Fellowship Training at the VA Boston Healthcare System
The Boston VA Medical Center was established recently as a merger between the facilities in Jamaica Plain and West Roxbury. These two campuses comprise the current VA Healthcare System for veterans in the Boston catchment area. The hospitals also serve to train medical students, residents, and fellows of Boston University and Harvard Medical School. Since January 2001, all inpatient services have been located at the West Roxbury Campus, while Outpatient Clinics are located at the Ambulatory Care Center at Jamaica Plain. The Boston VA Medical Center receives subspecialty and inpatient referrals from many of our affiliated clinics throughout the Boston metropolitan area, including the Brockton and Bedford VA Medical Centers. The inpatient service serves as the tertiary care center for all six New England states.
The West Roxbury Campus includes 160 beds comprising acute medical care (60 beds), surgery, rehabilitation, and intermediate care services. There is a model state-of-the-art Spinal Cord Injury service, and intensive care units for medicine, surgery, and cardiac care. The Emergency Department and the Radiology Service are equipped to handle difficult cases with the help of their new imaging facilities. The clinical expertise of the Section of Gastroenterology includes consultative services and interventional endoscopy for gastrointestinal bleeding, liver disease, pancreatitis and gallstone disease. Active clinical and research interest is focused on motility disorders, esophageal disorders, and inflammatory bowel diseases. Gastroenterology fellows are responsible for the clinical consultation service at the West Roxbury campus, including inpatient endoscopy, and participating in the outpatient clinics at the Jamaica Plain location. In addition to the general clinics in gastroenterology, an ongoing esophageal clinic focuses on the long-term management and natural history of Barrett’s Esophagus. Fellows see approximately 1400 inpatient consultations yearly at West Roxbury, most of which result in diagnostic and interventional endoscopic procedures. The gastrointestinal motility laboratory for anorectal manometry and esophageal motility/manometry serves both inpatient and outpatient populations.
The outpatient clinics see 140 patients per week at the Jamaica Plain campus, and the Endoscopy Unit performs approximately 5400 GI outpatient procedures per year. Interventional endoscopy includes standard treatment methods, such as the control of gastrointestinal hemorrhage, ERCP for gallstones, and management of benign and malignant disorders of the biliary and pancreatic ducts. Endoscopic ultrasound with diagnostic imaging, as well as fine needle aspiration is a service that draws referrals from all of New England. Laser photodynamic therapy for esophageal diseases, including both metaplasia and carcinoma, is another center of special expertise. Investigative procedures include optical coherence tomography and porphyrin mediated fluorescence spectroscopy. Therapeutic modalities include argon plasma coagulation, and endoprosthetic stent placement. The GI Section participates with the radiation therapy center in the care of a large population of veterans with gastrointestinal malignancies and serves as a tertiary referral center for hepatitis C treatment in the New England area. Each year, approximately 60-80 hepatitis C patients are enrolled in the standard treatment program, and many additional patients are participants in study protocols.
The range of ongoing research is summarized in the following list:
- Optical Coherence Tomography in Barrett’s Disease detection
- Use of tegaserod (a 5-HT4 partial agonist) in improvement of gastric emptying
- Modulation of gastrointestinal smooth muscle activity by nitric oxide synthases in genetic knockout animals
- Experimental definition of the neuromuscular basis of esophageal peristalsis to discover new targets of therapeutic intervention
- Use of embryonic and somatic stem cells for potential replacement of abnormal gut mucosa
- Genetic animal models (i.e., trefoil protein deficiency) to improve our understanding of the mechanisms of epithelial barrier maintenance and repair
- Clinical study of the efficacy and safety of photodynamic therapy (PDT) using Photofrin (porfimer sodium) for the ablation of high-grade dysplasia in Barrett’s esophagus
- Prospective, randomized open-label comparison between patients treated for one year with pegylated interferon combined with ribavirin
- Role of inhibitory nerves in the pathogenesis of gastroparesis
- Case-control study to investigate the risks of peptic ulcer associated with low-dose aspirin and Helicobacter pylori infection
- Natural history of high-grade dysplasia in Barrett’s esophagus
- Prospective multicenter study on use of endoscopic clips versus combination therapy in upper gastrointestinal bleeding
- Bile and enteric toxin sequestrants in clinical diarrheal states.