People with worrying lumps in the bowel could be spared major surgery thanks to a mechanical ‘claw’ that can grasp and cut away hard-to-reach growths.
Doctors in Southampton have become the first in the UK to use the device to treat pre-cancerous growths embedded deep in the lining of the small intestine.
Nicknamed ‘the bear claw’, the contraption is passed through a tube inserted into the mouth and fed down the oesophagus.
It can be used to quickly remove multiple layers of tissue in the stomach and duodenum, the first part of the small intestine, which leads directly from the stomach
It can be used to quickly remove multiple layers of tissue in the stomach and duodenum, the first part of the small intestine, which leads directly from the stomach.
For the past few years it has been used to get rid of tumours and pre-cancerous growths in the bowel, known as polyps, by passing the device through a tube via a patient’s back passage.
But now it is being used to tackle polyps in the small intestine too – and it is hoped it will also prove an effective way of tackling tumours in this area. ‘It’s early days, but very exciting,’ says Dr Imdadur Rahman, a consultant gastroenterologist at University Hospital Southampton.
About one in two people will develop polyps at some point in their lives. Commonly, they affect the large bowel – but they can develop anywhere in the digestive tract.
Usually, they do not cause any symptoms and they are often picked up incidentally while a patient is having scans or other investigations for different reasons. But some polyps may develop into tumours and as a result, doctors will normally opt to remove them if discovered. When they are removed, it is crucial that no potentially harmful tissue is left behind, to reduce the risk of cancer occurring.
At present, patients with polyps in the small bowel may face major abdominal surgery to do this in one go, meaning multiple days in hospital as they recover.
Others may have endoscopies – where a tube is inserted through the mouth and down the food pipe and a thin wire, shaped like a snare, is used to cut the polyp.
The treatment is being offered at Southmpton University Hospital, pictured
However, it is difficult to remove polyps using these methods in one piece, and the endoscopy may need to be repeated every six months to monitor for any changes, until all the potentially harmful tissue has gone. The procedure can be uncomfortable and can also result in bleeding or tears.
But the new technique could offer an alternative. Dr Rahman explains: ‘Before, when you had to cut the tissue, you would run the risk of making a hole in the lining which you’d have to close.
‘Now, we can pre-emptively clamp the tissue behind the polyp or tumour and then cut the tissue in front of it. Normally, this can only be done during open surgery.’
Taking just 45 minutes, the new procedure is carried out under either general anaesthetic or with enhanced sedation. A flexible tube, known as an endoscope, with the 2cm-wide ‘bear claw’ device placed on its end, is inserted through the mouth and down the food pipe. This is a specially designed plastic cap which has a clamping action claw, made of titanium alloy, and a snare incorporated within.
Once the polyp or tumour is reached, it is grasped and pulled into the cap and the special clamp is deployed to hold the linings of the bowel together. The snare is then closed around the growth, to cut off the tissue. The tube is removed from the patient, and the sample taken away, while the clamp is left in the bowel. Over a number of weeks, the area heals, and the clamp eventually passes out of the patient.
Joyce MacLean, 68, from Hampshire, was one of the first patients to undergo the treatment last year.
Two years ago, tests revealed a tumour in her bowel and a polyp in her duodenum. The cancer was successfully treated with surgery, but in August 2018 an attempt to remove the polyp in its entirety during a conventional endoscopy failed.
Joyce was told doctors could use the new technique to remove the polyp and an area measuring about an inch in diameter was removed in one go.
‘I spent the night in hospital afterwards and then went for a scan the following day to make sure everything was fine,’ Joyce says.
She will have another gastroscopy in 12 months’ time to check the area has healed – and should then require no further treatment.
‘I can now say she is free of pre-cancerous tissue,’ Dr Rahman says. ‘This has potentially saved us from having to do several, repeated endoscopies.’