Upper Gastrointestinal Surgery 腸胃外科
Contact phone number: 2855 4637
Fax number: 2819 4221
e-mail: ptkleung@hkucc.hku.hk

Clinical Staffs

Kent-Man CHU, 朱建民教授 Professor, Honorary Consultant, Division Chief MBBS(HK), MS(HK), FRCS(Edin), FCSHK, FHKAM(Surg), FACS Siu-Yin CHAN, 陳小燕 Specialist MBBS(HK), FRCS(Edin), FCSHK, FHKAM(Surg) R WEI, 韋樂申 Medical Officer MBBS(HK) Research Staffs Pansy TSE, MPhil Student BSc Lui SHING, Research Assistant BMed Pui Ki LAU, Research Assistant BSc

KM Chu

ACTIVITIES AND SERVICES

Clinical Services

The Division of Upper Gastrointestinal Surgery is responsible for the management of patients with disorders of the stomach, duodenum, and small bowel. Specialist services are provided for ingested foreign bodies, gastrointestinal bleeding, non-specific abdominal pain, peptic ulcer diseases and their complications (bleeding, perforation, and obstruction), and, benign and malignant tumours of the stomach, duodenum, and small bowel. With an ageing population, such clinical services have become more complicated and demanding.

Inpatient services

The Upper GI Surgery Ward C5 has 28 beds in Queen Mary Hospital catering to both emergency and elective admissions. Common emergency conditions, of which there are 1,600 yearly, include ingested foreign bodies, gastrointestinal bleeding (ulcer, gastritis, Mallory Weiss Syndrome, oesophagitis, tumour, small bowel, or obscure origin), and abdominal pain (ulcer, perforated ulcer, tumour, or non-specific nature). Elective admissions numbering 300 per year mainly involve patients with gastric tumours. The Division also provides specialist consultation services to all other Departments of Queen Mary Hospital as well as other hospitals in the Hong Kong Special Administrative Region.

Outpatient services

The Division runs two specialist outpatient clinics weekly at the S Block of Queen Mary Hospital and receives 8,500 visits annually. The Upper GI Oncology outpatient clinic manages patients with gastric, duodenal, or small bowel tumours and the Upper GI outpatient clinic manages patients with non-tumour upper GI conditions. Both clinics receive patients discharged from the Upper GI Surgery Ward as well as referrals from sources such as the Accident & Emergency Department and other Departments of Queen Mary Hospital, other outpatient clinics of the Hospital Authority, and private practitioners.

The Upper GI Oncology Outpatient Clinics are held weekly at the Queen Mary Hospital Specialist Outpatient Clinic on Tuesday afternoons. The Upper GI Outpatient Clinic is held weekly at the Queen Mary Hospital Specialist Outpatient Clinic on Friday afternoons. (For appointment at the Queen Mary Outpatient Specialist Outpatient Clinic, Tel: 2855 4177).

Private consultation is also available at the Private Clinic of the Department of Surgery, Queen Mary Hospital. (for appointment, Tel: 2855 4616)

Other related wards and facilities at Queen Mary Hospital

• Admission Ward D5 where all patients with a surgical emergency are admitted
• Esophageal Functional Laboratory at B5 where investigations such as esophageal manometry and 24-hour ambulatory pH monitoring are performed
• Intensive Care Unit (ICU) at C2/E2 where surgical patients requiring intensive care are managed
• Intermediate Care Area (ICA) at E5 where a moderate degree of intensive care is provided
• Surgery Day Centre K14N where day patients are admitted
• Private wards K21S and K21N where private patients are managed
• Specialist Outpatient Clinic at the S Block of Queen Mary Hospital

Special equipment of the Division

• Current models of upper endoscope, bronchoscope, and enteroscope
• Capsule endoscope
• Instruments for therapeutic endoscopy including injector, clipping, and heater probe
• Argon plasma coagulator
• Expandable metallic stents for endoscopic stenting of malignant GI strictures
• Endoscopic ultrasonography
• Percutaneous ultrasound
• Isotope ratio mass spectrometer for C13-urea breath test
• Esophageal manometry
• 24-hour ambulatory pH monitoring

Special equipment in the Operating Theatre

• An array of laparoscopic instruments for laparoscopic surgery
• Harmonic scalpel for laparoscopic surgery
• Laparoscopic ultrasound

STRENGTHS AND DEVELOPMENTS

Endoscopy

Except for bedside portable endoscopy for very sick patients, all endoscopic procedures are performed in the Surgical Endoscopy Centre. The Division performs the following endoscopic procedures:

• Diagnostic & therapeutic upper endoscopy (4000 annually)
  Diagnostic upper endoscopy is performed for patients with conditions such as dysphagia, heartburn and regurgitation, epigastric pain, upper GI bleeding, symptoms of gastric outlet obstruction, epigastric mass, or unexplained anaemia. Endoscopic biopsies are taken for diagnosis of malignancy as well as for Helicobacter pylori infection.
  Therapeutic endoscopy is also applied for retrieval of foreign bodies, insertion of self-expanding metallic stents for inoperable cancer of stomach, cessation of bleeding from gastric or duodenal ulcers, removal of gastric polyps, percutaneous endoscopic gastrostomy (PEG), and insertion of feeding tubes. A 24-hour emergency service is available for patients with substantial GI bleeding.
  
