Posted on Monday - 05/20/2019 to Up Close
Front and inside photos: Will McCullough, VACCHCS
UCSF Fresno and VA Partnership Makes Life-Saving Care Available Locally for Veterans
By Barbara Anderson
At the VA Central California Health Care System, new endoscopic equipment and the skills of Shreyas Saligram, MD, MRCP, director of advanced endoscopy at UCSF Fresno, are making minimally invasive procedures available to veterans that were unthinkable only a few years ago.
Endoscopic removal of early cancers of the colon and esophagus are now possible, reducing the need for major surgeries, Dr. Saligram said. “Imagine taking cancer out in a couple of hours and sending them home – that’s what we are doing.”
In the past, Fresno-area veterans had to be sent three or more hours away to the VA hospital in San Francisco or to the Palo Alto VA for the advanced endoscopic procedures.
“We started revamping our endoscopy unit about two and a half years ago,” Dr. Saligram said. “The VA management has been supportive as well as the chief of gastroenterology, Helen Wong, MD, UCSF clinical professor of medicine and fellow director at UCSF Fresno. She’s been the biggest proponent of not having our patients go to Palo Alto so they can remain here and we can treat them.”
Dr. Saligram’s training in advanced endoscopy has enhanced patient care, said Devang N. Prajapati, MD, an associate clinical professor at UCSF Fresno and gastroenterologist at VA-VACCHCS. “Having all the equipment is not the be all, you need the trained personnel. You can’t just buy the equipment and all of a sudden everything will be fine. You need the expertise.”
New endoscopy monitors, screens and scopes make it possible for gastroenterologists to intervene before cancer develops. Precancerous small, flat polyps on the right side of the colon are easier to detect and remove than with older endoscopic equipment. And advanced endoscopy is an option for removing large polyps of the colon which in the past had to be surgically removed. “The new tools aid in the ability to detect polyps, remove them with ease and perform procedures with fewer complications for patients,” Dr. Saligram said.
Diagnostic and therapeutic endoscopic ultrasound allow for easier cancer staging and management. A tumor of the pancreas, for example, can be viewed and a sample of the mass taken to determine if it is benign or malignant. “In the past, if there was a tumor in the pancreas we’d have a difficult time telling you whether it was cancer or not because it’s a very difficult location to biopsy,” Dr. Prajapati said.
The origin of an internal bleed also can be located by endoscopy instead of by exploratory surgery. Using a single balloon endoscope, damaged areas of the small bowel that had been inaccessible can be reached and repaired, for example.
Other endoscopy advances at VA-CCHCS: Radiofrequency ablation (localized treatment using high-energy radio waves to heat and destroy cancer cells) is available for treatment of Barrett’s esophagus, a condition that occurs in some patients who have chronic acid reflux. Pre-cancerous and cancerous tissues in the esophagus can be burned off, saving a veteran from surgery to remove all or part of the esophagus.
The new tools also make it easier to place stents to open up the esophagus of patients with esophageal cancer. “In the past we had to use X-rays to place the stents,” Dr. Saligram said. “Now we can deploy a stent through endoscopy so it’s easier on the patients. They come here and the procedure is done in 15 to 20 minutes.”
Preventing esophageal stents from migrating into the stomach also is possible through endoscopy. Dr. Saligram is able to sew the stent inside the esophagus, and when a tumor has shrunk through chemotherapy or radiation, the stent can be easily removed.
Radiofrequency ablation also can burn off cancer of the bile duct, a procedure that Dr. Saligram said is not being done elsewhere in Fresno.
“Now at this VA, we’re at the leading edge of this type of GI therapy and endoscopic therapy and management,” Dr. Prajapati said. And veterans appreciate the VA’s commitment to advanced endoscopy, he said. “Every week we have veterans who need these procedures.”
Dr. Saligram said it’s a privilege to work at the VA hospital. “Let’s not forget the kind of service they have given to our nation,” he said. “I think we’re indebted to them.”
The partnership between UCSF Fresno and VA Central California Health Care System makes front-line and life-saving care available locally to Central California veterans who honorably served our country.