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Center of Excellence for Treatment of Barrett's Esophagus
Gastroesophageal reflux disease (GERD) is the chronic backflow of stomach contents into the esophagus. While the tissue lining the stomach is able to handle digestive contents such as acid, the lining of the esophagus is not. As a result, when stomach contents back up into the esophagus, it can cause a burning sensation commonly referred to as heartburn, the major symptom of GERD. In addition to heartburn, other symptoms associated with GERD include regurgitation, chest pain, hoarseness, wheezing, and chronic cough. A major complication of GERD is Barrett's esophagus, a premalignant condition of the esophagus. More than 15 million Americans suffer from daily heartburn. Until recently, treatment options for GERD have been limited to chronic drug therapy or anti-reflux surgery. While prescription medications help suppress acid production, they do not prevent the physical backflow of gastric contents into the esophagus. Anti-reflux surgery is effective in addressing the root cause of GERD by correcting the weakened valve mechanism; however, such surgery requires general anesthesia, multiple incisions and a recovery period lasting several days. An endoscopic procedure called full thickness plication is now available that can reduce or eliminate the need for prescription medication in most patients.
Barrett's esophagus is a precancerous condition that develops in approximately 10% of patients who have gastroesophageal reflux disease (GERD). In Barrett's esophagus, the normal cells that line the esophagus, called squamous cells, turn into a type of cell called specialized columnar cells or Barrett's esophagus. Diagnosis of Barrett's esophagus involves an endoscopy procedure to look at the lining of the esophagus and biopsies to examine samples of suspect tissue. To do an endoscopy, your doctor gently guides a long, thin tube called an endoscope through the mouth and into the esophagus. The endoscope contains a camera and light that allows the doctor to see the lining of the esophagus and to remove a small tissue sample, called a biopsy. The biopsy will be examined in a lab to see whether the normal squamous cells have been replaced with Barrett's cells. Once the cells in the lining of the esophagus have turned into Barrett's cells, they will not revert back to normal. In about 5% of patients, Barrett's cells may develop abnormal changes called dysplasia. Over several years, the dysplasia may progress to adenocarcinoma (cancer) of esophagus. Patients with Barrett's esophagus are 30-40 times more likely to develop esophageal cancer than the normal population. There are different grades of dysplasia. Most patients will not develop any dysplasia within their Barrett's esophagus. Barrett's esophagus without dysplasia is also called intestinal metaplasia. In some patients, the Barrett's cells may progress to low grade dysplasia which is worse than intestinal metaplasia. Barrett's cells may become more dysplastic and develop into high grade dysplasia. High grade dysplasia is very similar to carcinoma in situ, or superficial cancer. Carcinoma in situ will eventually develop into invasive esophageal cancer if not treated.
Patients who have nodular disease (small lumps) within their Barrett's esophagus, may be candidates for a procedure called Endoscopic Mucosal Resection (EMR) followed by either PDT or BÂRRX procedure, depending on the grade of dysplasia. An endoscopic ultrasound (EUS) of the nodular area is typically performed to determine whether EMR and PDT/BÂRRX are the appropriate treatments. Currently, there are no approved treatment options for patients with low grade dysplasia. These patients need to be closely monitored with frequent endoscopy and biopsies. Thermal ablation procedures such as Nd:YAG laser or Argon plasma Coagulator (APC) may be used at the discretion of the physician.
How Does Photodynamic Therapy Work?
Photodymanic Therapy For Barrett's Esophagus
PDT: Savings of Approximately $60,000
BÂRRX procedure is a new endoscopic ablation technique used for treatment of patients with Barrett's esophagus without dysplasia. Barrett's esophagus without dysplasia is also called intestinal metaplasia.
The procedure is performed on an outpatient basis under conscious sedation. Typically, the procedure takes about 25 minutes and is well tolerated by patients. The risk of developing esophageal stricture is minimal after this procedure.
