Physician at Work: Using endoscopy for better outcomes

For this doctor and his colleagues, it can mean treating cancer sooner

Harry Aslanian, MD

Harry Aslanian, MD, enjoyed playing the early Atari video games in his youth. This may have contributed to the excellent hand-eye coordination that now make him a sought-after expert in complex endoscopy procedures.

A gastroenterologist who uses specialized endoscopy to diagnose and treat disorders of the pancreas and bile ducts, Dr. Aslanian was drawn to the field because he liked the immediate visual representation of disease and the technical challenge of endoscopy.

Focusing largely on endoscopic ultrasound, he uses an endoscope (a flexible lighted tube with a camera) with an ultrasound probe built into its tip to examine places that are difficult to reach. “The pancreas is right near the stomach and it’s a notoriously difficult area to get detailed pictures of. By looking from inside the stomach we get the most accurate imaging,” he said.

Dr. Aslanian and colleague Priya Jamidar MD, work together to interpret images magnified with a confocal microscope.

If he sees an abnormality, Dr. Aslanian is able to pass a tiny needle through the endoscope and perform a biopsy of the pancreas. The cells are analyzed immediately in the procedure room, by cytologists, experts in analyzing the microscopic appearance of cells, so that Dr. Aslanian can often provide a diagnosis before the patient goes home. If a cancer is identified, the patient is referred to a team of highly skilled specialists.

More and more, Dr. Aslanian, Priya Jamidar, MD, and their colleagues in the Yale Interventional Endoscopy Program are able to detect and treat early cancers and other conditions during the same procedure. They immediately remove precancerous polyps and superficial tumors of the colon, esophagus, stomach or small bowel through the endoscope.

In addition to endoscopic ultrasound and colonsocopy, Dr. Aslanian performs a procedure called endoscopic retrograde cholangio-pancreatography (ERCP), which combines endoscopy, a contrast dye and fluoroscopic X-rays to image and treat disorders of the bile and pancreas ducts, including blockages due to stones or tumors.

Technological advances in imaging continue to improve Dr. Aslanian’s ability to detect abnormalities. Using probe-based confocal microscopy, he can pass a very small microscope through the endoscope or the tip of a needle and see individual cells inside the intestine, bile duct or pancreas. “There’s nothing else like it because it’s so miniaturized and gives you views down to the cellular level in real time,” he said.

Meanwhile, he and his colleagues are working on new endoscopic ablative treatments that can destroy precancerous tissues of the esophagus, bile duct and pancreas. “There’s a continual evolution of tools and techniques, and it’s an exciting time to be performing interventional endoscopy,” he said.

Name: Harry Aslanian, MD

Title: Associate director of Endoscopy; associate professor of Digestive Diseases and director of the Advanced Endoscopy Fellowship at the Yale School of Medicine

Area of expertise: Interventional endoscopy, endoscopic ultrasound, pancreatic and biliary disease

Place of birth: Hartford, Connecticut

Age: 40

College: Brown University

Med School: Brown University

Training: Residency in internal medicine/gastroenterology, Mayo Clinic; fellowships in internal medicine/gastroenterology and therapeutic endoscopy, Yale School of Medicine

Family: Married to Meg Rydell, MD (New London Family Practice, New London, Connecticut); three children ages 4 to 10.

What is most challenging to you in academic medicine? Trying to optimize clinical skills, teaching, clinical research and practice management

What is most rewarding? The variety and experiences that the challenges provide

What do you like most about your practice? The opportunity to serve as a referral center for pancreas and biliary disease. Working as part of a very talented and dedicated team that includes interventional endoscopy, radiology, pathology, surgery and oncology, and knowing that patients are getting the best possible outcome

Personal interests or pastimes? Music, tennis, hiking, family

Last book read: The Size of the World by Joan Silber

What would you do to improve our clinical environment if you had a magic wand? Grant everyone 75 years of healthy life! As a more immediate change, I would bring together basic scientists and clinicians with common goals for one day each year to foster collaboration.