STONY BROOK, N.Y — Diana Zorilla-Fetherston will never forget when she was taken by ambulance to the Stony Brook University Hospital Emergency Department one day in August 2012, experiencing severe pain in her upper abdomen and chest area. The diagnosis: Her bile duct was blocked with stones. The 55-year-old nurse expected to have surgery, a long hospital stay, and endure a long recovery. Instead, she was back at work two days later because Stony Brook Medicine gastroenterologist Juan Carlos Bucobo, MD, used a novel endoscopic technique called double balloon endoscopy to gain access to portions of her gastrointestinal (GI) tract previously excluded by surgery and remove the bile duct stones.
In Diana’s case, Dr. Bucobo, Director of Endoscopy at Stony Brook’s Interventional Endoscopy Center and a nationally recognized clinician and educator in advanced therapeutic endoscopy, said the double balloon approach was necessary because prior bariatric surgery essentially re-routed her stomach and intestines making access to her bile duct virtually impossible using standard endoscopic equipment without surgical incisions. Double balloon endoscopy also enabled Dr. Bucobo to discover that Diana had many large stones, a scenario often requiring multiple procedures to resolve.
“By using double balloon endoscopy with customized endoscopic accessories, I was able to gain access and treat Diana’s complicated case of bile duct stones,” said Dr. Bucobo. “Identifying and removing her bile ducts stones with the double balloon endoscope proved effective and saved her a prolonged recovery time because surgery was unnecessary.”
He explained the steps he took to treat Diana, which resulted in three procedures that unfolded over several months.
“During the initial urgent procedure, the double balloon endoscope allowed me to reach the major papilla, which is the location of the exit of the bile duct into the small intestine. This allowed me to remove many of the obstructive stones and relieve her intense pain, as well as place a stent to allow drainage to prevent further complications, such as an infection of the bile duct,” explained Dr. Bucobo. “Six weeks later I performed lithotripsy (physical destruction) of the larger stones in order for them to be removed, and I replaced the stent for continued drainage. The third procedure enabled me to remove the remaining stones and stents since the bile duct was no longer blocked.”
None of the procedures required incisions. Diana, a mother, grandmother, and an Obstetrics nurse at Stony Brook University Hospital, had minimal pain and a quick recovery. She was able to return to work shortly after each of the procedures.
“I am absolutely thrilled, have no pain and feel great,” said Diana, after her third procedure. Her latest CT scans in April 2013 indicated no recurrence of bile duct stones.
“As a nurse I know without the double balloon endoscopy procedure, I would have needed surgery and a long recovery time. Other than the days around the procedure, I have been able to work, help take care of my grandchildren and live my busy life without interruption,” said Diana.
Dr. Bucobo said Diana’s case was more complicated than most patients with bile duct stones because of her surgical history and the number of large stones. The majority of patients with bile duct stones do not require multiple procedures. He added that generally patients who undergo double balloon endoscopy procedures typically experience very little discomfort and go home the same day of the procedure.
“This endoscopic approach is truly a leap forward for patients with issues involving the small intestine and those with areas of the GI tract deemed previously inaccessible by surgery, especially following gastric bypass surgery,” said Dr. Bucobo, who has performed more than 130 double balloon endoscopy procedures on patients with a wide range of complex GI tract disorders and complications involving the small intestine. He frequently performs this procedure in diagnosing cancer, treating GI bleeding and gaining access to problem areas in patients with surgically altered GI tracts.
“This technique enables GI specialists to evaluate the entire small bowel, the ability to move the endoscope through the GI tract efficiently, and provides a much less invasive option for examining and treating patients compared to other methods that require standard endoscopy and surgery,” summarized Dr. Bucobo.
During a double balloon endoscopy, the physician uses a flexible tube to maneuver through the GI tract. The endoscope and an overtube are coupled with a series of balloons that inflate and deflate as the tube moves along the GI tract. This allows the doctor to view the GI tract and provide necessary treatment, such as taking biopsies, cauterizing or removing small lesions.
Stony Brook University Hospital is the only hospital in Suffolk County to offer patients double balloon endoscopy to access conditions of the small intestine. At Stony Brook since 2010, Dr. Bucobo trains fellows in the technique and expects to expand its use for GI cases at Stony Brook.
Dr. Bucobo received his medical degree from the Sackler School of Medicine at Tel Aviv University in Israel, completed an Internal Medicine internship at Montefiore Medical Center/Albert Einstein College of Medicine, and a residency at Stony Brook University where he also completed a Gastroenterology Fellowship. He also completed an advanced fellowship in interventional endoscopy at Cedars-Sinai Medical Center in Los Angeles and is board certified in internal medicine and gastroenterology.
About Stony Brook Medicine:
Stony Brook Medicine integrates and elevates all of Stony Brook University’s health-related initiatives: education, research and patient care. It includes five Health Sciences schools — Dental Medicine, Health Technology and Management, Medicine, Nursing and Social Welfare — as well as Stony Brook University Hospital and 50 community-based healthcare settings throughout Suffolk County. To learn more, visit www.stonybrookmedicine.edu.