CENTER FOR ENDOSCOPIC RESEARCH AND THERAPEUTICS

ADVANCING PATIENT CARE

2014 ANNUAL REPORT

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EDUCATING24

EXCELLING14

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.

LEADING02

INNOVATING06

COLLABORATING18

DISCOVERING26

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The Center for Endoscopic Research and Therapeutics (CERT) at the University of Chicago Medicine was created to be a one-of-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.

ADVANCING PATIENT CARE

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IRVING WAXMAN, MD, FASGESara and Harold Lincoln Thompson

Professor, Medicine and Surgery

Director, Center for Endoscopic

Research and Therapeutics

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.

With deep experience and commitment to innovation

LEADING

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UZMA D. SIDDIQUI, MD, FASGEAssociate 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.

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LEADING

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.

VANI J. KONDA, MDAssistant Professor of Medicine

Director, Endoscopic Research

and Education Programs

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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.

ANDRES GELRUD, MD, MMSc, FASGEAssociate Professor of Medicine

Director, Pancreatic Disease Center

and Advanced Endoscopy

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Lynne Stearns, MSN, RNA 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 health-care system.

Ada I. Turner, RN,

BSN, CGRNAda 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.

Operations ManagerMarilu Andrade (center)

Administrative Assistants Breonda Bradie (left)Nina Miller (right)

Senior Research

Project ProfessionalAnn Koons

NURSE COORDINATORSPHYSICIAN ASSISTANTS

Megan Meiklejohn

PA-C, MPASMegan 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 Wisconsin-Madison, and then received her master’s degree in physician assistant studies in 2012 from Marquette University.

Mallory Geschke

PA-C, MPASMallory 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.

LEADING

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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.

From left to right, nurses Milena Vunjak, Sharon Pedrido, Jennifer Wang, Kelly Bryan,

Jennine Regan, and Johnny Webb.

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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.

INNOVATINGRealizing the promise of endoscopic technologies

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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.

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INNOVATING

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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.

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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

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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.

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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.

ADVANCED CARE IN A STATE-OF-

THE-ART PROCEDURE FACILITY

INNOVATING

Our patient satisfaction rating in 2014.Source: Press Ganey Patient Satisfaction Scores (July 2014 – Dec. 2014)

95%

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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 BlockEndoscopic Retrograde Cholangiopancreatography (ERCP)CholangioscopyAblation of cholangiocarcinomaLithotripsy of large biliary and pancreatic duct stonesAmpullectomyEndoscopic Mucosal Resection (EMR)Endoscopic Submucosal Dissection (ESD)Complex polypectomyRadiofrequency Ablation (RFA) of Barrett’s esophagus, radiation proctitis, and gastric antral vascular ectasia (GAVE)Confocal Laser Endomicroscopy (CLE)Pancreatic pseudocyst drainage and necrosectomyPhotodynamic therapy (PDT) Endoscopic suturingPalliative stenting of GI tract and pancreaticobiliary malignanciesExtracorporeal 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 colonComplications 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

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EXCELLING

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.

CERT by the numbers

2,116Total Patients

98%ERCP Success Rate

2,512Total CERT Procedures

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Endoscopic Ultrasound (EUS) Volume 2014Total Procedures 893

Endoscopic Retrograde Cholangiopancreatography (ERCP) Volume 2014Total Procedures 469

GRADE 1 3.5%

Pseudocyst enterostomy,

Cholangiopancreatography

with therapy (e.g., stent,

choledochoduodenostomy)

GRADE 2 26.2%

Diagnostic upper or lower

(no FNA sampling)

GRADE 3 60.5%

Diagnostic pancreatobiliary

(no FNA), Diagnostic

requiring dilation (no FNA),

FNA gut wall or contiguous

structure (mediastinum,

pancreas), Celiac plexus

blockade

GRADE 4 9.8% FNA distant/non-

contiguous structure,

Inject tumor therapy,

Fiducial placement, EUS

with EMR, Pseudocyst

aspiration/drainage,

Cholangiopancreatography;

diagnostic

GRADE 1 1.5%

Biliary stent removal/

exchange, Deep

cannulation of duct of

interest, Main papilla

sampling

GRADE 2 30.9%

Biliary stone extraction

< 10mmTreatment of

bile leaks, Treatment

of extrahepatic benign

& malignant strictures,

Placement of prophylactic

pancreatic stents

GRADE 3 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

540

60.5%

234

26.2%

31

3.5%

88

9.8%

Source: ASGE Grading System

7

1.5%

140

29.9% 145

30.9%

177

37.7%

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of physicians who referred a patient to

us once continue to refer their patients.

