Chapters Transcript Video What happens when GI doctors shape the future of endoscopic therapy and technology? If anybody knows someone with an esophageal stricture, it is one of the worst things that you can get because you can't eat. And so, um, that is a real problem for a lot of people and, um, and we get a lot of those sort of more complicated esophageal stricture cases and now there's a clinical trial that has a new product that can. Actually help these patients and happy to say that um this is working out really well for a lot of folks and they are just delighted that, you know, this technology, you know, came um came to UCI so we could um we could use it. Hi, I'm Lindsay Carrillo, Business Development director at UCI Health. Hi, my name is Doctor Sunil Verma. I'm the associate Chief Medical Officer for ambulatory and a professor of otolaryngology here at UCI Health. Welcome to Physician Huddle by UCI Health. So, today we're joined by Professor of Medicine, Doctor Jason Samrosina, who also is the Chief of the division of Gastroenterology and hepatology. Welcome, Jason. Hi guys. So Jason, you've been here for a bit. Tell us about your career and what you do here at UCI. Sunil, I've been here for 21 years. It's crazy to say that, but, um, um, I grew up in a small town in Saint John's, Newfoundland in Canada, and, um. And there's a great university there and I did undergrad there and I did med school there and I met a girl in my, uh, med school class who's from California said we're not staying in Newfoundland. We are going back to California and I said, OK, let's try that. She sounds smart, yeah, yeah, so, um, and so, uh. It was our 20 year wedding anniversary, um, a few months ago, and so, um, and, uh, yeah, so we ended up couples matching to UCI. She did pediatrics, I did internal medicine, and so, um, it's been a long journey for me here at UCI and um it's a real honor to be now the chief of GI and um um have seen this place just sort of blossom over the years and changed so much and And it's been great to be a part of that change and now, uh, leading has been a bit of a, um, an amazing experience for me. So tell us about your role as the chief of gastroenterology and hepatology. What does that mean and what do you do? So, being chief um of an academic division um uh within UCI really is about taking care of the, the people um that, you know, work in the division and that's really the doctors mainly and, and as well as the advanced practice providers our um our PAs and uh we really have an amazing team and um. And really it's my job to help them uh progress in their career and um help them with their passion projects and um keep the um. Um, keep the kind of the, the spark and the inspiration, uh, for our division, um, strong, um, so we can really, um, move the field forward, and I think we've got a, uh, an outstanding, um, group of world-class physicians that, um, and APPs that work in our division and we're really blessed that way and, um, and I think, um, what we're kind of doing together is, is pretty special. How long have you been in this role and what do you hope to do with it? So, uh, I've been the chief of GI and hepatology for about a year and, um, and the year that I've had it's been really an amazing year for personal growth for me, learning so much about really how, um, medicine works and how, uh, running a division, you know, has to be, um, has to be done, but um. This year has been just amazing year for growth. Uh, we've, uh, brought in, um, so many new faculty and, um, it's been great to see even fellows that had graduated a few years ago come back, um, to work, um, at UCI and, um, that's just always a, a pleasure to see, you know, people that you've trained and wanting to come back to your your home program and, and give back and, and, and, and build, um, but I think the, um. Um, the goal really is to push, you know, so many aspects of, of what we do, and, you know, one of them is patient care and, um, you know, providing, um, really the, the best quality patient care, um, that we can with really some amazing technologies that we have that really a lot of other centers don't, um, and, um, we've done a really great job with bringing in new technology to help um. Um, treat patients in a way that's minimally invasive, um, um, lower risk, and, um, and I think that's one of the areas that we're so strong, um, you know, things that I really wanna work on and build even more is sort of the research and innovation side of things and, um. And so we've recruited some just amazing faculty that are really um inspiring all of us to kind of think more and um innovate and and be more curious and uh and I think you know doing research um. Today is getting harder and harder. It's hard to get, you know, funded, um, but, um, um, despite that, you know, we've got faculty that are really pushing the envelope and, um, happy to say that, you know, it's, it's working out, um, and lastly I think, um. We do a really great job with training, um, we have an amazing uh GI fellowship program