By Brooke O'Neill
Photo by David Christopher
Left to right: Irving Waxman, MD, director of
the Center for Endoscopic Research and Therapeutics, and Lynne Stearns, RN, a clinical nurse.
Born a year apart, Joseph and Ellen Mangano grew up one block from each
other on Chicago’s West Side. As teenagers, they danced the night away
at his senior prom in 1952 and at hers the following year.
After 55 years of marriage and five children, they still act like
newlyweds, exchanging smiles and genuinely enjoying each other's
company. They spend their free time traveling the world together or
cultivating new hobbies, like watching opera. “We do a lot of laughing, I
have to say,” said Ellen, RN, 74. Yet six years ago they found
themselves facing a potentially tragic ordeal.
It started one Sunday morning in September, when Joe awoke with “a little
queasiness” in his stomach. “Something’s a little off today,” he told
He tried to shake it off by cooking breakfast, but suddenly ran from the
stove, overcome with nausea. Less than an hour later, Joe was in the
emergency room battling excruciating abdominal pains.
Ellen, a retired nurse, saw his lab results and knew the culprit
immediately: pancreatitis. An inflammation of the pancreas that can
range from mild to life-threatening, the condition is often associated
with family history, alcoholism or obesity, none of which fit Joe.
Subsequent tests revealed a “pseudocyst,” a pooling of fluid in his
pancreas, but physicians reassured the couple it was nothing to worry
about. Over the next two years, Joe suffered more pancreatitis attacks.
“The longer it went on, the antsier Ellen got,” Joe said. “I was the
dummy, just bouncing along.”
“It was really frightening for me,” said Ellen, who lost her mother to
pancreatic cancer at age 87 and knew chronic pancreatitis could be a
warning sign for the disease. Notorious for low survival rates,
pancreatic cancer is seldom caught early, making it the fourth leading
cause of U.S. cancer deaths.
In August 2007, the Manganos consulted a specialist at the University of
Chicago Medical Center who diagnosed the lingering cyst as a mucinous
cystic neoplasm, a malignant tumor, and recommended immediate surgery. A
month later, at a hospital closer to their Cary, Illinois, home, Joe
underwent a 10-hour Whipple procedure to remove the head of his pancreas,
which had a carcinoma in situ.
“That’s the scariest part,” Joe said, now 76. “You think you’re on the
right track and later on you find out you’ve been on the wrong path. It
could be a whole different outcome right now.”
The operation removed the carcinoma, but a year later, Joe’s pancreatic
duct became blocked, producing dangerous weight loss — and more
pancreatitis. Several physicians tried unsuccessfully to drain the
This past winter, the Manganos turned to Irving Waxman, MD, director of
the Center for Endoscopic Research and Therapeutics (CERT) and professor of
medicine and surgery at the Medical Center.
“Nobody had been able to help him,” said Barbara Cislo, MMS, PA-C, a
physician assistant for CERT. To fix the blockage, Joe needed a stent between his
stomach and pancreas, but prior surgery made the area difficult to
Fortunately, he was an ideal candidate for a groundbreaking,
non-surgical treatment known as endoscopic ultrasound (EUS) guided
transluminal therapy. Since the early 2000s, Waxman had used EUS to peer
inside the gastrointestinal tract. Now he also was using the technology
to do therapeutics — all without a single incision.
Lynne Stearns, RN, nurse coordinator for CERT, walked the couple through the
details. Ellen, she recalled, “was really anxious and wanted to get
moving on things.”
Using light anesthesia, Waxman inserted a specially designed endoscope
through Joe’s mouth into the stomach. He used an ultrasound device on
the scope to locate the blocked duct, puncture it with a needle and
place the stent.
The Medical Center, a leading developer of state-of-the-art EUS
applications, performs roughly 850 such endoscopic ultrasonographic
interventions annually. “There haven’t been a lot of innovations” in
endoscopy, Waxman said. Transluminal therapy “is really disruptive
thinking. It’s the future of the field.”
Nearly half a year after Waxman reopened Joe’s pancreatic duct, his
quality of life has improved dramatically.
“Once in a while, I’ll have symptoms, but they’re much better,” Joe
said. A low-fat diet often fixes things. “I eat instant oatmeal three
meals a day for a day or two, then it just resolves itself and I’m full
speed ahead.” This past May, he and Ellen took a riverboat cruise
through Belgium and the Netherlands and will spend the summer camping.
When it comes to pancreatic cancer, often discovered too late, Joe is
one of a handful of survivors. “I was lucky because I had a real
pancreatic attack at the very beginning,” he said. “I feel lucky all the