Massachusetts General Hospital

Biography

William R. Brugge, MD is the Director of the GI Endoscopy Unit at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. You may contact him via email: WBrugge@partners.org or his nurse practitioner, Lindsay Farragher lbf5@partners.org

Dr. Brugge is an active clinical consultant in gastroenterology and gastrointestinal endoscopy, focusing on patients with complex pancreatic diseases. His research has focused on the early diagnosis of pancreatic cancer, developing a variety of endoscopic techniques to aspirate malignant and pre-malignant lesions of the pancreas, including mucinous cysts, intra-ductal tumors, and masses. He also performs therapeutic endoscopic procedures such as ERCP, stent placement, FNA and EMR. Currently he is currently conducting a trial of injection therapy for pancreatic cystic neoplasms.

Procedures performed:

• Upper GI endoscopy
• Colonoscopy
• Esophageal dilation therapy
• Stent placement
• Endoscopic ultrasound with fine needle aspiration
• Endoscopic mucosal resection (EMR)
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Confocal laser endomicroscopy
• Radiofrequency ablation of Barrett's esophagus (BARRX)

Dr. Brugge is a Fellow of the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology and the American Gastroenterological Association. He directs annual meetings in endoscopic ultrasound and endoscopy unit management and the Advanced Endoscopy fellowship. Dr. Brugge has published more than 150 peer reviewed manuscripts in the field of gastrointestinal endoscopy.

Research

My clinical research program focuses on the early detection of gastrointestinal malignancy using advanced endoscopic techniques. Using endoscopic confocal microscopy, we compare the diagnostic accuracy of traditional endoscopy with mucosal resection to confocal microscopy in patients with high risk lesions arising from Barrett's esophagus. This clinical research program is conducted in the context of a national prospective multicenter trial (CEBE). We also have a protocol to determine the diagnostic accuracy of confocal microscopy in differentiating between adenomatous and inflammatory polyps.

We also use advanced endoscopic techniques for the detection of early pancreatic malignancy arising from cystic lesions of the pancreas. Endoscopic ultrasound is used to guide fine needle aspiration and optical coherence tomography (OCT) imaging. A variety of cyst fluid markers are used to enhance the diagnostic accuracy of EUS imaging alone. We have examined the accuracy of CEA and cytology in the diagnosis of mucinous cystic lesions. Currently we are investigating new molecular markers. OCT imaging is performed using a novel catheter placed within a EUS needle and guided into a cystic lesion.

For a list of current research projects, please visit Dr. Brugge's research page.

We are currently directing several clinical trials, including EUS guided Abraxane injection of pancreas cysts and a pilot study of endoscopic radiofrequency ablation of malignant bile duct strictures (visit the Clinical Trials website of the National Institutes of Health for more information).

Publications

View my most recent publications at PubMed

1. Pancreatic cystic neoplasms: diagnosis and management Yoon WJ, Brugge WR.Gastroenterol Clin North Am. 2012 Mar;41(1):103-18.

2. Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Mino-Kenudson M, Gut 2011;60:1712-1720

3. A prospective, randomized trial of esophageal submucosal tunnel closure with a stent versus no closure to secure a transesophageal natural orifice transluminal endoscopic surgery access site. Turner BG, Brugge WR.
Gastrointest Endosc. 2011 Apr;73(4):785-90

4. Oh HC, Brugge WR.EUS-guided pancreatic cyst ablation: a critical review. Gastrointest Endosc. 2013 Jan 12.

5. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Telford JJ, Carr-Locke DL, Baron TH, Brugge WR. Gastrointest Endosc. 2010 Nov;72(5):907-14.

6. High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than "positive" cytology. Pitman MB, Genevay M, Yaeger K, Chebib I, Turner BG, Mino-Kenudson M, Brugge WR. Cancer Cytopathol. 2010 Dec 25;118(6):434-40.

7. Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation.
DeWitt J, DiMaio CJ, Brugge WR. Gastrointest Endosc. 2010 Oct;72(4):862-6.

Physician-researchers discover keys to understanding pancreatic cysts

Up until the mid-1990s, physicians knew little about the relationship between pancreatic cysts and pancreatic cancer. But collaborative research conducted by gastroenterologists, surgeons, radiologists, and pathologists at the Massachusetts General Hospital Digestive Healthcare Center has led to a much greater understanding of pancreatic cystadenomas and what makes some cysts progress to cancer. These advances are opening up new therapies to target this deadly cancer early on, when it is most treatable.

New Radiology and Endoscopy Techniques Are Improving Treatment of Pancreatic and Biliary Disorders

Patients seeking care for pancreatic and biliary system disorders at Massachusetts General Hospital’s Digestive Healthcare Center receive the latest in diagnostic and therapeutic treatments from a collaborative team of experts, including gastroenterologists, interventional endoscopists, pathologists, medical oncologists, surgeons, radiation oncologists, and radiation therapists.