Options for GERD, lung and esophageal cancer
UH Clinical Update - December 2018
For Stephanie Worrell, MD, it’s an exciting time to be a thoracic and esophageal surgeon.
“We are living at a time of rapid technical advance in the field of thoracic surgery,” says Dr. Worrell, who recently joined the medical staff at UH. “For example, not everyone with esophageal cancer needs an esophagectomy. If caught early enough, we are able to treat these tumors with endoscopic mucosal resections.”
“We are also doing a lot of robotic procedures, both at UH Cleveland Medical Center and at UH St. John, for esophagus, the mediastinum and lung,” she adds. “The robot is particularly helpful for mediastinal surgeries – including anterior mediastinal tumors and thymectomies. I also use it for some foregut cases – very large paraesophageal hernias. It can help you get up into those spaces a little better.”
Another significant part of Dr. Worrell’s practice, she says, is treating patients with gastroesophageal reflux disease. She performs the traditional Nissen fundoplication procedure to wrap the top of the stomach around the lower esophagus and will also offer the LINX procedure.
“For certain patients the LINX is equivalent to the Nissen, and often better tolerated,” she says.
The LINX system is a small flexible band of interlinked titanium beads with magnetic cores. The magnetic attraction between the beads is intended to help the lower esophageal sphincter resist opening to gastric pressures, preventing reflux from the stomach into the esophagus.
“We think LINX is a more dynamic way to control reflux disease,” Dr. Worrell says. “After a Nissen procedure, patients can’t burp or belch. They actually complain about these complications. Some people with less severe reflux are averse to the complications associated with the Nissen. The LINX allows you to have that pop-off valve, so you can still belch and burp, while still controlling reflux disease.”
Candidates for either a Nissen or LINX procedure include people who’ve grown tired of taking reflux medications, those experiencing side effects from these medications and those for whom the medications don’t control their reflux symptoms.
“Even if a patient isn’t ready for surgery, it’s good to talk to a surgeon and discuss the different options that are available,” Dr. Worrell says. “We’re changing how we approach the disease as these new technologies emerge.”
Another especially important aspect of thoracic and esophageal surgery, Dr. Worrell says, is managing the influx of patients who’ve undergone low-dose CT scans for lung cancer screening.
“There are many patients who qualify for lung cancer screening with low-dose CT scans, and providers may or may not know what to do with the results,” she says. “We are happy to see all of those patients and determine whether they need surgery, need a biopsy or whether we can just follow them with serial CT scans.”
Dr. Worrell earned her medical degree at Creighton University School of Medicine. She completed general surgery residency training and a research fellowship in esophageal medicine at the University of Southern California/LAC+USC Medical Center. In addition, she completed fellowship training in cardiothoracic surgery at the University of Michigan Medical Center.
As she begins building her practice here, Dr. Worrell says she’s impressed with the UH approach to patient care and a positive patient experience.
“Our division has a great team of people,” she says. “Our administrative assistant calls all the patients, and the nursing group keeps on top of all the tests that we order. We have a great advanced care practitioner group for inpatient care. Someone is always calling and checking in on the patients. The team we have is what makes it a good experience for the patients.”
For more information about Dr. Worrell or to make a referral, please call 216-844-0065.