Endoscopic Mucosal Resection (EMR) is a relatively new procedure that is available for removal of small nodules within the Barrett's segment. These nodules are typically a sign of disease progression and should be removed before they become invasive cancer. Using Duette® Multi-Band Mucosectomy device, the nodules are removed by endoscopically placing a tiny rubber band around the nodule, making it easier to grasp. Then, an electrosurgical snare is used to cut and remove the nodule. EMR is performed during a routine endoscopy under conscious sedation. Several weeks after the site of EMR has healed, patients may receive PDT or BÂRRX procedure, depending on the grade of dysplasia. EMR may also be used to remove (treat) small areas of Barrett's esophagus. An advantage of EMR technique is that not only the nodule is removed, a pathological examination of the nodule may also be obtained which helps in determining the depth of abnormal cells. This helps in staging the progression of disease in Barrett's patients.
Endoscopic thermal ablation is an outpatient procedure that uses a laser (or non laser) source to thermally burn Barrett's tissue. The Center provides an Nd:YAG laser with contact probe to accurately treat small areas of Barrett's esophagus that are not suitable for photodynamic therapy or BÂRRX procedure. Nd:YAG laser is also used during the follow-up endoscopy of patients who return with small islands of Barrett's mucosa following PDT or BÂRRX procedure. Bipolar or monopolar electrosurgical techniques are also available and may be used at the discretion of physician.
The Center offers a new procedure called full thickness plication for patients with gastroesophageal reflux diseases (GERD) that can reduce or eliminate the need for prescription medications in most patients. The Plicator™ is an endoscopic device used to correct the underlying mechanical defect that causes gastroesophageal reflux disease (GERD). The Plicator is used to grasp, fold, and fixate tissue at the junction between the esophagus and the stomach, thus tightening the valve that acts as a natural barrier to gastric reflux. The Plicator procedure is performed under conscious sedation, typically in 20 minutes, enabling patients to return home the same day. In a multi-center clinical study, the Plicator procedure was shown to be effective in eliminating the need for prescription heartburn medications in 70% of treated patients out to at least 1-year post-procedure. In addition, 80% of patients treated with the Plicator experienced a reduction in the amount of gastric acid allowed to enter the esophagus. The plicator procedure is not recommended for patients with existing Barrett's esophagus. Plicator procedure introduces anatomical modification of the area between stomach and esophagus which may hide some or all of the Barrett's esophagus. It is recommended that Barrett's esophagus be treated first and patients remain clear of Barrett's tissue for at least 1 year before plication procedure is performed. Plicator procedure is recommended for patients with hiatal hernias of 3 cm or shorter.
Background The Center of Excellence for treatment of Barrett's esophagus is an alliance of numerous professionals from several clinical institutions, research organizations, and supporting services, which together form the Components of the Center of Excellence. A complete list of the Components and their roles in the program is provided later in this section. The Center of Excellence combines the expertise of a variety of disciplines to provide comprehensive and well coordinated care for patients, as well as to conduct pre-clinical and clinical research. This partnership has resulted in the introduction of new treatments for patients and the development of new technologies for early detection of cancer. Photodynamic therapy for Barrett's esophagus with high grade dysplasia was pioneered in 1990 at the Laser Center, located on the 4th floor of the Thompson Cancer Survival Center. Since then, the treatment has been improved through application of several generations of light delivery balloons. The Laser Center was one of the first institutions introducing BÂRRX procedure for treatment of Barrett's esophagus without dysplasia. Over a decade of experience has resulted in excellent treatment outcomes in our patients (see Publications). State-Of-The-Art Treatment and Technology
International Leadership The Laser Center is internationally known as a leader in the treatments for Barrett's esophagus. The Laser Center has gained this reputation as a result of innovations in protocol development, excellent treatment outcomes in a large number of patients, numerous publications, and multiple presentations. The light delivery balloon for PDT was initially tested in our laboratory at the University of Tennessee's College of Veterinary Medicine. The clinical development of the balloon followed at the Laser Center. This work led to a multicenter international study for treatment of HGD in Barrett's esophagus, which was conducted under the direction of the Medical Director of the Center of Excellence.
