Neil R. Sharma MD on Innovation and Advances in Minimally Invasive Surgery: EMR, ESD, POEM, Third-Space, EUS ERCP

Neil Sharma MD

Dr. Neil R. Sharma Explains What Patients Need to Know About Minimally Invasive Options

Sometimes surgery can leave just a scratch, not a scar, says Neil R. Sharma MD, President of Parkview Health. Five innovations in minimally invasive surgery are accelerating healing time and minimizing the trauma of necessary surgical operations.

Here is what Neil Sharma says patients need to know about each of these new options in surgical care.

EMR, or gastrointestinal endoscopic mucosal resection, is a procedure for removing precancerous tumors, abnormal tissues, or early-stage cancers from the gastrointestinal tract. The surgeon performs EMR endoscopically, with a long, thin tube called an endoscope down the throat to reach the affected site in the esophagus, stomach, duodenum (the upper part of the small intestine), or the colon. EMR is primarily used for treatment, but it can also be used to collect tissues for diagnosis.

Surgeons use ESD, or endoscopic submucosal dissection, to remove cancers or precancerous lesions from the digestive tract without removing the organ involved. The surgeon also uses an endoscope for this procedure, passing the scope through the patient’s mouth. Once the surgeon has located the tumor, its margins are marked. The surgeon injects fluid into the submucosal layer under the tumor to lift and separate it for easier removal. This procedure spares vital organs and gives the patient a much higher quality of life.

ESD is a complex technique that requires additional training and is usually done by highly specialized physicians who maintain a high proficiency.  ESD allows for large lesions to be removed in one piece, and this organ-sparing surgery reduces cost and morbidity for patients.

Peroral endoscopic myotomy, also known as POEM, is a method of treating achalasia, or constriction of the esophagus, without making an incision in the skin. This method also involves passing an endoscope through the mouth. The surgeon makes a small incision in the innermost layer of the esophagus, the mucosa. Then the surgeon uses the endoscope to create a tunnel down the length of the esophagus through the submucosa. Once inside the lower esophagus, the surgeon cuts muscle fibers holding the esophagus too tightly, and then removes the instrument and closes the incision.

Third-space endoscopy uses a similar procedure to reach a tumor underlying the esophagus or stomach. The surgeon tunnels under the mucosa of the esophagus, and then dissects and removes the tumor.

EUS, or endoscopic ultrasound, enables surgeons to examine the walls of the upper digestive tract with a tool combining endoscopy and high-frequency ultrasound. The surgeon can examine and take samples of structures and internal organs that lie next to the gastrointestinal tract, including the bile duct, lymph nodes, gallbladder, and pancreas. Beyond biopsies and staging of tumors, EUS can be used for a variety of therapeutic indications.

EUS allows access to organs and spaces outside the GI tract without open incisions. This allows for maneuvers such as the connection of cysts to the stomach for internal drainage, connection of the gallbladder to the bowel for internal drainage, connection of 2 organs for internal bypass, ablation of tissues, and more.  Neil R. Sharma M.D. has been a pioneer in the space of EUS and EUS therapeutics.

ERCP, or endoscopic retrograde cholangiopancreatography, is a similar procedure that uses an endoscope to access the bile or pancreatic ducts and then uses x-ray or “fluoroscopy” to perform therapies of these ducts without an open incision. Allowing for leaks, blockages, etc to be treated without open incisions.

Dr. Neil R. Sharma joined the Parkview Cancer Institute in Fort Wayne, Indiana in 2013. A specialist in surgical removal of upper GI tumors, Neil R. Sharma MD is the founder of the institute’s Interventional Oncology and Surgical Endoscopy Program and has used innovative surgical techniques to treat over 3,000 patients. Dr. Sharma is also the lead investigator in clinical trials of Nanopac, a new method of endoscopic ultrasound-guided fine-needle injection of paclitaxel after surgical resection of locally advanced pancreatic cancer for pancreatic surgery.

Neil R. Sharma, M.D has also led or participated in a number of other trials on EUS, ESD, ERCP, EMR, and GI Cancers leading to a variety of national and international publications and presentations that have contributed to the science and advancement of the field.

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