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Welcome to the next installment of

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Live Well with UCI Health.

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I'm Lisa Foxx

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with 104.3 MYfm and iHeart Radio.

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I would like to introduce

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two very special doctors

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today from UCI Health.

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We're gonna learn a lot,

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learn a lot and have some fun.

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First of all, Dr. Jason Samarasena

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known as Doctor Sam.

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He's an interventional gastroenterologist

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and chief

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of the Division of Gastroenterology.

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Exactly. You got it.

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And Dr. Brian Smith, right here.

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Gastrointestinal surgeon at UCI Health.

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Right.

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That is correct. Okay.

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Thanks for having us, Lisa.

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Got the pronunciations down. That's a good thing.

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Our conversation today

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is going to focus on

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the relationships

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between some things that we may not know,

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but we want to learn about,

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GERD, Barrett's

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esophagus.

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And the describe

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the minimally invasive procedures

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available to treat them here

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at UCI Health.

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Chao Digestive Health Institute.

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It's a lot. It's a mouthful.

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And it's a gut full.

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I mean, so we're

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going to kind of dive into it all, so...

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Let’s start with this, Doctor Smith,

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we're gonna start with you

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maybe a tell us a little bit

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about about your background.

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And I always like to ask doctors

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why you chose this area.

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You know, when you go to medical school,

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there's a lot of parts of the body

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you can focus on,

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and it always fascinates me

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to see why you chose this.

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So tell us about your background,

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Doctor Smith,

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and then why you chose this as your

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your your focus. Thanks, Lisa.

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So I chose surgery,

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particularly minimally invasive surgery,

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because there's so many opportunities

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to help patients while leaving a

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very small footprint behind.

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At the time that I came out

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of residency training,

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there was a lot of advancement

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in minimally invasive surgery.

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And what we were able to accomplish

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with really small incisions

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and our ability to do big surgery

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through small incisions

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usually means

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patients are going home faster,

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with less pain and a faster recovery.

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And we've been able to apply

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those techniques towards

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a lot of our cancer surgery,

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which is what

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we're going to focus on today,

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but also much of our benign,

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surgery as well,

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much of which is preventative towards

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some of the issues

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we're going to talk about today. Okay.

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And then how many years

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have you been with UCI Health?

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I'm approaching two decades here at UCI Health,

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Wow! Two decades. Trained here as a fellow.

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And, I was asked to stay on.

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And I've been here ever since.

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Nice. Can you top that, Doctor Sam?

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You know, I've also

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been here two decades.

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Okay.

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And,

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and I've had the pleasure

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of working with Doctor Smith.

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For for a number of years and,

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you know, really happy to

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be here with him to do this.

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And so, so, yes, my name is a mouthful.

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And what I do is a mouthful.

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So I'm

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an interventional

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gastroenterologist, and,

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and so that means that,

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I did training in internal medicine

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and then went on to do

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a gastroenterology fellowship

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and then did,

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another year in something

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called interventional gastroenterology

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and interventional gastroenterology,

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really deals

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with a lot of sort of oncologic things.

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So things related to cancer and,

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and esophageal cancer

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is something

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that I became interested in actually.

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And I didn't know

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you were going to ask you this question.

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So now I'm going to share personal story.

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So, when you

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apply

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to, gastroenterology

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fellowship, it's very competitive.

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And, and you get some of your professors

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that you've worked with, some of your,

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your mentors to write you a letter.

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And, one of my letters

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came from

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a rheumatologist that I worked

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with at the Long Beach VA, and, and she,

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was just an amazing, amazing person.

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Just just so brilliant and so bright.

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She mentored so many people.

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And I was one of the lucky ones

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to kind of get to spend time with her

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and and learn from her.

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And so she wrote a letter,

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for me for,

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for gastroenterology fellowship.

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And, you know,

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lo and behold,

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I got in and, and then, a few years later

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when I was actually, on staff here,

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I got a call from her saying

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that she couldn't swallow very well.

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And, and so me being a gastroenterologist

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and being a doctor,

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I'm sort of thinking the worst,

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you know,

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and and the worst in that situation is,

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you know,

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could there be a mass in her

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esophagus that's obstructing,

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her esophagus?

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And, but I was thinking to myself, well,

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she’s a female.

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So that's less likely

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because esophageal cancer is

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more common in men.

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You know, she's otherwise

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very, very healthy.

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She wasn't a smoker. She's a thin lady.

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It's like,

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what are the chances

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that she's got, like, reflux

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and then developed Barrett's esophagus

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and then developed esophageal cancer.

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And, and so anybody

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with those sorts of symptoms,

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we do something called an endoscopy.

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And so I was the one that, you know,

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actually did her endoscopy

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and she had a huge mass in her esophagus.

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Wow!

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And,

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and you know,

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as we're going to talk about,

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if you don't catch esophageal

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cancer early,

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you know, things don't go well.

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And she passed away within six months.

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And it was such a loss

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for so many of us

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and, and and and the Long Beach VA and,

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you know, all of the,

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the people that, you know,

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she worked with and,

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and I thought was,

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I think, a kind of a moment in my career

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where I was like, you know what?

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We have to do better here.

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And so esophageal disease

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and esophageal cancer and coming up

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with minimally invasive ways to treat it.

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That definitely shaped my decision.

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Yeah. Thank you for sharing that.

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And also,

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of course I know

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we're going to touch on that,

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but also, you know,

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symptoms and signs to look for

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and and all that stuff.

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So I mean, you're here to help fix it.

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But then like your,

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you know,

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like with her story

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a little,

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little bit too late in her case.

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Exactly. Yeah.

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Doctor Sam,

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what is the connection between,

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Gastroesophageal reflux,

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Barrett's esophagus, precancer

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and esophageal cancer?

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That's, a lot right there.

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Just in that one question. It really is,

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and and the medical terms are terrible.

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I agree.

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But, so gastroesophageal reflux.

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So gastro is stomach. Esophagus is esophagus.

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Reflux is basically,

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when things are moving.

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And so essentially gastroesophageal

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reflux disease is

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when things are moving

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from the stomach up into the esophagus.

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Going the wrong direction.

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They're going the wrong direction.

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Exactly.

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So you have your esophagus,

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which is like a 25 centimeter

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muscular tube that goes from your

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like bottom of your throat to the,

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to the top of your stomach.

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And then your stomach

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kind of goes below your diaphragm.

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And so the lower esophageal sphincter,

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is a valve

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that's supposed to open

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when food gets through

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to go into your stomach,

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and it should close up

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and then prevent things

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from refluxing back up.

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And when that valve

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in the bottom of your esophagus

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doesn't work well...

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And there could be

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a, a number of factors for that.

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But things can reflux back up.

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The problem is

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the stuff in the stomach is nasty stuff.

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It's hydrochloric acid.

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There's pancreatic enzymes,

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and there's something called bile

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that's produced by your liver

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that can kind of actually reflux

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back into your stomach

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from your small intestine.

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And all of that... It causes a lot of problems.

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It causes a lot of problems.

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So all of that stuff,

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if it touches your esophagus,

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which is a pretty,

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we'll say, sensitive organ,

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your esophagus doesn't like it.

