New minimally invasive GI procedure performed for the first time in Kentucky

Since she was in her early 20s, Jackie Denault has had issues with her gastrointestinal (GI) system. But in 2017, the problems became so severe that she was having trouble eating and would feel incredibly nauseated after a meal.

After trying to control the issue herself, Denault decided it was time to seek medical attention, so she went to UK Family & Community Medicine at Turfland to see her primary care provider. Due to her history of GI issues, she had to undergo a colonoscopy.

The diagnosis

Denault's colonoscopy revealed she had two polyps in her colon. One of the polyps was a Tubulovillous adenoma, or TVA, a type of polyp that grows in the colon and other places in the gastrointestinal tract and sometimes other parts of the body. These adenomas may become cancerous.

Endoscopic removal of adenomas can be problematic because if future polyps appear at the same site, a second removal becomes challenging due to scar tissue formation. Therefore, the typical treatment for this type of recurrent adenoma for patients with benign and relatively small lesions is a colon resection, which is considered a highly invasive procedure.

An innovative procedure

However, in 2017, the U.S. Food and Drug Administration approved new technology that allows physicians to perform a procedure called an endoscopic full thickness resection (EGTR). Unlike a bowel resection, an endoscopic full thickness resection can be done as an outpatient procedure, doesn't require external incisions and can be performed in an advanced endoscopy suite.

Before December 2018, patients wanting a more minimally invasive option for the procedure would have had to drive several hours and outside of Kentucky to receive this new treatment. But the advanced endoscopy group in the UK Digestive Health Program recently underwent the necessary training and is now able to provide this state-of-the-art care.

"Recurrent colon adenomas are challenging for endoscopists and surgeons alike," said Dr. Moamen Gabr, assistant professor in the Division of Digestive Health & Gastrointestinal Surgery. "Being able to perform this minimally invasive option to our Kentucky patients allows UK to be the place that offers comprehensive management for this condition. It also answers to the needs of our patients and community physicians who put great trust in us caring for their patients with the most complex conditions."

On Dec. 14, 2018, Drs. Gabr, Samuel Mardini and Wesam Frandah worked together to plan and perform the procedure. For Denault, knowing her care was a team effort was comforting. "Knowing that many people are involved in wanting it to go successfully helps you know things are going to be OK," she said.

Denault will return for a follow-up appointment in March, but so far, she is feeling a lot of relief. "I'm really happy and very grateful."