Matthew Kroh, MD, previous Section Head of Surgical Endoscopy in the Department of General Surgery in Cleveland, arrived in Abu Dhabi with his family last January to assume leadership of the Cleveland Clinic Abu Dhabi Digestive Disease Institute. In this interview, Dr. Kroh describes the mission of the Digestive Disease Institute in Abu Dhabi, the progress made in the intervening months, differences in pathologies with the patients served and the new treatment opportunities the institute brings to residents of this part of the world.
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Q: Past articles on Consult QD have referenced several Cleveland Clinic Abu Dhabi goals, including: building on existing clinical programs, adding expertise in subspecialties within gastroenterology, colorectal surgery and general surgery and incorporating new techniques in minimally invasive surgery and advanced endoscopic procedures. Can you bring us up to date on your progress over the past six months?
A: Glad to! We are currently seeing a 30 percent increase in patient volume year over year. While the majority of patients are still from the United Arab Emirates, we are becoming a referral center, expanding our global footprint. Many patients travel from other Gulf Coast countries but increasingly from areas of northern Africa, southeast Asia, and Europe. We have even had patients from North and South America.
As we continue to adhere to Cleveland Clinic’s ethos, stay on the leading edge of innovative work in digestive disease treatment, and staff with top physicians in their fields, we expect that increase to continue.
Q: Where does your team focus the majority of your time?
A: One major area of focus is obesity and metabolic disease. While obesity is a worldwide epidemic, the way in which it presents throughout the Middle East is different than in the U.S. Metabolic diseases (diabetes, in particular) are more prevalent here, and the impact we can have on quality of life is tremendous.
We are also able to help our many patients with inflammatory bowel disease (IBD). We have an Inflammatory Bowel Disease Center which comprises four physicians: two subspecialists in gastroenterology and two fellowship-trained colorectal surgeons.
Previously it was thought that IBD, which is particularly challenging and progressive, was not prevalent in the region. But after consolidating the expertise and creating a formal center, we find we are attracting patients from throughout the Emirate, and across the region. In addition to providing cutting-edge care, the IBD Center focuses on outcomes and data collection, establishing what these diseases are like here.
Q: What are some of the procedures that offer the best possible treatment for some of these diseases?
One way we positively impact patients with obesity and metabolic disease is through minimally invasive surgical procedures, including advanced laparoscopic foregut and provisional bariatric surgeries. These allow patients to recover faster and with fewer complications than with open procedures.
Our team in particular focuses on complex revisional procedures, as well as new and evolving endoscopic nonsurgical therapies.
Q: What else does Cleveland Clinic’s Digestive Disease Institute in Abu Dhabi offer that may not otherwise be available in this region of the world?
A: We offer many other cutting-edge endoscopic therapies that aren’t available at many other centers throughout the region. Examples include endoscopic removal of early cancers, complex endoscopic procedures for biliary and pancreatic diseases, POEM procedure for achalasia, POP procedure for gastroparesis, management of bariatric surgery complications with endoscopy, and primary bariatric procedures performed endoscopically without incisions.
Minimally invasive robotic or procedures for complex foregut and hepatobiliary disease are also part of our routine practice, yet not readily available elsewhere in the region.
Currently, we have several active research protocols, which aim to study data on a local level. This has been somewhat limited in the past.
We are also starting a comprehensive Pancreatic and Hepatobiliary Center that will offer treatment for these advanced diseases, including transplantation.
Q: How does your multidisciplinary team approach work?
A: Instead of breaking along the traditional lines of medical and surgical therapies, we treat patients in multidisciplinary clinics, based on disease processes. This institute model brings a range of experts to the patient and expedites care by physicians and surgeons as well as nutritionists, wound care experts, psychologists, pain management specialists and other medical subspecialists. This expedites the time for treatment and allows patients to get care in the most efficient means possible.
It’s a prime example of putting patients first.
Q: Tell me more about the staff at the Digestive Disease Institute in Abu Dhabi.
A: Our team is diverse. On the physician staff are representatives from North America, Europe and throughout the Middle East. Many of our faculty have spent time in the U.S. and quite a few have trained or worked at Cleveland Clinic in the U.S. This diversity gives us a range of expertise and opinions, and makes for a rich environment for managing patients and promoting active interchange amongst ourselves.
Currently, we have students and residents from both here and the Cleveland campus rotating with us in a fashion similar to that of an academic medical center.
Q: You return to Cleveland for one week per quarter. How do you foresee these visits helping to foster coordination and growth in research and clinical applications?
When I am in Cleveland, I connect with my partners to discuss opportunities for collaboration, and program growth and development. These exchanges give us the chance to work on exciting initiatives such as residency and fellowship training and educational programs, and develop courses training surgeons in all aspects of digestive diseases.
I also make sure that I check in with my surgical endoscopy team to see what therapies they are offering patients in Cleveland, and how we can continue to work together despite the physical distance between us. This includes participating in clinics in the endoscopy suite and in the operating room.
We also plan and manage the rotations of staff physicians, residents and medical students to and from Cleveland Clinic’s main campus and Cleveland Clinic Abu Dhabi.
Q: What will be topping your agenda over the next year?
A: First, we’re very excited about opening a comprehensive liver transplantation program, likely in the beginning of 2018, allowing us to bring transplantation and complex resection liver and pancreatic procedures to this region.
Second, as Cleveland Clinic Abu Dhabi progresses from a busy clinical and subspecialty center, we will continue to add research and educational programs. The mission will be to train physicians in a fashion typical of Cleveland Clinic standards and then promote practices, services and therapies that may not have previously been available in the region.
Continuous improvement and research will help generate data to drive quality and best outcomes for patients, principles that are core to Cleveland Clinic throughout the world.