and advanced uh uh fellowship program as well and um we invest so much into our trainees and, um, and you know we're, it's just a pleasure working with, you know, these like brilliant people and um. Um, and I think we've really kind of, um, the fellows really make it, um, just a kind of a family experience, you know, coming to work and, and seeing everyone, and, uh, you know, we are always together, we're, um, um, always, um, having a good time and, and I think that's um something that's sort of special about our group. So you've touched upon providing excellent clinical care, um, changing, you know, continuing to expand upon that, you've touched upon research and then upon training. So as you add physicians and advanced practice providers to the group, do they have to be able to do all three, or do you find that sometimes people are good at two but not one, or really, now how do you balance that out because at the end, like you said, this is an academic division, academic department. It's a great question and um. And I think you know when we bring someone in, you know, everyone's got their strengths and their passions and we really focus on that um you know we have um faculty that really are amazing at um program development but they may not be, you know, interested in, you know, writing a lot of research papers and so we put them in leadership roles and administrative roles that can help with operational things, um, and um that. Role is so important for our division and um and it's important that um you know we kind of value that skill set as well um because as the group grows things get more complicated and we need um people that can that can help manage um but um I think my job as a chief is really to understand each of those people and um because everyone that works for. You know, works under this division, it's come it's coming for a specific reason. There's a lot of other jobs out there and if you're here to, you know, work in this academic center, it's because there's, there's something about it that you appreciate and um and it's usually. You know, they wanna learn more, they wanna grow themselves and it's so it's my job as a chief to understand like what is it that you wanna do here and um and give them the freedom, give them the resources, um, empower them so that you know they can kind of reach those goals. Absolutely. So you touched on research. Your division is responsible for a lot of clinical trials, both medications, procedures, you yourself, accomplished researcher. So tell us what are the highlights going on among your team and then some specific ones that you told me about. So, um, There's just so much going on in gastroenterology and hepatology right now, and it's just been amazing. In the last 10 years, the advances that we've seen in interventional endoscopy, and inflammatory bowel disease, and hepatology and motility, really like there's just been so much going on and um. You know, it is like a pleasure to be at the forefront of all of that and you know one of the great things about being um part of this university is industry really look to us to, to help sort of validate a lot of this technology um and um run a lot of these trials and so um. Um, some of the kind of the, the highlights, um, in kind of the work that we're doing. There's a um There's a new balloon that can help open up um narrowed segments of the esophagus. Those are called strictures, and this is the first drug coated balloon in GI, and it's, there's a drug called Paclitaxel. It's coating the balloon, and when you dilate those strictures, um, the Paclitaxel prevents that scar tissue from reforming. And if anybody knows someone with an esophageal stricture, it is one of the worst things that you can get because you can't eat. And so, um, that is a real problem for a lot of people and um and we get a lot of those sort of more complicated esophageal stricture cases and now there's a clinical trial that has a new product that can. Actually help these patients and happy to say that um this is working out really well for a lot of folks and they are just delighted that, you know, this technology, you know, came um came to UCI so we could um we could use it. So it sounds like from a patient perspective, you may have had an issue 10 years ago, kind of let it fester maybe, but now there's new technology, new physicians, and access to frankly, the newest things here at UCI Health. So it's quite compelling for a patient or a referring doctor to have a patient seen within our system. Definitely, you know, I think, um. I think UCI has done a really great job in that way. Um, I think, you know, um. The differentiator for us is really um. Going to see a doctor that has access to just a lot more, um, that um is seeing things um firsthand and um going to conferences, learning about new things that they can potentially apply to their sort of difficult patients and um and that's what we do every, every year. You know, we go to multiple conferences, we, you know, learn about the, the, the newest things and then we