A. Malignant diseases

I. Gastric Cancer

Objectives:

The treatment of gastric cancer is complex and involves multiple specialists from different expertise to provide holistic care for the patient. Our medical team utilise Enhanced Recovery After Surgery (ERAS) in Gastric Cancer and Esophagus & Cardioesophageal Junction Cancer treatment, with the objective of reducing the length of hospital stay, reduce post-surgical complications and overall cost.

Members:

Endoscopists:

Diagnostic gastroscopy
  • Narrow band imagine (NBI) endoscopy technology for visualization of early gastric lesion.
  • Endoscopic Ultrasound (EUS) is desirable for biopsy (currently not available in any northern region private institution).
Therapeutic endoscopy
  • Endoscopic stenting for palliation of gastric outlet obstruction.
  • Endoscopic enteral nutrition tube placement.

Radiologist:

  • Conventional contrasted CT scan for staging

Nuclear Medicine Specialist:

  • PET-CT whole body with IV contrast for advanced staging

Upper Gastrointestinal Surgeon:

  • Conventional laparotomy, radical gastrectomy & D2 lymphadenectomy.
  • Minimal invasive (laparoscopic) radical gastrectomy & D2 lymphadenectomy.

Oncologist:

  • Pre-operative (neoadjuvant) chemotherapy for advanced cancer.
  • Pre-operative (adjuvant) chemotherapy or chemoradiotherapy cancer treatment.
  • Palliative care.

Dietician:

  • Optimization of pre-operative nutrition.
  • Post-operative (post gastrectomy) nutrition care.

II. Esophagus & Cardioesophageal Junction Cancer

Members:

Endoscopists:

Diagnostic esophagoscopy
  • Narrow band imagine (NBI) endoscopy technology for visualization of early gastric lesion.
  • Endoscopic Ultrasound (EUS) is desirable for biopsy (currently not available in any northern region private institution).
Therapeutic endoscopy
  • Endoscopic stenting for palliation of esophagus obstruction.
  • Endoscopic enteral nutrition tube placement.

Nuclear Medicine Specialist:

  • PET-CT whole body with IV contrast for staging

Upper Gastrointestinal Surgeon:

  • Conventional radical esophagogastrectomy with 2 or 3 field lymphadenectomy.
  • Minimal invasive radical esophagogastrectomy with 2 or 3 field lymphadenectomy.

Oncologist:

  • Pre-operative (neoadjuvant) chemotherapy for advanced cancer.
  • Pre-operative (adjuvant) chemotherapy or chemoradiotherapy cancer treatment.
  • Palliative care.

Dietician:

  • Optimization of pre-operative nutrition.
  • Post-operative (post esopagogastrectomy) nutrition care.


B. Benign Diseases

I. Refractory Gastroesophageal Reflux Disease (GERD)

Objectives:

In Penang Adventist Hospital, we provide one stop treatment for Refractory Gastroesophageal Reflux Disease (GERD) and Esophageal Motility Disorder (Achalasia), including wholistic medical and surgical treatment, as well as management of mortality disorder. We gathered different specialists such as gastroenterologist, radiologist, endoscopist, upper gastrointestinal surgeon and dietitian to provide a wholistic care for our patient.

Members:

Gastroenterologist:

  • Diagnostic upper endoscopy
  • Medical treatment for Refractory Gastroesophageal Reflux Disease (GERD).

Radiologist:

  • Videofluoroscopy barium swallow study

Upper Gastrointestinal Surgeon:

Diagnostic upper endoscopy
Therapeutic endoscopy
  • Endoscopic Balloon Radiofrequency Ablation for Pre-cancerous Barrett’s Esophagus.
Esophageal function study
  • Esophagus high resolution impedence manometry (HRiM).
  • Ambulatory pH-Impedence study.
Anti-reflux surgery
  • Laparoscopic Hiatal Hernia Repair & Fundoplication

Dietician:

  • Post-antireflux surgery nutrition care.

II. Esophageal Motility Disorder (Achalasia)

Members:

Endoscopists:

Therapeutic endoscopy
  • Endoscopic serial balloon dilatation

Upper Gastrointestinal Surgeon:

Therapeutic endoscopy
  • Peroral endoscopic mytomy (POEM)
Minimal invasive surgery
  • Laparoscopic Heller’s Cardiomyotomy
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