from the patient’s body.
If we detect suspicious areas, we can make real-time decisions
to take smarter biopsies and resections. We are pioneers in
developing and incorporating the optical biopsy into clinical
practice. Our team has participated in numerous clinical
studies ranging from pilot trials using tools for the first time
to international multicenter trials to validate novel imaging
technologies for wider use.
13
ADVANCED CARE IN A STATE-OFTHE-ART PROCEDURE FACILITY
In CERT’s state-of-the-art endoscopy
suite in the University of Chicago
Medicine Center for Care and Discovery,
patients benefit from the most advanced
endoscopy technologies available.
Procedures are performed under
monitored anesthesia care (MAC) by a
member of CERT’s core anesthesiology
group. On-site pathology and
cytopathology allow results to be shared
immediately with referring physicians —
in most cases, we can develop a plan of
care for your patient before the patient
leaves the endoscopy suite.
95%
Our patient satisfaction rating in 2014.
Source: Press Ganey Patient Satisfaction Scores (July 2014 – Dec. 2014)
INNOVATING
14
PROCEDURES
The full range of advanced interventional endoscopy procedures
we offer include the following:
Endoscopic Ultrasound (EUS) with Fine Needle Aspiration (FNA)
Celiac Plexus Nerve Block
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Cholangioscopy
Ablation of cholangiocarcinoma
Lithotripsy of large biliary and pancreatic duct stones
Ampullectomy
Endoscopic Mucosal Resection (EMR)
Endoscopic Submucosal Dissection (ESD)
Complex polypectomy
Radiofrequency Ablation (RFA) of Barrett’s esophagus, radiation
proctitis, and gastric antral vascular ectasia (GAVE)
Confocal Laser Endomicroscopy (CLE)
Pancreatic pseudocyst drainage and necrosectomy
Photodynamic therapy (PDT)
Endoscopic suturing
Palliative stenting of GI tract and pancreaticobiliary malignancies
Extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones
CONDITIONS WE DIAGNOSE AND TREAT INCLUDE
Achalasia (peroral endoscopic myotomy)
Large colon polyps (adenomas)
Ampullary polyps (adenomas)
Large bile duct stone (choledocholithiasis)
Infection of the bile ducts (cholangitis)
Bile duct strictures (malignant and benign)
Bile duct leaks following cholecystectomy
GI tract cancers, including cancers of the colon, stomach,
and esophagus
Difficulty swallowing (dysphagia)
Early cancers of the gastrointestinal tract
Malignant and benign obstruction of the GI tract,
including esophagus, stomach, duodenum, and colon
Complications of bariatric surgery
Gastrointestinal bleeding
Gastric cancer
Gastric carcinoid tumors
Pancreatic cystic neoplasms
Pancreatic pseudocyst
Walled-off pancreatic necrosis
Pancreatitis (acute and chronic)
Autoimmune pancreatitis
Hereditary pancreatic diseases
Post-operative strictures in the GI tract
Zenker diverticulum
15
EXCELLING
CERT by the numbers
Our volume—and the experience it represents—contributes
to both our excellent patient outcomes and our low rate of
complications. Our team performs more than 2,500 advanced
endoscopic procedures each year, making our interventional
endoscopy program one of the region’s largest and placing us
in the ranks of the nation’s leaders in progressive techniques.
