Advances in Therapeutic Endoscopy
From the Show: Childrens Health - Peer
Summary:
Air Date: 11/11/19
Duration: 10 Minutes
Dr. Bradly Barth shares information about pediatric GI surgery and advances in endoscopic procedures at Children’s Health.
Transcription:
Prakash Chandran (Host): When your child patients are suffering from advanced digestive issues, where should you send them? In this episode, we’ll be talking about the therapeutic endoscopy program at Children’s Medical Center Dallas and their approach which allows surgeons to view, diagnose and treat normally hard to reach areas of the GI tract. I’m Prakash Chandran and this is Pediatric Insights, Advances and Innovations With Children’s Health where we explore the latest in pediatric care and research. We’re joined today by Dr. Bradley Barth, Division Director of Pediatric Gastroenterology at Children’s Health and Professor of Pediatrics at the University of Texas Southwestern Medical Center. Dr. Barth, it’s a pleasure to have you here today. I wanted to start with the fascinating testimonial I saw on the Children’s Health Website. You treated a 21 month old boy who accidentally ingested some chemicals that caused severe burning to his mouth, his esophagus and stomach. Can you tell us a little bit more about this case?
Bradley Barth, MD (Guest): That was a case that I will never forget. When kids drink really basic substances and the pH is really high, they can get severe burns on their esophagus and some of these burns go really deep in the tissue and they can also go all the way through the tissue and cause perforation. Over time, those burns turn into scars. And the scars can be very long and tortuous which means they wind around, left and right and they don’t go straight. And if they get too firm, kids can’t eat. That was the big problem with that patient.
And it took us a long time. We treated him for years and we used just about everything we could possibly use with the balloon dilations and stents and rigid dilations and injections of different kind of medicines and ultimately, after a lot of hard work and a lot of time and a few complications; we ended up getting him back to normal and he’s actually doing great now. He’s probably 12 or 13 years old and thriving playing baseball, getting around and doing everything he wants to do.
Host: I think that’s wonderful. And one of the things that I saw on the testimonial was not only how happy and thankful he was, but how happy the mother was just to be kept in the loop the entire time. So, you know you mentioned that you tried a host of different measures but I’m curious as to what the treatment was that finally ended up working.
Dr. Barth: The final thing that we did and ended up working was a balloon dilation followed by what we call topical administration of mitomycin-C and that’s a medicine that’s – it actually a chemotherapeutic agent that in short prevents scar formation in some patients. And it’s got a few potential side effects but fortunately, he didn’t have any of those. You do the dilation and break the scar and then you kind of try to paint that medication onto the area of the esophagus using an endoscope, so the scars don’t form again. And once we started using that, I think it was just one or two dilations after that and he was essentially back to normal which is pretty amazing.
Host: Yeah, that is amazing. And the method that you used to administer that is what you are known for there at Children’s which is the pediatric therapeutic endoscopy, is that correct?
Dr. Barth: Yes.
Host: So, maybe talk a little bit about what you specifically do there at Children’s and why the program is so highly regarded in the nation.
Dr. Barth: So, therapeutic endoscopy in kids is a field that’s been growing over the past 20 years. and I finished my fellowship training in 2004 and back then, boy there were certainly fewer than 10 therapeutic endoscopists, maybe only five or six of us that did ERCPs at that time which is a procedure to treat problems of the bile duct and pancreatic ducts endoscopically. Most pediatric gastroenterologists do endoscopy and the basic diagnostic endoscopy is the bread and butter of what a lot of us do.
Some of us choose to get advanced training and do things that are a little bit more risky but with the potential to actually fix problems rather than diagnose them. And that’s kind of what the field of pediatric therapeutic endoscopy is. Our program here, has grown since 2004 with ERCP and endoscopic ultrasound and advanced treatment for GI bleeding and advanced treatment of difficult strictures and feeding tube placements. The volume has grown a lot. Lots of reasons for that. But there’s a lot of kids that benefit from advanced endoscopic therapies. So, when I got here, we were doing maybe 30 ERCPs per year and no endoscopic ultrasounds back then. That was a field that was really, really just starting. And now, in 2018, we do about 100 pediatric ERCPs per year and between 40 and 50 pediatric endoscopic ultrasound exams.
Host: Yeah, it’s really fascinating to hear not only how far technology has come but the amount of experience that you have in both EUS and ERCP. I’ve read that your team has been a four time winner of the pediatric endoscopy in naspghan and I’d love to hear more about why surgeons travel from all over to train with you.