think about those patients and when we see something, it's sort of almost immediate that the patient will come to mind and you'll say, wow, this is exactly what this patient needs and how do I get it? And uh unfortunately a lot of companies really appreciate the um um. Sort of the, we'll say the prestige and quality that we bring our patients at UCI and they're only too happy to work with us. And so, um, um, just, um, just today, um, there's a condition called irritable bowel syndrome. It's a very troublesome condition and a lot of patients, um, suffer from IBS and, uh, and today we were, um. Um, just looking and reviewing a, a, a, a randomized control trial looking at a new medication for IBS, and, um, I can tell you, um, IBS patients, they really struggle, and so the fact that we can potentially, you know, bring something new to them, um, it's exciting. You and I also talked about robotic procedures. Robotics is sort of, you know, taking up more space in your arena. Can you tell us a little bit more about that and how you're using it? So robotics is probably one of the most exciting things for me in my life, and, um, um, you know, endoscopy, um, is an amazing tool, you know, flexible endoscopy has been around for, you know, 30 or 40 years. And um what we've been able to do with that manual scope has just been, it's just amazing. um, but it is um taxing on the body and um as GI doctors, we really try to care for as many patients as we can in, in a, in a day, um, but at the end of that day, we're kind of sore, you know, we are tired and um because there's a lot of physical load and physical demand on our bodies, um, and. You know, what we've realized is, you know, this sort of volume for this many years and decades in a career can really wear on you. And so, um, so finding a solution that can make GI procedures more ergonomically sound and safer for our physicians, I think is a really important thing. And um and so I've had the pleasure of working with a company and that is producing the, the first robotic colonoscope platform. And um and um I um can't talk too much about it, but um I can tell you it is um probably gonna be one of the most amazing inventions in our field and it's not that far around the corner and um and I can't wait for the day that I'm sitting in this chair like this just swiveling around and with a controller in my hand and navigating a colonoscope and a patient uh in a way that is extremely safe, um. Um, with, um, proprietary tools that can help, um, do advanced procedures like, um, endoscopic resections of large polyps, um, in a way that's comfortable and relaxed, and, um, and I think that that day is coming soon and I'm sure UCI is gonna be one of the first centers in the world to to have that kind of technology. That's exciting. I mean, gastroenterology and hepatology, it's a balance, right? Because. The disease burden is so high, um, there's so much technology that's going into, uh, care of patients, and so I imagine a lot of times you also have to be able to separate the riffraff from the real stuff, um, just because I'm sure some of the technologies seem like they're gonna work initially and then, you know, something exciting like this and then hopefully not this platform but that something else maybe just doesn't go the way you exactly want it. So it's gotta be weird at times or challenging at times to be sort of a gatekeeper. Yeah, it's a, um, you know, I think, um, a lot of us, um. are getting better at sort of understanding, you know, what's truly going to be clinically valuable to a patient, I think. And Sometimes though, um, we're also advising companies and we'll see something, um, come across our desk and, and we'll have meetings with the company that are trying to do something and, and we, um, often can say, you know what, this is a really great idea, but I think you need to tweak it a little bit and um. And sort of take a slightly different approach or or maybe like, you know, simplify it or um make it less complicated and I think this is something that's really gonna be helpful um. But um, but there is a lot and you know, and I will say there's a lot of sort of like digital things now that are out there, especially in the GI space and it's hard to know like, OK, which app is like the one that I should be using and, and it's a, it's, it's, it's hard to keep up with a lot of this stuff, um, but whatever, if it's a device or an app or a medication, um, one of the things that, you know, we really harp on. Um, with the companies is there really has to be like a, a great explanation and training associated with that because sometimes, um, you know, you can't just sort of just drop a technology into, you know, an endo suite or a clinic setting and then just expect, you know, everybody to understand how to use it and, you know. You know, use it optimally and so, um, so that's one of the things that actually a lot of our physicians help companies with, um, sort of, um, teaching companies how to, um, kind of incorporate and integrate, you know, with, you