2,116
Total Patients
2,512
Total CERT Procedures
98%
ERCP Success Rate
16
Endoscopic Ultrasound
(EUS) Volume 2014
Total Procedures 893
GRADE 1
3.5%
Pseudocyst enterostomy,
Cholangiopancreatography
with therapy (e.g., stent,
choledochoduodenostomy)
FNA gut wall or contiguous
structure (mediastinum,
pancreas), Celiac plexus
blockade
GRADE 4
GRADE 2
31
3.5
%
26.2
%
Diagnostic upper or lower
(no FNA sampling)
88
9.8%
GRADE 3
60.5%
Diagnostic pancreatobiliary
(no FNA), Diagnostic
requiring dilation (no FNA),
234
26.2%
9.8%
FNA distant/noncontiguous structure,
Inject tumor therapy,
Fiducial placement, EUS
with EMR, Pseudocyst
aspiration/drainage,
Cholangiopancreatography;
diagnostic
540
60.5%
Endoscopic Retrograde
Cholangiopancreatography
(ERCP) Volume 2014
Total Procedures 469
GRADE 1
Biliary stent removal/
exchange, Deep
cannulation of duct of
interest, Main papilla
sampling
GRADE 2
7
1.5%
140
29.9%
145
1.5%
30.9%
Biliary stone extraction
< 10mmTreatment of
bile leaks, Treatment
of extrahepatic benign
& malignant strictures,
Placement of prophylactic
pancreatic stents
30.9%
GRADE 3
177
37.7%
Source: ASGE Grading System
37.7%
Biliary stone extraction
> 10mm, Minor papilla
cannulation in divisum
& therapy, Removal of
internally migrated biliary
stents, Intraductal imaging,
biopsy, FNA, Management
of acute or recurrent
pancreatitis, Treatment
of pancreatic strictures,
Removal of pancreatic
stones mobile & <5mm,
Treatment of hilar tumors,
Treatment of benign
biliary strictures, hilum
& above,Management of
suspected sphincter of
Oddi dysfunction (with or
without manometry)
GRADE 4
29.9%
Removal of internally
migrated pancreatic stents,
Intraductal image
guided therapy (e.g.,
photodynamic therapy,
electrohydraulic
lithotripsy), Pancreatic
stones impacted and/
or >5mm, Intrahepatic
stones, Pseudocyst
drainage or necrosectomy,
Ampullectomy, ERCP after
Whipple or Roux-en-Y
bariatric surgery
17
COLLABORATING
A partnership you can count on
Access
We know how hard it is on patients— and doctors—to
wait. That’s why our consultation or procedure turnaround
time is fast—24 to 36 hours.
Communication
As partners in your patient’s health, we keep you informed of
your patient’s status at every point in the process.
Navigation
Our nurse coordinators are dedicated to helping your
patients navigate their care at the University of Chicago
Medicine, whether that care is a simple, one-time procedure
or ongoing treatment.
86%
of physicians who referred a patient to
us once continue to refer their patients.
18
At the Center for Endoscopic Research and
Therapeutics, our research helps health care
professionals here and throughout the world
continue learning through participation in clinical
trials. We participate in studies that range from
pilot and feasibility studies on novel technologies
to randomized, multicenter clinical trials. Goals
of current multi-center clinical trials include
improved detection of precancerous cells in Barrett's
esophagus, optimizing resection of large colon
polyps, and improving drainage methods for the
treatment of fluid collections.
The University of Chicago Medicine is a leader in
clinical trials, with more ongoing clinical trials than
any other hospital in Illinois. Clinical trials give our
patients access to novel treatments and therapies that
often aren't available elsewhere. And the trials help
us determine how to improve treatment and find
cures whenever possible.
