The Culture of Different MKTG_150064494_2018 Service Line Big Book Full_FIN | Page 32

DIGESTIVE HEALTH INSTITUTE
GASTROENTEROLOGY
AND GI SURGERY
Centralizing Care for
Central Lines
Kids with intestinal failure need intravenous
nutrition to survive — but it involves a high risk of
infection, and much of the care happens at home.
LEADERSHIP:
Ronald Sokol, MD,
Chief, Pediatric
Gastroenterology,
Hepatology and
Nutrition
The Arnold Silverman,
MD, Chair, Digestive
Health
Robert Kramer, MD,
Co-Medical Director,
Digestive Health
Institute
Jason Soden, MD,
Co-Medical Director,
Digestive Health
Institute
READ MORE ABOUT
GASTROENTEROLOGY
AND GI SURGERY:
A proactive approach
to polyposis, p. 26
Hepatology and the
heart, p. 34
“When we train parents to manage central lines,
we’re asking for expert-level care that most
doctors would not be able to provide,” notes
pediatric gastroenterologist Jason Soden, MD.
Pediatric gastroenterologist
Jason Soden, MD, has worked to
identify trouble spots in at-home
care for parents whose kids need
intravenous nutrition.
As Medical Director of the Intestinal Rehabilitation
Program at Children’s Hospital Colorado, Dr.
Soden has worked for a decade to identify trouble
spots. Today, his team’s care bundle leverages
tools like telemedicine and the electronic medical
record system to coordinate the efforts of multiple
care providers from across seven states.
The result: a more than 50 percent decrease in
central line infections since 2016.
The Multi-Purpose
Balloon that
Could Simplify
Treatment for EoE
Until recently, counting eosinophils in
esophageal mucosal biopsies has been the
only way to gauge the severity of eosinophilic
esophagitis, or EoE. That’s a good place to start,
says pediatric gastroenterologist Calies Menard-
Katcher, MD, MSCS, but cell count doesn’t always
correlate with symptoms or the presence of
stricture or narrowing, which put patients at risk
for food impaction.
Dr. Menard-Katcher, along with colleagues at
Children’s Hospital Colorado and the Children’s
Hospital of Philadelphia, recently published on
how a new device can help measure function.
The EndoFLIP is essentially a balloon that inflates
in the esophagus to measure its diameter and,
through computer modeling, its pliancy.
Her team has shown that even patients with a
distant history of food impaction may have lower
baseline esophageal pliancy. Now, they’re working
to identify methods to predict not only whether a
patient may develop food impaction, but also how
they might respond to treatments for EoE.
“When kids feel fine in their day-to-day, untreated
inflammation can cause their esophagus to
become less pliant,” she says. “If we catch it early,
we can intervene.”
Pediatric gastroenterologist Calies Menard-Katcher, MD,
MSCS, demostrates the EndoFLIP, a balloon that inflates in
the esophagus to measure diameter and pliancy. She’s using
it to refine treatment for eosinophilic esophagitis.
She’s pushing her search for predictive data even
further by gathering biopsies from patients with
stricture as she measures them. While RNA
sequencing has identified biomarkers of EoE
distinct from populations without the disease, Dr.
Menard-Katcher is sequencing RNA for EoE with
stricture compared to EoE without — a level of
stratification that, so far, has never been done.
These markers will help the EoE team calibrate
therapy and, eventually, develop new therapies
targeting fibrosis. In the meantime, she’s confident
her team will use EndoFLIP not only to evaluate
strictures, but to monitor and treat the disease.
“You can identify narrowing and perform a dilation
with the same tool,” she says. “That ability to direct
therapy immediately will improve symptoms and
potentially long-term outcomes.”
Adapting the EndoFLIP not only to evaluate
strictures, but to treat them.
The Culture of Different
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