Distribution of Patients Referred to Laser Center
Patients are referred to the Laser Center from all areas of the United States and from other countries. To date, patients have traveled to the Laser Center from 40 states and several foreign countries. In fact, 25% of patients enrolled under the multicenter international PDT study have been treated at the Laser Center. The Laser Center is routinely invited to participate in pre-clinical and clinical trials of new PDT drugs and techniques. The clinical staff regularly chair and moderate national and international conferences and serve as reviewers for medical and scientific journals where related papers are published. Clinical and Pre-Clinical Research The Center of Excellence is committed to improving patient care and treatment outcomes through clinical and pre-clinical research. The clinical research program has been active since 1989 in collaboration with Clinical Trials Department, located on the 7th floor of the Thompson Cancer Survival Center. Clinical studies have been conducted using numerous photodynamic therapy protocols and ablation procedures. Through clinical research, the Laser Center has obtained extensive experience in applying PDT for a variety of conditions such as Barrett's esophagus (BE), esophageal cancer, lung cancer, skin cancer, metastatic breast cancer, Kaposi's sarcoma, and other cutaneous cancers. The Medical Director of the Center of Excellence has an Investigational New Drug (IND) filed with the Food and Drug Administration (FDA) for clinical studies using Photofrin. All of the research on BE, esophageal cancer, and skin cancer has been conducted under this IND. The development and testing of the light delivery balloon for PDT of Barrett's esophagus was also conducted under this IND. The pre-clinical research program is conducted at the College of Veterinary Medicine, University of Tennessee which has Laboratory space assigned for our collaborative work. The animal studies conducted there were instrumental in the development of the balloon light delivery device for PDT, a critical element in improving treatment outcomes. In addition, the partnership with scientists at the Oak Ridge National Laboratory has resulted in the development of techniques for early detection of cancer in Barrett's esophagus and skin cancers such as basal cell carcinoma and squamous cell carcinoma. Over the last decade, the faculty have received funding for clinical and pre-clinical research from:
And several PDT pharmaceuticals such as: Educational Services and Outreach Program The Laser Center is a national training facility for treatment of Barrett's esophagus and esophageal cancer where trainees learn the proper application of different treatments. Our hands-on teaching laboratory is located at the College of Veterinary Medicine, where physicians and nurses practice in an animal model. Physicians and nurses from many prestigious medical centers around the country and Europe have been trained here.
The Laser Center publishes a semiannual newsletter for several thousand physicians and patients around the country. It provides articles about the most recent advances in the treatments for Barrett's esophagus as well as answers to frequently asked questions. Outcome Comparison Against External Benchmarks Continuous comparison of outcomes against external benchmarks is achieved via publications, presentations, and literature reviews. The faculty have published over 45 clinical and pre-clinical papers in medical and scientific journals along with several book chapters and review articles (see Publications). In addition, the faculty routinely present clinical and pre-clinical research papers at the annual meetings of the:
Our Medical/Nursing Research Library, located on the 3rd floor of the Thompson Cancer Survival Center, conducts monthly searches of the published articles to keep abreast of the latest developments in the field of Barrett's esophagus. Excellent Patient Satisfaction
Full Range of Clinical Services We continuously strive to meet every need of our patients. Ancillary services such as laboratory, radiology and patient and family support are provided within the Thompson Cancer Survival Center. In the rare case of an emergency, inpatient services are available at Fort Sanders Regional Medical Center, across the street from the Thompson Cancer Survival Center.
Laser Center, Thompson Cancer Survival Center (TCSC)
Fort Sanders Regional Medical Center (FSRMC) Fort Sanders Regional Medical Center is a 556-bed hospital serving Knoxville and surrounding counties and is located across the street from the Thompson Cancer Survival Center. TCSC and the Medical Center provide laboratory, pathology, radiology, cardiology, and oncology services. FSRMC is used if a need for inpatient services arises. Gastrointestinal Associates (GIA) / The Endoscopy Center