CERT CLINICAL TRIALS AS OF JUNE 2015
Cellvizio - Probe Based Confocal Laser
Endomicroscopy (CLE)
Tissue Banking for Gastrointestinal Malignant and Premalignant Lesions
Molecular Evaluation in Barrett’s
Esophagus
Ex Vivo Tissue Study with Probe Based
Confocal Laser Endomicroscopy (CLE)
Detection of Circulating Tumor Cells
(CTCs) in Pancreatic Cancer via
EUS-guided Portal Vein Sampling
EUS-guided core needle biopsy
(EUS-CNB) versus EUS-guided
single-incision with needle knife (SINK)
for the diagnosis of upper gastrointestinal subepithelial lesions
Principles of Low coherence Enhanced
Backscattering Spectroscopy (LEBS)
Tissue Study with Duodenal Biopsies
Stratification of colon cancer risk with
spectroscopy (Low coherence Enhanced
Backscattering Spectroscopy (LEBS)
Probe and Nanocytology with Partial
wave spectroscopy (PWS))
Low coherence Enhanced Backscattering
Spectroscopy (LEBS) of the Duodenum
for Pancreatic Cancer Screening
Esophageal cancer screening with
Nanocytology by Partial Wave
Spectroscopy (PWS)
Development and Validation of an International Classification System for the
Prediction of Dysplasia in Barrett’s Esophagus using Narrow Band Imaging (NBI)
EUS Fine Needle Aspiration with the
ProCore 22G Needle
Large Colorectal Polyp Resection Study
Nanocytology by Partial wave spectroscopy (PWS) of Buccal Cells for Esophageal cancer risk stratification
EUS guided Liver Biopsy
Gene Sequencing of Esophageal Cancer
In vivo Optical Diagnosis of Colon Polyps
with Narrow Band Imaging (NBI) with
Near Focus
Exocrine Pancreatic Insufficiency
Coordinating Center for the North
American Pancreatitis Study 2 (NAPS2)
High Resolution Optical Imaging of
Esophageal Tissue with Volumetric Laser
Endomicroscopy (VLE)
Patient Survey Project on Risk
Perception in Barrett's Esophagus
To recommend a patient for a clinical trial or to learn more, please contact
Senior Research Project Professional Ann Koons at 773.834.0152 or via
email at [email protected]
19
“Endoscopic
techniques and
technology are
constantly advancing,
and we treat more
complex cases here
than anywhere in
the region.”
DR. WAXMAN
Getting the Bile
Flowing Again
As a veteran pilot, Louis Freeman doesn’t take
chances. When his wife told him in August 2013
that his itching could be a sign of liver trouble, he
headed for the doctor. “Aside from the itching, I
felt fine,” Freeman recalls, “no pain, no nausea,
nothing. I had lost about 20 pounds, but then I was
out there walking every day, trying to lose a little
weight.”
Freeman was found to have elevated liver tests by
his internist and his original gastroenterologist
told him he had jaundice but needed specialized
endoscopic care for further evaluation.
COLLABORATING
20
He said, “Within a couple of days, I was back
on Dr. Waxman’s table at U of C” and was being
worked up for possible cancer.
he did not have a malignancy, but instead had
a rare benign condition called autoimmune
sclerosing pancreatitis.
Dr. Waxman performed an endoscopic
ultrasound (EUS) and found strictures not
only of the common bile duct but also of
the pancreatic duct. Then, using endoscopic
retrograde cholangiopancreatography (ERCP),
Dr. Waxman collected cells from the ducts to
obtain a diagnosis, and then placed stents inside
both biliary and pancreatic ducts. Freeman was
relieved when Dr. Waxman informed him that
With his bile flowing again and steroids tackling
the inflammation, Freeman was out of the woods,
and he’s stayed there.
“I was blessed,” he says. “I didn’t have the usual
symptoms, but from my internist on down, I had
doctors who took the extra steps to figure out
what was really going on and send me to someone
who could fix it.”
“A multidisciplinary
team approach like
ours is critical when
you’re caring for
patients with complex
pancreatic diseases
or complications from
acute and chronic
pancreatitis.”
DR. GELRUD
Treating Pancreatitis
Turned Deadly
The words “There’s nothing more we can do” don’t
usually precede a full recovery. Against all odds, for
Kloe Salerno they did.
First hospitalized for a relapse of childhood
leukemia, Kloe received chemotherapy that triggered
pancreatitis. Soon her liver showed signs of venoocclusive disease (VOD), and she developed GI
bleeding. By the time the doctors had stopped the
trial therapy for her liver, Kloe’s pancreatitis had
turned deadly.
