Gursimran Kochhar, MD: Interventional IBD Programs

Complications for patients with inflammatory bowel disease (IBD) can be painful and debilitating because they are often treated with surgery.

However, gastroenterologists from the Allegheny Health Network have developed a special interventional IBD program involving an endoscopic stricturotomy that is less invasive and safer way to treat strictures in the gastrointestinal tract.

Leading the program is Gursimran Kochhar, MD, who explained the program in an interview with HCPLive®.

HCPLive: Can you explain your role in treating IBD?

Kochhar: My specialty is treating and managing complex complications in patients with inflammatory bowel disease. And I can very proudly say that we have one of the few centers in the country that officially offers this kind of therapy for our patients.

HCPLive: How do you handle these complications?

Kochhar: Patients with inflammatory bowel disease, they currently do not have a cure for a disease, they are managed with medications and quite often, most of the patients, especially with Crohn's disease, they end up needing surgery for various issues and complications.

However, there are certain complications now in which we can either avoid the surgery or delay the surgery. Patients with IBD has strictures and traditionally the gold standard of care for strictures is surgery.

The problem is there is no endpoint. It’s not like once the surgery is done, you will never ever again need a surgery. Over the course of year may involve endoscopic therapy, like using a balloon to dilate the center and keep it open as long as possible.

Now what we can do is we can use an endoscope and in selected patients we can cut that stricture open internally with the use of an electronic incision knife and thereby avoiding and delaying the surgery. For the patient that is a big deal because patients basically come as they are going to have a colonoscopy or endoscopy and can go home the same day.

We have pioneered this technique.

HCPLive: Why do you think this technique hasn’t caught on yet at other hospitals?

Kochhar: To set up a practice like this you not only need an endoscopist like me, but you need a very good medical team, which we have. We have six people right now who, including myself who do medical management of IBD.

And then you also need the surgical support and backup because these procedures can have complications. So you have to have surgical support.

Now, because this is a new technique, technique to learn, we are training and teaching other people.

I’m encouraged to say it is picking up at other places but it is not as large as it is currently at AHN.

We also started actually the first interventional IBD conference, which was held in New York this year to spread the knowledge and to train other gastroenterologists in this procedure.

I think our goal is that this technique become very widely utilized and available. I also want to add one little thing here just to make you understand why this is unique. So, normally, doctors who treat patients with inflammatory bowel disease, they do not perform advanced endoscopy procedures, they do basic endoscopy procedures. And we have the doctors who are trained in advanced endoscopy procedures, they routinely don’t manage IBD patients. So that is another reason why not too many IBD physicians do this work.

HCPLive: When a patient has a complication with this, what kind of prognosis is there?

Kochhar: IBD is usually a disease in young patients where these patients are otherwise healthy. However, some complications in IBD patients can cause a lot of morbidity. So, it's not like they're about to die tomorrow. However, these patients can be sick.

Because if you have a stricture in your belly, you are not eating properly, plus you have inflammation from the disease.

So these procedures are challenging, but you know, we've had some good, good success. We have come close to 80 of these procedures since I joined last three years, beginning in 2018.

HCPLive: What percentage of patients with IBD would need this surgery and is it more prevalent in Crohn’s disease or ulcerative colitis?

Kochhar: Complications of strictures is more common in patients with Crohn’s disease. The prevalence of strictures can be as high as 25% in Crohn’s disease.

HCPLive: Where would you like to see this field grow in the coming years?

Kochhar: In the coming years, two things need to happen. One is, we need to definitely educate more gastroenterologist and surgeons about this technique. And as I said we have various avenues through which we are trying to do that.

The second is we obviously have to improve our training centers. We have to teach the fellows and the advanced fellows in these techniques as we are training them, so once they go out, they can practice these techniques.