Clinical Trials Department, Thompson Cancer Survival Center (TCSC) Clinical Trials Department provides state-of-the-art clinical research for physicians and patients in the East Tennessee area. The staff includes a team of highly qualified oncology certified nurses who coordinate and perform data management for oncology protocols in cooperation with such NCI research groups as the Southwest Oncology Group, the National Surgical Adjuvant Breast and Bowel Program, and the Clinical Trials Support Unit. In addition, research is conducted in collaboration with several pharmaceutical sponsors and other cancer research centers. There are currently 45 active research protocols. There have been over 1500 patients enrolled in clinical trails since the department began in 1988. Clinical Trials department has been involved with Barrett's research since 1989. The department is located on the 7th floor of the Thompson Cancer Survival Center. College of Veterinary Medicine, University of Tennessee (UTCVM)
Advanced Biomedical Science and Technology Group, Oak Ridge National Laboratory (ORNL)
Covenant HomeCare is the home health agency providing care for all PDT patients. The nurses are well trained to provide the individualized care required by these patients. The nurses work closely with the Laser Center staff to assure that the details of each patient's care are individually planned and implemented. Medical/Nursing Research Library The Medical/Nursing Research Library is located on the third floor of the Thompson Cancer Survival Center. It currently houses more than 5,000 books and subscribes to 175 clinical journals. The library is staffed with two librarians, who are available to provide immediate access to medical journals and up-to-the moment medical literature through library online databases. The library conducts monthly searches of databases for all relevant published papers. The Fellowship Center is an outpatient-lodging center created to assist out-of-town patients and family members with housing while the patients receive care at the Thompson Cancer Survival Center or the Fort Sanders Regional Medical Center. The Fellowship Center consists of eighteen fully furnished apartments with laundry facilities. The apartments are provided free of charge to all patients. The services are totally sustained through the generosity of its guests and friends. The Fellowship Center is a member of the National Association of Hospital Hospitality Houses. The Fellowship Center is located within a block of the Laser Center. Thompson Cancer Survival Center Foundation The Thompson Cancer Survival Center Foundation, established in 1994, extends resources to such projects as therapeutic and diagnostic research, education, and direct patient care. The Foundation has been instrumental in the establishment of the photodynamic therapy program and continues its support through annual grant applications. American Laser Foundation American Laser Foundation was established in 1981 to enable research, training and education focusing on technologies and treatments utilizing lasers in the diagnosis and management of human diseases. American Laser Foundation provides support through grant applications.
Clinical Staff: Affiliations
Preclinical Research Staff: Affiliations
Masoud Panjehpour, Ph.D.: Laser Center, UTCVM, ORNL
Supporting Services Staff: Affiliation
Listed in reverse chronological order.
Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients.
Porfimer Sodium Photodynamic Therapy for Management of Barrett's Esophagus with High Grade Dysplasia
Photodynamic Therapy for Barrett's High-Grade Dysplasia
An Educational Tool for Photodynamic Therapy of Barrett's Esophagus with High-Grade Dysplasia: From Screening through Follow-up
Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized phase III trial.
Optimization of light dosimetry for photodynamic therapy of Barrett's esophagus: efficacy vs. incidence of stricture after treatment.
What is the best management strategy for high grade dysplasia in Barrett's oesophagus? A cost effectiveness analysis.
Development of a fluorescence detection system using optical parametric oscillator (OPO) laser excitation for in vivo diagnosis.
Photodynamic Therapy for Barrett's Esophagus with Dysplasia and/or Early Stage Carcinoma: Long Term Results
Therapeutic Applications of Lasers in Gastroenterology
Photodynamic Therapy Using Verteporfin (benzoporphyrin derivative monoacid ring A, BPD-MA) and 630 nm Laser Light in Canine Esophagus