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And so we have sort of this sort of

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whitish wallpaper to our esophagus.

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It's called

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the stratified squamous epithelium.

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And and that's sort of the normal lining

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that we're, we're born with.

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And when you have things

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refluxing up into your esophagus

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and damaging it,

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it can cause inflammation.

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And eventually the esophagus will say,

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you know what?

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I'm sick and tired of dealing

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with all this inflammation.

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I'm going to change my cell type

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into something

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that's a little bit more resistant

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and a little stronger.

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And so then the stratified squamous

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epithelium changes to

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Barrett's esophagus,

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which is a kind of a pinkish tissue.

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And the pinkish tissue,

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it is more resistant.

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It does, you know, handle the, the

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the reflux better, but

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it is abnormally it's

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genetically abnormal tissue.

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And if left in the esophagus,

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it has the risk of going on

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to developing more genetic changes,

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which will eventually lead

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to a esophageal cancer.

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And the problem is

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And that’s pretty much guaranteed

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is that the cancer

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would be the next phase?

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Yeah. So it depends on

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it really depends on,

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how much Barrett's esophagus you have.

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Long segment disease

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means that you've got more

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than three centimeters of your esophagus

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that

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the wallpaper has changed to Barrett's,

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and short segment

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is less than three centimeters of your esophagus.

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But generally for

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just Barrett's where how it starts off,

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it's about a 0.3% per year of progression

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to something called high grade

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dysplasia or cancer.

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But if you're Barrett's already

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has something called low grade dysplasia,

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which is the next step,

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it's sort of like a 3 to 5% chance

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per year.

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And if you have high grade

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dysplasia in your Barrett's already,

00:08:47:23 - 00:08:50:06
it's like a 10 to 30% chance

00:08:50:06 - 00:08:52:00
a year of getting cancer.

00:08:52:00 - 00:08:53:08
And so,

00:08:53:08 - 00:08:53:23
most people

00:08:53:23 - 00:08:56:04
fortunately have the first type,

00:08:56:04 - 00:08:58:04
which is Barrett's without dysplasia.

00:08:59:08 - 00:09:03:04
But, the problem is, as we’ll talk about,

00:09:03:04 - 00:09:03:20
a lot of people

00:09:03:20 - 00:09:04:18
are walking around with this,

00:09:04:18 - 00:09:05:20
and they have no idea.

00:09:05:20 - 00:09:06:10
I was gonna say, yeah,

00:09:06:10 - 00:09:09:05
but sorry, question, the back of the room.

00:09:09:05 - 00:09:11:01
And are these things you can easily see?

00:09:11:01 - 00:09:11:16
Is it,

00:09:11:16 - 00:09:13:03
some kind of like, how is the exam?

00:09:13:03 - 00:09:14:03
Like, how can you see all this

00:09:14:03 - 00:09:15:00
that's going on?

00:09:15:00 - 00:09:15:13
Great question.

00:09:15:13 - 00:09:18:10
So, so as a gastroenterologist,

00:09:18:10 - 00:09:19:21
one of the most common procedures

00:09:19:21 - 00:09:22:19
that we do something call an endoscopy,

00:09:22:19 - 00:09:24:03
and endoscopy

00:09:24:03 - 00:09:25:15
is basically looking inside...

00:09:25:15 - 00:09:26:23
Is that with a camera that goes... It is

00:09:26:23 - 00:09:28:21
it's a, it's a flexible camera.

00:09:28:21 - 00:09:30:07
It's about,

00:09:30:07 - 00:09:32:00
wide around as my ring finger.

00:09:32:00 - 00:09:33:10
And, it's got a camera

00:09:33:10 - 00:09:34:11
and a light at the end of it.

00:09:34:11 - 00:09:36:08
And we're able to go in through the mouth

00:09:36:08 - 00:09:38:08
and look at the entire esophagus,

00:09:38:08 - 00:09:39:15
the stomach.

00:09:39:15 - 00:09:40:06
And the first part

00:09:40:06 - 00:09:41:09
of the small intestine.

00:09:41:09 - 00:09:43:02
And that's sort of an upper

00:09:43:02 - 00:09:45:00
endoscopy or an EGD.

00:09:45:00 - 00:09:46:22
And that is really,

00:09:46:22 - 00:09:47:17
a great tool

00:09:47:17 - 00:09:48:18
because now the camera's high

00:09:48:18 - 00:09:50:01
definition, there's, you know,

00:09:50:01 - 00:09:52:14
all these features that can help us look,

00:09:52:14 - 00:09:53:22
for Barrett's cells

00:09:53:22 - 00:09:55:15
better than we could before.

00:09:55:15 - 00:09:58:08
And, and so that's really kind of the,

00:09:58:08 - 00:10:00:23
the best way to, to, to diagnose it,

00:10:00:23 - 00:10:02:11
because when we see some salmon

00:10:02:11 - 00:10:03:02
colored stuff

00:10:03:02 - 00:10:04:12
in the bottom of the esophagus,

00:10:04:12 - 00:10:06:00
then we'll biopsy it,

00:10:06:00 - 00:10:07:00
and then we'll send it

00:10:07:00 - 00:10:07:17
to the pathologist,

00:10:07:17 - 00:10:08:13
and they'll be able to tell us… And see

00:10:08:13 - 00:10:10:17
what stage you're at and. Exactly.

00:10:10:17 - 00:10:11:16
Yeah. Okay.

00:10:11:16 - 00:10:12:16
Thank you for that.

00:10:12:16 - 00:10:13:03
Doctor Smith.

00:10:13:03 - 00:10:15:12
Let's talk symptoms. Absolutely.

00:10:15:12 - 00:10:17:05
So symptoms are a challenge

00:10:17:05 - 00:10:18:17
because they occur on a spectrum

00:10:18:17 - 00:10:21:13
starting from completely asymptomatic

00:10:21:13 - 00:10:24:11
to traditional symptoms of reflux,

00:10:24:11 - 00:10:26:15
which usually are any combination

00:10:26:15 - 00:10:29:15
of heartburn, chest pain or regurgitation…

00:10:29:15 - 00:10:30:11
Too much Mexican food.

00:10:30:11 - 00:10:31:04
You know, it happens,

00:10:31:04 - 00:10:31:12
you know,

00:10:31:12 - 00:10:32:06
spicy foods,

00:10:32:06 - 00:10:34:08
common, sure, that

00:10:34:08 - 00:10:36:01
you're you'll feel your heartburn

00:10:36:01 - 00:10:38:03
more severely if you have spicy food.

00:10:38:03 - 00:10:39:15
Red wine relaxes

00:10:39:15 - 00:10:41:10
the sphincter and allows,

00:10:41:10 - 00:10:42:16
and caffeine as well,

00:10:42:16 - 00:10:43:22
allows a little bit more reflux

00:10:43:22 - 00:10:45:12
to get up into the esophagus.

00:10:45:12 - 00:10:47:21
Those are classic heartburn symptoms.

