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Digestive Disease Firsts

The Digestive Disease Institute at Virginia Mason has gained national and international acclaim with its innovative clinical, education and research program. As a leader in digestive disease care, the Digestive Disease Institute's Centers of Excellence rely on multidisciplinary experts who focus on patient safety and superior patient outcomes as their top priority. For more than 20 years, physicians in the Digestive Disease Institute have collaborated to achieve breakthrough after breakthrough, translating their findings into improved patient outcomes and innovative, quality care.

1983 (published 1985)

  • Innovation: Endoscopic drainage of pancreatic pseudocysts
  • First In: World
  • Impact: This new treatment was unheard of at the time it was introduced by Virginia Mason physicians. It is now the treatment of choice in many centers around the world.

1988

  • Innovation: Used tunable dye laser lithotripsy to treat choledocholithiasis
  • First In: United States
  • Impact: This treatment was the first demonstration that large, un-removable bile duct stones could be fragmented and removed endoscopically.

1988

  • Innovation: Published the longest follow-up study on any benign disease entity: 20 year follow-up results on the Hill Procedure
  • First In: World
  • Impact: This publication was the first to verify the long-lasting results of the Hill Procedure of anti-reflux surgery as a proven method for providing relief to patients with reflux disease.

1989

  • Innovation: Used methotrexate to induce remission in patients with refractory inflammatory bowel disease
  • First In: World
  • Impact: Virginia Mason physicians were the first to describe and employ this now common treatment of refractory Crohn's disease.

1991

  • Innovation: Used endoscopic transpapillary therapy for disrupted pancreatic duct and pancreatic fluid collection
  • First In: World
  • Impact: This treatment has supplanted surgery in many centers for patients with amenable anatomy who have developed a pancreatic fluid collection from pancreatitis.

1992

  • Innovation: Placed metallic, self-expanding stents in the duodenum
  • First In: World
  • Impact: This treatment has now become commonplace and extends life for patients with unresectable pancreatic and duodenal cancer.

1992

  • Innovation: Used endoscopy to treat pancreatic duct stones and obstructive pancreatitis
  • First In: Region
  • Impact: This treatment is now used around the world and has supplanted surgery as the first line treatment.

1994

  • Innovation: Treated pancreatic ascites endoscopically
  • First In: World
  • Impact: This treatment is now the treatment of choice internationally for pancreatic ascites patients.

1996

  • Innovation: Described gastroesophageal flap valve as an anti-reflux mechanism
  • First In: World
  • Impact: These descriptions led to medical understanding of the reflux mechanism so that appropriate surgical repair could be undertaken in patients with refractory reflux.

1998

  • Innovation: Initially utilized in the mid-1980s, described percutaneous computerized tomography-guided catheter drainage of infected acute necrotizing pancreatitis
  • First In: World
  • Impact: This procedure allowed immediate relief for patients with life-threatening infection related to pancreatic necrosis.

1998 (published 2002)

  • Innovation: Reported extra corporeal shock wave lithotripsy for treatment of pancreatic stones
  • First In: United States
  • Impact: This treatment is now used around the world and has supplanted surgery as the treatment of choice in centers where it is available. It also set the standard for a requisite skill set to endoscopically remove stone fragments.

1999

  • Innovation: Demonstrated that Barrett's Esophagus can potentially regress following successful anti-reflux surgery
  • First In: United States
  • Impact: By verifying that Barrett's Esophagus can be affected by reliable reflux control, patient risk for malignancy has the potential to be significantly diminished.

2002

  • Innovation: Linked paraesophageal hernia repair to routine improvement in pulmonary function
  • First In: World
  • Impact: This new understanding allowed patients with compromised pulmonary function to regain significant function without treating their lungs.

2003

  • Innovation: Developed the Virginia Mason Protocol for chemotherapeutic-radiation treatment of patients with resected pancreatic cancer
  • First In: World
  • Impact: This protocol for adjuvant treatment of pancreas cancer has produced the highest survival rates ever for patients with pancreas cancer.

2003

  • Innovation: Demonstrated that partially covered metallic stents could be removed from the esophagus
  • First In: World
  • Impact: Before the development of fully covered removable stents for patients with benign strictures of the esophagus, this procedure allowed patients to avoid repeated dilation procedures and resume normal swallowing and diets within days.

2005

  • Innovation: Adopted double balloon enteroscopy to diagnose and treat very distal small bowel lesions
  • First In: Region
  • Impact: This technique treats lesions that cause intestinal bleeding and/or obstruction in the medial small intestine, avoiding surgery altogether.

2007

  • Innovation: Combined an external catheter into walled-off pancreatic necrosis with transenteral stents to eliminate pancreatic-cutaneous fistulae
  • First In: World
  • Impact: This dual drainage technique has now been used around the world as means of decreasing complications, reducing exposure to ionizing radiation, and decreasing costs for patients with walled-off pancreatic necrosis.

2007

  • Innovation: Utilizing standardized clinical pathways, published a large series of esophageal resections with mortality rate under 1 percent, earning the Journal of Gastrointestinal Surgery's Best Paper of the Year Award
  • First In: World
  • Impact: These results were the first indication that patients undergoing surgery for the treatment of esophageal cancer could have very high survival rates and outcomes.

2008

  • Innovation: Endoscopically treated dominant and intrahepatic strictures in patients with Primary Sclerosing Cholangitis (PSC), utilized since the 1990s
  • First In: Region
  • Impact: Reduced recurrent infections and the need for immediate liver transplant in PSC patients with deteriorating liver function.

2008

  • Innovation: Introduced T2* weighted MRI for hepatic iron measurement
  • First In: United States
  • Impact: This discovery allowed physicians to measure liver iron content without biopsy for the first time.

2008

  • Innovation: Studied multiple new medication therapies for liver disease, including obeticholic acid, lambda IFN, and NS5 polymerase inhibitors
  • First In: Region
  • Impact: With no proven therapy for fatty liver, the most common liver disease in the country, and major unmet needs for care of Hepatitis C, these studies bring new treatment options to patients.

2009

  • Innovation: Used simultaneous antegrade-retrograde endoscopy to reestablish patency of the completely obstructed esophagus and colon
  • First In: U.S. West Coast
  • Impact: This procedure provides an option to patients who cannot withstand surgery or who have no surgical options.

2009

  • Innovation: Created the Salvage Procedure for internal drainage of disconnected pancreatic ducts
  • First In: World
  • Impact: Patients with a disconnected pancreatic duct and an external fistula can have them drain directly to the stomach for internal drainage rather than requiring a distal pancreatectomy.

2009

  • Innovation: Participated in the first study of a novel non-invasive method, susceptometry, to measure hepatic iron
  • First In: United States
  • Impact: This non-invasive method has allowed patients to avoid biopsy for measurement of biochemical iron.

2010

  • Innovation: Published largest study to date exploring the relationship between hepatic iron content and severity of fatty liver
  • First In: World
  • Impact: This study demonstrated that excess iron may contribute to severity of fatty liver disease, thus providing a safe, inexpensive therapeutic target for patient care.

2010

  • Innovation: Launched the first dedicated hepatology fellowship in the Pacific Northwest
  • First In: Region
  • Impact: As the Hepatitis C epidemic matures and prevalence of fatty liver disease is recognized, this fellowship is critical for meeting patient care needs.