Gastroenterology GP update 2023

About Dr Marius

Born in Holland and trained in Australia / New Zealand, I am an advanced interventional endoscopist specialising in gastroscopy, colonoscopy, endoscopic mucosal resection, endoscopic ultrasound and ERCP. My Clinics are at Waitemata Gastroenterology and I perform endoscopy at WHB and Waitemata Endoscopy.

NEW PANCREAS CANCER PREVENTION TRIAL

With the help of a gut foundation grant, the first pancreatic cancer prevention trial in Australisia is starting at WDHB by injecting gemcitabine/paclitaxel chemotherapy into high risk pancreatic cysts. This has been shown to be safe and effective in the CHARM I trial. This is a very exciting development for patients in New Zealand, where for the first time we can prevent pancreatic cancer instead of observing the natural history of pancreatic cysts with serial MRI’s. Please contact me if you have patients with IPMN pancreatic cysts greater than 3 cm or worrying features to see if they are eligible.

PPI’S TO PREVENT BARRETT’S CANCER

Proton pump inhibitors (PPIs) play a crucial role in preventing cancer development in individuals with Barrett's oesophagus, where chronic acid reflux causes metaplasia, a change in the mucosa type. Even if your patient does not have reflux symptoms, they should continue a PPI to prevent chronic acid exposure. This has shown to reduce cancer development by 40% (Foregut. 2021;1(1):50-62)

ENDOSCOPIC ULTRASOUND FOR BILIARY PAIN

Did you know that small common bile duct (CBD) stones are frequently missed on MRCP, CT or external ultrasound? If your patient has typical biliary pains, epigastric or RUQ, constant occuring 1 hour after heavier meals they could have small stones, sludge or microlithiasis. An endoscopic ultrasound has the highest sensitivity for CBD stones. For instance in idiopathic pancreatitis with no cause found on other imaging, EUS detects stones/sludge in 30% of patients.

NEW IBD MEDICATIONS FUNDED IN NZ

After extensive lobbying from gastroenterologists, PHARMAC has finally approved two new biologic treatments for inflammatory bowel disease for patients who have failed current anti-TNF treatment. This is an exciting development and finally brings NZ back in line with other developed coutnries. Vedolizumab (Entyvio) blocks lymphocyte translocation to the gut only by blocking α4β7 integrin. Ustekinumab(Stelara) mediates T- cell response by inhibiting IL12 and IL23.

NEW ENDOSCOPIC REFLUX TREATMENT

There is a new endoscopic treatment for refractory reflux called antireflux mucosal ablation (ARMA). This tightens the valve between the oesophagus and stomach by creating a horse shoe shaped burn which then contracts. This has been shown to allow 85% of patients to stop their PPI and is a simple day-stay endoscopic procedure.

ENDOSCOPIC GASTRIC BYPASS

Malignant gastric outlet obstruction from a duodenal or pancreatic cancer has very poor outcomes and often was managed with end of life care or naso gastric drainage tube. Endoscopic gastric bypass with an EUS placed “lumen-apposing” AXIOS stent can give these patients good quality of life and permanently fix the gastric obstruction. I am the only gastroenterologist that can perform these advanced EUS techniques in the Auckland region. This has a very high clinical success rate with 95% of my 19 patients able to resume a normal diet.

PRACTICE GASTRO UPDATE PRESENTATION

Nothings beats an interactive meeting to catch up on the latest developments in gastroenterology. I can come to your practice and provide a catered 30–60 minute presentation. To keep it interactive there are only 1-2 slides per topic with time for questions in between.

NEED SOME FRIENDLY GASTRO ADVICE?

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