00:10:47:21 - 00:10:50:05
Now, if you have progressed

00:10:50:05 - 00:10:52:03
beyond just classic heartburn

00:10:52:03 - 00:10:54:01
and you have damage in your esophagus,

00:10:54:01 - 00:10:54:22
which usually would then

00:10:54:22 - 00:10:56:15
move towards Barrett's

00:10:56:15 - 00:10:58:09
and then ultimately cancer,

00:10:58:09 - 00:10:59:09
you're talking about a little bit

00:10:59:09 - 00:11:00:23
more severe set of symptoms.

00:11:00:23 - 00:11:02:08
We're talking about esophageal cancer

00:11:02:08 - 00:11:04:07
patients commonly will have some food

00:11:04:07 - 00:11:06:07
hang up. We call that dysphasia.

00:11:06:07 - 00:11:08:02
They may actually have some weight loss

00:11:08:02 - 00:11:09:05
that is unexplained.

00:11:09:05 - 00:11:10:09
And sometimes it comes before

00:11:10:09 - 00:11:11:08
the dysphasia. Is it painful?

00:11:11:08 - 00:11:12:17
Are we having any pain at all?

00:11:12:17 - 00:11:15:03
It is often not particularly painful.

00:11:15:03 - 00:11:17:02
And for gastrointestinal cancers

00:11:17:02 - 00:11:17:15
in general,

00:11:17:15 - 00:11:18:16
that's one of the reasons

00:11:18:16 - 00:11:20:16
they're so lethal is they don't.

00:11:20:16 - 00:11:21:03
They often

00:11:21:03 - 00:11:23:01
do not come with alarm symptoms,

00:11:23:01 - 00:11:25:03
per se. Of the patients

00:11:25:03 - 00:11:26:18
that develop esophageal cancer

00:11:26:18 - 00:11:29:03
as a consequence of longstanding reflux,

00:11:29:03 - 00:11:30:23
the ones that I, over the years I found

00:11:30:23 - 00:11:33:02
were most frustrated by their diagnosis.

00:11:33:02 - 00:11:34:10
So the ones that never had

00:11:34:10 - 00:11:37:00
any reflux symptoms in the first place,

00:11:37:00 - 00:11:38:18
which means they didn't have any reason

00:11:38:18 - 00:11:39:17
to get scoped

00:11:39:17 - 00:11:42:00
and really didn't have any warning.

00:11:42:00 - 00:11:43:09
And that's not to suggest

00:11:43:09 - 00:11:44:13
that everybody should get scoped

00:11:44:13 - 00:11:46:01
just to make sure that they don't get esophageal…

00:11:46:01 - 00:11:47:08
I'm ready to get scoped right now.

00:11:47:08 - 00:11:47:22
I'm just letting

00:11:47:22 - 00:11:49:03
you know, I'm ready for the camera.

00:11:49:03 - 00:11:50:08
Ready.

00:11:50:08 - 00:11:51:01
But typically

00:11:51:01 - 00:11:52:10
if you have reflux symptoms,

00:11:52:10 - 00:11:54:00
then you at some point

00:11:54:00 - 00:11:55:12
you should probably get scoped.

00:11:55:12 - 00:11:58:07
But can I ask though, is it genetic or

00:11:58:07 - 00:11:59:05
who is more likely?

00:11:59:05 - 00:12:00:08
You mentioned men earlier.

00:12:00:08 - 00:12:02:18
Who is more likely to maybe get this?

00:12:02:18 - 00:12:04:09
It it really is not.

00:12:04:09 - 00:12:06:11
Reflux itself is not genetically linked

00:12:06:11 - 00:12:07:22
and only a very small percentage

00:12:07:22 - 00:12:09:03
of esophageal cancers

00:12:09:03 - 00:12:10:09
are genetically linked.

00:12:10:09 - 00:12:13:03
Most of them occur de novo, unrelated

00:12:13:03 - 00:12:14:17
to any sort of relatives

00:12:14:17 - 00:12:16:05
with either of these diseases.

00:12:16:05 - 00:12:19:02
Now, interestingly, reflux itself

00:12:19:02 - 00:12:19:15
can occur

00:12:19:15 - 00:12:22:12
if the valve’s too loose and lets refluxate gets up

00:12:22:12 - 00:12:23:21
into the esophagus,

00:12:23:21 - 00:12:26:08
but more commonly patients will develop

00:12:26:08 - 00:12:27:21
what's called a hiatal hernia.

00:12:27:21 - 00:12:28:15
And that is where

00:12:28:15 - 00:12:29:21
the hole in your diaphragm

00:12:29:21 - 00:12:30:23
that separates your chest

00:12:30:23 - 00:12:32:09
from your abdomen

00:12:32:09 - 00:12:33:16
gets a little bit too big.

00:12:33:16 - 00:12:34:21
And the stomach actually

00:12:34:21 - 00:12:36:11
herniates up through that hole

00:12:36:11 - 00:12:39:11
and it encourages loosening of the valve.

00:12:39:12 - 00:12:41:01
And so most commonly

00:12:41:01 - 00:12:43:06
when we see patients with reflux

00:12:43:06 - 00:12:44:20
and certainly those that have Barrett's

00:12:44:20 - 00:12:46:02
and longstanding reflux,

00:12:46:02 - 00:12:47:01
it's very typical

00:12:47:01 - 00:12:49:03
that we see a hiatal herniation.

00:12:49:03 - 00:12:50:02
And then the patient

00:12:50:02 - 00:12:51:08
has symptoms of reflux.

00:12:51:08 - 00:12:51:22
That's probably

00:12:51:22 - 00:12:53:10
the most common presentation.

00:12:53:10 - 00:12:53:22
And the hernia...

00:12:53:22 - 00:12:55:01
You can feel those suckers,

00:12:55:01 - 00:12:55:23
those are like, oh...

00:12:55:23 - 00:12:57:04
So interestingly,

00:12:57:04 - 00:12:58:10
this is one of the few hernias

00:12:58:10 - 00:12:59:13
you cannot feel… Can’t feel? Wow…

00:12:59:13 - 00:13:00:08
on physical exam.

00:13:00:08 - 00:13:01:07
It goes through

00:13:01:07 - 00:13:02:08
the diaphragm in the back

00:13:02:08 - 00:13:03:11
near your spine… It’s all internal.

00:13:03:11 - 00:13:05:18
And so we can't feel them on exam.

00:13:05:18 - 00:13:07:01
They're extraordinarily common.

00:13:07:01 - 00:13:08:16
60% of everybody over

00:13:08:16 - 00:13:09:07
the age of 50

00:13:09:07 - 00:13:10:17
has a hiatal hernia,

00:13:10:17 - 00:13:11:22
but only 10% of patients

00:13:11:22 - 00:13:13:06
have any symptoms from them.

00:13:13:06 - 00:13:14:21
So they're common.

00:13:14:21 - 00:13:16:15
But we generally don't fix them

00:13:16:15 - 00:13:18:02
if they don't cause any symptoms.

00:13:18:02 - 00:13:18:08
Okay.

00:13:18:08 - 00:13:19:15
I was going say common and fixable,

00:13:19:15 - 00:13:20:11
thanks to you guys.

00:13:20:11 - 00:13:21:19
Indeed. Lisa, one thing

00:13:21:19 - 00:13:23:21
I wanted to add about signs and symptoms.

