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Gastroenterology & GI Surgery — Baylor St. Luke's Medical Center

Innovative health care in Houston, Texas

Baylor St. Luke’s Medical Center is an internationally recognized leader in innovation, research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world.

Our strong alliance with Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve. 

Baylor St. Luke’s Medical Center is also the first hospital in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award six consecutive times.

Training latest advanced procedures in GI endoscopy

Dr. Mohamed Othman, medicine subspecialities service line leader at Baylor St. Luke's Medical Center, along with members of the Texas Interventional Endoscopy Group led the 4th annual Transluminal Workshop, held on May 3-4, 2024 at Baylor St. Luke's. The purpose of the workshop was to educate community GIs on the latest advanced endoscopy procedures.

The Texas Interventional Endoscopy Group was formed in 2016 with a vision to increase education and collaborative training for techs, nurses, GI fellows, and GI practitioners with an interest in advanced endoscopic procedures. 

Dr. Othman and other Baylor physicians performed live endoscopy cases in the workshop, where they showcased the advanced capabilities at Baylor St. Luke's Medical Center. 

In 2024, Dr. Othman, along with Baylor surgeons Dr. Jawaid and Dr. Keihanian, reached a milestone in completing 1,000 Endoscopic Submucosal Dissection procedures.  

Study increases understanding of why recurrent meningiomas are aggressive

Researchers at Baylor College of Medicine and Washington University School of Medicine in St. Louis have identified clinical and genetic predictors of multiply recurrent meningiomas (MRMs), a most aggressive form of this common brain tumor. Published in Science Advances, the study opens new opportunities for future development of potential biomarkers and therapeutic agents for these challenging tumors.

“Although meningiomas are often effectively treated with surgery and radiation, in about 20% of cases these tumors behave aggressively and recur. A smaller subset of these resist treatment and recur multiple times,” said co-corresponding and co-senior authors Dr. Akash J. Patel, associate professor of neurosurgery and member of the Dan L Duncan Comprehensive Cancer Center at Baylor. 

“We wanted to find out if meningiomas that come back multiple times and require multiple treatments are different at the molecular level from brain tumors that don’t come back,” said co-corresponding and co-senior authors Dr. Albert H. Kim, August A. Busch Jr. Professor of Neurosurgery and director of the Brain Tumor Center at WashU Medicine. “Knowing which meningiomas will come back again and again will fundamentally change how we treat them from the very beginning.”

The team studied the tumors of 1,186 patients with primary meningiomas. Thirty-one of these primary tumors went on to be MRMs. The researchers compared clinical and genetic characteristics of MRM with those of non-recurrent meningiomas (NRM).

“We found that, compared to NMR, MRM are more numerous, larger and more common in men than in women,” Patel said. 

The researchers analyzed the chromosomes of the tumors and found that MRMs have greater chromosomal instability and loss than non-aggressive meningiomas. “It has been well established that chromosomal instability is present in many human cancers and that increased instability has been associated with more aggressive cancers,” Patel said. “Our finding that greater chromosomal instability is associated with MRMs, a more aggressive form of meningiomas, is an important point to study in the future.” 

In addition, the researchers found increased DNA methylation in MRM’s genomes, an indication that the expression of certain genes is different in these tumors. “We discovered that the expression of gene EDNRB is reduced in MRM tumor cells,” Patel said. “When we knocked down this gene in meningioma cells in the lab, the cells proliferated more. Taken together, this first clinical and molecular investigation of MRMs provides a deeper understanding of these highly aggressive tumors.”

“This information will teach us how to fight them better with precision medicine and lays the foundation for predicting at the time of the first surgery which meningiomas will most likely recur repeatedly,” Kim said.
Drs. Sangami Pugazenthi and Bhuvic Patel at WashU Medicine and Dr. Collin W. English at Baylor are co-first authors of the work.

Other contributors to this work include William A. Leidig, Kyle P. McGeehan, Colin R. McCornack, Shinghei Mok, Markus Anzaldua-Campos, Shervin Hosseingholi Nouri, Kaleigh Roberts, Ajay Chatrath, A. Basit Khan, Ron Gadot, Hiroko Yano, Tiemo J. Klisch, Akdes S. Harmanci and Albert Kim. 

This work was supported by the Alvin J. Siteman Cancer Research Fund GF0010218, the Duesenberg Research Fund, Washington University School of Medicine Dean’s Medical Student Research Fellowship for the MD5 Yearlong Research Program, 2023 NREF Medical Student Summer Research Fellowship, NINDS - K08NS102474 and the Roderick D. MacDonald Fund.

Elevating mean arterial pressure target may boost survival in cirrhosis with septic shock

A recent study led by Baylor researchers investigated the association between MAP targets and 28-day survival and recovery after acute kidney injury (AKI) among patients with decompensated (advanced) cirrhosis.

Maintaining a mean arterial pressure (MAP) target of 65 mmHg or greater is central to the management of sepsis in patients without cirrhosis to improve survival and kidney function. 

Researchers sought to find an optimal MAP target for patients with decompensated cirrhosis with septic shock after acute kidney injury (AKI). Their study examined data from 1,729 patients admitted to the ICU between 2014 and 2022. 

