GASTROENTEROLOGY |
CLINICAL PROGRAMS
|
Division Chief: Michael V. Sivak, Jr., M.D.
Under the leadership of Michael V. Sivak, Jr., M.D., the Division of Gastroenterology physicians are among the nation’s leaders in the prevention, diagnosis and treatment of diseases of the digestive tract and liver. Ranked as one of the best programs in the country by U.S. News & World Report, the Division’s physicians pursue a comprehensive, academic approach with the provision of a full range of consultative services from the simplest to the most complex. The Division of Gastroenterology acts as a consultative, tertiary care referral center to numerous other medical institutions and gastroenterology practices across the mid-west. The Division emphasizes close interaction with referring physicians, coupled with sympathetic understanding of the patients’ needs in the context of their disease.
AREAS OF DISTINCTION
Consultative Services
· General gastroenterology and hepatology
· Preventative gastroenterology and hepatology
· Tertiary care referral
· Liver transplantation
Endoscopic Services
Endoscopy Unit Medical Director, UHC: Richard C.K. Wong, M.D.
Endoscopy Unit Medical Director, VAMC: Ananya Das, M.D.
The Division of Gastroenterology prides itself in the state-of-the-art delivery of a full spectrum of diagnostic and therapeutic endoscopic services in a manner that is both rapid and efficient, including:
· Colonoscopy (including colonoscopy screening for colorectal cancer)
· Esophagogastroduodenoscopy (EGD) (including screening for Barrett esophagus)
· Flexible sigmoidoscopy
· Wireless capsule endoscopy for the evaluation of obscure GI bleeding
· PEG, PEG/J for enteral feeding and gastric decompression, and direct PEJ (DPEJ)
· Nasoenteric feeding tube placement
· Dilatation of strictures under direct and fluoroscopic guidance
· Endoscopic variceal band ligation
· Endoscopic tattooing for marking important GI track lesions
Open-Access Scheduling of Endoscopic Services (without need for prior GI consultation)
For many years, the Division of Gastroenterology has successfully employed a system of open-access scheduling of basic, diagnostic endoscopic services (EGD, colonoscopy, flexible sigmoidoscopy, 24 hour esophageal pH monitoring, esophageal manometry and various breath tests), for certain approved medical indications for the procedures. This simple and straightforward system allowed the referring physician to bypass a formal GI office consultation, if it was not required. Open-access endoscopic scheduling has worked well and continues to be frequently used by all types of referring physicians. In order to use this system, all the referring physician needs to do is to complete a brief requisition form and fax it to our central scheduling office, who will then proceed to contact the patient, obtain any medical pre-authorization that is required, and schedule the procedure. Following completion of the endoscopic procedure or test, a formal procedure or test report will be sent back to the referring physician, for subsequent patient follow-up. This system is not meant to and does not provide formal GI consultation. If the referring physician and/or patient desires, a formal GI consultation can be rapidly and easily arranged.
Advanced Therapeutic Endoscopy
Chief of the Division of Gastroenterology, Michael V. Sivak, Jr., M.D., and four other faculty members have specialized, advanced training in therapeutic endoscopy. Dr. Sivak is Editor-in-Chief of the medical journal, Gastrointestinal Endoscopy, which is the preeminent journal in its field in the U.S., and possibly worldwide. Two other faculty members of the Division of Gastroenterology are Associate Editors of the Journal. In addition, Dr. Sivak is the Editor of the main reference textbook in this area, Gastroenterologic Endoscopy. This concentration and focus of endoscopic expertise in one single institution is exceptional and permits the practice of state-of-the-art gastrointestinal endoscopy at University Hospitals of Cleveland and the VA Medical Center.
· E.R.C.P.
