Houston Methodist Underwood Center for Digestive Disorders Brochure

LEADING DIGESTIVE CARE

MESSAGE FROM THE DIRECTORS

As we celebrate our tenth anniversary at the Houston Methodist Lynda K. and David M. Underwood Center for Digestive Disorders, we are both humbled and proud of the incredible growth of our team and the accomplishments made by our physician and nurse partners, staff, researchers and administration.

The Underwood Center was founded in 2013, thanks to a generous gift from Houston philanthropists David and Lynda Underwood. Their goals were to be:

• Dedicated to the delivery of integrated care across digestive disorder specialties

• Devoted to the education and training of health care practitioners, students, patients and their families

• Committed to clinical and translational research

These continue to be our guiding principles. Through the integration of gastroenterologists, thoracic, gastrointestinal (GI), hepatobiliary, colorectal and metabolic surgeons, transplant hepatologists, radiologists, oncologists, and pathologists, we provide exceptional breadth and depth of experience.

The team includes dedicated researchers who continually seek new strategies for prevention as well as new approaches to treatment for patients.

Our patients benefit from disease prevention, precise and personalized therapies, innovative research, and a multidisciplinary team of forward-thinking doctors and health professionals. With the most advanced imaging and surgical technologies available, along with state-of-the-art inpatient and outpatient facilities, our program is committed to ensuring the highest level of clinical outcomes and patient satisfaction.

Clinicians and research scientists work side by side to advance the discovery of novel and personalized treatment through clinical and translational research, bridging the gap between science and patient care.

As we embark on our second decade, we look forward to building upon our patient-centered approach, strengthening relationships with our community, and investing in translational research that will lead to groundbreaking improvements in digestive disease care. We also look forward to further expanding the reach and impact of the Underwood Center across Houston, in Houston Methodist’s seven hospitals.

Thank you for your support along this journey. We look forward to partnering with you in providing unparalleled care for all patients.

Eamonn M. Quigley, MD, FRCP, FACP, MACG, FRCPI

David M. Underwood Chair of Medicine in Digestive Disorders

Co-director, Lynda K. and David M. Underwood Center for Digestive Disorders

Chief, Gastroenterology and Hepatology, Houston Methodist Hospital Professor of Medicine, Weill Cornell Medicine

Adjunct Professor of Medicine, Texas A&M Health Sciences Center College of Medicine

Wade M. Rosenberg, MD, FACS

Co-director, Lynda K. and David M. Underwood Center for Digestive Disorders

Assistant Professor of Clinical Surgery, Weill Cornell Medicine

FACTS AND FIGURES

U NDERWOOD CENTER BY THE NUMBERS

Since its inception 10 years ago, the Underwood Center has surpassed all expectations and aspirations in growth. We have grown from a small handful of physicians to 110, and our medical team spans the Greater Houston area at all seven Houston Methodist locations. Our substantial patient volumes provide us with the breadth and depth of experience to care for the most complex and unusual conditions. And we continue to build our research program, in both translational research and clinical trials.

2022 HOUSTON METHODIST HOSPITAL

GI PROCEDURAL VOLUMES

 12,500 Colonoscopies

 9,000 Upper Gastrointestinal Endoscopies

110 MEMBERS

COLLABORATING EXTERNAL ORGANIZATIONS (collaboration on publications)

231 organizations in 38 countries

North America

Houston Methodist

Africa

Asia

South America

Australia

QUALITY

NSQIP Outcomes:

• General Surgery Morbidity: Exemplary

• General Surgery Mortality: Exemplary

• Colorectal Surgery Morbidity: Exemplary

• Colorectal Surgery Length of Stay: Exemplary

GIQuIC Outcomes:

• Colorectal Cancer Prevention: Adenoma Detection Rates (Houston Methodist Hospital in the Texas Medical Center only)

– Female: 38.88 (Benchmark: 35.61)

– Male: 50.49 (Benchmark: 48.90)

RESEARCH

Clinical Trials: 37

Active Protocols: 37 Grants:

• R01 – Early Detection of Hepatocellular Carcinoma (Primary Sponsor: The University of Texas MD Anderson Cancer Center)

• A Phase II and Biomarker Study of Dual VEGF/PDL1 Blockade in Neoadjuvant Setting in Resectable HCC Patients (Primary Sponsor: The University of Texas MD Anderson Cancer Center)

• R01 – Predicting Outcomes in Nonalcoholic Steatohepatitis with Advanced Fibrosis (Primary Sponsor: Virginia Commonwealth University)

Publications

> 770 (2013-2022) Publications

2022 PUBLICATION HIGHLIGHTS

Nature Reviews Gastroenterology and Hepatology

Lancet Gastroenterology and Hepatology

Gastroenterology

Journal of Gastrointestinal Surgery

Surgical Endoscopy

Colorectal Disease

Invention Disclosures

2022: Tolfenamic Acid and Its Novel Analogs for Cancer Treatment and Prevention (Lead Inventor: Maen Abdelrahim)

UNIQUE SUBSPECIALTY EXPERTISE

GENERAL GI

Our team of gastroenterologists, specialty surgeons, radiologists, oncologists and pathologists, in addition to dedicated researchers, continually seek new prevention methods and therapies for individuals with episodic and chronic GI issues.