  
• Endoscopic ultrasonography (220 annually)
  This is performed routinely for diagnosis of submucosal lesion of the upper GI tract (for example, a stromal tumour), and staging of carcinoma of the esophagus and stomach. It is currently the most accurate method for local staging of tumour and lymph node spread in upper GI cancer.
  
  
• Small bowel enteroscopy
  This is valuable for investigating patients with suspected small bowel pathology. In about 5% of patients presenting with GI bleeding, the bleeding source originates from the small bowel.
  
  
• Capsule endoscopy
  This is a new investigation for patients with suspected small bowel pathology, especially GI bleeding of obscure origin. The patient carries a portable recorder which receives images continuously from a special capsule swallowed on the day of examination.

Urea breath test

A non-radioactive C13-urea breath test is available for accurate testing of Helicobacter pylori infection. The urea breath test allows detection of Helicobacter pylori without the need for endoscopic biopsies.

Figure 2. Urea breath test

Regional intra-arterial chemotherapy

The Division, in collaboration with the Department of Diagnostic Radiology, introduced the use of regional intra-arterial chemotherapy for the treatment of gastric cancer in Hong Kong. Traditionally, patients with unresectable or metastatic carcinoma of the stomach were given systemic chemotherapy. Such treatment is, however, associated with frequent systemic toxicity. Regional intra-arterial chemotherapy maximises the local concentration of chemotherapeutic agents and minimises levels in the systemic circulation. The local effects of chemotherapeutic agents may thus be enhanced while systemic side effects are obviated as far as possible. The results of treatment with regional intra-arterial chemotherapy have been remarkable. Regional intra-arterial chemotherapy offers new hope for patients with diseases that were thought to be unsalvageable, and it is also given pre-operatively to patients with advanced gastric cancer with an aim to increase the chance of cure following gastric resection.

Figure 3A. CAT scan of a patient with carcinoma of stomach and bilobar liver metastases

Figure 3B. CAT scan of the same patient after regional intra-arterial chemotherapy. Note the dramatic response of both the primary tumour and the liver metastases

Operations

Surgical operations are a well-established service of the Division. Most operations are performed for neoplastic disease of the upper GI tract. In recent years, minimally invasive surgical methods such as thoracoscopic and laparoscopic approaches for gastric disorders have been developed. Examples include laparoscopic or thoracoscopic approaches for peptic ulcer diseases, staging laparoscopy and laparoscopic ultrasonography for gastric cancer, laparoscopic resection of benign gastric tumours, and laparoscopic gastrectomy for gastric cancer.

A 24-hour emergency surgical service is available for the management of upper GI disorders such as perforated ulcer diseases and gastrointestinal bleeding that cannot be controlled by endoscopic means.

Figure 4. Laparoscopic gastrectomy being performed

RESEARCH INTERESTS

• Foreign body ingestion
• Peptic ulcer diseases and their complications
• Helicobacter pylori infection
• Endoscopic ultrasonography
• Clinical and laboratory (including molecular biology) research on gastric tumours, including adenocarcinoma, lymphoma, and gastrointestinal stromal tumour (GIST)
• Surgical education

AWARDS AND GRANTS

1. Prof. KM Chu was the 1999 International Guest Scholar of the American College of Surgeons
2. A prospective randomised controlled trial on neoadjuvant regional chemotherapy for gastric cancer. Grant received: RGC Research Grant Award, July 1999.
3. Aberrant promoter hypermethylation of growth regulatory genes in cancers of the gastrointestinal tract. Grant received: RGC Research Grant Award, July 1999, with Dr SY Leung, Department of Pathology.
4. Identification of novel differentially expressed genes in gastric cancer and their functional characterization. Grant received: RGC Research Grant Award, July 2001, with Dr SY Leung, Department of Pathology.
5. Prof. Chu received the JSGS 2001 Akita Award from The Japanese Society of Gastroenterological Surgery.
6. High resolution mapping of chromosomal aberrations by cDNA microarray-based comparative genomic hybridization and their correlation with gene expression profile of gastric adenocarcinoma. Grant received: RGC Research Grant Award, July 2002, with Dr SY Leung, Department of Pathology.
7. Delineation of prognostic biomarkers in gastric cancer using cDNA microarray data, validation in independent dataset and their functional characterization. Grant received: RGC Research Grant Award, July 2003, with Dr SY Leung, Department of Pathology.
8. Prof. Chu was awarded the Faculty Teaching Medal 2003, Faculty of Medicine, The University of Hong Kong, Hong Kong.