00:13:23:21 - 00:13:25:03
Sometimes, you know,

00:13:25:03 - 00:13:26:08
we'll get the story

00:13:26:08 - 00:13:28:15
about somebody who says

00:13:28:15 - 00:13:31:02
and say they're in their 50s now.

00:13:31:02 - 00:13:31:17
Well, doc,

00:13:31:17 - 00:13:33:15
like in my 20s and 30s,

00:13:33:15 - 00:13:35:11
I had terrible reflux.

00:13:35:11 - 00:13:36:19
It was like awful.

00:13:36:19 - 00:13:38:03
I remember being in college

00:13:38:03 - 00:13:39:13
and, you know, through grad school

00:13:39:13 - 00:13:41:01
and through my first job, I was like,

00:13:41:01 - 00:13:42:15
popping Tums like crazy.

00:13:42:15 - 00:13:43:12
But you know what?

00:13:43:12 - 00:13:44:10
In my 40s,

00:13:44:10 - 00:13:45:10
it just kind of went away

00:13:45:10 - 00:13:46:11
and it got better.

00:13:46:11 - 00:13:48:18
And then for a lot of doctors,

00:13:48:18 - 00:13:50:09
when they hear that like, oh, great,

00:13:50:09 - 00:13:52:23
you know, things, things just improved.

00:13:52:23 - 00:13:55:14
But you know, when I hear that story,

00:13:55:14 - 00:13:57:06
I get actually even more concerned

00:13:57:06 - 00:13:58:16
because,

00:13:58:16 - 00:14:00:17
when the esophagus changes

00:14:00:17 - 00:14:01:19
from the stratified squamous

00:14:01:19 - 00:14:03:12
epithelium to the Barrett's,

00:14:03:12 - 00:14:05:13
Barrett's has less nerve endings.

00:14:05:13 - 00:14:06:21
And so,

00:14:06:21 - 00:14:08:09
initially when you have sort of that

00:14:08:09 - 00:14:09:08
normal lining,

00:14:09:08 - 00:14:10:14
you're more symptomatic

00:14:10:14 - 00:14:11:15
because you can feel it more

00:14:11:15 - 00:14:13:01
because there's more nerve endings.

00:14:13:01 - 00:14:14:15
And when it converts to Barrett's,

00:14:14:15 - 00:14:15:22
then Barrett's again,

00:14:15:22 - 00:14:17:05
kind of more resistant,

00:14:17:05 - 00:14:18:04
and it doesn't have

00:14:18:04 - 00:14:19:01
as many nerve endings.

00:14:19:01 - 00:14:20:10
And then your reflux symptoms

00:14:20:10 - 00:14:21:20
actually improve.

00:14:21:20 - 00:14:23:09
And so so

00:14:23:09 - 00:14:25:02
symptoms are one of those things

00:14:25:02 - 00:14:27:23
where it's just not reliable either way.

00:14:27:23 - 00:14:29:16
Sometimes, you know,

00:14:29:16 - 00:14:30:12
people can have something

00:14:30:12 - 00:14:31:10
called silent reflux

00:14:31:10 - 00:14:32:21
where they've been refluxing,

00:14:32:21 - 00:14:33:23
you know,

00:14:33:23 - 00:14:36:17
for years and we wouldn't know it until,

00:14:36:17 - 00:14:37:14
we, we go in

00:14:37:14 - 00:14:39:08
and take a look at their esophagus.

00:14:39:08 - 00:14:40:16
And then there's other folks that say,

00:14:40:16 - 00:14:42:11
well, I have terrible heartburn.

00:14:42:11 - 00:14:44:00
I have terrible reflux,

00:14:44:00 - 00:14:44:20
you know, every night.

00:14:44:20 - 00:14:45:17
And then we go in

00:14:45:17 - 00:14:47:17
and the esophagus actually looks fine

00:14:47:17 - 00:14:48:14
and there's no Barrett's.

00:14:48:14 - 00:14:51:15
So, so sometimes you can't really tell

00:14:51:15 - 00:14:52:06
either way.

00:14:52:06 - 00:14:52:23
And sometimes

00:14:52:23 - 00:14:54:17
the best way is just taking a look.

00:14:54:17 - 00:14:55:15
Do you do an exam?

00:14:55:15 - 00:14:56:00
Do you do,

00:14:56:00 - 00:14:56:22
like I said, with the camera,

00:14:56:22 - 00:14:59:10
just as a precaution.

00:14:59:10 - 00:15:00:03
Do you know. Right.

00:15:00:03 - 00:15:01:07
Are you able to do that somewhere.

00:15:01:07 - 00:15:02:14
Watch this and say, oh my gosh,

00:15:02:14 - 00:15:03:02
I want to make sure

00:15:03:02 - 00:15:04:13
I don't have anything going on.

00:15:04:13 - 00:15:05:10
Can you request

00:15:05:10 - 00:15:07:06
you know, an appointment and

00:15:07:06 - 00:15:08:09
and just have it to,

00:15:08:09 - 00:15:09:17
you know, have a check to be,

00:15:09:17 - 00:15:10:06
you know,

00:15:10:06 - 00:15:11:16
just to make sure everything's okay.

00:15:11:16 - 00:15:12:06
You can

00:15:12:06 - 00:15:13:12
the tough thing is it's,

00:15:13:12 - 00:15:16:14
it's sort of, hard to screen everyone,

00:15:17:03 - 00:15:19:15
for esophageal cancer because,

00:15:19:15 - 00:15:21:06
although it is prevalent,

00:15:21:06 - 00:15:22:03
it's not as prevalent

00:15:22:03 - 00:15:23:04
as some of the other cancers,

00:15:23:04 - 00:15:24:23
where the national guidelines say

00:15:24:23 - 00:15:26:02
that everyone

00:15:26:02 - 00:15:27:02
over the age of 45

00:15:27:02 - 00:15:27:16
needs to be screened

00:15:27:16 - 00:15:29:16
for colon cancer, for example.

00:15:29:16 - 00:15:30:23
So esophageal cancer, it’s

00:15:30:23 - 00:15:32:13
sort of a selective population

00:15:32:13 - 00:15:33:19
that needs to be screened.

00:15:33:19 - 00:15:35:05
But now we're getting a little bit

00:15:35:05 - 00:15:36:18
better and,

00:15:36:18 - 00:15:38:08
kind of dialed in in terms of

00:15:38:08 - 00:15:40:11
what are the high risk groups.

00:15:40:11 - 00:15:41:12
And so,

00:15:41:12 - 00:15:42:14
so some of the risk factors

00:15:42:14 - 00:15:43:19
for esophageal cancer

00:15:43:19 - 00:15:46:19
and Barrett's are age over 50,

00:15:46:22 - 00:15:49:22
male gender, history of smoking,

00:15:50:08 - 00:15:51:18
family history of esophageal

00:15:51:18 - 00:15:54:07
cancer or Barrett's, obesity.

00:15:55:06 - 00:15:56:12
And if you've had any

00:15:56:12 - 00:15:58:10
occupational exposure.

00:15:58:10 - 00:15:59:20
So for example,

00:15:59:20 - 00:16:00:20
like firefighters,

00:16:00:20 - 00:16:03:16
you know, they have smoke inhalation and

00:16:03:16 - 00:16:05:03
and we actually did a,

00:16:05:03 - 00:16:06:00
a screening program

00:16:06:00 - 00:16:07:18
for some firefighters in Orange County.

