Providence institutes offer specialized care to patients with foregut conditions

Authors: Hagen Kennecke, M.D., MHA, FRCPC, medical director, Gastrointestinal Oncology, Providence Cancer Institute
Christy M. Dunst, M.D., FACS, program director, Advanced GI-Foregut Fellowship, Providence Cancer Institute; esophageal surgeon, The Oregon Clinic

The Providence Foregut Program was created in partnership by Providence Cancer Institute and Providence Digestive Health Institute of Oregon to provide innovative treatments and care to help improve outcomes for people with diseases and malignant diagnoses of the esophagus and stomach.

Specifically, esophageal cancer is the fastest-rising cancer in the United States with a historically poor survival rate. However, when diagnosed early, esophageal cancer can be cured in nearly 85% of patients using advances in flexible endoscopy.

Our foregut specialists use the most advanced technology to diagnose and treat esophageal and gastric cancer at the earliest stages.

Improving outcomes through early detection and routine care

The key to making an impact on esophageal cancer outcomes is to identify patients with the precursor lesion known as Barrett’s esophagus. We identify Barrett’s esophagus by using technologies such as the high-sensitivity confocal laser endomicroscopy, which provides a virtual “real-time optical” biopsy, as well as wide epithelial sampling that allows for a larger sampling of cells than standard protocols. Once identified, patients with Barrett’s esophagus are enrolled in routine endoscopic surveillance strategies to find even invisible cancers.

Abnormal cells can then be ablated or removed using flexible endoscopic techniques such as endoscopic resection, radiofrequency ablation and cryotherapy. A patient’s surveillance schedule can be tailored to their risk of progressive disease based on advanced genetic analysis performed on tissue biopsies.

Providence is the largest foregut program and most experienced endoscopy program in Oregon, attracting patients from throughout the Pacific Northwest. Our team consistently maintains higher success rates and lower complication rates than the national average.

Treating foregut cancers with innovative technology and research

Working collaboratively with Earle A. Chiles Research Institute, a division of Providence Cancer Institute,  our team has access to the most innovative cancer research and therapies. For more advanced cancers, a multidisciplinary team provides leading-edge therapy. Comprehensive advanced imaging using endoscopic ultrasound, CT, MRI and PET scanning provides the most accurate cancer staging, allowing the team to tailor chemotherapy, MRI-guided radiation and minimally invasive surgery to each patient.

In some cases, we may use genomic sequencing technology and resources through Providence Molecular Genomics Lab to characterize the biology of a patient’s cancer and immune system. Additionally, at Providence we have the capability to pursue adoptive cellular therapy, a highly personalized type of cancer immunotherapy, in the Adoptive Cell Therapy Lab.

Benign foregut diseases

In addition to treating foregut cancer patients, we evaluate esophageal and gastric function for possible foregut benign conditions, such as gastroesophageal reflux disease (GERD) and hiatal hernias. For patients seeking alternatives to medical management for GERD, we offer gold-standard fundoplication, trans-oral incisionless fundoplication and magnetic lower esophageal sphincter augmentation. In addition, the team pioneered per-oral endoscopic myotomy (POEM), a minimally invasive, incisionless endoscopic procedure for achalasia.

Expertise within the foregut team

The Providence Foregut Program team includes fellowship-trained foregut surgeons, medical and radiation oncologists, gastroenterologists, pathologists and RNs. Our surgeons have decades of experience performing complex esophageal and gastric surgeries, ranging from vagal nerve-sparing options to complex reconstruction. After surgery, clinical teams on the Providence Portland Medical Center campus care for our patients throughout their recovery.

Oncology nurse navigators are the primary point of contact for our patients. They ensure patients and their families understand the treatment plan and guide them to resources as needed during and after treatment.

To support patients with foregut conditions or side effects from treatment, registered dietitians provide specialized care and help treat side effects of oncology treatments. On-site and outpatient dietitians train patients, provide nutritional goal assessments and develop supplement programs.

For more information

Training foregut experts

The foregut surgery team at Providence Cancer Institute regularly teaches its techniques of POEM and laparoscopic paraesophageal hernia repair to visiting surgeons and gastroenterologists from around the world. The Providence Advanced GI Foregut Surgical Fellowship is for physicians who have completed a general surgery residency and have a specialty interest in all aspects of foregut disease, including pathophysiology, flexible endoscopy and laparoscopic surgery.

Learn more about the foregut fellowship program.

About the Author

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