ADVANCED GI

For complex or advanced conditions, Houston Methodist’s vast resources enable our integration of interventional gastroenterologists to confirm accurate diagnosis, develop personalized treatment plans and provide sound second opinions.

INFLAMMATORY BOWEL DISEASE (IBD)

Internationally respected for IBD care and research, our medical and surgical teams are unified in their approach, resulting in superior outcomes for even the most difficult and complicated presentations of these diseases.

NEUROGASTROENTEROLOGY

Houston Methodist is one of few centers in the nation with specialization in the full spectrum of neurogastroenterological disorders, with specialists who have experience treating neurological diseases that impact nerves and muscles involved in digestion, from diabetes to Parkinson’s disease. Our researchers have dedicated expertise in clinical and translational research, studying less common conditions like achalasia, gastroparesis and refractory reflux, as well as irritable bowel syndrome, constipation and unexplained diarrhea.

HEPATOLOGY

Houston Methodist’s team of hepatologists, hepatic oncologists and hepatobiliary surgeons specialize in fatty liver disease, alcoholic cirrhosis, viral hepatitis and liver cancers, among other advanced liver diseases. Our liver transplant program is one of the top two in the nation in terms of volume, and maintains superior outcomes — even as we challenge current criteria and transplant critically ill, high-risk patients.

GENERAL GI SURGERY

General and GI surgeons at Houston Methodist are renowned for their pursuit of the least invasive approaches for acute and elective surgery involving the abdomen and gastrointestinal tract. While laparoscopic and robotic-assisted techniques dominate our operating rooms, our surgeons are proficient in open cases as needed.

COLORECTAL SURGERY

We specialize in minimally invasive surgical management of colorectal diseases and conditions, using minimally invasive approaches for more than 95% of colorectal surgeries, including when a patient’s specific condition or medical history is complex. These techniques result in faster recovery with less pain, which means that our patients get back to their normal lives sooner — without the use of opioids.

THORACIC SURGERY

We provide comprehensive surgical treatment of diseases involving the chest, including the lungs, esophagus, mediastinum, foregut, airway, pleura, diaphragm and chest wall. We employ the latest minimally invasive and robotic technologies, such as da Vinci Xi robot, Endoflip™, LINX®, Veran SPiN Perc™ and the MatrixRIB™ Fixation System.

METABOLIC SURGERY

The Houston Methodist Center for Weight Loss and Bariatric Surgery provides comprehensive and leading-edge medical and surgical therapy to treat metabolic disease and obesity. Our team of surgeons, obesity-medicine trained doctors, dietitians, behavioral therapists and exercise therapists work together to address obesity and its associated comorbid illnesses. In addition to performing primary weight loss surgery, our team specializes in reoperative/revisional surgery, as well as surgery for patients with end-stage organ failure and following transplant.

HEPATOBILIARY SURGERY

Specialized surgeons from the department of surgery, transplantation, surgical oncology and GI surgery perform complex procedures on the liver, pancreas and biliary tract to treat benign and malignant conditions. We recently adopted robotic surgery practices to achieve major resection of the liver and/or pancreas.

INNOVATIVE TECHNOLOGIES

• Barrett’s ablation

• Bowel ultrasound

• EndoFlip™

• Endoscopic ultrasound-guided liver biopsy and portal pressure measurements

• Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD)

• Peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy (G-POEM)

• SmartPill®

• Transoral incisionless fundoplication (TIF)

INTEGRATED CARE, DYNAMIC RESEARCH FOOD AND HEALTH ALLIANCE: HELPING OPTIMIZE DIETS

The gut microbiome is fundamental to human health, and it interacts directly and in a bidirectional manner with the food we eat. Diet and its interaction with our gut plays a critical role in virtually every system and function in the human body. This was the impetus for the Food and Health Alliance, developed by Houston Methodist with a vision to establish a premier destination for patients and the public to optimize their diet for health and wellness through evidence-based medicine and nutritional science.

The Food and Health Alliance incorporates a number of strategies that include patient and family education and dietary interventions as part of the therapeutic plan, and research on diet and microbiome in human health and disease. Our goal is to help patients understand the effect diet has on our bodies and empower them to make lifestyle changes that can improve their health. This involves not just the digestive tract, but also inflammation in any location — cardiovascular and neurodegenerative diseases, psychiatric issues, and the aging process itself.

Clinically, we have established a special patient clinic for metabolic liver disease, and we will have a dedicated dietitian, and will soon introduce a psychologist dedicated to GI patients. Additional areas of focus include any GI or liver disease related to obesity, such as GERD and certain cancers; food allergies and intolerances, including eosinophilic esophagitis and celiac disease; and food intake issues and the nutritional consequences of GI or other diseases.

Research projects relate to nonalcoholic fatty liver disease, irritable bowel syndrome and its interaction with depression and anxiety, gastrointestinal effects of the lowFODMAP diet, and the role of food allergies in modern diets. This year, the research team will hire a nutritional scientist.