00:16:07:18 - 00:16:09:20
We screened 150 firefighters,

00:16:09:20 - 00:16:12:00
for for Barrett's esophagus with,

00:16:12:00 - 00:16:14:01
with a kind of a new tool that I can

00:16:14:01 - 00:16:15:03
I can tell you about. Oh.

00:16:15:03 - 00:16:16:07
And, you know,

00:16:16:07 - 00:16:18:04
one of the things that I think

00:16:18:04 - 00:16:19:08
one of the messages that we have

00:16:19:08 - 00:16:20:10
today is that,

00:16:20:10 - 00:16:21:20
you know, getting an endoscopy

00:16:21:20 - 00:16:22:20
is sort of a big deal.

00:16:22:20 - 00:16:23:19
You know, you're going to be

00:16:23:19 - 00:16:24:12
put to sleep,

00:16:24:12 - 00:16:25:11
you're going to have sedation,

00:16:25:11 - 00:16:26:20
you won't be able to drive that day.

00:16:26:20 - 00:16:29:00
You need somebody to take you home.

00:16:29:00 - 00:16:30:20
So there's a lot of sort of direct

00:16:30:20 - 00:16:33:02
and indirect cost and time related to,

00:16:33:02 - 00:16:34:10
you know, getting an endoscopy.

00:16:34:10 - 00:16:36:18
And now there are some newer,

00:16:37:22 - 00:16:38:23
I will say,

00:16:38:23 - 00:16:40:11
noninvasive screening

00:16:40:11 - 00:16:42:08
tools for Barrett's esophagus.

00:16:42:08 - 00:16:44:15
So, for the firefighter event,

00:16:44:15 - 00:16:46:19
we used a device called EsoCheck.

00:16:46:19 - 00:16:50:06
And, essentially, it's a swallowable capsule.

00:16:50:06 - 00:16:51:17
It's on a kind of a spaghetti,

00:16:51:17 - 00:16:54:12
like catheter. And,

00:16:54:12 - 00:16:55:18
and the nurse practitioners

00:16:55:18 - 00:16:57:08
that, that do this,

00:16:57:08 - 00:16:58:13
they are just like, pros

00:16:58:13 - 00:17:01:03
at sort of dropping this, capsule in

00:17:01:03 - 00:17:02:07
and kind of getting it down

00:17:02:07 - 00:17:03:05
into the stomach.

00:17:03:05 - 00:17:05:03
Then you kind of inflate this little bulb

00:17:05:03 - 00:17:05:23
and it's got these

00:17:05:23 - 00:17:08:09
kind of little, ridges,

00:17:08:09 - 00:17:11:09
and then you basically pull it out and...

00:17:11:09 - 00:17:13:07
Oh wow. And they’re awake for that?

00:17:13:07 - 00:17:13:14
Yeah.

00:17:13:14 - 00:17:15:13
Do they say it was fun or not so much? You know what?

00:17:15:13 - 00:17:16:03
I've done it.

00:17:16:03 - 00:17:17:16
I've had it done on myself five times.

00:17:17:16 - 00:17:18:12
Oh.

00:17:18:12 - 00:17:20:06
It's really not a big deal.

00:17:20:06 - 00:17:23:01
It takes three minutes and...

00:17:23:01 - 00:17:23:18
and you get about

00:17:23:18 - 00:17:24:21
having peace of mind, right?

00:17:24:21 - 00:17:25:15
Having peace of mind.

00:17:25:15 - 00:17:26:19
And you get tons of cells

00:17:26:19 - 00:17:29:04
and that can be sent for analysis

00:17:29:04 - 00:17:30:07
with this special assay.

00:17:30:07 - 00:17:31:17
And, and it can tell you

00:17:31:17 - 00:17:33:04
if you have no Barrett's

00:17:33:04 - 00:17:34:06
or if you have some Barrett's

00:17:34:06 - 00:17:36:07
or even if you have dysplasia or cancer.

00:17:36:07 - 00:17:36:15
So,

00:17:38:01 - 00:17:38:23
and if

00:17:38:23 - 00:17:39:14
that test

00:17:39:14 - 00:17:41:05
comes back positive,

00:17:41:05 - 00:17:42:08
then the next step is getting

00:17:42:08 - 00:17:44:10
a routine endoscopy. Sure, sure.

00:17:44:10 - 00:17:46:01
Doctor Smith why why is it,

00:17:46:01 - 00:17:48:04
do you think that it's, more likely

00:17:48:04 - 00:17:50:02
that this would happen to men than women?

00:17:50:02 - 00:17:51:14
Well, men in general

00:17:51:14 - 00:17:52:23
tend to carry their extra weight

00:17:52:23 - 00:17:54:13
inside their abdominal cavity.

00:17:54:13 - 00:17:57:03
That means that a man who's overweight

00:17:57:03 - 00:17:58:11
is going to have a higher pressure

00:17:58:11 - 00:17:59:02
in his abdomen

00:17:59:02 - 00:18:01:05
than a woman who's overweight,

00:18:01:05 - 00:18:04:08
and that in turn, encourages reflux.

00:18:04:08 - 00:18:05:21
Higher pressure in your abdomen tends

00:18:05:21 - 00:18:07:16
to push refluxate

00:18:07:16 - 00:18:09:22
from your stomach up into your esophagus.

00:18:09:22 - 00:18:11:10
So that that's,

00:18:11:10 - 00:18:14:15
probably one of the major reasons, diet,

00:18:15:08 - 00:18:16:14
that's probably debatable

00:18:16:14 - 00:18:17:02
whether or not

00:18:17:02 - 00:18:20:02
men tend to take in more

00:18:20:02 - 00:18:21:15
tobacco and alcohol

00:18:21:15 - 00:18:22:01
and things

00:18:22:01 - 00:18:23:23
that are irritating to the esophagus.

00:18:23:23 - 00:18:24:22
And then talk about,

00:18:24:22 - 00:18:26:09
you know, obviously you too

00:18:26:09 - 00:18:27:08
have been with UCI Health

00:18:27:08 - 00:18:28:07
for two decades.

00:18:28:07 - 00:18:30:13
It's, What is what is it about?

00:18:30:13 - 00:18:31:21
This place is so special.

00:18:31:21 - 00:18:33:15
And how how you're able,

00:18:33:15 - 00:18:34:12
you know, to have the tools,

00:18:34:12 - 00:18:35:06
the right tools

00:18:35:06 - 00:18:37:01
to handle these types of situations.

00:18:37:01 - 00:18:37:07
Yeah.

00:18:37:07 - 00:18:38:15
And from my standpoint,

00:18:38:15 - 00:18:39:11
you know, I think,

00:18:40:14 - 00:18:42:10
there is just a

00:18:42:10 - 00:18:42:20
great deal

00:18:42:20 - 00:18:43:10
of emphasis

00:18:43:10 - 00:18:44:06
in bringing, like,

00:18:44:06 - 00:18:46:16
the best technologies available,

00:18:46:16 - 00:18:47:09
to the patient.