Their findings concluded that MAP is strongly associated with patient mortality. Increasing the mean arterial pressure target from 55 mmHg to 75 mmHg decreased the odds for 28-day mortality by 85% in patients with decompensated liver cirrhosis with septic shock. An increase from 65 mmHg also decreased the odds for acute kidney injury nonrecovery by 8%.

The researchers also reported that odds of mortality were significantly lower combining a MAP target of 75 mmHg with early fluids and antibiotics.

Results from the study could lead to a more structured approach to managing MAP in this population, resulting in improved patient outcomes, enhanced clinician guidance and potentially more efficient use of health care resources. 

Thoracic surgeon reaches historic milestone: 100 robotic-assisted minimally invasive esophagectomies

Dr. Shawn Groth, associate professor in the David J. Sugarbaker Division of Thoracic Surgery, performed his 100th robot-assisted minimally invasive esophagectomy in July. This extraordinary accomplishment is not just a personal triumph for Groth, but it also signifies an evolution in the field of esophageal surgery and underscores the experience and expertise of Baylor surgeons.

“This milestone highlights the strength of the robotic cardiothoracic surgery team at Baylor, allowing us to perform a high volume of complex cardiac and thoracic operations through less invasive techniques,” says Groth.

The esophagus is a muscular tube that carries food and liquid from the mouth to the stomach. An esophagectomy is a surgical procedure in which a portion of the esophagus is removed and (typically) reconstructed with the stomach. It is performed for cancer and some benign disorders, such as severe scarring of the esophagus or achalasia. Traditionally, esophageal surgery was performed through large “open” incisions in the chest, abdomen and/or neck. Though effective, these surgeries often require a prolonged recovery period and are associated with significant discomfort and complications.

Recognizing the need for a more patient-centric approach that offers operations that are safer and more easily tolerated, visionary surgeons at Baylor like Groth have dedicated themselves to perfecting less invasive surgical techniques. The advanced robotic technology provides surgeons like Groth with a magnified, 3D high-definition visual field and miniature wristed instruments that mirror the dexterity of the human hand. This exceptional precision and control, combined with enhanced vision, places robot-assisted minimally invasive esophagectomies in a class of their own compared to standard laparoscopic and thoracoscopic techniques.

“There’s an abundance of data in the literature supporting the benefits of minimally invasive esophagectomy over traditional ‘open’ esophagectomies, including less pain, lower complication rates, less blood loss, shorter hospital stays, faster recovery and a better quality-of-life,” says Groth. “A robotic approach allows us to perform complex operations, such as esophagectomy, with a great deal of precision and ensures patients receive the highest standards of oncology care, including a thorough lymph node evaluation, resecting the tumor with negative margins and optimizing long-term survival.”

Leading research to improve outcomes, reduce mortality from liver cancer and other GI diseases

With its chief mission of improving digestive health through excellence in clinical care, Baylor College of Medicine’s Baylor College of Medicine’s Section of Gastroenterology and Hepatology leads the nation as a research center in gastrointestinal and liver diseases. 

It also trains and educates the next generation of gastroenterologists and hepatologists who will assume leadership roles as clinician scientists, clinicians and educators within and outside the US. 

The Section includes a comprehensive, highly sought-after fellowship training program that offers a clinical and an NIH T-32-funded research training track. Baylor’s is the only adult GI research-training program that is supported by a National Institutes of Health (NIH) training grant in Texas as well as neighboring states. The Section also supports an ACGME-accredited transplant hepatology fellowship and a competitive advanced endoscopy fellowship.  

With over $15 million in research grant funding, the Section continues to be the clinical home for the NIH-funded Digestive Disease Center, one of 17 federally funded centers focusing on research in GI diseases. It also serves as the coordinating center for the Texas Collaborative Center for Hepatocellular Cancer, a platform to promote collaboration among scientists, clinicians, community leaders, and policymakers to reduce liver cancer mortality in Texas. 

Additionally, the Section also houses an NCI-funded Translational Research Center and a Program Project focused on improving mortality from liver cancer. 

Regular screenings for H. pylori could dramatically reduce global incidences of gastric cancer

Regular screenings for the bacteria that causes ulcers, gastritis and stomach cancer could soon be as common as mammograms and colonoscopies for detecting and preventing cancer.

Helicobacter pylori (H. pylori), a bacteria that lives in the gut, is the most ubiquitous chronic bacterial infection worldwide and affects up to two-thirds of the global population. H. pylori can be asymptomatic or cause gastritis and ulcers, but the greatest public health concern lies in its association with cancer. Stomach, or gastric cancer (GC), is the fourth deadliest cancer worldwide with more than 768,000 deaths annually and the majority of cases are attributed to chronic H. pylori infection. 

Baylor College of Medicine gastroenterologist David Graham, MD, MACG is among a panel of global experts recommending screening all adults aged 20-40 in high-risk regions for H. pylori.

While prevalence of GC is highest in Africa and the Eastern Mediterranean, a recent study projected the US population burden at 25.8%, mainly in Black and Hispanic populations and Southern states.

