Clinical Programs In Gastroenterology & Hepatology at the Participating Hospitals

Stanford University Medical Center

Stanford Hospital is a 600-bed tertiary care facility, where Drs. Ahmed, Banerjee, Cartwright, Cooper, Garcia, Gerson, Gray, Gregory, Keeffe, Lowe and Van Dam are based. Most patients are referred by internists, surgeons and community physicians. Patients with complex gastrointestinal and liver diseases that present major diagnostic and therapeutic challenges are seen at Stanford. For example, appreciable numbers of patients with complex inflammatory bowel disease, biliary tract disease, end-stage liver diseases, abdominal pain of uncertain etiology and gastrointestinal complications of cardiac, renal, liver and bone marrow transplants are evaluated and treated in the Stanford Hospital and Clinics.

The clinical gastroenterology team, consisting of a first-year fellow, a medical resident, one or more students and a faculty attending, perform inpatient consultations on the various medical and surgical services. The fellow also works with faculty attendings to evaluate outpatients in 2-3 half-day gastroenterology clinics weekly. On a daily basis, the fellow performs endoscopic procedures on patients from the inpatient consult service and outpatient clinics under the supervision of a faculty attending. On average, 40-50 inpatient consults and 450 outpatient visits (1/4 new patients) are seen in the GI and general hepatology clinics per month. Approximately 200 endoscopic procedures are performed each month. Conferences include the weekly GI Clinical Conference “Grand Rounds”, weekly Journal Club, weekly didactic Topic Review, a monthly research conference, as well as radiology and pathology conferences for the consult team.

The Endoscopy Unit at Stanford Medical Center is in the process of undergoing expansion. The current four procedure rooms (prior to expansion) are equipped with state-of-the-art video endoscopic equipment, a computerized endoscopy report and image management system, an endoscopic ultrasound system, a Nd:Yag laser, capsule endoscopy, a small bowel enteroscope and the double balloon enteroscope. A fully equipped manometry unit is also part of the Endoscopy Unit. A team of highly trained endoscopy nurses ensures efficient performance of the full spectrum of diagnostic and therapeutic procedures. Over 5,000 procedures are performed in the Endoscopy Unit annually.

The Liver Transplant Program at Stanford consistently achieves top one-year patient survival rates and performs approximately 70-80 liver transplantations annually. There is an inpatient hepatology service. The four transplant hepatologists, Drs. Ahmed, Cooper, Garcia and Keeffe, supervise a second year GI fellow in the management of inpatient and outpatient liver transplant candidates and recipients during their rotation on the Hepatology Service.

Santa Clara Valley Medical Center (SCVMC)

Santa Clara Valley Medical Center , located 25 minutes south of Stanford, is a 500-bed teaching hospital with a diverse patient population. SCVMC is owned and operated by the County of Santa Clara and serves its indigent population. SCVMC is also a medical resource and referral center for difficult problems in multiple medical and surgical areas. Currently, more than 120 postdoctoral trainees in various specialties, as well as medical students from Stanford and other medical schools, are based at SCVMC at any one time.

Drs. Cummings, Davila and Kramer comprise the current full-time faculty of the SCVMC Gastroenterology Section. They are supported by 13 private practice gastroenterologists who teach in the clinics and participate in conferences. Like all subspecialty medical services at SCVMC, gastroenterology functions as a consulting service for inpatients and outpatients. The first-year fellow based at SCVMC works closely with each of the full-time attendings, a medical resident and a medical intern on the consult service. Diagnostic capabilities and services include: esophageal motility, ambulatory pH studies, anorectal manometry, endoscopic procedures (diagnostic and therapeutic, including ERCP), liver biopsy, various types of dilation, and pancreatic function tests. The conference schedule includes a weekly GI pathology conference, weekly combined GI Grand Rounds (located at Stanford with case presentations from SCVMC once per month), and twice monthly gastroenterology-surgery conference, radiology conference and journal club. The clinical load is heavy and the spectrum is broad. More than 160 new consults (46% inpatient) and ~300 patient return visits are seen per month. In addition, more than 160 endoscopic procedures and miscellaneous studies are performed each month. The first-year fellow, medical resident and medical intern share night-call responsibilities, with attending back up.

VA Palo Alto Health Care System (VAPAHCS)

The VA Palo Alto Health Care System is a 900-bed, multi-campus integrated facility of hospitals and clinics, and a tertiary referral center. It is also one of the largest VA centers in the country and has won multiple VA distinction such as designated Centers of Excellence in 6 programs and one of the four Cooperative Studies Program Coordinating Centers in the nation. The Palo Alto campus, located four miles from the Stanford University Hospital , has active medical, psychiatric and surgical services, a spinal cord injury center, blind rehabilitation unit, geriatric research and education center and two clinical research centers. A new, state-of-the-art hospital opened on the Palo Alto VA campus in 1997. All teaching services are fully integrated with Stanford University Medical Center , and the two hospitals share a common housestaff. The Palo Alto VA Medical Center is the major referral center for VA satellite campuses that include the Livermore VA Medical Center, the San Jose and Monterey Clinics.

Drs. Cheung, Friedland, Greenberg, Matsui, Omary andSoetikno, are based at the VAPAHCS. In addition, eight gastroenterologists from the community participate in teaching and consultative activity in the clinics, wards and Endoscopy Suite of the Palo Alto VA Medical Center.

The Gastroenterology and Hepatology Section serves mainly a consulting function to inpatients and outpatients. The spectrum of diseases is wide and quite complex. A variety of services to evaluate and treat patients are available. These include a full range of diagnostic and therapeutic procedures (endoscopy, colonoscopy, ERCP, endoscopic ultrasound, esophageal, gastric outlet and colonic dilation and stent placement, ) and advanced endoscopic procedures such as mucosal resection of large lesions and localized neoplasm. The endoscopy unit is also very active in the development of new endoscopic techniques and hardware such as oximeter to measure tissue oxygenation of the GI tract. The conference schedule consists of a weekly conference with Surgery and Radiology, the weekly combined GI Grand Rounds at Stanford, and weekly pathology conference to review active cases. Clinical activities within the VAPAHCS have increased significantly over the past few years. For example, more than 3,000 endoscopic and other GI procedures, 500 inpatient and over 4,000 outpatient GI consultations are performed annually. There is also an active research program in hepatology with main focus on chronic hepatitis C, including phase 1-4 clinical trials on anti-viral therapy in the clinical study unit, and basic research on virology and immunology in the lab. Both Dr. Greenberg and Omary run a large research lab at the VAPAHCS with funding support from both the NIH and VA.