Dedicating more resources to improving digestive health

Published on 8 May 2024

NUH’s new digestive health centre leverages the latest technologies to achieve early diagnosis and precise treatment of digestive illnesses.

In January 2023, Mdm Lin Yan Ran visited Alexandra Hospital for pain in her lower back. Her doctors ordered an endoscopy and found a large ascending colon polyp. She was referred to Dr Dimitrii Dolgunov, Senior Resident Physician at the Division of Colorectal Surgery at the National University Hospital (NUH) who performed an endoscopic mucosal resection procedure on Mdm Lin in March 2023 to remove the polyp.

A second colonoscopy that she subsequently underwent turned out to be life-saving for Mdm Lin, as it led to the discovery of a new precancerous anal lesion. Dr Dimitrii Dolgunov eventually carried out the removal of the lesion with a surgical procedure called endoscopic submucosal dissection (ESD). Such a minimally invasive procedure meant a faster recovery process and shorter hospital stay for Mdm Lin, who was observed for one night and discharged the next day.

Mr Ivan Castello Hoyes, 69, was surprised to find a large caecal polyp in his colon in his first colonoscopy. The polyp was growing quietly and would have remained hidden if he did not undergo the screening. 

Like Mdm Lin, he was recommended to undergo an ESD procedure instead of a resection surgery, which would help speed up his recovery process. Mr Hoyes’ ESD procedure was also performed by Dr Dolgunov in October 2023. But Mr Hoyes’ history of heart condition and previous aortic dissection performed by surgeons at the National University Heart Centre, Singapore (NUHCS) complicated matters slightly. In ensuring that Mr Hoyes’ blood thinning medication would not cause excessive bleeding during and after the polyp removal surgery, the collaborative effort by the medical teams was paramount in providing a seamless integration of care.

Fortunately, the polyp in Mr Hoyes’ colon was found to be benign. And thanks to early treatment, Mdm Lin and Mr Hoyes were able to return to their day-to-day activities without complications. They are now both healthy and cancer-free and are only required to see Dr Dulgonov every six months for follow-up checks.

Saving lives through early detection

Based on the Singapore Cancer Registry Annual Report 2021, cancer of the digestive tract is one of the most common cancers in Singapore, comprising 31.1 per cent of cancers in men, and 18.3 per cent of cancers in women. The trend is set to continue with Singapore’s ageing population, where one in four Singaporeans will be aged 65 and above by 2030.

Despite its prevalence, gastric and colorectal cancers are curable if diagnosed at an early stage. It is however often associated with a dire prognosis when diagnosed too late.  

That’s why regular colorectal screening and tests are so important, said NUH’s Adjunct Associate Prof Lee Guan Huei. “Early detection makes a world of difference when it comes to treatment and recovery,” he added.

In an effort to cater to our ageing population’s gastrointestinal health, NUH is stepping up its focus on preventative treatment and early detection. On 16 April 2024, it launched the National University Centre for Digestive Health to strengthen patient access to cutting-edge diagnostics and treatment innovations.

“We are continuously striving for better outcomes where treatment is less invasive, more effective, and tailored to the individual needs of each patient. The introduction of new technologies into our surgical practices will be a game-changer,” said Associate Professor Asim Shabbir, Head & Senior Consultant, Department of Surgery, NUH.

Leveraging artificial intelligence (AI) and advanced technology, the new Centre will be able to deliver same-day diagnostics and treatment capabilities. These advancements open doors for early treatment and better patient outcomes for digestive tract issues.

An example of these advancements is the use of EndoMaster, a robotic-assisted endoscopic surgery system. Engineered with miniature “crab claws”, this innovative technology takes on a novel incision-less surgical approach to remove gastric and colon tumours with increased precision. Clinical trials have demonstrated a reduction in complication rates to below five per cent and hospital stays to less than a day.

In addition to the EndoMaster, the Centre will employ computer-assisted detection, diagnosis and quality control in colonoscopies, all of which utilise AI and work in tandem to diagnose colorectal lesions in real time.

The ArtisQ X-ray based system is another example of state-of-the art innovations at the Centre. The first in Southeast Asia to use a ceiling-mounted angiogram system for endoscopy, it provides 3D imaging with improved sharpness at low radiation dose levels. These images can be superimposed to enable 3D roadmapping, which allows doctors to better visualise surgical procedures and cut down surgery time when locating diseased tissues and removing lesions.

These technological investments signify the centre’s commitment to early detection and treatment, to cure gastric cancers before they require more extensive medical intervention. “We want to shift the focus to early-stage cancer treatment, without the need for chemotherapy, radiotherapy or even general anaesthesia,” said Prof Lee.

 In consultation with Adjunct Associate Prof Lee Guan Huei, Head and Senior Consultant, Division of Gastroenterology and Hepatology, Department of Medicine, NUH and Associate Professor Asim Shabbir, Head & Senior Consultant, Department of Surgery, NUH.