COLLABORATING
22
“She became septic. Her abdomen was filling with
infected fluids. They kept saying they had seen
pancreatitis before, but not like this,” says Brandi
Salerno, who stayed at her daughter’s side as they
moved from hospital to hospital and specialist to
specialist and the weeks turned into months.
assisted retroperitoneal debridement. It’s a novel
procedure for the pancreas, but it’s how we saved
her.”
That’s when Kloe’s aunt, searching the Internet,
found Dr. Andres Gelrud and the team at UCM.
“Dr. Matthews, the surgeon, was superb. The
interventional radiology team was superb, as well.
It was just an incredible team effort.”
“When Brandi called us, we immediately devised a
plan of care,” says Gelrud. “Kloe was so sick. She
had a complete pancreatic ductal dysfunction,
but I was able to do an ERCP and get it
reconnected. I did a necrosectomy—we tried to
work endoscopically as much as possible, but there
was a huge walled-off necrosis and we needed the
surgeons to go in and do a VARD, videoscopic
On January 24, 2015, the team’s extraordinary skill
and experience paid off. For the first time in more
than a year, Kloe and her mother went home.
“I said I wasn’t going to leave the hospital without
my daughter,” says Brandi. “Thanks to Dr. Gelrud
and Dr. Matthews, I was able to keep that promise.”
Reopening a Nearly
Closed Esophagus
“CERT offers patients—
and their referring
physicians—a truly
multidisciplinary
treatment setting, with
all the tools in place
and the ability to try
different approaches.”
DR. KONDA
COLLABORATING
24
“Life is good. It really is.”
Waymond Copeland’s treatment for stage IV throat
cancer five years ago didn’t just leave him cancer
free. It left him free to enjoy his life. Despite
aggressive radiation, the 70-year-old doesn’t depend
on a permanent feeding tube, and for that he is
truly grateful.
“I was pretty miserable,” he remembers. “I had to
have IVs to stay hydrated, and that tube was just
aggravating me. After three months, I was ready to
have it out.”
With the help of Dr. Vani Konda, he was able
to. Shortly after the radiation and chemo ended,
she started Copeland on a series of treatments to
reopen his nearly closed esophagus so that food
could once again pass into his stomach and not
his windpipe.
“Complex, radiation-induced strictures are much
more persistent and challenging than others,” says
Konda. “It takes patience and persistence, and a
team approach to be prepared to handle difficult
airways and anticipate the nutritional needs and
expectations of the patient .”
Every two weeks at first, using balloons and flexible
rods, Konda would coax open the passageway a
few millimeters more. Steroids and mitomycin C
helped break up the scar tissue, and within a few
months, she was able to reduce the frequency of
treatments to once a month, and then gradually to
once a year or so, a schedule they maintain.
For Copeland and his wife, who recently returned
from a 7-day Caribbean cruise, the results are
worth it. “I love the water,” he says, “and with a
cruise, you can always eat.” And that’s exactly what
he did. “The food,” he says, “was fantastic.”
“We’re used to
working together
as a team, and each
of us has more than
10 years experience
dealing with the most
complicated and
complex cases.”
DR. SIDDIQUI
Restoring a Young
Man’s Health
Ashley Summers calls her husband, Andy, “the
luckiest unlucky guy I know.”
It would be hard to disagree. What started as a
simple gallstone attack progressed to necrotizing
pancreatitis, then to a pseudocyst that twice became
infected, and finally to a necrotic gallbladder.
Andy’s lead physician, gastroenterologist Dr. Uzma
Siddiqui, described his medical condition as
potentially “life threatening.”
COLLABORATING
26
Fortunately, the 32-year-old construction worker
had more than luck on his side. He had Ashley,
who despite being “10 months pregnant” with
their fourth child was both advocate and emotional
support. And he had a superb medical team—
doctors not only skilled in performing surgery and
endoscopic procedures but experienced enough to
know when the very best option was to just sit tight.