Acid Suppression and Reepithelialization After Ablation of Barrett's Esophagus
Evaluating Treatments of Barrett's Esophagus That Shows High-Grade Dysplasia
Laser-Induced Fluorescence Spectroscopy for in vivo Diagnosis of Nonmelanoma Skin Cancers
Results of Photodynamic Therapy for Ablation of Dysplasia and Early Cancer in Barrett's Esophagus and Effect of Oral Steroids on Stricture Formation
Light Sources and Delivery Devices for Photodynamic Therapy in the Gastrointestinal Tract
Photodynamic Therapy in the Management of Barrett's Esophagus With Dysplasia
Results of Photodynamic Therapy in Barrett's Esophagus: A review
Photodynamic Therapy for Barrett's Esophagus: Follow-up in 100 Patients
Photodynamic Therapy in Barrett's Esophagus
Laser-induced Fluorescence for Esophageal Cancer and Dysplasia Diagnosis
Photodynamic Therapy for Barrett's Esophagus: Cardiac Effects
Photodynamic Therapy for Barrett's Esophagus
Photodynamic Therapy for Barrett's Esophagus: Clinical Update
Endoscopic Fluorescence Detection of High-Grade Dysplasia in Barrett's Esophagus
Balloon Photodynamic Therapy of Esophageal Cancer: Effect of Increasing Balloon Size
Photodynamic Therapy With Porfimer Sodium Versus Thermal Ablation Therapy With Nd: YAG Laser for Palliation of Esophageal Cancer: a Multicenter Randomized Trial
Photodynamic Therapy in Barrett's Esophagus: Reduction of Specialized Mucosa, Ablation of Dysplasia, and Treatment of Superficial Esophageal Cancer
Barrett's Esophagus: Photodynamic Therapy for Ablation of Dysplasia, Reduction of Specialized Mucosa, and Treatment of Superficial Esophageal Cancer
Spectroscopic Diagnosis of Esophageal Cancer: New Classification Model, Improved Measurement System
In Vivo Cancer Diagnosis of the Esophagus Using Differential Normalized Fluorescence (DNF) Indices
Photodynamic Therapy for Esophageal Cancer Using a 180 Degrees Windowed Esophageal Balloon
Tumor Cell-Enhanced Sensitivity of Vascular Endothelial Cells to Photodynamic Therapy
A Centering Balloon for Photodynamic Therapy of Esophageal Cancer Tested in a Canine Model
Comparative Study Between Pulsed and Continuous Wave Lasers for Photofrin Photodynamic Therapy
Photodynamic Therapy for Treatment of Early Adenocarcinoma in Barrett's Esophagus
Quantification of Phthalocyanine Concentration in Rat Tissue Using Laser-Induced Fluorescence Spectroscopy
Cytokine Modulation of Endothelial Cell Sensitivity to Photodynamic Therapy
Comparative Pharmacokinetics of the Photosensitizer Tin-Etiopurpurin in Dogs
Laser and Photodynamic Therapy of Esophageal Cancer
Centering Balloon to Improve Esophageal Photodynamic Therapy
Nd:YAG Laser Hyperthermia Treatment of Rat Mammary Adenocarcinoma in Conjunction With Surface Cooling
Nd:YAG Laser-Induced Hyperthermia Treatment of Spontaneously Occurring Veterinary Head and Neck Tumors
Nd:YAG Laser-Induced Interstitial Hyperthermia Using a Long Frosted Contact Probe
Blood Flow Values
Laser Treatment of Esophageal Cancer
Canine Normal and Tumor Tissue Estimated Blood Flow During Fractionated Hyperthermia
Laser Treatment of Upper Gastrointestinal Hemorrhage
The Relationship of Temperature Profiles to Frequency During Interstitial Hyperthermia
Biographical Information for Clinical and Pre-clinical Research Staff
Bergein F. Overholt, M.D., FACP, MACG
John M. Haydek, M.D., FACP, FACG
Tuan Vo-Dinh, Ph.D.
Robert C. DeNovo, D.V.M., M.S., D.A.C.V.I.M.
Alfred M. Legendre, D.V.M., D.A.C.V.I.M.
Shelly Abrams, RN; Vicki Forester, RN
Jan Miller, RN
Karen Abbott, LPN
Jennifer Raney, LPN
Mary N. Phan, BS
Josie Stanga, RN; Sue Thompson, RN; Missy Maynatt, RN
Mary Ann Whittaker
Joanne Bohl, RN, BSN, CRNI,
Tammy Moyers, LVMT, Jimmy Hayes, LVMT
Kui Chen, Ph.D., Postdoctoral Research Associate
Mary Ann Whittaker
Phone: (865) 541-1433 Our website is: www.barretts-esophagus.org Additional information may be found at: www.gihealthcare.com
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Treatment options for Barrett's patients depend on the grade of dysplasia. The Center provides several treatment options for Barrett's esophagus. Until recently, the only treatment for patients with high grade dysplasia was esophagectomy, or surgical removal of the esophagus. The Center provides a non-surgical laser treatment called Photodynamic Therapy (PDT) for patients with high grade dysplasia. An option for patients who do not have any dysplasia (have intestinal metaplasia) is observation with regular endoscopy and biopsies. The center offers an outpatient endoscopic ablation technique called BÂRRX procedure for patients with Barrett's esophagus without dysplasia.