A recent meta-analysis found that eradicating H. pylori halved gastric cancer risk in asymptomatic persons. Eradicating H. pylori modifies disease risk most dramatically before the onset of precancerous changes in the stomach. 

These findings make a compelling case for regular H. pylori screening for primary GC prevention in all at-risk populations.

Leaders in per oral endoscopic myotomy (POEM) volume and outcomes

The Baylor College of Medicine General Thoracic Surgery group at Baylor St. Luke’s Medical Center offers the full range of thoracic and foregut surgery, no matter the complexity. The clinic prioritizes patients, seeing cases within a week or earlier if needed.

Dr. Shawn Groth, Director of Esophageal Surgical Services at Baylor College of Medicine, brings experience to the clinic, completing over 400 surgical cases each year and over 340 robotic surgical cases to date. As a proctor for Intuitive, he shares his robotic thoracic surgery knowledge to train surgeons across the nation on best practices.

Contributing to the innovative procedures at Baylor St. Luke’s, Groth along with Dr. Mohamed Othman, Chief of Gastroenterology at Baylor St. Luke’s Medical Center and Associate Professor at Baylor College of Medicine, performed the first Peroral Endoscopic Myotomy (POEM) in 2016.

Today, over 450 POEMs have been completed, primarily for achalasia. POEM can treat spastic disorders of the esophagus such as Type III achalasia and Jackhammer esophagus as well as pyloric stenosis and Zenker’s diverticuli. Baylor St. Luke’s has the highest volume of POEM procedures in Texas and is a leader in third space endoscopy nationally and internationally.

High-volume center for esophagectomy

Capable of performing the most complex procedures, the Baylor College of Medicine General Thoracic Surgery team at Baylor St. Luke’s Medical Center is among the roughly 1% of hospitals in the nation that perform esophagectomy at a high-volume level. The group’s consistently high volume meets the threshold criteria for “Take the Volume Pledge” based on data from the National Cancer Database. With a 30-day mortality rate of less than 1%, the team has committed to growing the program significantly while maintaining outstanding outcomes that rival the best in literature. With the arrival of new leadership, the team has increasingly performed minimally invasive esophagectomies, placing Baylor St. Luke’s as a high-volume center.

Minimally invasive esophagectomy has proven to result in 70% lower odds of major complications and 60% lower rate of pulmonary complications without compromising oncologic quality of operation. This includes a 70% decreased risk of pneumonia as opposed to open esophagectomy.

Pioneers in pancreatic treatments

With over 170 papers in scientific journals and over $8.9 million in research funding in 2019, the Center remains a leader in research in gastrointestinal and liver diseases. The Section continues to be the clinical home for the NIH-funded Digestive Disease Center, one of 17 federally funded centers focusing on research in GI diseases.

Section members are in key leadership positions, ranging from serving in the Faculty Senate at the College level to holding the office of the President of the American Gastroenterological Association (AGA) at the national level. The Section also serves as the home for the Clinical Gastroenterology and Hepatology, one of the major clinical journals in the field.

Comprehensive GERD care

Baylor St. Luke’s Medical Center incorporates a comprehensive, multidisciplinary, patient-centered approach to care with otolaryngology, gastroenterology, and thoracic surgery, offering the full spectrum of GI testing capabilities and treatment options. This includes laparoscopic fundoplication and transoral incisionless fundoplication (TIF) for primary and redo procedures. Additional capabilities include the LINX System, a small, flexible band of magnets enclosed in titanium beads connected by titanium wires helping to keep a weak lower esophageal sphincter (LES) closed to prevent reflux.

Kalpesh Patel, M.D.

Center for Advanced Endoscopy

Baylor St. Luke’s Center for Advanced Endoscopy is one of the largest referral practices for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in Houston.

Our program’s gastroenterologists perform endoscopic submucosal dissection (ESD) of esophageal and colorectal tumors, endoscopic mucosal resection (EMR) in patients with Barrett’s esophagus and early-stage cancer, as well as diagnostic and therapeutic ERCP for:

  • The management of benign and malignant biliary strictures.
  • The comprehensive management of chronic and recurrent pancreatitis with pancreatic sphincterotomy, stricture dilation, and stent placement.
  • Patients with complex post-surgical anatomy.

The Center offers patients a variety of advanced therapeutic endoscopic services, including:

  • Radiofrequency ablation
  • Cryotherapy
  • Endoscopic mucosal resection (EMR)
  • Endoscopic submucosal dissection (ESD)
  • Endoscopic retrograde cholangiopancreatography (ERCP) * With Spyglass® (cholangioscopy)
  • Endoscopic ultrasound (EUS) * With biopsy
  • Small bowel enteroscopy
  • Full thickness endoscopic resection of submucosal tumors
  • Endoscopic sleeve gastroplasty (ESG)
  • Laparoscopic fundoplication and hiatal hernia repair
  • Peroral endoscopic myotomy for achalasia

The Center also involves medical oncology and offers endoscopic bariatric therapies, including minimally invasive, laparoscopic, robotic, and transanal surgical procedures for benign and malignant pathology of the colon, rectum, and anus.