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BackTable / VI / Podcast / Episode #319

How to Collaborate with GI on a New Outpatient Service Line

with Dr. Jerry Tan and Dr. Sandeep Bagla

In this episode, host Dr. Aaron Fritts interviews Dr. Jerry Tan and Dr. Sandeep Bagla about how IR and GI can collaborate in the outpatient space, and how they developed a multidisciplinary approach to the minimally invasive treatment of hemorrhoids.

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How to Collaborate with GI on a New Outpatient Service Line with Dr. Jerry Tan and Dr. Sandeep Bagla on the BackTable VI Podcast)
Ep 319 How to Collaborate with GI on a New Outpatient Service Line with Dr. Jerry Tan and Dr. Sandeep Bagla
00:00 / 01:04

BackTable, LLC (Producer). (2023, May 5). Ep. 319 – How to Collaborate with GI on a New Outpatient Service Line [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Jeremias Tan discusses How to Collaborate with GI on a New Outpatient Service Line on the BackTable 319 Podcast

Dr. Jeremias Tan

Dr. Jeremias (Jerry) Tan is a practicing gastroenterologist in Fairfax, VA.

Dr. Sandeep Bagla discusses How to Collaborate with GI on a New Outpatient Service Line on the BackTable 319 Podcast

Dr. Sandeep Bagla

Dr. Sandeep Bagla is a practicing interventional radiologist with the Vascular Institute of Virginia and the president of Prostate Centers USA.

Dr. Aaron Fritts discusses How to Collaborate with GI on a New Outpatient Service Line on the BackTable 319 Podcast

Dr. Aaron Fritts

Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.

Synopsis

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.

Resources

JVIR 2023 Hemorrhoid Artery Embolization:
https://www.jvir.org/article/S1051-0443(23)00112-4/fulltext#%20

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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