know, the, uh, the current workflows and, um, and that's a very kind of rewarding experience because when you can um sort of take something that somebody really worked hard on and then. Um, sort of help a company, you know, get it, um, kind of in the right hands, used the right way, um, you know, that's, that's, that's really, um, also helpful with the process. So you mentioned apps and technology. I'm sure artificial intelligence is just one of many of those things that are now cropping up and people trying to get your attention on. Tell us what's relevant. What are you're actually seeing that works, and, you know, what are you personally working on and developing here at UCI? So, um, so we're seeing AI everywhere in our daily lives and, um, and you know, GI has been actually, um, Uh, one of the kind of earliest specialties to adopt AI and um have algorithms that are kind of built into the scope, um, and so, um, uh, Bill Karnes, like my colleague and I started a company called Docbot several years ago, uh, which actually focused on what we call computer vision algorithms and, um. Um, so this is basically, uh, an algorithm kind of watching, um, as you do the endoscopy, and it's highlighting things of concern. And so, uh, did an amazing algorithm to detect colon polyps. It was one of the first algorithms ever released in GI and published on and, um, and, um, we took it a step further where we could characterize polyps so we can tell the the pre-cancerous ones. From the non-pre-cancerous ones, uh, we took it a step further to, um, understand sort of where we were in the colon, um, how clean the colon was, how we were removing these polyps, and then all of a sudden, now the AI is actually helping you write the report and, um, that would save you time, lead to more accurate reports. Um, I worked on an algorithm that. Um, help detect dysplasia, which is, um, a very high risk pre-cancer in the esophagus, uh, within a condition called Barrett's esophagus, and, um, and now since we've sold the company, we're actually helping get, um, algorithms like this, um, through the FDA process to, um, to be available for physicians because, um, one of the things that we know is, um, every endoscopist has a different skill set. Um, but if you can train an algorithm, um, to the skill set of the expert, and then you can incorporate that algorithm, you know, in the scope, then all of a sudden that maybe a low performer can turn into a high performer, and that could really make a clinical difference for a patient. Um, there's a lot of things that we see on endoscopy that I can recognize, um, or another expert, but, um, um. You know, someone who, you know, didn't train at UCI may not see that and, and now a lot of them. Um, I know there's a lot of surgeons and family physicians, internal medicine physicians, and then if you think about, you know, training throughout the entire world, you know, a, a really solid algorithm that you could apply to really any endoscope anywhere that really make an impact. So I think computer vision algorithms probably are, you know, the, uh, the part of AI that's most exciting in GI right now. And that kind of overlaps with your space literally. Yeah, it's um it's crazy to think all this technology that's coming through and, and how it's gonna make our lives easier, um, and, and improve, especially like you said with disparate training experiences and, um, probably a little bit more leveled off in the United States, but certainly when you, it's really a great worldwide application, yeah, yeah, make it easier for us, you know, I think the other part of AI that's sort of interesting is this um. These large language models and that are being used to um essentially serve as like health agents. And um and so we, we've been working with a company that um can help answer questions about your bowel preparation before colonoscopy. And so, um, a couple of years ago, this algorithm was kind of a website that you went to and you typed in some questions and um. And um then, you know, it was, it answered really, really well and you could actually train it yourself so I could um kind of create the voice of the of the um the the agent that was responding accent is that what you mean? It would have a really, really nice Canadian accent soothing tone and um but um. And um and it was sorry so it wasn't voice it was just it was just sort of like the you know how how it respond to the questions but um what was neat about it is you know you could train and and on very, very specific things it's sort of like you could ask it like, you know, what's the best way to park when I got to the medical center um you know, how long does these procedures typically take and, and then you could, you know. Make sure it didn't answer other questions like, you know, um, where does Doctor San Francio live and so, but, um, um, but then it evolved, um, now to a phone number that you can call and um you have a conversation with this AI bot you can have a conversation with this health agent and it speaks 75 languages and so this