To Freeze or Not to Freeze?

When they concentrated on their own work, the U.S. surgeons had a hot time over a cool, cool question: Is it a good thing to freeze the human stomach to suppress the nagging pain of duodenal ulcer and--hopefully--to heal the ulcer?

Deceptively Simple. The argument began in 1958, when the University of Minnesota's aggressively pioneering professor of surgery, Owen H. Wangensteen, described a deceptively simple treatment for a notoriously stubborn illness. He and his colleagues get the patient to swallow a plastic tube with a balloon at the end. When the balloon is in the stomach, the doctors run frigid alcohol through it, at a temperature around --4DEG F. After an hour or so, the patient's stomach wall is presumably frozen. This freezing generally cuts down the stomach wall's ability to secrete hydrochloric acid, leaves less acid to spill into the duodenum and inflame any ulcers there. According to first reports by Dr. Wangensteen and Dr. Edward T. Peter, such treatment usually gives the ulcer victim freedom from pain for six months or longer. When it wears off, the freezing can be repeated.

Trouble was, the Minneapolis researchers proclaimed that stomach freezing was so safe that it could be done in a doctor's office. Enterprising industry put the machines into production, and now nobody knows exactly how many of them are being used--and misused--in the U.S.

New Ulcers for Old. A few extremists have charged that stomach freezing is so dangerous that it can be lethal; they insist it should be stopped. Less certain about their opposition, other surgeons are nonetheless bothered by a few cases in which freezing has caused the appearance of a new ulcer in the stomach itself--more dangerous than the original ulcer in the duodenum that freezing was supposed to relieve.

Last week a University of Oregon team argued that the Wangensteen method does not always freeze the stomach wall, and that when it does, it may do irreparable damage. The Oregon spokesman, Dr. E. Douglas McSweeney Jr., said that supercooling to a temperature just below freezing point might be more effective than the Wangensteen technique. They have tried this by putting a medical antifreeze, Dimethyl Sulfoxide, into the stomach or nearby arteries and cooling to 23DEG F.

Some Risks. Surgeon Wangensteen tried hard not to engage in polemics when he rose to answer his critics, but he was in no mood to pull punches. "Admittedly," he said, "the procedure has some risks," but he insisted that they are less than the risks of gastrectomy and similar operations to which ulcer patients might otherwise be subjected. True, even on his own service at the University of Minnesota hospitals, two patients have had perforated gastric ulcers after freezing, and a few have needed transfusions to tide them over temporary bleeding. But all told, 1,200 patients in three carefully planned research projects* have had their stomachs frozen, and there have been no deaths from the treatment.

Far from being ready to give up stomach cooling, Dr. Wangensteen is now trying to improve it by leaving out the balloon. In a new method, so far tested only on dogs, the doctors pass a plastic tube (actually, four tubes in one) into the stomach. Two of the tubes carry air to inflate miniature balloons that serve only as plugs at the upper and lower ends of the stomach. One of the two other tubes carries a cooling liquid, a Dow Chemical Co. silicone that sloshes around and gets into all the crevices of the stomach's seamy wall. The remaining tube carries the used coolant back to the pump. The first human trial of this method will come in late November.

* At the university hospitals in Minneapolis, at five Twin City hospitals, and at five university clinics from New York to Missouri.

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