“They all knew my case every bit as well as
Dr. Siddiqui did,” says Summers, “They would
kind of bounce ideas off each other on whether
to do another procedure or just let it set.
It was wonderful.”
Her first task was to stabilize Summers, who had
been transferred from Kankakee at Ashley’s request
when his condition deteriorated. This meant
to control his pain, get his electrolyte levels to
baseline, and place a nasojejunal feeding tube. In
subsequent weeks, she performed an endoscopic
ultrasound-assisted cystogastrostomy to drain
infected fluid from a pseudocyst on two occasions.
“It’s been a long road, but we have been so blessed,”
“When dealing with severe necrotizing pancreatitis, says Ashley. “Through everything, Dr. Siddiqui
just went way, way beyond what I ever anticipated.
we always work closely with our surgical
colleagues, and in Andy’s case we had the expertise She got him home for all the important stuff—for
of our Chairman of Surgery, Dr. Jeffrey Matthews,” the baby, for Christmas. She got him home, and
she got him well.”
says Siddiqui.
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EDUCATING
Live endoscopy courses
taught by internationally
recognized experts
We are committed to educating colleagues on how to use advanced
endoscopic imaging and incorporate these technologies into their medical
practices.
CERT faculty members demonstrate their capabilities during two live
endoscopy courses each year that attract attendees and faculty from around
the world. Both are held in the University of Chicago Medicine Center for
Care and Discovery.
Our annual EUS LIVE course is one of the biggest endoscopy courses
focusing on endoscopic ultrasound (EUS). The course, held in the fall, last
year celebrated its 19th year of successful collaboration with Massachusetts
General Hospital. The schedule included 24 lectures, 16 live cases, debates,
two interactive quiz sections and a hands-on workshop. We were able to
showcase not only master endoscopists from all over the world, but also our
University of Chicago Medicine colleagues from pulmonary, surgery and
pathology.
Live from the University of Chicago! Endoscopic Advances for Clinical
Practice, offered in the spring, outlines current standard practices in
endoscopy and how innovations may enhance or revolutionize endoscopy
practice in the future. The two-day course includes lectures, debates and live
case demonstrations conduced by expert faculty from leading institutions.
In addition to the two large CME courses, CERT faculty members routinely
give lectures at conferences around the world.
For information about upcoming CME opportunities, visit
cme.uchicago.edu
29
DISCOVERING
Committed to leadership in
endoscopic research and innovation
Our practice is shaped by an ongoing commitment to discovery and innovation in
gastrointestinal interventional endoscopy.
As leaders in endoscopic research, we are pioneering new techniques and tools
to advance the diagnosis and treatment of many conditions, including Barrett’s
esophagus, esophageal cancer, biliary disorders, pancreatitis, pancreatic cancer and
colon cancer. We participate in studies that range from pilot and feasibility studies on
novel technologies to randomized, multicenter clinical trials. Our physician-scientists
publish numerous peer-reviewed manuscripts in leading journals each year.
HIGHLIGHTED PUBLICATIONS:
829 Detection of Portal Vein (PV) Circulating Tumor Cells (CTCs) in
Pancreatic Cancer (PC) Patients Obtained by EUS Guided Pv Sampling.
A Safety and Feasibility Trial. Gastrointestinal Endoscopy Volume 79, Issue 5,
Supplement, Pages AB173-AB174 (May 2014). DDW 2014 ASGE Program
and Abstracts, DDW 2014 ASGE Program and Abstracts, Chicago, Illinois,
3–6 May 2014.
A.
B.
C.
D.
30
EUS guidance was utilized to acquire
blood from the portal vein of patients with
suspected pancreaticobiliary cancers and
completed circulating tumor cell (CTC)
enumeration with direct comparisons to
matched peripheral blood. We found 100%
(12/12) patients had CTCs in the portal
venous blood as compared to only 8.3%
(1/12) in peripheral blood. Interestingly, even
in patients with resectable and/or borderline
resectable malignancy, CTCs were identified.
