NOVEL ENDOSCOPIC INTERVENTIONS RESTORE NUTRITION IN TEEN WITH COMPLEX GI COMPLICATIONS​​

Featuring: Amrita Sethi, MD
A multidisciplinary team at the Northwestern Medicine Center for Advanced Endoscopy recently treated a the highly complex case of a 17-year-old from Cyprus with severe GI sequelae following lymphoma therapy, including chronic inflammation, recurrent pancreatitis and a severe duodenal stricture that left him unable to tolerate solid food for nearly two years. Nutritional status deteriorated significantly, requiring supplemental nutrition and ongoing medical support.

After multiple unsuccessful attempts in Europe to address the obstruction endoscopically, the patient was referred to  Amrita Sethi, MD, now medical director of the Northwestern Medicine Center for Advanced Endoscopy at Central DuPage Hospital. Imaging and prior procedural findings revealed an exceptionally challenging anatomy, including migrated embolization coils within the small bowel and luminal narrowing that prevented standard endoscopic access.

Over the course of several therapeutic procedures, Dr. Sethi used advanced endoscopic techniques to dilate the obstructed duodenum and remove obstructing coil material, restoring GI continuity and allowing the patient to resume oral intake. The interventions enabled substantial nutritional recovery and eliminated the need for a liquid-only diet.
Following Dr. Sethi’s transition to Northwestern Medicine, the patient became the first international patient treated at the Center for Advanced Endoscopy at Central DuPage Hospital. Continued evaluation identified persistent pancreatic duct obstruction contributing to recurrent pancreatitis episodes. Because conventional ERCP was not feasible, Dr. Sethi used an endoscopic ultrasound (EUS)-guided ERCP approach to create an alternative drainage pathway and place a stent facilitating pancreatic drainage.

“Using EUS-guided intervention allowed us to create a new drainage pathway with the goal of improving pancreatic function and reducing future complications,” explains Dr. Sethi.

The case underscores growing opportunities for advanced endoscopic management of complex benign GI disorders that historically required surgical intervention. It also demonstrates the value of specialized centers that can handle highly individualized care for patients with altered anatomy, treatment-related complications and difficult-to-access pancreaticobiliary disease.
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Part of Northwestern Medicine Digestive Health Institute, the Center for Advanced Endoscopy brings together physician-scientists and therapeutic endoscopists specializing in advanced ERCP, EUS-guided interventions and other novel endoscopic techniques. As one of only a small number of dedicated advanced endoscopy centers in the United States, it’s expected to serve as a referral destination for patients with complex GI and pancreaticobiliary disorders from around the world.
Amrita Sethi, MD, now medical director of the Northwestern Medicine Center for Advanced Endoscopy at Central DuPage Hospital.

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