By AMANDA PEDERSEN
Medical Device Daily Senior Staff Writer
In the words of a leading interventional gastroenterologist, Sohail Shaikh, MD, bariatric surgery is "awesome" when it works but when it doesn't work it can lead to painful and dangerous complications, such as fistulas, ulcers, or leakage. Regaining weight is another post-surgical concern of which roughly 25% to 30% of the patients who undergo bariatric surgery have to contend.
Shaikh, of the New Jersey Advanced Gastroenterology (Woodland Park, New Jersey) practice, is one of only a handful of doctors worldwide who are currently able to address post-bariatric surgery complications endoscopically, without external cuts, resulting in less post-operative discomfort and greatly reduced hospital stays. His practice provides a range of services, including pouch reduction surgery to help restore original pouch size and help stop post-surgical weigh gain.
Shaikh also addresses post-bariatric surgery complications such as fistulas, ulcers and other issues that can develop after a procedure. These complications can cause weight gain, persistent pain, bleeding or dangerous leakage. Shaikh locates these defects and addresses them with advanced endoscopic techniques to promote healing, eliminate leakage and reduce discomfort. Because of the minimally invasive nature of these procedures, many patients go home the same day. Traditional open surgery to address these same complications would require about a four to five day hospital stay.
"I've been very fortunate," Shaikh said. "It's a privilege to use advanced, minimally invasive endoscopic techniques to make a difference in the lives of those who have suffered because of weight, especially in patients who have complications after bariatric surgery. It is incredibly gratifying to help them achieve change and see life-altering results."
It's especially an area that's dear to him personally, he told Medical Device Daily, because his mother passed away from post-surgical GI complications.
"Bariatric surgery, when it works, it's awesome, but when it doesn't work, it can cause a lot of complications and a lot of these patients get deathly sick," Shaikh said. "Now we can actually go in and close the holes that were leaking endoscopically."
Shaikh was the first physician in New Jersey to perform endoscopic suturing cases, the first to repair esophageal fistulas via endoscopic techniques and the first to repair gastric pouches for mechanical defects of dilated gastric outlets and pouches as well as the first to endoscopically repair sleeve leaks and endoscopically remove an eroded gastric lap band.
"We're doing things that are really stretching the boundaries," he said.
Shaikh is considered a key opinion leader in endoluminal advanced suturing procedures, including the advanced gastric sleeve technique, and one of only a few physicians in the world currently performing that particular minimally invasive bariatric surgery. He has published in peer-reviewed journals and has been a guest expert on health-related television programs, including "American Health Front."
Shaikh trained in upper endoscopy and colonoscopy during a gastroenterology fellowship in Northern New Jersey and then pursued advanced training in bariatric and developmental endoscopy at Brigham and Women's Hospital (Boston) during a fellowship with Harvard University (Cambridge, Massachusetts). Shaikh also mastered complex procedures during an advanced endoscopy fellowship at the University of Arizona (and has received advanced training in endoluminal therapeutics.
"Over 30% of the U.S. population is affected by the obesity epidemic," Shaikh said. "That number is expected to grow to 42% by 2030. But with intervention and advanced medical techniques, we can help patients fight obesity and live fuller, healthier lives."
The problem is these advanced endoluminal procedures are very difficult and require a lot of training, a great deal of skill, and coordination to perform, he said. For example, Shaikh spent two years in advanced endoluminal training. "There are only a few who are truly capable of doing it, it requires a lot of vigilance," he said.
In the future, these advanced endoluminal techniques could be used for primary intervention in addition to addressing post-surgical complications.
"It's definitely a lower-risk profile than surgery," Shaikh said. There will always be a role for surgery, he added, but this is another tool for doctors in this field to utilize. "Primary applications are really tempting to think about."
Amanda Pedersen, 912-660-2282;
Published October 22, 2012