In one case, we completed genomic analysis
(CTNNB1 G34E missense mutation) in the
isolated CTCs to confirm the source of cells
to be the primary tumor. In this patient, we
also completed immunofluorescent staining
of tumor suppressor proteins (p53, smad4,
p16) in individual CTCs during EPCAM
flow cytometry via ImageStream technology.
This study establishes a novel role for EUS as it will be the first published report
demonstrating that EUS guided sampling of the portal vein for CTCs is 1.
Both feasible and safe and 2. Able to provide cells for tumor biology assessment
that otherwise would not be possible from peripheral blood given hepatic
sequestration of CTCs. As the management for non-metastatic, potentially
curable pancreatic cancers continues to evolve, we believe EUS guided ‘realtime’ portal venous blood sampling has the potential to provide an adjunctive
role in risk stratification identifying post-surgical recurrence, assessing response
to neo-adjuvant therapies, and determining molecular features of tumor
biology.
Complete endoscopic mucosal resection is effective and durable
treatment for Barrett’s-associated neoplasia Clin Gastroenterol Hepatol. 2014
Dec;12(12):2002-10.e1-2. doi: 10.1016/j.cgh.2014.04.010. Epub 2014 Apr 13.
We have a robust program for the treatment of Barrett’s esophagus and
associated neoplasia here at the University of Chicago. Our experience spans
over a decade starting from when endoscopic resection was a novel technique in
the esophagus to encompass a period where it is now standard therapy among
several endoscopic treatment options. We have published on the efficacy and
durability of complete endoscopic resection for Barrett’s associated neoplasia.
Long term outcomes of endoscopic therapy such as this are critical in order to
establish endoscopic therapy as standard therapy for these patients.
Total pancreatectomy with islet autotransplantation: summary of
a National Institute of Diabetes and Digestive and Kidney diseases
workshop. Ann Surg. 2015. Jan;261(1):21-9.
Diseases of the pancreas require comprehensive care from a multidisciplinary
team of experts. At the University of Chicago Medicine, our pancreatic
disease care team is comprised of physicians from several specialties, including
gastroenterology, interventional endoscopy, surgery, oncology, radiology,
pathology, pain management and genetics, and extends to include highly
trained nurses, genetic counselors and nutritionists. These specialists are
recognized leaders in pancreatic disease care.
We’re one of a handful of hospitals in the country to offer total pancreatectomy
with islet cell autotransplantation (autologous islet cell transplantation), a
procedure aimed at preventing diabetes or reducing its effects after removal of
the pancreas due to pancreatitis and severe pain.
Minimizing, recognizing, and managing endoscopic adverse events.
Gastrointest Endosc Clin N Am. 2015 Jan;25(1):xiii-xiv.
This volume of GI Endoscopy Clinics of North America entitled “Minimizing,
Recognizing, and Managing Endoscopic Adverse Events” is a comprehensive
review of possible undesirable outcomes related to all types of endoscopic
procedures. As the number of endoscopic procedures preformed continues to
increase, so does the potential for adverse events (AE). Previous articles and
endoscopy courses may have addressed a specific type of AE related to one or
two endoscopic procedures, however this volume will explore the full range of
endoscopic AE.
SELECTED PUBLICATIONS:
In Vivo Risk Analysis of Pancreatic Cancer Through Optical
Characterization of Duodenal Mucosa. Mutyal NN, Radosevich AJ, Bajaj
S, Konda V, Siddiqui UD, Waxman I, Goldberg MJ, Rogers JD, Gould B,
Eshein A, Upadhye S, Koons A, Gonzalez-Haba Ruiz M, Roy HK, Backman V.
Pancreas. 2015 Jul; 44(5):735-41.
Endoscopic imaging. Konda VJ. Curr Treat Options Gastroenterol. 2015 Jun;
13(2):198-205.