86%

COLLABORATINGA 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.

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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

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 akoons@medicine.bsd.uchicago.edu

Cellvizio - Probe Based Confocal Laser Endomicroscopy (CLE)

Ex Vivo Tissue Study with Probe Based Confocal Laser Endomicroscopy (CLE)

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 In-ternational Classification System for the Prediction of Dysplasia in Barrett’s Esoph-agus using Narrow Band Imaging (NBI)

Tissue Banking for Gastrointestinal Ma-lignant and Premalignant Lesions

Detection of Circulating Tumor Cells (CTCs) in Pancreatic Cancer via EUS-guided Portal Vein Sampling

EUS Fine Needle Aspiration with the ProCore 22G Needle

Large Colorectal Polyp Resection Study

EUS guided Liver Biopsy

In vivo Optical Diagnosis of Colon Polyps with Narrow Band Imaging (NBI) with Near Focus

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

Molecular Evaluation in Barrett’s Esophagus

EUS-guided core needle biopsy (EUS-CNB) versus EUS-guided single-incision with needle knife (SINK) for the diagnosis of upper gastrointesti-nal subepithelial lesions

Nanocytology by Partial wave spectros-copy (PWS) of Buccal Cells for Esopha-geal cancer risk stratification

Gene Sequencing of Esophageal Cancer

Exocrine Pancreatic Insufficiency

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“Endoscopic

techniques and

technology are

constantly advancing,

and we treat more

complex cases here

than anywhere in

the region.”

DR. WAXMAN

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.

Getting the Bile Flowing Again

COLLABORATING

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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.

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

he did not have a malignancy, but instead had a rare benign condition called autoimmune sclerosing pancreatitis.

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.”

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“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

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 veno-occlusive 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.

“She became septic. Her abdomen was filling with infected fluids. They kept saying they had seen pancreatitis before, but not like this,” says Brandi

Treating PancreatitisTurned Deadly

COLLABORATING

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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.

That’s when Kloe’s aunt, searching the Internet, found Dr. Andres Gelrud and the team at UCM.

“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

assisted retroperitoneal debridement. It’s a novel procedure for the pancreas, but it’s how we saved her.”

“Dr. Matthews, the surgeon, was superb. The interventional radiology team was superb, as well. It was just an incredible team effort.”

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.”

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“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

“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.”

Reopening a Nearly Closed Esophagus

COLLABORATING

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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.

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.

“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 .”

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.”

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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.”

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—COLLABORATING

“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

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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.”

“When dealing with severe necrotizing pancreatitis, we always work closely with our surgical colleagues, and in Andy’s case we had the expertise of our Chairman of Surgery, Dr. Jeffrey Matthews,” says Siddiqui.

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,” says Ashley. “Through everything, Dr. Siddiqui just went way, way beyond what I ever anticipated. She got him home for all the important stuff—for the baby, for Christmas. She got him home, and she got him well.”

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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

EDUCATINGLive endoscopy courses taught by internationally recognized experts

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DISCOVERINGCommitted 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.

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 ‘real-time’ 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.

A. B.

D.

C.

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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):339-44.

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, Schnoll-Sussman 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.

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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.

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

Philanthropic Partnerseffective 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.

For supporting these and other initiatives, we wish to thank and acknowledge those who provided philanthropic support over the past year.

The Francis L. Lederer FoundationThe Gerald O. Mann Charitable Foundation – Harriet and Allan Wulfstat, OfficersJulius Lewis and the Rhoades Foundation The Rolfe Pancreatic Cancer FoundationMrs. 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.

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TALK TO USTo get an answer, schedule an admission, make a referral, or request a consultation, call us directly at 773.702.1459.

The University of Chicago Medicine5700 S. Maryland Avenue | MC8043Chicago, 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

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uchospitals.edu/cert

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