Photodynamic therapy (PDT) is a treatment that uses a combination of photosensitizer (a light-activated drug) and laser light to destroy abnormal cells. PDT patients are injected with a photosensitizer to render their tissue extremely sensitive to laser light. The lesion is then illuminated with a laser light of proper power and wavelength (color). The interaction of laser light and the photosensitizer causes a chemical reaction, killing the abnormal cells. Photodynamic therapy can be used to reduce the tumor mass in patients with advanced esophageal cancer. However, a primary use of PDT is as an alternative to esophagectomy (the surgical removal of the esophagus) for patients with high-grade dysplasia and early cancer in Barrett's esophagus.
Until recently, the standard treatment for patients with high-grade dysplasia was esophagectomy. This is an invasive surgical procedure associated with a 3.4%-19% mortality rate and significant morbidity. Typically, patients require several weeks of hospitalization and full recovery may take months.
Photodynamic therapy is an alternative outpatient endoscopic procedure for patients with high-grade dysplasia in Barrett's esophagus. During PDT, patients are injected with a photosensitizer (Photofrin). Laser light is delivered two-three days later using a specially designed light delivery balloon. A side effect of Photofrin is light sensitivity. Patients must avoid direct exposure to sunlight and bright lights for about 4-6 weeks. The primary complication of PDT for Barrett's esophagus is esophageal stricture, scarring and narrowing of the esophageal lumen. This occurs in approximately 20% of patients and is managed by dilation. We are currently working on reducing or eliminating the stricture formation.
The PDT balloon, which is necessary for effective delivery of laser light to Barrett's esophagus, was clinically developed and tested at the Laser Center, where all the treatments are performed. The Laser Center is considered a world leader in the use of balloon-PDT for Barrett's esophagus.
Photodynamic therapy is an alternative to esophagectomy for patients with high-grade dysplasia in Barrett's esophagus. All treatments are performed as outpatient services. All visits/treatments are coordinated to be performed over a short period of time, reducing the length of total treatment time for patients and family members. PDT is safer, less expensive and produces results that are at least equal to, or probably better than those of esophagectomy. 
During the procedure, the exact diameter of the esophagus is measured using an automated dilation catheter. Then using a proper sized ablation catheter called HALO360, radiofrequency (RF) energy is delivered to a 3 cm circumferential segment of the Barrett's esophagus. Delivery of energy is automated and takes a few seconds. The energy is adjusted to allow a limited depth of injury to destroy the Barrett's cells without destroying the normal tissue in the deeper layer. The ablation may be repeated until the entire length of the Barrett's segment is treated.
The center is a state-of-the-art outpatient endoscopy facility equipped to provide an array of treatment options for patients with Barrett's esophagus to include PDT for Barrett's esophagus with high-grade dysplasia/early cancer, laser treatment for advanced esophageal cancer and endobronchial lung cancer, BÂRRX procedure for Barrett's esophagus without dysplasia, Endoscopic Mucosal Resection (EMR) for removal of nodules, thermal ablation techniques for treatment of small Barrett's areas, Endoscopic Ultrasound (EUS) for staging of disease as well as Plicator Procedure for patients with gastroesophageal reflux disease (GERD).
Patient education is strongly emphasized in our program via personal phone discussions between our patients, physicians and staff. An extensive array of brochures and other informative material is mailed to patients before they come for treatment. Several days before the procedures, the nurse meets with the patient and family members and discusses the treatment in detail. Ample opportunity is provided for the patients to ask questions. Each patient education session requires about two hours.
All patients are asked to complete a satisfaction survey. Asked to assign an overall satisfaction score of 1 to 10, with 10 being the most satisfied, 93% of the patients have registered a satisfaction score of 10. A pie chart of patient satisfaction scores is shown below (seventy-three patients, January 2001 through August 2002). High scores are the result of over a decade of clinical experience leading to a well-coordinated and well-established patient care process and excellent clinical outcomes.
The Laser Center occupies the fourth floor of the Thompson Cancer Survival Center where all clinical procedures are performed. The Laser Center is a state-of-the-art outpatient facility fully equipped to provide a full array of treatment options for Barrett's patients, such as Photodynamic Therapy, BÂRRX, EMR, thermal ablation as well as plicature procedure for patients with gastroesophageal reflux disease (GERD). All procedures are performed under conscious sedation or general anesthesia. The facility consists of the treatment area, recovery area, waiting room, registration area, patient education room, exam rooms, and administrative area. The Laser Center is staffed by laser treatment specialists, physicians, nurses, research staff, and administrative staff.