Cyst Gastrostomy and Necrosectomy for the Management of Sterile
Walled-Off Pancreatic Necrosis: a Comparison of Minimally Invasive
Surgical and Endoscopic Outcomes at a High-Volume Pancreatic Center.
Khreiss M, Zenati M, Clifford A, Lee KK, Hogg ME, Slivka A, Chennat J,
Gelrud A, Zeh HJ, Papachristou GI, Zureikat AH. J Gastrointest Surg. 2015
Jun 2. [Epub ahead of print]
Rectal Optical Markers for In-vivo Risk Stratification of Premalignant
Colorectal Lesions. Radosevich AJ, Mutyal NN, Eshein A, Nguyen TQ,
Gould B, Rogers JD, Goldberg MJ, Bianchi LK, Yen E, Konda VJ, Rex DK,
Van Dam J, Backman V, Roy HK. Clin Cancer Res. 2015 May 19. [Epub
ahead of print]
Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic
fluid collections with lumen-apposing covered self-expanding metal
stents. Shah RJ, Shah JN, Waxman I, Kowalski TE, Sanchez-Yague A, Nieto J,
Brauer BC, Gaidhane M, Kahaleh M. Clin Gastroenterol Hepatol. 2015 Apr;
13(4):747-52.
Preservation of beta cell function after pancreatic islet autotransplantation:
University of Chicago experience. Savari O, Golab K, Wang LJ, Schenck
L, Grose R, Tibudan M, Ramachandran S,Chon WJ, Posner MC, Millis JM,
Matthews JB, Gelrud A, Witkowski P.
Am Surg. 2015 Apr; 81(4):421-7.
Chronic pancreatitis pain pattern and severity are independent of
abdominal imaging findings. Wilcox CM, Yadav D, Ye T, Gardner TB,
Gelrud A, Sandhu BS, Lewis MD, Al-Kaade S, Cote GA, Forsmark CE, Guda
NM, Conwell DL, Banks PA, Muniraj T, Romagnuolo J, Brand RE, Slivka A,
Sherman S, Wisniewski SR, Whitcomb DC, Anderson MA. Clin Gastroenterol
Hepatol. 2015 Mar;13(3):552-60;
Use of narrow-band imaging with magnification to predict depth of
invasion of early esophageal squamous cell cancer and to guide endoscopic
therapy. Singh A, Konda VJ, Siddiqui U, Xiao SY, Waxman I. Gastrointest
Endosc. 2015 Feb; 81(2):469-70.
A single-center experience of endoscopic submucosal dissection performed
in a Western setting. Lang GD, Konda VJ, Siddiqui UD, Koons A, Waxman I.
Dig Dis Sci. 2015 Feb; 60(2):531-6.
Performance of endoscopic ultrasound in staging rectal adenocarcinoma
appropriate for primary surgical resection. Ahuja NK, Sauer BG, Wang AY,
White GE, Zabolotsky A, Koons A, Leung W, Sarkaria S, Kahaleh M, Waxman
I, Siddiqui AA, Shami VM. Clin Gastroenterol Hepatol. 2015 Feb; 13(2):33944.
Biliary strictures: diagnostic considerations and approach. Singh A, Gelrud
A, Agarwal B. Gastroenterol Rep (Oxf ). 2015 Feb;3(1):22-31
Minimizing, recognizing, and managing endoscopic adverse events.
Siddiqui UD, Gostout CJ. Gastrointest Endosc Clin N Am. 2015 Jan; 25(1):
xiii-xiv.
Complete endoscopic mucosal resection is effective and durable treatment
for Barrett’s-associated neoplasia. Konda VJ, Gonzalez Haba Ruiz M,
Koons A, Hart J, Xiao SY, Siddiqui UD, Ferguson MK, Posner M, Patti MG,
Waxman I. Clin Gastroenterol Hepatol. 2014 Dec; 12(12):2002-10.e1-2.
