Getting to Know Dr Lee Piao Jarrod

As a gastroenterologist, I specialise in conditions affecting the digestive system, which includes the following organs: oesophagus, stomach, small intestine, colon, liver, pancreas, gall bladder and biliary ducts. Common digestive problems that I treat include abdominal discomfort or pain, bloating or gas symptoms, constipation, diarrhoea, heartburn, jaundice and swallowing problems. #readmore

As a physician, my main role is to make an accurate diagnosis, then formulate a management plan to help the patient. I utilise various modalities to make a diagnosis, including clinical assessment, radiology imaging, blood tests and endoscopy. Over 98% of patients with digestive conditions can be treated with medication and a diet or lifestyle modification. However, a small proportion will need to see another specialist for surgery.

I specialise in advanced endoscopy. Endoscopy is a minimally invasive procedure where a thin, flexible instrument is inserted through either the mouth or the anus to examine the stomach or the colon. Advanced endoscopy goes several steps further. Put simply, it can examine more structures, examine more thoroughly and perform more treatments compared to routine endoscopy. It also allows endoscopy in an altered anatomy, such as after reconstructive surgery. There are 2 broad areas: advanced imaging and advanced therapeutics. #readmore

Advanced imaging utilises specialised techniques and technology to detect problems that are missed by routine endoscopy. It can also examine organs not normally seen by routine endoscopy, including the small intestine, pancreas, bile ducts and even external structures adjacent to the digestive tract. Advanced therapeutics allows endoscopic treatment of conditions without actual surgery. This includes removal of growths or biliary stones, opening blockages, draining fluids, establishing feeding channels, and many other procedures which were not even thought possible a few years ago.

When I graduated from medical school, I was conflicted about which specialty to choose. I treasured the deep analytical ability of physicians, yet I yearned for the excitement and technical challenges found in surgery. Then I discovered Gastroenterology. Immediately it seemed like a perfect fit, a converging point of medicine and surgery. Gastroenterology is a subspecialty of internal medicine, and demands the thinking skills of a physician, yet endoscopic procedures demand the technical skills expected of every surgeon. #readmore

Advanced endoscopy takes it a step further. It is considered a subspecialised procedural field, and requires years of additional training, no different from surgeons who choose to subspecialise beyond general surgery. The technical skills are not easy to learn, and few can truly master the discipline. It is also heavily reliant on technology, and as such is always evolving in tandem with technological advancements.

Perhaps the most difficult endoscopic procedures are advanced endoscopic procedures in patients whose anatomy have been altered by surgery. There is an internationally accepted 1 – 4 grading scale in endoscopy for technical difficulty where 4 is the most difficult. While 99% of procedures are grade 1 – 2 difficulty and can be performed by most advanced endoscopists, level 3 – 4 procedures have only been successfully performed by an elite few. Even in the top medical institutions in the world, these procedures have a success rate of only 60 – 80%. #readmore

I relish the challenge of attempting these level 3 – 4 procedures. I remember the first time I attempted a level 4 procedure, an endoscopic removal of a bile duct stone in a patient with the stomach completely removed. It was a case no one had successfully performed in Singapore before. I remember planning the case for over a week, and even brought in special equipment. I watched surgery recordings of top experts who had performed similar cases until I could visualise exactly what I had to do. The actual procedure was an epic experience with many unexpected hurdles. 2 hours later, the endoscopy team could proudly say it was the first to safely and successfully perform this procedure in Singapore. Since then, I have had opportunity to attempt many such cases, with results comparable to top international institutions. Yet, one never forgets the first time.

Digestive problems are very common, affecting 20 – 40% of adults every year. Hence, there is tremendous potential for us to improve the quality of lives of many people. Gastroenterology is a young and rapidly evolving field. We have many new advances and understanding that were not even available 5 – 10 years ago! #readmore

Besides endoscopy, there are many advances in the field of intestine movement and function. The majority of patients with digestive problems will produce normal results after an endoscopy procedure. Hence, these new investigations will help patients better understand their symptoms, and to tailor medication, diet and lifestyle to help them. In digestive cancers, we have progressed from early cancer detection to cancer prevention. Utilising risk stratification and advanced endoscopy techniques, we are better able to identify pre-cancerous growths, and to intervene before they become malignant.