I am Dr.
Nadim Haddad,
the chief of Gastroenterology at MedStar Georgetown University Hospital.
I'm also the executive physician director at MedStar Health GI Services.
In our department, we care for a wide
variety of patients with GI diseases,
from pancreaticobiliary disorders
to esophageal and inflammatory bowel diseases.
We provide a comprehensive care
approach, multidisciplinary approach to our patients with strong
spirit of collaboration among our colleagues in other disciplines.
I chose to go into gastroenterology
for these couple of specific reasons
because it affords me the opportunity to not only to make diagnosis,
but also to intervene and offer
some treatment via endoscopy.
I look at it as a hybrid between medicine and surgery.
You're able to not only to diagnose,
but also to intervene
and endoscopy allows us to do that
and also to diagnose
problems and also treat
and save the patients,
you know, major operations.
I can tell you that
the future looks very, very appealing and exciting
based on what we have seen in the last ten to 15 years.
There has been so much growth
in research and development in the field of endoscopy.
So, we're able to better diagnose,
to more accurately diagnose conditions
early on before they turn into cancer.
And this will allow us to intervene earlier
and prevent cancer from developing and prevent
avoid major interventions like
surgery, chemotherapy, or so forth.
The impact that we have on patients' lives
is such a rewarding experience to see
patients benefit from what we do.
And the challenge of always trying to do better.
The challenge of trying to improve our capabilities,
whether in terms of the diagnosis, making the diagnosis earlier,
making sure we have the newest technology
to make a better, earlier diagnosis.
At the same time, having the tools to intervene early and help the patients.
And the fact that we're engaged in
a lot of clinical research, leading the clinical research
will provide our patients
with the best care possible.
The fact that the GI Department
has made the decision to create
centers of excellence around
specific diseases makes it unique.
So, we have established multiple centers of excellence
within the department, one to focus on pancreaticobiliary diseases,
one that focuses on inflammatory bowel disease,
and another one around esophageal diseases and liver diseases.
So, those are unique and the fact that we have access
to multidisciplinary approach to patient care
also benefits our patients
in order to provide a more comprehensive care
in an efficient way and an efficient setting
like MedStar Georgetown.
There are specific criterias.
It's a long list of
requirements,
but the main ones are that are that
you have to have the clinical expertise and you have to have,
in addition to
just the clinical expertise, to have
the research component that goes with it
and the other tools
necessary to create those those centers
and also maintain the quality,
looking at your outcomes also.
It's not enough to
just call yourself a center of excellence, but you have to show results
that you are living up to those expectations.
It's probably best to walk you
through a scenario, a clinical scenario.
A patient is referred with a suspected pancreatic tumor,
so the patient comes in and gets evaluated
by our team in GI. Undergoes an endoscopic ultrasound
to make the diagnosis.
And if we determine
that it is cancer, then
the multidisciplinary team is looped in
and the team includes a surgeon,
a radiologist that is dedicated
to patients with
pancreatic or biliary diseases,
oncologist, the radiation oncologist,
the pathologist and the team of,
you know, fellows and residents that participate and learn.
So, the case is presented and shared,
and then everybody weighs in and we come up with a consensus
recommendation.
And then that recommendation is
transmitted to the patients,
whether it's recommended to go to surgery.
Then they are scheduled to see a surgeon.
So, all this is expedited.
So, a lot of work goes behind the scenes that patients may not be aware of.
They just see the end result.
If the recommendation is to go a different path,
you know, go to through oncology, radiation oncology, then they're scheduled
to be seen by those specific specialists to start treatment.
This is one of the unique
centers of excellence.
It's the only one in the D.C.
metro area.
And the center consists of physicians,
nurse practitioners, APCs,
and the nurse specialist.
And in addition to seeing patients they have,
they carry on a multidisciplinary approach
They have a monthly conference
where unique cases are presented
and the pathologists are pulled in and radiologists are included in those.
And the colorectal surgeons are included
in these multidisciplinary discussions
and conferences.
So, again, this translates into a more efficient way of
coordinated care per se.
So, you know, the patients are seen
whether they come through surgery or through GI.
There's always that line of communication
and coordinated care
in terms of providing the best care to the patients.
This is
a center that I've been involved with,
and this is sort of an area of my expertise and interest.
So, there's a strong collaboration between us
and the surgeons and
we, you know, we coordinate
the evaluation, the diagnostic workup
and therapeutic interventions and
any other recommendations for our patients.
So, the patients are evaluated by surgeons,
oncologists, pathologists are involved, radiologists
who are dedicated to seeing these types of patients.
And we focus on
keeping track of our outcomes.
Is this technique benefiting our patients?
Are we having good outcomes?
Good results?
Should we do something different?
Is there something...we're always looking at
the literature. Is there something new in the literature?
