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Clinical Care

The following are special clinical activities that the Gastroenterology physicians at UMass take part in:

Inflammatory Bowel Disease

Care of inflammatory bowel disease (IBD) at UMassMemorial Medical Center encompasses a multidisciplinary approach lead by gastroenterologists with extensive expertise in the evaluation and treatment of Crohn’s disease and ulcerative colitis. Our IBD-specialists focus on understanding the specific needs of each patient and help to direct an appropriate, thorough evaluation and treatment plan. We work in conjunction with nutrition specialists, radiologists, and colorectal surgeons (surgeons specializing in patients with inflammatory bowel disease) communicating closely on each patients specific needs. Our medical center offers all state-of-the-art tests and therapies for IBD with extensive experience in endoscopy and all therapies for IBD including:

  • Endoscopy – Colonoscopy, upper endoscopy, small bowel endoscopy including video capsule and Spirus, endoscopic dilation, chromoendoscopy
  • Medications – Individualized approach to biologic medications, medication monitoring
  • Radiology Imaging – CT and MRI including enterography protocols to assess the small intestine
  • Health Maintenance - Nutrition strategies, general health maintenance including vaccinations, bone density testing,  smoking cessation assistance
  • IBD Surgery – Minimally invasive techniques for bowel resection and J-pouch creation, treatment of perianal disease, ostomy care

Endoscopic Treatment of Barrett’s Esophagus

The Division of Gastroenterology provides endoscopic treatment of Barrett’s Esophagus. Barrett’s Esophagus is a pre-malignant change in the lining of the esophagus. In patients who develop dysplasia, the GI Division offers endoscopic treatment of the condition using Radiofrequency Ablation (RFA). RFA is normally performed as an outpatient and takes between 45-60 minutes to accomplish. This technique provides a “flash burn” of the diseased esophageal mucosa via specialized endoscopic equipment. Eradication of the dysplastic Barrett’s lining can normally be achieved after several RFA sessions.

Pancreatico-Biliary Disease

Pancreatico-biliary diseases are unique in the field of gastroenterology. They involve benign conditions (gallstone disease, strictures, acute and chronic pancreatitis) as well as neoplastic processes (IPMN, cholangiocarcinoma, and pancreatic cancer):

1). The biliary component of these diseases are dealt with through endoscopic retrograde cholangiopancreatography (ERCP) and choledochoscopy which combined are done here on a regular basis with over 500/year at our center. Recently, we have employed a newer technique-EUS-guided rendezvous for difficult ERCP with success.

2). The pancreatic component of these diseases is evaluated and at times treated using endoscopic ultrasound (EUS). Over the past few years, the proportion of therapeutic EUS dealing with these entities has included celiac blockade, endoscopic cystgastrostomy and endoscopic necrosectomy. Combined, over 750 of these procedures are performed at our center.

Peroral Endoscopic Myotomy (POEM)

Achalasia is a rare, but treatable condition of the esophagus secondary to failed relaxation of the lower esophageal sphincter when swallowing. The most common symptoms of achalasia are dysphagia (difficulty swallowing) to solids and/or liquids as well as regurgitation. Up until now the most commonly performed definitive treatment for this condition was laparoscopic surgery to cut the lower sphincter and improve swallowing. Peroral endoscopic myotomy (POEM) is a new endoscopic procedure to treat achalasia with comparable outcomes to surgery. The entire procedure is performed endoscopically without the need for surgery. The physician makes small incisions in the esophagus to create a tunnel. The lower sphincter is then identified and the tunnel is closed. We are currently performing this procesduer at our institution. Appointments can be made through the Division of Gastroenterology or the Department of Surgery.

Fecal Microbiota Transplantation (stool transplants) for Clostridium Difficile Infection

The Division of Gastroenterology has an active protocol for fecal transplantation run by Dr. Randy Pellish, Co-Director of the UMass Center for Microbiome Research. Patients presenting with either recurrent or refractory C. difficile infection can be candidates for fecal transplantation. Along with the UMass Center for Microbiome Research, we hope to one day understand how fecal transplant may be utilized in other diseases in the future.

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