§ Therapeutic biliary and pancreatic ERCP
§ Advanced techniques in diagnostic tissue sampling
§ Cholangioscopy and pancreatoscopy
§ Intraductal EUS
§ Mechanical lithotripsy
§ Metallic biliary and pancreatic stent placement
§ Endoscopic drainage pancreatic pseudocyst
§ Endoscopic therapy of the minor papilla in pancreas divisum
§ Sphincter of Oddi manometry
· Endoscopic ultrasound (EUS) and EUS with fine needle aspiration (FNA)
§ Diagnostic and therapeutic EUS
§ Evaluation of diseases affecting the pancreas, esophagus, stomach, duodenum, colon and rectum
§ Tumor staging (pancreas, esophagus, stomach, rectum and lung)
· Small bowel push enteroscopy (diagnostic and therapeutic)
· Argon plasma coagulation (APC) for treatment of GI bleeding lesions
· Laser photocoagulation for esophageal cancer and for GI bleeding lesions
· Photodynamic therapy (PDT) for esophageal cancer
· Metallic enteral stent placement for palliative (non-surgical) treatment of malignant obstruction of the esophagus, stomach, duodenum and colon
· Endoscopic mucosal resection (EMR) as curative (non-surgical) treatment of selected, early-staged cancers
· Achalasia treatment, including BOTOX injection and pneumatic balloon dilation
· Endoscopic clip application for bleeding lesions and for small bowel feeding tube placement
· Use of endoscopic Doppler ultrasound in guiding the treatment of GI bleeding lesions
DIGESTIVE DISORDERS
The Division of Gastroenterology diagnoses and treats all types of digestive conditions such as:
· GERD (including atypical manifestations)
· Barrett esophagus
· Peptic ulcer disease and its complications
· Acute, chronic, recurrent and obscure GI bleeding
· Gastrointestinal tumors (esophagus, stomach, duodenum, small bowel and colorectal)
· Pancreatic tumors
· Acute and chronic pancreatitis
· Sphincter of Oddi dysfunction
· Inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis and their acute and long-term complications
· Management of IBD in pregnancy
· Chronic diarrhea (including microscopic colitis)
· Recurrent Clostridium difficile colitis
· Acute and chronic hepatitis
· Cirrhosis and complications of portal hypertension
· Management of pregnancy-associated liver disease
· Liver tumors
· Biliary tract diseases and tumors
· Motility disorders such as gastroparesis, achalasia and nutcracker esophagus
· Irritable bowel syndrome (IBS)
Additional Services
· Liver biopsy
· Large volume paracentesis
· Specialized breath testing for H. pylori infection, lactose intolerance and small bowel bacterial overgrowth
· Motility studies (esophagus)
· pH monitoring of the esophagus (including the new BRAVO system)
LIVER DISEASE AND LIVER TRANSPLANTATION
Liver Transplant Medical Director, UHC: Anthony Post, M.D.
The liver transplant program at University Hospitals of Cleveland includes an inpatient hepatology service and specific outpatient clinics for patients with chronic liver disease. A team of transplant hepatologists, nurse coordinators, nurse practitioners, and transplant surgeons care for a growing population of liver transplant candidates and recipients. Aspects of clinical expertise in hepatology include the management of acute and chronic liver disease, adult and pediatric liver transplantation, comprehensive treatment of Hepatitis A, B and C, coordinated multimodality approach to management of liver tumors, and radiological evaluation and therapy of chronic liver disease. The diagnostic and treatment modalities include ultrasound, liver biopsy, transjugular intrahepatic portosystemic shunt (TIPS), Doppler scanning of hepatic and renal blood flow, MRI and PET scans. Several current clinical trials for chronic viral hepatitis, transplant immune suppression, and management of patients with fulminant liver failure are ongoing.
Procedures include (but are not limited to):
· Adult and pediatric liver transplantation
· Esophageal variceal band ligation
· Liver biopsy
As well as diagnosis and treatment for:
· Acute and chronic hepatitis
· Fulminant liver failure
· Variceal bleeding
INFLAMMATORY BOWEL DISEASE
The Division of Gastroenterology offers expert evaluation and treatment for patients with inflammatory bowel disease (IBD). Four full-time faculty members are dedicated to providing the latest advances in diagnosis and management to patients with Crohn’s disease and ulcerative colitis, including infliximab (Remicade) therapy, genetic, pharmacogenomic and serologic analysis, and wireless capsule endoscopy. Comprehensive consultative and ongoing care is readily available, directed not only at symptom management , but also at improving the overall quality of life for individuals with IBD. In addition, all patient care is provided in close cooperation with expert colorectal surgeons, gastrointestinal pathologists, and radiologists. Patients with IBD have the opportunity to enroll in a wide variety of ongoing IRB-approved clinical trials.
Medical Directors and Committee Participation (UHHS and VAMC)
Amitabh Chak, MD
Endoscopy Medical Director, UHC, 1995-2003
Task Force for Pancreatic Cancer pathway, UHC, 2001-
DOM Quality Improvement Committee, 2003 -
DOM Practice Advisiory Group, 2002-2004
Gregrory S. Cooper, MD
DOM Quality Improvement Committee, 1993 -
Ananya Das, MD
Endoscopy Medical Director, VAMC, 2003 -
Jeffry A. Katz, MD
Pharmacy and Therapeutics Committee, UHC
Chair, Nutrition Subcommittee of the Pharmacy and Therapeutics Committee, UHC
Margaret Kinnard, MD
Section Head, Gastroenterology Division, VAMC
Nutrition Committee, VAMC
Tumor Board Committee, VAMC
Sean Lacey, MD
Medical Advisory Committee, UHHS Westlake
Levine, A.
Member, Medical Scientist Training Program (MSTP; MD/PhD) Steering Committee, 1999-
Member, Faculty Council, Case Western Reserve University School of Medicine, 1999-2002
Member, Faculty Council Steering Committee, Case Western Reserve University School of Medicine, 2000-2002
Member, Pharmacology Training Program Steering Committee, 2001-
Member, Case Western Reserve University School of Medicine Committee for Appointments, Promotions, and Tenure, 2003-
Member, Case Western Reserve University Faculty Senate, 2003-
Anthony B. Post, MD
Liver Transplant Medical Director, UHC
Lab Liaison Commiette, UHC
Richard C.K. Wong, MD: Endoscopy Medical Director, UHC
Service Activities
Chak, A.
Whipple support group physician panel