Is there something new that we need to adopt?
Do we need to change our approach, our practice?
At the same time, you know, we are involved in clinical trials
that we as a group, as a multidisciplinary group,
feel we need to to be involved in.
We have a strong
interest in GI cancer as a result of having Lombardi Cancer Center
based at MedStar Georgetown. And,
you know, with the
with our interest in GI and GI cancer
and there's a strong collaboration between between the two.
And as a matter of fact, we have a new faculty member,
and her focus is GI cancer,
looking at patients with hereditary genetic cancer.
And that's Dr. Kanth.
And, you know, the whole
theme is about how to manage
those complex cases.
It's not enough to just diagnose patients
with cancer. We're looking at how to prevent it.
You know, do we diagnose it early or even diagnose it before it
it develops?
So, you know, an example is there are families
where patients have, you know, each member has a type of cancer.
And, you know, somebody with pancreatic cancer goes to see a pancreatic
specialist, another one with a uterine cancer,
they go to see a gynecologist. So, multiple members of the families
have different cancers, but nobody is aware of the connection.
So, it takes somebody
who's interested in GI cancer to connect that and then
shed some light about
the fact that there is genetic predisposition in that family.
So, it's important to bring them in and make sure they have genetic
evaluation and genetic screening.
And it's important not just for those members that have cancer, but for
offsprings.
When do you start screening? Do you screen early?
Do you screen at the age of 20 or even earlier?
So, that's the importance of having somebody with a focused
interest on a GI cancer.
The multidisciplinary approach is unique.
But in addition to that, our motility lab is well-established
and has been in existence for a long time and a lot of experience.
30 years worth of experience in looking at motility
disorders, dysfunction of the esophagus,
which can be challenging, trying to,
you know, chest pain, trying to differentiate chest pain from a
GI source versus chest pain from a cardiac source.
And sometimes that requires,
you know, a cardiac evaluation, first of all, and then,
you know, some advanced testing for the esophagus.
And we're fortunate to have
a faculty members here who are interested in this
disease.
And we have the technology to support that.
As of note is that we recently acquired
a tool called Endo Flip, which is the most sophisticated way of
assessing the pressure in the esophagus, the motility of the esophagus, real time.
You know, you can get an assessment
whether the esophagus is working well or not right away.
You can use it when the surgeons are doing surgery.
Did the surgeon achieve the goal or not?
Should they adjust the the surgery while they're still in the operating room?
So, these are just a few of the advantages.
One of our main
endoscopic techniques
is endoscopic ultrasound. And I happen to be one of the people
that learned it early on,
started about 20 some years ago.
And MedStar Georgetown has been the premier in these
types of techniques.
So, we adopted the technique early, and
what it does is that it allows us to look not only inside the GI tract,
but outside the GI tract within the wall.
So, as an example, you know, the pancreas is outside the stomach
and it's been difficult to get a closer
look at the pancreas or get a biopsy of the pancreas.
But with endoscopic ultrasound, that's relatively easy nowadays.
You know, you go with the endoscope inside the stomach and then obtain the biopsy.
And over the years, we maintain that skill.
Endoscopic ultrasound has many advantages, and one of the main ones
is that it allows us to stage cancer
in the esophagus and the stomach and the rectum
and the pancreas and the biliary tree
and those are important information to have
when a decision is being made on how to treat a patient.
It also, in the area of the pancreaticobiliary
arena, it allows us to determine
if a pancreatic lesion is benign
versus malignant.
If it's benign, no need to surgery and sometimes no need to follow up,
which is a big relief to those patients.
And if it's cancer, you know, catch it early and act on it early.
Also, in the recent
years, we've been able to turn it into
an interventional technique not just diagnostic.
We can do so much with this technology,
managing patients with pancreatitis.
You know, instead of going to surgery
for, you know, debridement, for resection, you know, this can be done via
ultrasound. This is just one example.
And there are many, many more.
And one of the techniques, original techniques
that we pioneered at MedStar Georgetown is
working with our colleagues in CyberKnife, in radiation oncology,
we were able to develop a technique where we can plant the seeds
which help the CyberKnife
to direct the beam, the radiation beam, exactly
where the tumor is.
It's very rewarding.
And really, this is what what keeps us
engaged and growing and looking to do better and better.
And so many times we hear it from patients when they come
to get treated at MedStar Georgetown.
They feel the culture, they appreciate the culture.
And they feel that they get a comprehensive care.
You know, they feel that we don't just treat
the disease or the organ or fix a problem.
We look at the patients as a whole and also
they feel the coordination
between the different specialists, the different
doctors and nurses
within the organization.
And I just want our patients to know
that we have great doctors that care, great nursing
staff, great nurse practitioners.
We have great associates, great people, great specialists
that speak to each other in order to provide the best care possible.