Introducing Our Combined Pediatric & Adult Colorectal Surgery Clinic

A combined Pediatric and Adult Colorectal Surgery Clinic unites gastroenterologists and colorectal surgeons from Cleveland Clinic Digestive Disease & Surgery Institute with pediatric gastroenterologists and surgeons from Cleveland Clinic Children’s for patients of all ages with chronic diseases.

Continuity of care

Meagan Costedio, MD, FACS, a colorectal surgeon, says the purpose of the clinic is to provide treatment to children and adolescents with lifelong illnesses, including Crohn’s disease, ulcerative colitis, chronic constipation, rectal prolapse and congenital diseases, including anorectal malformations, familial adenomatous polyposis and Hirschsprung’s disease.

“The combined expertise will provide a good transition for kids as they become adults,” Dr. Costedio says. “They will have the ability to meet the adult surgeons, providing an easier bridge to adult care when the time comes.”

On the pediatric side, Anthony DeRoss, MD, a pediatric general surgeon, said transitioning pediatric patients to adult care is a struggle.

“This will provide some continuity of care of patients — particularly adolescent patients who are diagnosed with diseases and are going to require long-term follow up, particularly Crohn’s and ulcerative colitis patients,” Dr. DeRoss says. “It’s important for patients with theses disease processes to remain on top of their care and learn how to start caring for themselves.”

Dr. DeRoss says identifying symptoms that require intervention and take medications as prescribed are skills teens need to develop as they leave home.

“Getting teen patients to take ownership of their disease, in terms of knowing what their disease process is, is important,” he says. “We’re working with gastroenterologists to try and provide that education to patients and parents several years in advance, so when they reach that stage they are prepared.”

Multidisciplinary care model

The main focus of the clinic right now is Crohn’s disease, ulcerative colitis, polyposis and rectal prolapse. Over time the clinic will expand to include other patients, including those with pelvic floor, thyroid and esophageal problems that stem from gastrointestinal diseases.

Barbara Kaplan, MD, a pediatric gastroenterologist, says the clinic is a great example of how pediatric and adult specialists can work together for patients.

“At Cleveland Clinic, everyone works together. We are free to collaborate,” Dr. Kaplan says. “That doesn’t happen everywhere.”

As the clinic adds patients and becomes more robust, Dr. DeRoss says it will move from a collaborative model to a multidisciplinary model with adult and pediatric colorectal surgeons and gastroenterologists meeting with their adult counterparts to discuss and co-manage patients.

The clinic is supported by:

• Pediatric surgeons
  • David Magnuson, MD
  • Anthony DeRoss, MD
  • John DiFiore, MD
  • Richard Herman, MD
• Pediatric gastroenterologists
  • Lisa Feinberg, MD
  • Barbara Kaplan, MD
  • Marsha Kay, MD
  • Jacob Kurowski, MD
  • Lori Mahajan, MD
  • Kadakkal Radhakrishnan, MD
  • Vera Hupertz, MD
  • Sophia Patel, MD
• Adult colorectal surgeons
  • Tracy Hull, MD
  • Meagan Costedio, MD
  • Massarat Zutshi, MD
• Adult gastroenterologists
  • Jessica Philpott, MD, PhD
  • Bo Shen, MD

Dr. Costedio says the clinic now sees 30 to 40 patients and anticipates pediatric and adult gastroenterologists and pediatric and adult colorectal surgeons working together with psychology, nutrition and other specialties as the needs of the patient base expands.

“Kids with chronic disease become adults with chronic disease,” Dr. Costedio says. “We want to minimize the impact.”

Transitions

While the clinic is still in its infancy, Dr. Costedio says the ultimate goal is to keep kids in the Cleveland Clinic system to make the transition easier for parents and families. She says referring physicians also benefit from having a multidisciplinary team available to their patients.

“Our goal is to help them. We see kids for a variety of things, whether it’s a second opinion or they just want to confirm they are doing the right thing,” Dr. Costedio says. “We can help with the transition to adult care, particularly for people who come from a freestanding children’s hospital where the crossover to the adult side is a huge barrier.”

Dr. DeRoss adds that the clinic provides an avenue for patients and their families to meet the gastroenterologists and surgeons before a middle-of-the-night acute issue. Dr. Kaplan says the value of patients and families meeting caregivers ahead of time reinforces that continuity of care.

“We want to get to know the patient and explain to them what we do,” he says. “The goal is to provide some degree of introduction into the surgical world so they have a chance to meet us ahead of time.”

An experienced pediatric nurse is available through the referral line — 216.444.8555 — to answer questions from referring physicians and to triage patients to the appropriate specialist.