00:18:47:09 - 00:18:50:11
And, and I've, really,

00:18:52:13 - 00:18:54:15
benefited so much from training here

00:18:54:15 - 00:18:57:19
and just learning, from just great people

00:18:57:19 - 00:19:00:19
how to do things and, and now,

00:19:01:05 - 00:19:02:08
working with companies

00:19:02:08 - 00:19:03:04
and working

00:19:03:04 - 00:19:04:14
with industry to develop

00:19:04:14 - 00:19:07:14
sort of the next technologies that can

00:19:07:14 - 00:19:08:19
that can help,

00:19:08:19 - 00:19:10:11
sort of in this in the space and,

00:19:10:11 - 00:19:12:04
and I think, you know, people

00:19:12:04 - 00:19:13:03
that work at UCI Health

00:19:13:03 - 00:19:16:03
are, are sort of like minded in that way.

00:19:16:08 - 00:19:17:03
We're just

00:19:17:03 - 00:19:19:14
always trying to push the envelope.

00:19:19:14 - 00:19:22:14
And I think you know, with,

00:19:23:08 - 00:19:24:20
esophageal cancer,

00:19:24:20 - 00:19:26:15
there's a lot of,

00:19:26:15 - 00:19:27:16
and Barrett's esophagus.

00:19:27:16 - 00:19:30:15
There's there's so much here that is,

00:19:31:07 - 00:19:33:01
minimally invasive to treat

00:19:33:01 - 00:19:34:13
before it gets to cancer.

00:19:34:13 - 00:19:36:19
And, and so we talked a little bit about,

00:19:36:19 - 00:19:37:21
like, diagnosing it,

00:19:37:21 - 00:19:39:10
you know, with either

00:19:39:10 - 00:19:40:09
you know, a swallowable

00:19:40:09 - 00:19:41:20
device, an endoscopy.

00:19:41:20 - 00:19:43:06
But once it's diagnosed,

00:19:43:06 - 00:19:43:19
there's so much

00:19:43:19 - 00:19:45:01
that we can do to treat it

00:19:45:01 - 00:19:46:06
before it gets to cancer.

00:19:46:06 - 00:19:47:20
Right, right. And that is,

00:19:49:00 - 00:19:50:04
you know, when,

00:19:50:04 - 00:19:51:23
I see somebody with Barrett's esophagus,

00:19:51:23 - 00:19:54:01
we talk about literally six

00:19:54:01 - 00:19:55:04
different ways

00:19:55:04 - 00:19:56:21
that we can treat Barrett's esophagus.

00:19:56:21 - 00:19:59:05
And and most of them, involve

00:19:59:05 - 00:20:00:10
something called ablation.

00:20:00:10 - 00:20:01:01
And ablation

00:20:01:01 - 00:20:02:19
is basically kind of injuring

00:20:02:19 - 00:20:05:06
or kind of destroying, the cells.

00:20:05:06 - 00:20:06:12
And, and some

00:20:06:12 - 00:20:08:06
modalities use heat ablation

00:20:08:06 - 00:20:09:13
and some modalities

00:20:09:13 - 00:20:11:02
actually like cryoablation

00:20:11:02 - 00:20:12:20
or freezing,

00:20:12:20 - 00:20:14:02
to, to treat the cells.

00:20:14:02 - 00:20:15:20
But it's all with the endoscope.

00:20:15:20 - 00:20:17:10
And so typically,

00:20:17:10 - 00:20:18:01
people come in

00:20:18:01 - 00:20:18:22
every three months

00:20:18:22 - 00:20:21:11
for one of these ablation treatments.

00:20:21:11 - 00:20:22:11
And we can

00:20:22:11 - 00:20:24:12
basically eradicate all the Barrett's.

00:20:24:12 - 00:20:26:20
And then the healthy stratified squamous

00:20:26:20 - 00:20:28:20
epithelium will grow back.

00:20:28:20 - 00:20:29:21
And so we can essentially

00:20:29:21 - 00:20:31:01
restore their esophagus

00:20:31:01 - 00:20:32:16
to kind of the way it looked like

00:20:32:16 - 00:20:33:20
when they were a teenager.

00:20:33:20 - 00:20:34:12
And that’s so crazy.

00:20:34:12 - 00:20:36:03
It’s, it's wild… Magical.

00:20:36:03 - 00:20:37:19
Yeah. It is amazing.

00:20:37:19 - 00:20:38:22
And

00:20:38:22 - 00:20:40:18
and so that's

00:20:40:18 - 00:20:41:23
got to be one of the

00:20:41:23 - 00:20:42:20
best parts of my job.

00:20:42:20 - 00:20:43:11
And hopeful.

00:20:43:11 - 00:20:44:02
I mean to,

00:20:44:02 - 00:20:44:19
you know, to hear that,

00:20:44:19 - 00:20:46:11
that the technology is here,

00:20:46:11 - 00:20:47:21
that, God forbid, happens to somebody,

00:20:47:21 - 00:20:49:11
that this would be a great place to come

00:20:49:11 - 00:20:50:06
and get the best treatment

00:20:50:06 - 00:20:51:10
with the latest technology.

00:20:51:10 - 00:20:53:03
Well, and once he's done that, then he's

00:20:53:03 - 00:20:53:22
going to pick up the phone

00:20:53:22 - 00:20:54:15
and call me and say,

00:20:54:15 - 00:20:55:11
hey, I have this patient

00:20:55:11 - 00:20:56:19
that needs some definitive treatment

00:20:56:19 - 00:20:58:10
for their reflux.

00:20:58:10 - 00:20:58:18
We've been

00:20:58:18 - 00:20:59:23
we've had the patient on medications

00:20:59:23 - 00:21:00:17
for a long time.

00:21:00:17 - 00:21:02:10
Clearly their disease has progressed.

00:21:02:10 - 00:21:03:10
We probably need to think

00:21:03:10 - 00:21:04:14
about a surgical intervention

00:21:04:14 - 00:21:06:12
to try to get the valve

00:21:06:12 - 00:21:07:11
at the bottom of the esophagus

00:21:07:11 - 00:21:09:14
to do a better job at stopping reflux.

00:21:09:14 - 00:21:10:01
Now, I was gonna say,

00:21:10:01 - 00:21:10:19
it seems like you two

00:21:10:19 - 00:21:11:20
would be good collaborators.

00:21:11:20 - 00:21:13:16
We are phenomenal collaborators.

00:21:13:16 - 00:21:14:23
I would argue that that's

00:21:14:23 - 00:21:16:11
actually one of the real benefits

00:21:16:11 - 00:21:18:02
of this institution is

00:21:18:02 - 00:21:20:09
we work together on

00:21:20:09 - 00:21:22:08
almost anything related to the esophagus,

00:21:22:08 - 00:21:23:22
is usually multidisciplinary,

00:21:23:22 - 00:21:25:01
and that's not exclusive

00:21:25:01 - 00:21:25:16
to the esophagus.

00:21:25:16 - 00:21:26:17
But that's the beauty

00:21:26:17 - 00:21:27:21
of having a comprehensive

00:21:27:21 - 00:21:29:06
digestive health center,

00:21:29:06 - 00:21:30:03
which is what we have,

00:21:30:03 - 00:21:31:09
much like a cancer center,

00:21:31:09 - 00:21:32:22
where all of the different specialties

00:21:32:22 - 00:21:34:13
are focused around treating cancer.