RESEARCH INITIATIVES

• Participation in an international study of a live biotherapeutic in irritable bowel syndrome

• Direction of a study of probiotics on the brain and the gut in irritable bowel syndrome and how this may be mediated through the gut-brain axis and inflammation

• Participation in a multicenter study on the role of atypical food allergies in gut symptoms

• Study on how the microbiome may influence fat accumulation in the liver and fat metabolism

• Participation in an international study on changes in the gut microbiome in irritable bowel syndrome

• Examination of how changes in the gut microbiome may influence the effect of a probiotic in chronic constipation

• Involvement in reviews/guidelines on diet and the gut, small intestinal bacterial overgrowth, how diets may help in irritable bowel syndrome, postbiotics

• Studies on interactions between celiac disease and irritable bowel syndrome

INTEGRATED CARE, DYNAMIC RESEARCH

ACHALASIA: EMPLOYING LEADING-EDGE TECHNOLOGIES FOR DIAGNOSIS AND SURGICAL CARE

With one of the busiest diagnostic GI laboratories in the country, the Underwood Center has the ability to accurately diagnose people with achalasia and a variety of other swallowing problems. While achalasia is a relatively uncommon disease, our team has the unique opportunity to see a large volume of cases — among the top three in the country — which allows us to provide superior care.

“Medications for

with

short- and long-term solutions,” said Gulchin Ergun, MD, gastroenterologist. “We work in unity with surgeons to handle all cases, with the goal of allowing each patient to eat well and have a good quality of life.”

New technologies such as the robot-assisted Heller myotomy with Dor fundoplication and peroral endoscopic myotomy (POEM), in which Houston Methodist surgeons are uniquely proficient, have shown fewer postsurgical complications. Robotic Heller myotomy has a 0% esophageal perforation rate and a median length of stay of just one day.

Further, other new tools like the Esoflip™ and Endoflip™ enable surgeons to get real-time feedback on surgical success through monitoring changes in sphincter pressure, ensuring symptom relief yet reducing the risk of reflux.

CLINICAL DIFFERENTIATORS

• Intraoperative tools enable our specialists to measure motility, distensibility, diameter and cross-sectional area around the gastroesophageal junction to ensure successful outcomes.

• POEM is a breakthrough procedure that treats achalasia and other conditions endoscopically.

RESEARCH INITIATIVES

• EndoFlip™ studies on success of surgical procedures

• Studies on the optimal surgical approach to gastroesophageal reflux

achalasia don’t typically work well, so our efforts are procedural,

both

INTEGRATED CARE, DYNAMIC RESEARCH

GERD AND HIATAL HERNIAS: COMBINING INNOVATIVE MEDICAL AND SURGICAL CARE FOR COMPLEX CASES

Houston Methodist physicians and surgeons intersect multiple disciplines in the treatment of diseases and disorders related to gastroesophageal reflux. The team operates under standards and guidelines they developed to ensure each patient’s unique needs are met.

While reflux, GERD and hiatal hernias are common, our team tends to see the more unusual and challenging presentations. In addition, we often receive referrals from pulmonologists, otolaryngologists and allergists for evaluation of atypical symptoms.

The Houston Methodist J.C. Walter Jr. Transplant Center is a leading lung transplant center in the U.S., and one of just a few in the nation to perform early transplantation for end-stage lung disease due to severe COVID pneumonia.

“One of the most devastating complications of lung transplant is gastroesophageal reflux causing aspiration, which then inflames lung tissue and triggers organ rejection,” said Gulchin Ergun, MD, gastroenterologist. “The pandemic gave us an opportunity to study this unique patient population to determine the importance of reflux testing before and after transplant, and to help ensure optimal outcomes for them.” Surgeons at the Underwood Center then use minimally invasive surgery techniques to provide a barrier to prevent reflux and resulting organ rejection.

Esophageal function testing via manometry, impedance-pH and BRAVO™ in our world-class diagnostic GI lab is often performed to assess the contribution of reflux to symptoms and determine if surgery is needed. Our surgeons relentlessly pursue the newest technologies and tools that provide the least invasive options, providing faster recovery with less pain — including robotic-assisted fundoplication.

A focused effort on enhanced recovery after surgery with a multimodal pain regimen has allowed Houston Methodist to send patients home after surgical treatment of GERD and hiatal hernia with only over-thecounter pain medications. Narcotic use at the time of discharge has dropped from 87% to 9.6% over the last three years with good pain control, in turn dramatically reducing complications after surgery.

“Through a multimodal pain management protocol, we help patients understand how to control their pain through education and the use of multiple non-narcotic pain medications after surgery,” said Min Kim, MD, gastrointestinal surgeon.

CLINICAL DIFFERENTIATORS

• Our team provides comprehensive assessment and advanced diagnostics, including pH impedance testing, BRAVO™ pH testing, high-resolution manometry and Endoflip™.

• From medications to endoscopic approaches, to laparoscopic and robotic surgery, we offer a variety of treatment options, including treatment for patients who had encountered failure from prior surgeries.