Total pancreatectomy with islet autotransplantation: summary of
a National Institute of Diabetes and Digestive and Kidney diseases
workshop. Bellin MD, Gelrud A, Arreaza-Rubin G, Dunn TB, Humar A,
Morgan KA, Naziruddin B, Rastellini C, Rickels MR, Schwarzenberg SJ,
Andersen DK. Pancreas. 2014 Nov; 43(8):1163-71.
Practice patterns in FNA technique: A survey analysis. DiMaio CJ, Buscaglia
JM, Gross SA, Aslanian HR, Goodman AJ, Ho S, Kim MK, Pais S, SchnollSussman F, Sethi A, Siddiqui UD, Robbins DH, Adler DG, Nagula S. World J
Gastrointest Endosc. 2014 Oct 16;6(10):499-505.
Optical biopsy approaches in Barrett’s esophagus with next-generation
optical coherence tomography. Konda VJ, Koons A, Siddiqui UD, Xiao SY,
Turner JR, Waxman I. Gastrointest Endosc. 2014 Sep; 80(3):516-7.
Enhanced mucosal imaging and the esophagus–ready for prime time?
Tomizawa Y, Waxman I. Curr Gastroenterol Rep.2014 June; 16(6):389.
Combined interventional radiology followed by endoscopic therapy as a
single procedure for patients with failed initial endoscopic biliary access.
Tomizawa Y, Di Giorgio J, Santos E, McCluskey KM, Gelrud A. Dig Dis Sci.
2014 Feb; 59(2):451-8.
Single balloon enteroscopy (SBE) assisted therapeutic endoscopic
retrograde cholangiopancreatography (ERCP) in patients with roux-en-y
anastomosis. Tomizawa Y, Sullivan CT, Gelrud A. Dig Dis Sci. 2014 Feb;
59(2):465-70.
Endoscopic diagnosis and therapies for Barrett esophagus. A review.
Waxman I, González-Haba-Ruiz M, Vázquez-Sequeiros E. Rev Esp Enferm
Dig. 2014 Feb; 106(2):103-19.
31
Philanthropic Partners
CERT’s ambitious research agenda would not be
possible without our donors’ strong commitment
to improving patient care and outcomes. These
generous individuals and organizations provide
vital support as our physician-scientists investigate
ways to advance the diagnosis and treatment of
gastrointestinal cancers and other diseases through
endoscopic discovery and innovation.
effective screening for esophageal cancer and
creating a mouse model for the disease, which will
enable researchers to study the interplay between
diet and cancer risk.
During the past year, private philanthropy has
supported Dr. Irving Waxman’s trials using
endoscopic ultrasound rather than the current
method of blood testing to identify and examine
circulating tumor cells. This research could lead
to earlier detection of pancreatic cancer and a
better understanding of its prognosis to help
patients and physicians make more informed
choices about therapies. Philanthropy has
also provided essential resources for Dr. Vani
Konda’s recent projects, which include applying
nanocytology to developing earlier and more
The Francis L. Lederer Foundation
32
For supporting these and other initiatives, we wish
to thank and acknowledge those who provided
philanthropic support over the past year.
The Gerald O. Mann Charitable Foundation –
Harriet and Allan Wulfstat, Officers
Julius Lewis and the Rhoades Foundation
The Rolfe Pancreatic Cancer Foundation
Mrs. Jane Woldenberg
To make a gift online, visit givetomedicine.
uchicago.edu/give. Please include “Center for
Endoscopic Research and Therapeutics” in the
special instructions field.
TALK TO US
To get an answer, schedule an
admission, make a referral, or
request a consultation, call us
directly at 773.702.1459.
The University of Chicago Medicine
5700 S. Maryland Avenue | MC8043
Chicago, IL 60637
PHONE
773.702.1459
FAX
773.834.8891
To learn more about the Center for Endoscopic Research and Therapeutics,
please visit www.uchospitals.edu/cert
773.702.1459
uchospitals.edu/cert