Department of Gastroenterology Kun Li
I went to Mount Sinai Beth Israel Hospital during November 2016 to Feburary 2017 for a clinical observership program.
Mount Sinai medical center is one of the top medical centers in the United States, wihch has 8 hospitals. Mount Sinai Beth Israel Hospital is one of them. It was founded in 1890 in Lower East side of Manhattan, New York City.
The spectacular main building of the hospital is called Petre Division. The hospital has strict requirements for immunization. After providing a variety of immune vaccination certificates and a toxicology test, we finally got the staff card.
Department of Gastroenterology is located on the 17th floor of Baird Hall, where I met my tutor, Dr. L.Carr-Locke David. He was tall, courteous and accessible. He asked me some questions, and introduced the department and colleagues to me. With 5 operating rooms, its endoscopy unit can do a number of endoscopic surgeries.
The residency training system in the United States is strict. After undergraduate education, usually the top 15% students can apply for medical school. The students become resident doctors after medical education and examinations. The training time for residents varies from 3 to 7 years. The residents of GI need 3 years of training, and then 3 more years of training in the department of gastroenterology. The training process is very challenging. The residents are full of energy and optimism because doctors are highly respected and well paid in the United States.
There are about 30 to 40 endoscopic treatments in GI endoscopy unit every day. The most common one is colonoscopy. If intestinal polyps are identified, they are usually removed with snare or biopsy forceps. The incidence of esophageal squamous cell carcinoma and gastric cancer in the United States is lower than that in China while Barrett’s esophagus and esophageal adenocarcinoma are more common. So they pay more attention to monitoring Barrett’s esophagus. EUS and ERCP are the traditional strengths of the United States. EUS is mainly used for the diagnosis and treatment of biliary and pancreatic diseases as well as the level of tumor. ERCP is usually used to treat bile duct stones and tumors, similar practice in China.
Gastrointestinal endoscopy is generally operated by residents with attending doctors standing by to guide. Residents are keen on these opportunities, and attending doctors will give them a good guide. All of them are very friendly to the visiting doctors.
My tutor, Dr. David L.Carr-Locke is proficient in all endoscopic therapies. ESD, and POEM which are rarely done in the United States, he does very skillfully. When he performs POEM, there would be a lot of doctors standing by to observe. Two types of new technologies are currently use in the department. One is Cellvizio, the first probe type confocal laser endomicroscopy. Micro probe can enter the biopsy channel, in vivo to cell level direct observation also known as the “optical pathology”. It can be used in the judgment of gastrointestinal tumors, also in ERCP, EUS-FNA. The other one is called Overstich, a new endoscopic full-thickness suture with gastric equipment. When some gastric tumor needs endoscopic full-thickness resection of the stomach, the equipment may be used to suture. Although Overstich has not yet widely used in China, it is predictable that it has a broad prospect in the future.
New York Society for Gastrointestinal Endoscopy 40th Annual Course was held in 15th-16th, December 2016. The venue is located in the Marriott Hotel nearby the Times Square, Manhattan. The venue is very large, and there were about five hundred ginsengs. The content of the meeting involved almost all aspects of gastroenterology, including inflammatory bowel disease, chronic pancreatitis, reflux esophagitis, liver cirrhosis and early carcinoma of digestive tract, gastrointestinal bleeding and so on.Dr. Carr-Locke delivered a lecture entitled “The upper and lower GI emergency endoscopy in 40 years”. The live demonstration is also brilliant, ESD, EUS, ERCP and a variety of new developments.
The Gastroenterology of the US also has weaknesses, for instance, in the diagnosis and treatment of early gastrointestinal cancer. In recent years, great progress in this area has been achieved in China. Some doctors in the U.S. propose “From East to West”, which means to learn from the East.
During the visit to the United States, I not only learned new technologies but also updated new ideas about clinical medicine, all of which encourages me to provide a better service for the patients.