RESEARCH INITIATIVES

• Robotic-assisted procedures and outcomes

• Studies to compare recent innovations, looking at clinical outcomes and patient experiences

• Impacts of GERD on lung transplants in COVID-19 patients

“Endoflip™ is a particularly beneficial tool in fundoplication procedures, as we use it intraoperatively to measure the tightness of the procedure to avoid significant dysphagia after surgery.”

Min Kim, MD, thoracic surgeon

INTEGRATED CARE, DYNAMIC RESEARCH CROHN’S DISEASE: SEAMLESS MEDICAL AND SURGICAL APPROACHES

The Fondren Inflammatory Bowel Disease (IBD) Program, directed by Bincy Abraham, MD, is unique in the region for the team’s vast experience with difficult and challenging IBD cases. Internationally respected for IBD care and research, our medical and surgical teams are unified in their approach, resulting in superior outcomes for the complicated disease.

“We have incredible collaboration with gastroenterologists, so our surgeons are very familiar with patients who might benefit from surgery well before we operate,” said Eric Haas, MD, chief, colon and rectal surgery. “And, our patients are so well-optimized medically, we’re way ahead of the game when it comes to surgery. You put all that together, and the outcomes have been phenomenal.”

Further, a close alliance with pediatric colleagues at other institutions helps provide a smooth transition of care for patients entering adulthood, and partnerships with physicians in women’s health ease patients’ anxieties during pregnancy.

Technology plays an integral role in disease management, including tools like CT, MR enterography for imaging, and chromoendoscopy for colorectal cancer surveillance in high-risk patients. Upper endoscopy and capsule endoscopy allow physicians to explore upper-GI tract and small-bowel involvement of IBD.

Houston Methodist was among the first in the U.S. to introduce intestinal ultrasound for the assessment of IBD activity. In fact, Abraham was the first physician in the country to use the technology in an adult patient.

If surgery becomes necessary, our colorectal surgeons employ advanced robotic approaches that lessen the need for extensive resection and enhance recovery times. Robotic technologies are used in strictureplasty — which preserves the bowel and reduces the necessity for future surgeries — fistula repair and bowel continuity surgery.

“The long-term benefits are substantial,” Haas said. “Recurrent obstruction rates are significantly less, we rarely see a hernia, and the need for colostomy is dramatically reduced.”

CLINICAL DIFFERENTIATORS

• Houston Methodist is among North America’s first centers to offer pointof-care advanced transabdominal ultrasound imaging of the bowel for patients with IBD.

• Our state-of-the-art infusion suite is conveniently located in the office, is staffed by experienced infusion nurses and provides access to the very latest medications.

• Our surgeons perform robotic-assisted strictureplasty and bowel continuity surgery, with superior outcomes.

• We are a tertiary referral center for J pouch surgery and have some of the highest volumes in the country for robotic-assisted restorative proctocolectomy with J pouch reconstruction.

RESEARCH INITIATIVES

• Clinical scientist dedicated to inflammation and microbiome research in IBD

• Site for multicenter clinical trials, offering patients access to new therapies prior to FDA approval

• Translational research in collaboration with researchers at Texas A&M University and University of Houston, looking at newer inflammatory markers that may guide future innovations in diagnosis and management

• Biorepository for long-term, large-scale studies

• Published studies on relationships between IBD and cardiovascular disease

• One of several national sites following mothers with IBD through pregnancy, and their infants through age 18, to monitor disease presentation and progress

• Looking at stem cell therapy for perianal fistulas — a partnered effort between medicine and surgery

• Natural orifice robotic surgery to avoid colostomy and abdominal wall incision during complex IBD procedures

• Robotic approaches for minimally invasive restorative J pouch surgery

“We can use this ultrasound technology in our IBD clinic and get more detailed information about the patient’s disease activity than lab work or a physical exam.”

Bincy Abraham, MD, director, Fondren IBD Program

INTEGRATED CARE, DYNAMIC RESEARCH COLORECTAL CANCER: LEADING THE NATION IN DETECTION, PREVENTION AND MINIMALLY INVASIVE SURGERY

With a special focus on colorectal cancer prevention and detection, Houston Methodist gastroenterologists perform high-quality colonoscopies to look for and remove precancerous lesions. We participate in a program called “GIQuIC” (GI Quality Improvement Consortium, Ltd.) a national quality benchmarking registry that monitors colonoscopy performance and outcomes. More than 50 gastroenterologists across seven Houston Methodist locations participate in the registry, giving physicians insight into their outcomes by leveraging nationally established quality measures.

“In place for nearly a decade at Houston Methodist, the GIQuIC program shows we are performing at the highest possible level for colon polyp detection and cancer prevention,” said Karen L. Woods, MD, gastroenterologist.

Collectively, Houston Methodist’s adenoma detection rate (ADR) — which is inversely related to cancer development and mortality — has consistently exceeded the national recommended benchmark of 25%. In 2022, our ADR was 43.6%, exceeding that of our national peer gastroenterologists.

“We know that high adenoma detection rates reduce interval colon cancer development,” Woods said. “We are unique in that our large system is systematically monitoring physician performance to ensure that patients always receive a high-quality colonoscopy. Data shows not all colonoscopies are equal, so our quality is differentiating.”

