How to Collaborate with GI on a New Outpatient Service Line

Dr. Tan trained in D.C. at George Washington from medical school through his gastroenterology fellowship, before completing an advanced endoscopy fellowship in Boston. He performs endobariatric procedures at a private practice affiliated with Gastro Health, where Dr. Bagla practices.

Dr. Tan believes gastroenterologists have been gatekeepers of hemorrhoid patients due to their common presentation of rectal bleeding. Dr. Bagla agrees with this, and adds that IR has been more involved recently due to hemorrhoid artery embolization. Because it is a fairly new procedure, it is still not widely known to the public. Dr. Tan reviews hemorrhoid treatments he has offered throughout his career. In the late 2000s, he began trying infrared coagulation (IRC), with varied success. In the last decade, rubber band ligation (RBL) has been the mainstay of minimally invasive treatment. He usually recommends lifestyle management, including increased fiber intake, topical drugs and RBL for his patients, before referring them to surgery for a hemorrhoidectomy. Hemorrhoidectomies are quite successful, but come with significant morbidity and are one of the most painful surgeries to recover from. Through his collaboration with Dr. Bagla, Dr. Tan now has another procedure to refer his patients who do not wish to go to surgery or are poor surgical candidates.

Dr. Tan refers his patients to an IR for hemorrhoid artery embolization if they have failed conservative management or banding, or are poor candidates for a series of banding procedures. For very large hemorrhoids seen on colonoscopy that he knows will not be treated well with RBL, he refers them directly to IR. The two feel that between IR and GI there has been a smooth transition for these referrals. They have received some pushback from surgeons in the community. They approach this with continued education and presentation of evidence and outcome data. The two emphasize that communication is key. They approach physicians from other specialties by expressing curiosity in what they can offer, before asking them to refer for a new procedure they may have never heard of. The patient population for a disease like hemorrhoids is very large, and there are many communities where the need is unmet. This is a disease that should be tackled from multiple angles, and specialists should be aware of all options to present to their patients.