Dr. Barth: We’re pediatricians and we go into pediatric gastroenterology as a fellowship. And we don’t actually do surgery. We do advanced endoscopies. So, really no cutting through the skin. It all goes through the mouth or from below. What makes us different is persistence, I think. If you want to be a pediatric therapeutic endoscopist; it’s not really an easy road. There’s no formal training programs for us. You actually have to have access to adult patients in order to get really good at this and that’s tough too because adult gastroenterologists have their own therapeutic endoscopy programs. So, you have to be persistent and very flexible with your career and you got to be willing to take a little bit of abuse because we end up after having trained in pediatric hospitals for six years, going over to work in adult centers where sometimes we’re seen as people who slow down their processes because we are not as experienced with procedures on adults as they are.
We fought through that and when I did my training, it was a bit difficult but by 2007 maybe after three years of finishing my fellowship, I was independent and able to do these procedures. Then I was fortunate enough to train, Dr. David Troendle who now works here with me as faculty at UT Southwestern and at Children’s and David runs our endoscopic ultrasound program and after training him, we became known as a center that successfully do that. And since people don’t have a whole lot of options and we have experience with it and we have had success with awards and good outcomes and publications that show that we do these procedures well; people tend to look to us and find us at meetings or call us or email us and ask us what the best way is to get training.
Host: Yeah, it sounds comprehensive. So, if a pediatric healthcare provider is listening to this, what tips might you have for them in terms of when they should seek more advanced treatments for their patients from an organization like Children’s Health.
Dr. Barth: If something comes up that a pediatric gastroenterologist isn’t familiar with or hasn’t seen endoscopically or just doesn’t feel comfortable with the risk that goes into doing a certain procedure; we are happy to help out. We do have experience with advanced endoscopy and we also have a lot of backup in case things don’t go well with pediatric surgeons and interventional radiologists and pediatric ICU that we work closely with. So, there are times when volume really counts and by volume, I mean how often you’ve done something. And if somebody doesn’t feel entirely comfortable with what they need to do; that’s when they should call us.
Host: Well Dr. Barth, this has been extremely informative. And I wanted to wrap up by commenting on something you said at the end of that testimonial that I watched. You said that your job ultimately was about making sure that a child could eat properly. And I thought that this was a great way to put what you do into perspective. Because eating on your own without the help of feeding tubes is part of the human experience, isn’t it Dr. Barth?
Dr. Barth: Gastroenterology is when you really get down to it, it’s plumbing and making sure that everything gets to where it needs to go. We do have ways to do that and that’s part of what makes our job great. I think I have the greatest job in the world where we can actually interact with new patients and help them and hopefully change their lives.
Host: And you are certainly doing that. So, thank you so much Dr. Barth. For more information on our conversation please visit www.childrens.com/GIscope. If you found this podcast helpful, please rate and review or share the episode. Please follow Children’s Health on your social channels. Thanks and we’ll talk next time.
Prakash Chandran (Host): When your child patients are suffering from advanced digestive issues, where should you send them? In this episode, we’ll be talking about the therapeutic endoscopy program at Children’s Medical Center Dallas and their approach which allows surgeons to view, diagnose and treat normally hard to reach areas of the GI tract. I’m Prakash Chandran and this is Pediatric Insights, Advances and Innovations With Children’s Health where we explore the latest in pediatric care and research. We’re joined today by Dr. Bradley Barth, Division Director of Pediatric Gastroenterology at Children’s Health and Professor of Pediatrics at the University of Texas Southwestern Medical Center. Dr. Barth, it’s a pleasure to have you here today. I wanted to start with the fascinating testimonial I saw on the Children’s Health Website. You treated a 21 month old boy who accidentally ingested some chemicals that caused severe burning to his mouth, his esophagus and stomach. Can you tell us a little bit more about this case?
Bradley Barth, MD (Guest): That was a case that I will never forget. When kids drink really basic substances and the pH is really high, they can get severe burns on their esophagus and some of these burns go really deep in the tissue and they can also go all the way through the tissue and cause perforation. Over time, those burns turn into scars. And the scars can be very long and tortuous which means they wind around, left and right and they don’t go straight. And if they get too firm, kids can’t eat. That was the big problem with that patient.
And it took us a long time. We treated him for years and we used just about everything we could possibly use with the balloon dilations and stents and rigid dilations and injections of different kind of medicines and ultimately, after a lot of hard work and a lot of time and a few complications; we ended up getting him back to normal and he’s actually doing great now. He’s probably 12 or 13 years old and thriving playing baseball, getting around and doing everything he wants to do.
Host: I think that’s wonderful. And one of the things that I saw on the testimonial was not only how happy and thankful he was, but how happy the mother was just to be kept in the loop the entire time. So, you know you mentioned that you tried a host of different measures but I’m curious as to what the treatment was that finally ended up working.
Dr. Barth: The final thing that we did and ended up working was a balloon dilation followed by what we call topical administration of mitomycin-C and that’s a medicine that’s – it actually a chemotherapeutic agent that in short prevents scar formation in some patients. And it’s got a few potential side effects but fortunately, he didn’t have any of those. You do the dilation and break the scar and then you kind of try to paint that medication onto the area of the esophagus using an endoscope, so the scars don’t form again. And once we started using that, I think it was just one or two dilations after that and he was essentially back to normal which is pretty amazing.
