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DIANA SNYDER: Symptoms that affect the esophageal tract certainly affect patients' day-to-day quality of life. Being able to eat is a core principle of our daily joy, and part of our culture, and part of our nutrition. So it's really important for us to be able to help patients to have reduced symptoms and be able to swallow better.
PRASAD IYER: The esophageal clinic is multidisciplinary and provides specialized care to patients with symptoms and diseases pertaining to the esophagus. All the way from the benign end, such as patients with reflux disease, to the other end of the spectrum, or patients with esophageal cancer or patients with pre-cancer of the esophagus, which typically happens in a condition called Barrett's esophagus. We are fortunate at Mayo Clinic in Rochester to not only have access to providers who are experts at eliciting the right history, doing the right examination, but also coming up with the right investigative plan.
DIANA SNYDER: One of the most important sets of diagnostic tools that we have is for our patients with esophageal motility disorders, particularly achalasia. For these patients, we have a specialized esophagram protocol to image their esophagus. This is very dependent on the nurses performing the procedure as well as the physician interpreting it. And we all have specialized training at Mayo to complete this.
In addition, more recently, we've been using an adjunctive test to help guide and manage our achalasia patients called FLIP, or functional lumen-imaging probe. This is a probe that's placed during an upper endoscopy and can help us assess secondary peristalsis of the esophagus as well as distensibility or relaxation at the esophagogastric junction in our achalasia patients.
PRASAD IYER: We have been working on a non-endoscopic way of diagnosing esophageal pre-cancer or cancer. Wherein tests can be done by a nurse in an outpatient office in about 10 minutes. This involves swallowing a capsule, which we call a sponge on a string.
DIANA SNYDER: It then opens up from a capsule inside the stomach and then is pulled out in samples, eosinophils within the esophagus. This has been a great innovation because, essentially, it allows our patients to avoid serial endoscopic exams with biopsies that require rides, and support, and anesthesia. Instead, they can check their eosinophil counts in a 5-, 10-minute, quick unsedated clinic visit.
PRASAD IYER: We also have access to a number of unique treatments where endoscopically we can now non-surgically treat patients. We are now doing a procedure called POEM, P-O-E-M, per oral endoscopic myotomy, where instead of doing the myotomy or the muscle incision from the outside, surgically, we can now go in on the inside with the endoscope and make that incision. And this becomes an outpatient procedure. Patients go home the next day. This can be done in an endoscopy suite.
DIANA SNYDER: It's particularly important for referring physicians to send patients to us that have Barrett's esophagus or a pre-cancerous condition that can lead to cancer. We have numerous therapies that we use for Barrett's esophagus with dysplasia, depending on the level of dysplasia. For nodular disease, we have experts that can complete endoscopic mucosal resection as well as endoscopic submucosal dissection. We also have radiofrequency ablations that can ablate flat areas of dysplastic Barrett's. In addition, we have other therapies using frozen nitrogen, such as cryotherapy, that can help reduce the risk of progression to cancer.
PRASAD IYER: Our goal is to make care, and evaluation, and treatment as non-invasive as possible. I love when I see patients who have been cured of esophageal cancer or patients who are now able to swallow and be on a much improved diet compared to what they were able to do before. And their quality of life is amazing.
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