00:21:34:13 - 00:21:35:13
We have a center

00:21:35:13 - 00:21:37:13
that is focused around digestive health,

00:21:37:13 - 00:21:38:22
and we work very closely

00:21:38:22 - 00:21:39:23
with our oncologists

00:21:39:23 - 00:21:41:06
that that treat cancer

00:21:41:06 - 00:21:43:06
from a chemotherapy perspective.

00:21:43:06 - 00:21:44:15
We have radiation oncologists.

00:21:44:15 - 00:21:46:09
We have specialized pathologists.

00:21:46:09 - 00:21:48:04
We have gastroenterologists,

00:21:48:04 - 00:21:49:13
GI radiologists.

00:21:49:13 - 00:21:51:02
We all work together

00:21:51:02 - 00:21:52:13
to make sure that we are

00:21:52:13 - 00:21:53:10
maximizing organ

00:21:53:10 - 00:21:54:21
preservation and quality of life.

00:21:54:21 - 00:21:55:19
At UCI Health,

00:21:55:19 - 00:21:57:01
we put the best minds together

00:21:57:01 - 00:21:57:23
to give you the best chance

00:21:57:23 - 00:21:59:09
of survival on your terms.

00:21:59:09 - 00:22:00:21
Starting with these two minds right here.

00:22:00:21 - 00:22:01:12
I'm a fan.

00:22:01:12 - 00:22:03:02
Thank you Lisa. Well done.

00:22:03:02 - 00:22:05:10
Anything else you want folks to know?

00:22:05:10 - 00:22:06:15
About watching out for this

00:22:06:15 - 00:22:08:06
or getting getting care and help here.

00:22:08:06 - 00:22:10:12
I think early detection is the key.

00:22:10:12 - 00:22:12:19
And one of the beauties about UCI

00:22:12:19 - 00:22:13:19
is we get patients

00:22:13:19 - 00:22:15:18
in, we we get them evaluated

00:22:15:18 - 00:22:18:00
and we figure out what they need next.

00:22:18:00 - 00:22:19:05
And we pass the baton

00:22:19:05 - 00:22:20:21
to one another as needed.

00:22:20:21 - 00:22:21:08
Our goal

00:22:21:08 - 00:22:22:23
here is not just minimally

00:22:22:23 - 00:22:24:15
invasive approaches.

00:22:24:15 - 00:22:26:03
It's minimally invasive surgery.

00:22:26:03 - 00:22:27:01
If it comes to that,

00:22:27:01 - 00:22:28:04
and we do everything we can

00:22:28:04 - 00:22:29:23
to try to spare patients

00:22:29:23 - 00:22:31:07
the ultimate operation,

00:22:31:07 - 00:22:33:08
which is an esophagectomy.

00:22:33:08 - 00:22:34:05
Many esophageal

00:22:34:05 - 00:22:35:14
cancers are diagnosed late

00:22:35:14 - 00:22:36:22
and if they have to have surgery

00:22:36:22 - 00:22:38:06
to have their esophagus removed.

00:22:38:06 - 00:22:40:02
We have minimally invasive approaches

00:22:40:02 - 00:22:41:00
here as well

00:22:41:00 - 00:22:43:07
to help patients recover faster

00:22:43:07 - 00:22:44:09
and really get back

00:22:44:09 - 00:22:46:18
to sort of a normal sense of their

00:22:46:18 - 00:22:47:18
their lives

00:22:47:18 - 00:22:50:02
in spite of a very massive operation

00:22:50:02 - 00:22:51:23
when needed for esophageal cancer

00:22:51:23 - 00:22:53:22
And then we can ultimately

00:22:53:22 - 00:22:55:01
turn them back to GI

00:22:55:01 - 00:22:57:05
for further surveillance if need be.

00:22:57:05 - 00:22:58:18
Doctor Sam has a number of techniques

00:22:58:18 - 00:23:00:02
for actually removing cancers

00:23:00:02 - 00:23:01:10
from inside the esophagus

00:23:01:10 - 00:23:02:20
if we catch it early.

00:23:02:20 - 00:23:04:23
And so our goal is early detection.

00:23:04:23 - 00:23:06:18
And after that it's organ preservation.

00:23:06:18 - 00:23:07:07
Wonderful.

00:23:07:07 - 00:23:09:19
Thank you, Doctor Sam, any words as we wrap up?

00:23:09:19 - 00:23:11:06
You know, I think,

00:23:11:06 - 00:23:12:23
this is sort of a spectrum.

00:23:12:23 - 00:23:13:08
You know,

00:23:13:08 - 00:23:14:21
it starts with reflux

00:23:14:21 - 00:23:15:22
and then it ends with the 

00:23:15:22 - 00:23:17:03
esophageal cancer.

00:23:17:03 - 00:23:21:18
And this is one disease, Lisa, that I can tell you... 

00:23:21:18 - 00:23:23:11
There are so many points

00:23:23:11 - 00:23:24:22
where we can intervene.

00:23:24:22 - 00:23:27:14
And with minimally invasive things.

00:23:28:13 - 00:23:30:03
Before,

00:23:30:03 - 00:23:31:08
if somebody had Barrett's,

00:23:31:08 - 00:23:33:09
they were having like major surgery.

00:23:33:09 - 00:23:34:19
Now, if you have Barrett's,

00:23:34:19 - 00:23:35:20
you know, we can,

00:23:35:20 - 00:23:38:11
you know, treat it endoscopically.

00:23:38:11 - 00:23:39:18
Before, when you had high grade

00:23:39:18 - 00:23:41:03
dysplasia in your esophagus,

00:23:41:03 - 00:23:41:23
in your Barrett's,

00:23:41:23 - 00:23:43:11
you're having major surgery

00:23:43:11 - 00:23:44:16
and now with,

00:23:44:16 - 00:23:46:00
you know, endoscopic intervention.

00:23:46:00 - 00:23:47:08
The technology is so much better.

00:23:47:08 - 00:23:48:12
We can do that now.

00:23:48:12 - 00:23:51:02
And so and as Doctor Smith just said,

00:23:51:02 - 00:23:52:04
even if you develop

00:23:52:04 - 00:23:53:21
early esophageal cancer,

00:23:53:21 - 00:23:54:18
there are things that,

00:23:54:18 - 00:23:56:00
you know, I can do with the scope

00:23:56:00 - 00:23:57:01
to remove it,

00:23:57:01 - 00:23:58:15
you know, without having surgery.

00:23:58:15 - 00:24:01:15
And so the key really is early detection.

00:24:01:18 - 00:24:02:21
And, and,

00:24:02:21 - 00:24:03:17
you know, we're excited

00:24:03:17 - 00:24:05:10
about having these new swallowable

00:24:05:10 - 00:24:08:01
devices that can be done.

00:24:08:01 - 00:24:09:14
You know, it doesn't require a doctor.

00:24:09:14 - 00:24:11:05
It can be done by a nurse practitioner.

