Innovation at work

A polyp in Susan Thompson's intestine was removed via an innovative procedure at Sanford Health. The painless procedure was, in Thompson's words, "A piece of cake."

Susan Thompson feared she would need a major surgery to locate and treat the source of bleeding in her small bowel. Fortunately, she found a high-tech procedure at Sanford Health that took care of the problem without a single incision. In May 2009, the Mandan woman said she suspected something was wrong when she began tiring more easily. One morning, she had to rest after climbing stairs in her home, waiting for the dizziness and nausea to pass. “I had noticed black stools that morning, but thought nothing of it,” she said. She went to work and during lunch experienced an episode that brought her to the point of tears, lying on a bench sweating and fearing she would vomit. Her friend drove her to a walk-in clinic. Thompson mentioned the black stools, and the doctor sent her to the Sanford Emergency and Trauma Center. “Susan had symptoms associated with bleeding in the intestines, such as an ulcer in the stomach,” said Douglas Renton, MD, a Sanford Health gastroenterologist. A gastroenterologist is a doctor who specializes in treating problems with the gastrointestinal tract, including the esophagus, stomach, small and large intestines, liver and gallbladder. “The source of bleeding was not found through upper endoscopy (a test that entails snaking a lighted scope down a

Thompson swallowed a vitamin-sized capsule containing a camera and radio transmitter. A miniature computer strapped to her hip collected the images over an eight-hour time span, long enough for the capsule to travel the entire 20 feet of the small bowel. The images revealed a polyp that explained the bleeding.

“Dr. Renton explained the small bowel is unreachable with endoscopy from the top or colonoscopy from the bottom,” Thompson said. “I had never heard of the capsule, but I was grateful there was an alternative to possibly eliminate the need for surgery to find the source of bleeding.” Without capsule endoscopy, Thompson might have undergone surgery involving the surgeon searching the small bowel by hand through a large incision. The capsule showed the polyp was located in the front of the bowel, but not the exact location. That’s when an innovative procedure called single balloon enteroscopy came into play. Dr. Renton used a specialized scope designed to advance deeply into the small bowel and locate the polyp, which was roughly the size of a fingertip.

Douglas Renton, MD Gastroenterology

“Dr. Renton was very knowledgeable and experienced regarding this procedure,” Thompson said. “I was confident he could take care of the polyp without having to resort to major surgery.”

For single balloon enteroscopy, a long flexible tube is equipped with a light and camera at the tip and is fitted with an equally long overtube. On the tip of the overtube is a balloon that can be inflated and deflated. After advancing the endoscope as deeply as possible, the balloon is inflated, anchoring the bowel onto it. The overtube is pulled back, shortening and straightening the small intestine to make passage of the inner endoscope easier. The process is repeated until the endoscope has advanced as deeply as possible.

Single balloon enteroscopy is used to reach lesions in the small intestine. Inserting specialized tools through a channel in the endoscope, Dr. Renton is able to perform biopsies, mark the location of polyps with a tattoo and, in some cases, remove the polyp.

“My initial goal was to tattoo the location so a surgeon could easily remove a small part of the bowel through a small incision,” he said. “But I was able to remove the polyp with the scope, eliminating the need for Susan to have any surgery.”

Dr. Renton was the first in North Dakota to perform this innovative procedure, which became available at Sanford Health in 2009.

“I was so relieved I didn’t have to undergo surgery,” Thompson said. “This procedure was a surprisingly simple, easy way to take care of something that had made me feel so awful. I had no pain or recovery time and went home the same day. It was a piece of cake.”

Click here for more information about Sanford Gastroenterology or call (701) 323-8030.