MDT for Upper Gastrointestinal Surgeries
At Penang Adventist Hospital, we practise multidisciplinary approach for our cancer patients and in other relevant areas such as gastrointestinal diseases. The Multidisciplinary Team (MDT) is made up of professionals from different clinical backgrounds including surgeons, oncologists, radiologists, nuclear medicine specialist and other medical professionals to contribute their best advice for the benefit of our patients. We believe healthcare towards our patient should be patient-centric with holistic approach. Hence our multidisciplinary team also consists of psychologist to help patient to cope with their emotional and psychological needs, as well as dietitian to help patients on diet planning for their nutritional wellbeing.
Below are the types of gastrointestinal diseases.Malignant diseases
A. Gastric Cancer
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.
Team members:
1. 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.
2. Radiologist:
- Conventional contrasted CT scan for staging
3. Nuclear Medicine Physician:
- PET-CT whole body with IV contrast for advanced staging
4. Upper Gastrointestinal Surgeon:
- Conventional laparotomy, radical gastrectomy & D2 lymphadenectomy.
- Minimal invasive (laparoscopic) radical gastrectomy & D2 lymphadenectomy.
5. Oncologist:
- Pre-operative (neoadjuvant) chemotherapy for advanced cancer.
- Pre-operative (adjuvant) chemotherapy or chemoradiotherapy cancer treatment.
- Palliative care.
6. Dietician:
- Optimization of pre-operative nutrition.
- Post-operative (post gastrectomy) nutrition care.
B. Esophagus & Cardioesophageal Junction Cancer
Team members:
1. 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.
2. Nuclear Medicine Physician:
- PET-CT whole body with IV contrast for staging
3. Upper Gastrointestinal Surgeon:
- Conventional radical esophagogastrectomy with 2 or 3 field lymphadenectomy.
- Minimal invasive radical esophagogastrectomy with 2 or 3 field lymphadenectomy.
4. Oncologist:
- Pre-operative (neoadjuvant) chemotherapy for advanced cancer.
- Pre-operative (adjuvant) chemotherapy or chemoradiotherapy cancer treatment.
- Palliative care.
5. Dietician:
- Optimization of pre-operative nutrition.
- Post-operative (post esopagogastrectomy) nutrition care.
Benign Diseases
I. Refractory Gastroesophageal Reflux Disease (GERD)
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.
Team members:
1. Gastroenterologist:
- Diagnostic upper endoscopy
2. Radiologist:
- Videofluoroscopy barium swallow study
3. 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
4. Dietician:
- Post-antireflux surgery nutrition care.
II. Esophageal Motility Disorder (Achalasia)
Team members:
1. Endoscopists:
Therapeutic endoscopy
- Endoscopic serial balloon dilatation
2. Upper Gastrointestinal Surgeon:
Therapeutic endoscopy
- Peroral endoscopic mytomy (POEM)
Minimal invasive surgery
- Laparoscopic Heller’s Cardiomyotomy