00:24:12:07 - 00:24:12:14
There's

00:24:12:14 - 00:24:13:10
a, there's a

00:24:13:10 - 00:24:15:17
center in orange County that,

00:24:15:17 - 00:24:16:07
can offer this.

00:24:16:07 - 00:24:18:04
You're in and out of your car,

00:24:18:04 - 00:24:20:06
like ten minutes and you can be screened.

00:24:20:06 - 00:24:21:11
And so,

00:24:21:11 - 00:24:23:05
these are kind of important technologies

00:24:23:05 - 00:24:24:01
that really

00:24:24:01 - 00:24:25:08
we need to kind of hit

00:24:25:08 - 00:24:27:08
this disease at the front end,

00:24:27:08 - 00:24:28:18
because what's happening is

00:24:28:18 - 00:24:31:18
a lot of people are not aware of,

00:24:31:21 - 00:24:34:20
you know, being checked for this,

00:24:35:04 - 00:24:36:02
and I think this is

00:24:36:02 - 00:24:38:12
why we're so appreciative of you

00:24:38:12 - 00:24:40:13
and, you know, coming by and,

00:24:40:13 - 00:24:42:19
and talking to us because I think,

00:24:42:19 - 00:24:43:12
the hope is that

00:24:43:12 - 00:24:45:01
this will kind of reach a lot of people

00:24:45:01 - 00:24:46:17
and kind of get on people's minds.

00:24:46:17 - 00:24:49:00
And, you know, there's,

00:24:49:00 - 00:24:49:09
sort of

00:24:49:09 - 00:24:50:10
never a good time

00:24:50:10 - 00:24:53:04
to do a medical procedure for screening.

00:24:53:04 - 00:24:54:05
But, you know,

00:24:54:05 - 00:24:54:21
one of the things

00:24:54:21 - 00:24:56:00
that we've,

00:24:56:00 - 00:24:56:21
really encouraged is

00:24:56:21 - 00:24:58:21
when people are getting a colonoscopy,

00:24:58:21 - 00:25:00:09
you can actually get an upper endoscopy

00:25:00:09 - 00:25:02:05
at the same time. While you're in there.

00:25:02:05 - 00:25:04:04
Yeah, while you’re in there,

00:25:04:04 - 00:25:06:19
We call that a double. There you go.

00:25:06:19 - 00:25:07:20
That's one of the things

00:25:07:20 - 00:25:09:19
that we're trying to get better at,

00:25:09:19 - 00:25:12:07
as a field in GI is, you know,

00:25:12:07 - 00:25:13:16
we're seeing all these people

00:25:13:16 - 00:25:15:15
for screening colonoscopies.

00:25:15:15 - 00:25:16:22
But now we're trying to encourage our

00:25:16:22 - 00:25:18:11
GI doctors to,

00:25:18:11 - 00:25:20:07
you know, ask about upper symptoms,

00:25:20:07 - 00:25:20:14
you know,

00:25:20:14 - 00:25:22:05
have you had any problem swallowing?

00:25:22:05 - 00:25:23:10
Do you have heartburn?

00:25:23:10 - 00:25:24:13
Do you have any family history

00:25:24:13 - 00:25:25:14
of somebody with esophageal

00:25:25:14 - 00:25:26:18
or stomach cancer?

00:25:26:18 - 00:25:28:16
And then if you know there's

00:25:28:16 - 00:25:30:08
anything that kind of like,

00:25:30:08 - 00:25:31:10
you know, that flags

00:25:31:10 - 00:25:33:03
on some of those screening questions,

00:25:33:03 - 00:25:34:13
okay, let's do an upper endoscopy

00:25:34:13 - 00:25:35:14
at the same time.

00:25:35:14 - 00:25:37:17
But but, you know, everyone's busy.

00:25:37:17 - 00:25:38:11
And if

00:25:38:11 - 00:25:39:13
as a patient,

00:25:39:13 - 00:25:39:20
you know,

00:25:39:20 - 00:25:41:22
you're going for a colonoscopy,

00:25:41:22 - 00:25:43:14
you can say, you know what?

00:25:43:14 - 00:25:44:13
I'm going to ask

00:25:44:13 - 00:25:45:16
my doctor if,

00:25:45:16 - 00:25:47:08
I should be… Check some things out…

00:25:47:08 - 00:25:48:20
a good candidate for an upper endoscopy,

00:25:48:20 - 00:25:50:16
because, honestly,

00:25:50:16 - 00:25:52:19
there's been countless times

00:25:52:19 - 00:25:55:10
where somebody has had a colonoscopy

00:25:55:10 - 00:25:56:20
and then their GI doctor said, hey,

00:25:56:20 - 00:25:58:00
let's just do an upper endoscopy

00:25:58:00 - 00:25:58:21
just to check things.

00:25:58:21 - 00:25:59:20
And they found a by accident

00:25:59:20 - 00:26:00:16
and they found it.

00:26:00:16 - 00:26:01:03
Yeah.

00:26:01:03 - 00:26:02:15
And it's been like the perfect time

00:26:02:15 - 00:26:04:16
because it's, you know, not too late.

00:26:04:16 - 00:26:06:02
It's early in the spectrum

00:26:06:02 - 00:26:06:22
and we can take care of it.

00:26:06:22 - 00:26:07:10
And sadly,

00:26:07:10 - 00:26:08:00
if it were to happen,

00:26:08:00 - 00:26:08:17
anything were to happen,

00:26:08:17 - 00:26:10:11
they would be in the best hands

00:26:10:11 - 00:26:11:09
if they were to come here.

00:26:11:09 - 00:26:13:12
Well, and I would go out on a limb

00:26:13:12 - 00:26:14:20
and say we significantly

00:26:14:20 - 00:26:15:13
trust each other.

00:26:15:13 - 00:26:16:03
Jason's done

00:26:16:03 - 00:26:17:00
my endoscopies

00:26:17:00 - 00:26:18:17
and… He’s operated on me…

00:26:18:17 - 00:26:20:07
may or may not have operated on him. Wow!

00:26:20:07 - 00:26:21:01
Well thank you so much for it.

00:26:21:01 - 00:26:22:08
It’s just a wealth of information

00:26:22:08 - 00:26:24:01
And, like I said, it's important

00:26:24:01 - 00:26:24:11
to share it.

00:26:24:11 - 00:26:26:07
So it's kind of on people's radars

00:26:26:07 - 00:26:27:19
and certainly if it were to come up

00:26:27:19 - 00:26:29:08
and someone were to be diagnosed,

00:26:29:08 - 00:26:30:10
this would be the place to get

00:26:30:10 - 00:26:31:20
the best care with you two

00:26:31:20 - 00:26:33:01
So Doctor Smith and Doctor Sam,

00:26:33:01 - 00:26:34:12
we really appreciate your time today.

00:26:34:12 - 00:26:35:05
Thank you, Lisa.

00:26:35:05 - 00:26:36:04
Thank you for helping spread the word.

00:26:36:04 - 00:26:36:16
Thank you so much.

00:26:36:16 - 00:26:37:02
Thank you.

00:26:37:02 - 00:26:37:15
Thanks for watching

00:26:37:15 - 00:26:38:15
Live Well with UCI Health

00:26:38:15 - 00:26:40:02
I'm Lisa Foxx. Until next time.