MDT for Upper Gastrointestinal Surgeries

At Penang Adventist Hospital, we practise multidisciplinary approach for our cancer patients and in other relevant areas such as gastrointestinal diseases. The Multidisciplinary Team (MDT) is made up of professionals from different clinical backgrounds, including surgeons, oncologists, radiologists, nuclear medicine specialists and other medical professionals, to contribute their best advice for the benefit of our patients. We believe healthcare towards our patient should be patient-centric with holistic approach.

Hence our multidisciplinary team also consists of psychologists to help patients cope with their emotional and psychological needs, as well as dietitians to help patients on diet planning for their nutritional well-being.

Below are the types of gastrointestinal diseases.

Malignant diseases

A. Gastric Cancer

The treatment of gastric cancer is complex and involves multiple specialists from different expertise to provide holistic care for the patient. Our medical team utilise Enhanced Recovery After Surgery (ERAS) in Gastric Cancer and Oesophagus & Cardioesophageal Junction Cancer treatment, with the objective of reducing the length of hospital stay, reducing post-surgical complications and overall cost.

Multidisciplinary Team Involved in Gastric Cancer Care:

1. Endoscopist:

Diagnostic Gastroscopy

Narrow Band Imaging (NBI) endoscopy technology for visualisation of early gastric lesions.
Endoscopic Ultrasound (EUS) is desirable for biopsy (currently not available in any northern region private institution).

Therapeutic Endoscopy

Endoscopic stenting for palliation of gastric outlet obstruction.
Endoscopic enteral nutrition tube placement.

2. Radiologist:

Conventional contrasted CT scan for staging.

3. Nuclear Medicine Specialist:

PET-CT whole body with IV contrast for advanced staging.

4. Upper Gastrointestinal Surgeon:

Conventional Laparotomy, Radical Gastrectomy & D2 Lymphadenectomy
Minimal Invasive (Laparoscopic) Radical Gastrectomy & D2 Lymphadenectomy

5. Oncologist:

Pre-operative (neoadjuvant) chemotherapy for advanced cancer.
Pre-operative (adjuvant) chemotherapy or chemoradiotherapy cancer treatment.
Palliative care.

6. Dietician:

Optimisation of pre-operative nutrition.
Post-operative (post-gastrectomy) nutrition care.

B. Oesophagus & Cardioesophageal Junction Cancer

Multidisciplinary Team Involved in Oesophagus & Cardioesophageal Junction Cancer Care:

1. Endoscopist:

Diagnostic Esophagoscopy

Narrow Band Imaging (NBI) endoscopy technology for visualisation of early gastric lesions.
Endoscopic Ultrasound (EUS) is desirable for biopsy (currently not available in any northern region private institution).

Therapeutic endoscopy

Endoscopic stenting for palliation of esophagus obstruction.
Endoscopic enteral nutrition tube placement.

2. Nuclear Medicine Physician:

PET-CT whole body with IV contrast for staging.

3. Upper Gastrointestinal Surgeon:

Conventional radical esophagogastrectomy with 2 or 3-field lymphadenectomy.
Minimal invasive radical esophagogastrectomy with 2 or 3 field lymphadenectomy.

4. Oncologist:

Pre-operative (neoadjuvant) chemotherapy for advanced cancer.
Pre-operative (adjuvant) chemotherapy or chemoradiotherapy cancer treatment.
Palliative care.

5. Dietician:

Optimisation of pre-operative nutrition.
Post-operative (post-esophagogastric resection) nutrition care.

Benign Diseases

I. Refractory Gastroesophageal Reflux Disease (GERD)

At Penang Adventist Hospital, we provide one-stop treatment for Refractory Gastroesophageal Reflux Disease (GERD) and Oesophageal Motility Disorder (Achalasia), including wholistic medical and surgical treatment, as well as management of mortality disorder. We gather different specialists such as gastroenterologists, radiologists, endoscopists, upper gastrointestinal surgeons, and dietitians to provide holistic care for our patients.

Multidisciplinary Team Involved in GERD Care:

1. Gastroenterologist:

Diagnostic upper endoscopy

2. Radiologist:

Videofluoroscopy barium swallow study

3. Upper Gastrointestinal Surgeon:

Diagnostic Upper Endoscopy

Therapeutic Endoscopy

Endoscopic Balloon Radiofrequency Ablation for Pre-cancerous Barrett’s Oesophagus.