Further, our interventional GI physicians are experts at removing large, difficult polyps endoscopically, often avoiding the need for surgery. Advanced molecular diagnostics performed by our pathology department further aid in treatment planning of colorectal cancers.

Surgeons at Houston Methodist use minimally invasive approaches in more than 95% of colorectal surgeries, resulting in faster recovery, less pain and fewer complications. We are the epicenter for a natural orifice technique developed here in 2018. The natural orifice intracorporeal anastomosis with extraction of specimen (NICE) procedure uses robotic technologies that avoid any abdominal wall incisions during cancer resection.

CLINICAL DIFFERENTIATORS

• Houston Methodist surgeons pioneered the robotic natural orifice intracorporeal anastomosis with extraction of specimen (NICE) procedure.

• Our gastroenterologists have developed advanced endoscopic techniques to remove large polyps that have historically required surgery.

• Houston Methodist is home to one of the largest advanced minimally invasive fellowship programs in the country.

• Our colon and rectal surgeons employ techniques that reduce the need for colostomies, successfully reverse colostomies, and often eliminate the need for opioids.

RESEARCH INITIATIVES

• Clinical trials and protocols for comprehensive molecular profiling of colorectal tumor tissues to guide immunotherapy and targeted chemotherapy

• Circulating tumor DNA usage for all patients after curative surgeries to evaluate for minimal residual disease and close surveillance and monitoring

• Robotic-assisted technologies and techniques for cancer resection, including national and international presentations on the NICE procedure

“We have shown in peer-reviewed publications and at national and international meetings that the NICE procedure affords numerous patient benefits, including avoidance of opioids in recovery and an early return to daily activities,” said Eric Haas, MD, colorectal surgeon.

“This and other innovative procedures have helped us achieve significantly shorter postoperative hospital stays and lower surgical site infection and complication rates compared to national averages.”

Eric Haas, MD, colorectal surgeon

INTEGRATED CARE, DYNAMIC RESEARCH

LIVER DISEASE: LEADING THE NATION AND CHALLENGING CURRENT CARE STANDARDS

With more than one-third of Texans considered obese in 2019, and diabetes cases expected to increase by 45% by 2030, Texas has some of the highest incidence and mortality rates for liver disease and liver cancer in the country.

Underwood Center physicians collaborate with peers at the Sherrie and Alan Conover Center for Liver Disease & Transplantation and Houston Methodist J.C. Walter Jr. Transplant Center to provide a full spectrum of care for patients.

Normal liver

Liver with cirrhosis

We have placed special emphasis on disease prevention in fatty liver disease, partnering with our bariatric and metabolic program. We have a dedicated metabolic liver disease program that incorporates medical, nutritional and pharmacologic treatments for each patient. Our hepatologists remain committed to eradicating viral hepatitis with the very latest therapies and dedicated clinics. Our physicians have created a variety of programs that address conditions such as amyloidosis and alcohol-related liver disease. We expanded our team to include surgeons with expertise in robotic surgery for hepatobiliary disease, which will also help expand options in our living donor liver transplant program.

Houston Methodist transplant hepatologists and surgeons have evolved the liver transplant program to become one of the top two in the nation in terms of volume — performing 232 liver transplants in 2022. Liver transplant patient survival at Houston Methodist consistently exceeds expected outcomes, with the Scientific Registry of Transplant Recipients (SRTR) reporting a 92-94% oneyear survival rate for those transplanted here over the past decade. Our excellent outcomes occur despite our intention to provide transplantation to patients with critical illness, including those with exceptionally high Model for End-Stage Liver Disease (MELD) scores and on mechanical support.

We know liver transplant remains the best cure for liver cancer; however, the landscape is changing with more effective nontransplant therapies. We have invested in transplant oncology as an emerging specialty — which combines the use and expansion of medical therapies with the expertise of our transplant center. We partner with MD Anderson Cancer Center and Houston Methodist Neal Cancer Center to transplant patients with large intrahepatic cholangiocarcinomas, yet maintain an overall survival rate of greater than 80% at five years. This was facilitated by the adoption of novel approaches to assess tumor biology and behavior rather than tumor size alone for patients who do not meet traditional transplant criteria.

CLINICAL DIFFERENTIATORS

• We are among the nation’s two largest and most comprehensive liver transplant programs.

• Liver perfusion helps us optimize potential donor organs, expanding the number of transplants we’re able to perform.

• Our nationally recognized physician leaders push the envelope on standard treatments for liver and hepatobiliary cancers.

• Our surgical liver ICU is one of the highest acuity ICUs in the country.

• We employ robotic-assisted procedures for resection of hepatobiliary lesions and living donor transplant.