Host: Yeah, that is amazing. And the method that you used to administer that is what you are known for there at Children’s which is the pediatric therapeutic endoscopy, is that correct?
Dr. Barth: Yes.
Host: So, maybe talk a little bit about what you specifically do there at Children’s and why the program is so highly regarded in the nation.
Dr. Barth: So, therapeutic endoscopy in kids is a field that’s been growing over the past 20 years. and I finished my fellowship training in 2004 and back then, boy there were certainly fewer than 10 therapeutic endoscopists, maybe only five or six of us that did ERCPs at that time which is a procedure to treat problems of the bile duct and pancreatic ducts endoscopically. Most pediatric gastroenterologists do endoscopy and the basic diagnostic endoscopy is the bread and butter of what a lot of us do.
Some of us choose to get advanced training and do things that are a little bit more risky but with the potential to actually fix problems rather than diagnose them. And that’s kind of what the field of pediatric therapeutic endoscopy is. Our program here, has grown since 2004 with ERCP and endoscopic ultrasound and advanced treatment for GI bleeding and advanced treatment of difficult strictures and feeding tube placements. The volume has grown a lot. Lots of reasons for that. But there’s a lot of kids that benefit from advanced endoscopic therapies. So, when I got here, we were doing maybe 30 ERCPs per year and no endoscopic ultrasounds back then. That was a field that was really, really just starting. And now, in 2018, we do about 100 pediatric ERCPs per year and between 40 and 50 pediatric endoscopic ultrasound exams.
Host: Yeah, it’s really fascinating to hear not only how far technology has come but the amount of experience that you have in both EUS and ERCP. I’ve read that your team has been a four time winner of the pediatric endoscopy in naspghan and I’d love to hear more about why surgeons travel from all over to train with you.
Dr. Barth: We’re pediatricians and we go into pediatric gastroenterology as a fellowship. And we don’t actually do surgery. We do advanced endoscopies. So, really no cutting through the skin. It all goes through the mouth or from below. What makes us different is persistence, I think. If you want to be a pediatric therapeutic endoscopist; it’s not really an easy road. There’s no formal training programs for us. You actually have to have access to adult patients in order to get really good at this and that’s tough too because adult gastroenterologists have their own therapeutic endoscopy programs. So, you have to be persistent and very flexible with your career and you got to be willing to take a little bit of abuse because we end up after having trained in pediatric hospitals for six years, going over to work in adult centers where sometimes we’re seen as people who slow down their processes because we are not as experienced with procedures on adults as they are.
We fought through that and when I did my training, it was a bit difficult but by 2007 maybe after three years of finishing my fellowship, I was independent and able to do these procedures. Then I was fortunate enough to train, Dr. David Troendle who now works here with me as faculty at UT Southwestern and at Children’s and David runs our endoscopic ultrasound program and after training him, we became known as a center that successfully do that. And since people don’t have a whole lot of options and we have experience with it and we have had success with awards and good outcomes and publications that show that we do these procedures well; people tend to look to us and find us at meetings or call us or email us and ask us what the best way is to get training.
Host: Yeah, it sounds comprehensive. So, if a pediatric healthcare provider is listening to this, what tips might you have for them in terms of when they should seek more advanced treatments for their patients from an organization like Children’s Health.
Dr. Barth: If something comes up that a pediatric gastroenterologist isn’t familiar with or hasn’t seen endoscopically or just doesn’t feel comfortable with the risk that goes into doing a certain procedure; we are happy to help out. We do have experience with advanced endoscopy and we also have a lot of backup in case things don’t go well with pediatric surgeons and interventional radiologists and pediatric ICU that we work closely with. So, there are times when volume really counts and by volume, I mean how often you’ve done something. And if somebody doesn’t feel entirely comfortable with what they need to do; that’s when they should call us.
Host: Well Dr. Barth, this has been extremely informative. And I wanted to wrap up by commenting on something you said at the end of that testimonial that I watched. You said that your job ultimately was about making sure that a child could eat properly. And I thought that this was a great way to put what you do into perspective. Because eating on your own without the help of feeding tubes is part of the human experience, isn’t it Dr. Barth?
Dr. Barth: Gastroenterology is when you really get down to it, it’s plumbing and making sure that everything gets to where it needs to go. We do have ways to do that and that’s part of what makes our job great. I think I have the greatest job in the world where we can actually interact with new patients and help them and hopefully change their lives.
Host: And you are certainly doing that. So, thank you so much Dr. Barth. For more information on our conversation please visit www.childrens.com/GIscope. If you found this podcast helpful, please rate and review or share the episode. Please follow Children’s Health on your social channels. Thanks and we’ll talk next time.