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Specialist clinics Healthcare Innovations 41


Save the gut: endoscopic diagnosis and treatment


Gut cancers: find, remove and prevent Patients with Barrett’s oesophagus are at risk of developing cancer of the oesophagus, which has a very poor outcome. Barrett’s patients can present with heartburn, but are often asymptomatic and are only diagnosed on endoscopy. Te early cancer changes in Barrett’s are very subtle


and can easily be missed


during standard endoscopy (with a 10-20% miss rate). Prof Bhandari has pioneered a tech-


nique of vinegar-assisted endoscopy to identify cancerous cells that are otherwise not visible during endos- copy. He routinely uses this tech- nique for assessment of patients with Barrett’s oesophagus. Similarly, early cancers in stomach and colon can be very subtle and easily missed (10-25%) during standard endoscopy. Prof Bhandari uses a range of techniques like image enhancement, dyes and artificial intelligence in research and clinical practice to accurately detect cells with cancer potential. Once identified, they can be removed via endoscope to prevent future cancers. Screening


endoscopy performed


by an expert can help prevent future cancers.


Save the gut from unnecessary surgery for early cancers Cancer of the colon often arises from polyps, which are wart-like overgrowths in the colon. Similarly, cancers


of the oesophagus colonic polyps and


stomach also start as very flat lesions. When


and early


cancers of stomach and oesophagus are very large in size, or very flat, they’re often subjected to surgical resection. Prof Bhandari is one of the pioneering


doctors who introduced a technique called ESD (Endoscopic Submucosal Dissection). Tis involves peeling off the inner lining of the gut, along with the cancer, in one single piece via an incision-less endoscopic procedure. He now uses this technique to treat early cancerous or pre-cancerous lesions in the stomach, oesophagus, small bowel and colon, thereby reducing the need for surgery in these patients.


Save the gut from unnecessary surgery for benign conditions A pharyngeal pouch is a condition associated with out-pouching of the food pipe in the neck. It can cause difficulty in swallowing, cough, regur- gitation and recurrent chest infec- tions. It can be diagnosed at endoscopy


or with x-rays. Prof Bhandari special- ises in this, and uses a quick endo- scopic technique to open the pouch into the oesophagus, curing the condition without standard surgery. Achalasia is a condition where the


sphincter between the oesophagus and the stomach fails to relax. Similar issues can affect the sphincter at the other end of stomach, resulting in delay in emptying of stomach. Tis leads to swallowing problems, weight loss and vomiting. Prof Bhandari specialises in the techniques of POEM and G-POEM, which are endo- scopic procedures designed to fix these sphincters without the need for surgery. Obesity isn’t uncommon, and


when diet and lifestyle measures fail, surgical options are commonly sought. Surgery is very effective, but it does result in losing a significant amount of the gut and its functions. In severely obese patients, surgery is highly recommended. However, mild to moderate obesity can be treated by endoscopic sleeve gastroplasty with a very good outcome.


T: 07549165212 E: themedicalpa@gmail.com thelondonclinic.co.uk and spirehealthcare.com


MEET THE EXPERT


Prof Pradeep Bhandari MB, MD, FRCP(UK), FJGES(Japan)


Prof Pradeep Bhandari specialises in endoscopic diagnosis and treatment of gastrointestinal conditions. He has developed an international reputation in performing early cancer diagnosis and the removal of cancerous and pre-cancerous lesions by incision-less endoscopic procedures. He receives referrals from all around the world and shines a light on some of the advances made in the field of endoscopy. Prof Bhandari has authored several


national and international guidelines and more then 200 peer reviewed scientific publications. He leads the research committee of the European Society of Gastrointestinal Endoscopy and has been honoured by the Hopkins Endoscopy Prize from British society of Gastroenterology, the American Society for Gastrointestinal Endoscopy Crystal Award and the Royal college of Physicians (Edin) Freeland Barbour award for his contribution to advancing science.


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