RESEARCH INITIATIVES

• Clinical trials of new treatments to prevent advanced disease

• Pharmaceutical and investigator-initiated trials that look at chemotherapy and immunosuppressant therapies before and after transplant to find optimal outcomes in high-risk patients

• Clinical trials examining nutrition and assessing calorie needs in patients with liver cancer

• Exploring the role of molecular profiling and its prognostic significance in predicting outcomes in various liver cancers in the nontransplant and posttransplant setting

• Trials looking at the combination of chemotherapy and immunotherapy, along with locoregional therapies, in controlling large liver tumors in patients in the transplant and nontransplant setting

• Studies of noninvasive biomarkers and imaging modalities in assessing fibrosis in liver patients

“Our goal is to exhaust all efforts to identify and treat every patient in a curative manner, with the hope being to prevent cirrhosis and cancer. We treat the individual, aiming to help each patient reach an outcome that helps them live longer, healthier lives.”

David Victor, MD, transplant hepatologist

INTEGRATED CARE, DYNAMIC RESEARCH PANCREATIC CANCER: COLLABORATING TO EXPEDITE DIAGNOSIS AND ELIMINATE CANCER

With a consistent record of superior patient outcomes, active research is underway to explore novel treatments for pancreatic cancer. Our team has unrivaled expertise in treating pancreatic cancer, collaborating with oncology researchers to study new diagnostic modalities that may expedite diagnosis in the future.

All patients at Houston Methodist undergo multidisciplinary evaluation and care with therapeutic plans based on weekly tumor board meetings, a collaboration between the Underwood Center and the Neal Cancer Center. For locally advanced cancer, patients may undergo neoadjuvant therapy to downstage, or our surgeons may perform complex resection and vascular reconstruction. We routinely perform tumor mutational testing for advanced and metastatic tumors.

Our interventional endoscopy team maintains a high success rate for obtaining endoscopic ultrasound-guided biopsies in patients with pancreas mass lesions.

CLINICAL DIFFERENTIATORS

• We offer innovative surgical options, including pancreaticoduodenectomy (Whipple) and minimally invasive pancreatectomies.

• Houston Methodist’s advanced imaging and endoscopic techniques help detect and evaluate pancreatic cancer, with the ability to biopsy and analyze in detail lesions of concern.

• Our multidisciplinary approach of neoadjuvant, surgical and adjuvant therapies enables us to maintain one of the lowest mortality rates in the country.

Techniques include using endoscopic ultrasound-guided gastro-gastric stent placement in gastric bypass patients for performing biopsy from pancreatic mass lesions; using a new tool called the SpyGlass™ cholangioscopy to better visualize the bile ducts; and conducting mutational testing of pancreatic cyst fluid aspirates.

Various genetic mutations predispose patients to a higher risk for pancreatic cancer, including STK11/LKB1, CDKN2A, BRCA-1, BRCA-2, PALB2, ATM, MLH1, MSH2 and MSH6. We offer pancreatic cancer screening after extensive discussion of pros-and-cons with patients.

We are a high-volume center with proven surgical outcomes — even with a higherrisk patient population. Most studies indicate that high-volume pancreatic surgery centers are best suited to care for patients with pancreatic cancer, as evidenced by the superior outcomes for our seven experienced pancreatic surgeons. For many patients, our goal is to expedite diagnosis and elimination of cancer. Our innovative therapies include minimally invasive surgical techniques, novel chemotherapy and immunotherapy.

Most distal pancreatectomies at Houston Methodist are performed using minimally invasive techniques, with new robotic surgeries and technologies on the not-sodistant horizon.

RESEARCH INITIATIVES

• Reviewing molecular analysis of cystic fluid to differentiate benign cystic lesions from cystic lesions with malignant potential

• Identifying the role of cholangioscopy-directed biopsies versus the use of large-caliber cytology brushes in obtaining a diagnosis in technically challenging hilar bile duct strictures — a significant portion of Houston Methodist’s patient population

• Developing CAR T-cells against pancreatic cancer

• Launching a clinical trial of immunotherapy combined with chemotherapy against pancreatic cancer

“While endoscopic biopsies are not unique, we have proven expertise in advanced techniques.”

Sunil Dacha, MD, interventional gastroenterologist

PROVIDING UNPARALLELED EDUCATION AND TRAINING FOR LEADERS TODAY AND TOMORROW

PEER EDUCATION

• The weekly CME-accredited multidisciplinary gastrointestinal conference is the longest-running clinical conference at Houston Methodist Hospital, chaired by Alberto Barroso, MD, gastroenterologist. With active participation from medical students, residents and fellows, our medical and surgical teams present interesting and challenging cases to peers each week.

• Our clinicians participate in a monthly CME-accredited Houston GI Motility Conference, comprised of clinicians from Houston Methodist, MD Anderson Cancer Center, Baylor College of Medicine, Memorial Hermann Hospital and Texas Children’s Hospital, during which they discuss cases and clinical issues.

• Quarterly meetings with the Texas Gulf Coast GI Society encompass all GI fellowship programs and practicing gastroenterologists in the Greater Houston and Galveston areas.

• With a focus on clinical challenges in ulcerative colitis and Crohn’s disease, gastroenterologist Bincy Adams, MD, chairs a CME-accredited, inter-institutional monthly IBD case conference. Radiology, pathology, colorectal surgery and gastroenterology experts from local institutions provide input and insight into challenging cases presented by the teams.