Gastrointestinal Associates (GIA) consists of thirteen gastroenterologists, a nurse practitioner, nurses and staff. The Endoscopy Center is a licensed ambulatory surgery center (ACS) associated with GIA where endoscopy procedures are performed. It holds the distinction of being the first certified freestanding endoscopic ASC in the nation. The group has been involved in photodynamic therapy for esophageal cancer and dysplasia in Barrett's esophagus since 1989. All screening and follow-up endoscopies for PDT patients are conducted at GIA/The Endoscopy Center, which is within five miles of the Laser Center.
The College of Veterinary Medicine at the University of Tennessee is the site of much of the pre-clinical PDT activities. The PDT Laboratory at the College is used for research and development of new techniques and devices as well as for hands-on training during our PDT courses. The Laboratory is equipped with PDT lasers and endoscopy systems similar to those used in our clinical areas. This laboratory was critical in testing and developing the balloon for PDT of Barrett's esophagus. The small animal clinic within UTCVM is the referral center for East Tennessee where client-owned animals have access to the latest in PDT treatments (experimental or approved procedures).
The Advanced Biomedical Science and Technology Group is a biomedical research division located at Oak Ridge National Laboratory, about 20 miles from the clinical facilities of the Center of Excellence. Scientists at ORNL conduct a variety of biomedical research projects. Currently, the group is involved in projects for non-invasive detection of PDT drugs to optimize treatment protocols. In addition, they have been involved in projects to optically detect dysplasia and early cancer in Barrett's esophagus.
For out-of-town patients and their family members, furnished apartments are provided at the Fellowship Center at no cost, eliminating hotel expenses. 
Excellence may only be achieved by a multidisciplinary approach to patient care. Our Team of Excellence is a group of highly motivated and experienced physicians, scientists, nurses, technicians, and supporting staff with a common goal of delivering the best care to our patients. In addition, our patients constitute an important part of our team. In fact, our patients have been the best advocates of the program.
Bergein F. Overholt, M.D.: Laser Center, GIA, UTCVM
Dr. Overholt is the Medical Director of the Center of Excellence. He is a gastroenterologist and the chief of the Laser Center and managing partner of Gastrointestinal Associates. His clinical and pre-clinical research in treatments for Barrett's esophagus have been the pioneering work in the field. He is considered an international leader in the use of PDT for Barrett's esophagus and has lectured and published extensively on the subject. He has served as President of the American Society for Gastrointestinal Endoscopy and the American Society of Outpatient Surgeons, and is a founding member and past President of the Tennessee Society for Gastrointestinal Endoscopy. He has served as Chief of Staff at St. Mary's Medical Center, Knoxville. He is a past Trustee of the American Society of Internal Medicine. He has received numerous professional and civic awards including the distinction of being named Master by the American College of Gastroenterology.
Dr. Haydek is a gastroenterologist at Gastrointestinal Associates. He joined the Laser Center in 1996 to work on photodynamic therapy for Barrett's esophagus. He has coauthored several papers as a result of his research on Barrett's. Dr. Haydek is a Fellow of the American College of Physicians and a Fellow of the American College of Gastroenterology. Prior to his relocation to Knoxville, Dr. Haydek worked as an academic gastroenterologist and assistant professor of medicine at Loyola University Medical Center and Hines V.A. Hospital in Chicago.
Dr. Panjehpour is the Director of Research at the Laser Center. He is also a Research Associate Professor at the College of Veterinary Medicine and holds a visiting scientist appointment at Oak Ridge National Laboratory. His collaborative work with the College of Veterinary Medicine and Oak Ridge National Laboratory has resulted in several human clinical studies including development of balloon photodynamic therapy and non-invasive detection of cancer using laser induced fluorescence spectroscopy. He lectures extensively on PDT and has published numerous papers and book chapters. He is a member of the American Society for Laser Medicine and Surgery, American Society for Photobiology, the International Society for Optical Engineering (SPIE) and the American Gastroenterological Association.
Ms. Whittaker is the Project Coordinator for the Laser Center. She is often the first person who speaks to patients who inquire about treatment options. She answers questions about the treatment, mails out packets of information, collects and reviews patients' records, pre-certifies insurance and assists the patients and their families to make their treatment as pleasant as possible.