is now, you know, really exciting. Now taking it a step further, now the agent can actually do outbound calls. So now, you're, um, you can say, OK, I've got, you know, you know, 10 patients tomorrow, um, you know, can you call them, see how they're doing, if they have any questions, you know. Um, you know, let us know, um, did they get all their instructions, um, and, um, and then, you know, the ones that are flagged that we could call back and so I think this is sort of another really interesting use of, of AI to kind of decrease the burden on the resources that we have, um, um, and I think, um. As it gets customized even more, it'll make less errors, but I have to say I've been really impressed with like how, you know, these are working now. Yeah. Uh, we've touched on a lot of technological advances, educational advances, and one place where that is going to be showcased is the upcoming digestive Health summit. It is sort of a new flavor, new brand, new approach. Tell us about how you're approaching this event and you know, how is it meaningful to physicians here and then also beyond. So this is something that we are super excited about, um. So, you know, one thing that's unique about um the way we deliver digestive health care at UCI is we, all the physicians work under essentially one roof and it's called Digestive Health Institute. And it is a um um 3 surgical divisions, NR GI and hepatology division coming together and um um. Working together to collaborate on clinical things, research things, training things, and, um, and also, um, kind of working as a team to meet metrics that um together and um and I think that's just been a wonderful um. Wonderful thing to be a part of and um we've been doing really, really well together and it's um and our summit now is our chance to kind of show, you know, what we're doing and um and so the DHI summit is gonna showcase. The talent that we really have, um, from the surgical side, from the GI medicine side, and um it's gonna be um. You know, very, very educational on so many digestive health topics, but one of the things I'm kind of excited about is a track that we have in there called the Leadership and empowerment track. And, um, and, you know, sprinkled throughout the two days of didactics, there's gonna be some keynote speakers that are gonna talk about things that I think a lot of doctors are interested in. Uh, one is financial fitness for MDs, um, another one is personal branding and medicine. Um, there's another talk on all the new AI things that can help, um, reduce physician burnout. Um, there's gonna be talk about, um, you know, how the business of healthcare is evolving and, you know, future insights and, um. And I think, you know, um, this is really gonna be, um, oh, I forgot one more, um, innovating your career every few years, um, and how important that is and one of the executive coaches are gonna talk about that. So, um, we've got some, you know, a lot of great, um, you know, medical and surgical content, um, but one of the things that I'm especially excited to hear is these five leadership empowerment talks, um. You know, as part of the summit, we also have a um a hands on. Which is really a world class event. Um, our, um, comprehensive digestive disease center in Orange has 10 endoscopy rooms. We are going to, um, have all the rooms open to companies that are going to showcase, um, different technologies, but we are gonna have 9 interventional endoscopists be there at those stations, um, teaching. Um, those, um, those procedures and, um, that is, um, really kind of, you know, the best way to really understand or even get introduced to, you know, what's out there, um, seeing the products, you know, in action, um, being trained by someone who's really, um, really an expert, and I'm really proud to say that all the interventional endoscice that are gonna be there training. Or either current faculty or previous fellows that are coming back to help with the training. So, um, this is, uh, this is really exciting. So not your dad's educational summit. No, not at all. And, and it's, it's gonna be nice. It's gonna be at the Hunting Hyatt, um, and, um, right on the beach, and, um, you know, uh, Lindsay, we had a chance to, uh, to check out the venue recently and it's just gonna be a, a really pretty place to, to do some, uh, um, to do some CME. And also it's super fun. Yeah, absolutely we've got some, we've got some surprises, um, as part of the summit, uh, we have a very, let's say, um, useful and fun leadership team, um, and, uh, at, at DHI, and, um, and we're gonna, we're gonna show that. I love it. Well, thank you both so much for being with us. You're welcome. Thank you. This has been Physician Huddle by UCI Health. Thank you for joining us. This was an episode of the Physician Huddle podcast by UCI Health, produced by Brett Shahen, Angelica Yagubi, and Victor Ting. For more episodes, information on clinical trials at UCI Health, or to refer a patient, view the show notes or visit clinical connection. UCIhealth.org. Created by