UNDERWOOD SYMPOSIUM

Initiated in 2015, the Underwood Symposium invites speakers from across North America who, together with our own gastroenterologists, oncologists, surgeons, pathologists and radiologists, showcase clinical and research activity from the last year.

We include a hands-on component at the Houston Methodist Institute for Technology, Innovation & Education (MITIESM) to introduce trainees to advanced diagnostic and therapeutic endoscopic techniques and technology in the areas of mucosal ablation and resection, tissue closure, intraluminal stenting, gastroesophageal reflux, and ERCP. Participants learn to:

• Demonstrate proper technique for endoscopic mucosal resection using multiple methods

• Describe important principles of electrosurgical energy as applied in the GI tract

• Demonstrate the use of rescue strategies for GI bleeding or perforation following advanced tissue removal in the GI tract

• Discuss technical differences between endoscopic submucosal resection (EMR) and endoscopic submucosal dissection (ESD)

• Demonstrate full thickness resection of small gastric masses

• Discuss the advantages of per oral choledochoscopy over cholangiography in managing select biliary pathology

• Describe the use of lumen-apposing metal stents

• Demonstrate transoral incisionless fundoplication treatment of GERD

RECENT UNDERWOOD SYMPOSIUM INVITED

KEY-NOTE SPEAKERS:

• Charles Bernstein, MD Max Rady College of Medicine, University of Manitoba

• James Fleshman, MD, Baylor Scott & White Health

• Robert Hawes, MD, Orlando Health

• Ikuo Hirano, MD, Northwestern University Feinberg School of Medicine

• Norio Kulami, MD, Mayo Clinic

• John Martinie, MD, Atrium Health

• Jeffrey Ponsky, MD, Cleveland Clinic

• Gottumukkala Raju, MD, MD Anderson Cancer Center

• Satish Rao, MD, Medical College of Georgia, Augusta University

• Nicholas Shaheen, MD, University of North Carolina School of Medicine

• Reem Sharaiha, MD, NewYork Presbyterian Hospital/Weill Cornell Medical Center

• Nathanial Soper, MD, Northwestern University Feinberg School of Medicine

• Stuart Spechler, MD, Baylor Scott & White Health

• Lee Swanstrom, MD, The Oregon Clinic Center for Advanced Surgery

• Michael Ujiki, MD, NorthShore University Health System

• Mark Whiteford, MD, Providence Cancer Institute

SIMULATION TRAINING AT MITIE

MITIE is an innovative virtual hospital and hands-on clinical training facility for health care professionals seeking to maintain excellent procedural skills and acquire new proficiencies. MITIE also enables clinicians to develop and integrate new technologies into their practices. Through these educational and research pursuits, we aim to improve patient safety and deliver less invasive medical care.

Simulation labs in MITIE provide trainees with a low-risk, low-stress environment that allows them to perform a task repetitively until it is mastered. Additionally, the educator can adapt training to the level of the trainee. This environment is employed to introduce the beginner to the basics of endoscopy and facilitate the hand-eye coordination skills that are fundamental to effective and safe endoscopy.

The Underwood Center organizes simulation labs throughout the year for GI fellows, covering specific skills areas, such as polypectomy and GI bleeding. The Underwood Symposium also offers a simulation lab for more advanced procedures, allowing trainees and practitioners to learn new techniques or hone existing skills.

IBD LECTURE SERIES

Under the leadership of renowned expert Bincy Abraham, MD, and supported by Carl Schmulen, MD, and his wife Lyn Schmulen, Houston Methodist hosts an annual IBD lecture series in which prominent clinicians and researchers from around the world are invited to speak about special aspects of IBD. Included in the two-part evening and morning event, attendees also have the opportunity to present tough cases and gain insight from the speaker.

“I am really proud to offer such a well-rounded program to our fellows, where they can learn from very complicated cases, and go into the world as the next generation of leaders in subspecialty care.”

Visit houstonmethodist.org/underwoodcenter_events to

GI FELLOWSHIP PROGRAM

In 2014, the Underwood Center launched a three-year GI fellowship program. The program initially accepted two new fellows each year, which increased to three fellows in 2019. To date, 12 fellows have completed the program. During their time at Houston Methodist, fellows are exposed to every aspect of gastrointestinal care. They participate in a large volume of complex cases, and lead both clinical and translational research focused on some of the toughest challenges in digestive diseases.

TRANSPLANT HEPATOLOGY FELLOWSHIP PROGRAM

An advanced transplant hepatology fellowship was started in 2022, which is a one-year program intended for physicians already enrolled in a GI fellowship at Houston Methodist, or those who have recently completed a GI fellowship. Our goal is to train new physicians to become skilled, evidence-based and innovative experts in this growing field.

Program director: David Victor, MD

Bincy Abraham, MD, program director

COLLABORATING AND EXPANDING ACROSS HOUSTON TO SERVE OUR COMMUNITY

At the Underwood Center, we believe strongly that collaboration is key to successful patient outcomes. Recognizing the excellence in care provided at our seven hospitals, we are focused on engaging GI physicians and surgeons to enhance continuity of care and ensure patient experiences are uniform and unparalleled across Houston Methodist. Our goals are to:

• Ensure seamless transfer of patients within our system

• Standardize quality of care

• Develop a clinical research network across the system

• Optimize education experiences for faculty and staff

Long-term, we hope to establish a strong, nationally and internationally competitive research network.

B aytown

Willowbrook

Sugar Lan d

The Woodlands

Clear Lake

Katy-West Houston

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GASTROENTEROLOGISTS

Ali Aamar, MD

Bincy Abraham, MD

Rajeshwar Abrol, MD

Samir Ashfaq, MD

Yassir Ashraf, MD

Alberto Barroso, MD

Arturo Bravo, MD

Daniel Bushyhead, MD

Abraham Chacko, DO

Avais Chatha, MD

Deepika Chona, MD

Ronald Colman, MD

Sunil Dacha, MD

Svetang Desai, MD

Amar Dodda, MD

Gulchin Ergun, MD

Christopher Fan, MD

Sohaib Faruqi, MD

Steven Frachtman, MD

Kerri Glassner, DO

Ali Hashmi, MD

Malcolm Irani, MD

Shabbir Jamali, MD

Neeharika Kalakota, MD

Brian Kaplan, MD

Abdul Khan, MD

Nasrullah Manji, MD

Neha Mathur, MD

Thomas McCarty, MD, MPH

Frank Meriano, MD

Valentine Millien, MD

Uma Mohan, MD

Samir Nath, MD

Anam Omer, MD

Eamonn Quigley, MD

Ali Raza, MD

Arvind Reddy, MD, MPH

Rachel Schiesser, MD

Franz Schneider, MD

Peter Schwarz, MD

Matthew Tompson, MD

Steven Ugbarugba, MD

Fernando Urrutia, MD

Nitesh Vachhani, MD

Adrianne Van Norman, DO

Karen Woods, MD

Hani Zamil, MD, CMQ

TRANSPLANT HEPATOLOGISTS

Victor Ankoma-Sey, MD

Tamneet Basra, MD

Andrea Duchini, MD

Chukwuma Egwim, MD

Rashid Khan, MD

Sudha Kodali, MD

Robert McFadden, MD

Mazen Noureddin, MD, MHSc

David Victor, MD

SURGEONS

Ata Ahmad, MD

Kelvin Allenson, MD

Gabriel Arevalo, MD

Amanda Arrington, MD, MHM

Khawaja Azimuddin, MD

H. Randolph Bailey, MD

Richard Caplan, MD

Edward Chan, MD

Victoria Chang, MD

Yee Lee Cheah, MD

Ray Chihara, MD, PhD

Joshua Coursey, MD

Marianne Cusick, MD

Bidhan Das, MD

Garth Davis, MD

Rachel Ellsworth, MD

Nestor Esnaola, MD, MPH

A. Osama Gaber, MD

R. Mark Ghobrial, MD

Katherine Gray, MD

Eric Haas, MD

Gilchrist Jackson, MD

Tareq Kamal, MD

Min Kim, MD

Jean Knapps, MD

Jean Paul LeFave, MD

Ali Mahmood, MD

Diego Marines Copado, MD

Lee Morris, MD

Rodolfo Oviedo, MD

Ronak Patel, MD

Viet Phuong, MD

Tal Raphaeli, MD

Michael Reader, MD

Patrick Reardon, MD

Wade Rosenberg, MD

Ashish Saharia, MD

Vadim Sherman, MD

Caroline Simon, MD

Michael Snyder, MD

Nabil Tariq, MD

Dexter Turnquest, MD

Christina Warner, MD

Matthew Weaver, MD

Todd Worley, MD

ONCOLOGISTS, RADIOLOGISTS AND PATHOLOGISTS

Maen Abdelrahim, MD, PhD, PharmD

Garth Beinart, MD

Jett Brady, MD

Edward Brian Butler, MD

Blythe Gorman, MD

Kirk Heyne, MD

Anaum Maqsood, MD

Dina Mody, MD

Mary Schwartz, MD

Monisha Singh, MD

2018-2023 INTRAMURAL AWARDS

TOTALING $2,063,244

Brown, Smith & Raymond EnMed Capstone

Innovator Award

Basil Alias, MD

Clinical Scholars Award

Christopher Fan, MD

Clinician Educator Award

Edward Chan, MD

Jerold B. Katz Investigator Award

Nestor Esnaola, MD

MITIE Education Training Awards

Edward Chan, MD, Rodolfo Oviedo, MD

President’s Award: Excellence in Education

Min Kim, MD, Rodolfo Oviedo, MD

President’s Award: Excellence in Research

A. Osama Gaber, MD

Rice University Collaborative Seed Grant

A. Osama Gaber, MD and Rodolfo Oviedo, MD

Siemens Internal Seed Funding

David Victor, MD

Houston Methodist Lynda K. & David M. Underwood Center 6565 Fannin St., Houston, TX 77030 713.441.9770

houstonmethodist.org/underwood-center

Houston Methodist Hospital is ranked No. 8 in the nation for digestive disease and is the highest nationally ranked hospital in Texas.

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW

At Houston Methodist, we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.