Dr. Chen is one of the foremost experts in endoscopic gastroenterology in the United States. Four years ago, he was recruited to the University of Colorado Medical School to design one of the most advanced endoscopy facilities in the country. In addition to his practice, he currently serves as a professor at the University of Colorado Medical School. He draws patient referrals from sixteen states, largely because of his reputation for being on the cutting edge of cancer staging and endoscopic therapies.
Body1: Was there a point in your life when you realized you wanted to be a doctor?
Dr. Chen: That question goes farther back than I can remember. I come from a medical family. I had a brother in medicine, and my grandfather was a doctor as well. When I was in college I started in electrical engineering, but I transferred into premed when I realized that I missed the service and the people contact. I found medicine to be an opportunity to combine my interest in hard science and my interest in helping people. It’s one of the few fields where you can marry the two; a lot of people fields are really social sciences. But the transition in my thinking occurred in college towards the end of my sophomore year.
Body1: You went to medical school at the University of the Philippines. Did you receive your undergraduate degree there as well?
Dr. Chen: Yes. My dad worked for an American oil company in the Philippines, which is where I grew up. It was the only state university [in the Philippines], so it was the premier program, and I was on scholarship there.
Body1: At what point in your life did you know you wanted to be a gastroenterologist?
Dr. Chen: That happened towards the end of my second year in my internal medicine residency. I knew that I was very interested in surgical fields when I was a student. In my clinical rotations, I did a lot of surgical electives. But I missed the diagnostic aspect, the analytical aspect, of the internal medicine field. So I was torn between the two during my interviews. I actually interviewed in both surgery and internal medicine, but I decided that the more intellectual aspects of internal medicine were more important at that point in time.
Internal medicine is a three-year residency, and during my residency, I saw an opportunity to recoup my interest in working with my hands, [by pursuing a subspecialty in gastroenterology]. So I chose gastroenterology, moving quickly into endoscopy. It was a surgical field but it gave me a chance to get into the core specialty of internal medicine, with all of its diagnostic emphasis.
Body1: You mention that one of your clinical interests is therapeutic endoscopy. Can you tell us more about your specific interests within that field?
Dr. Chen: That’s the core of my practice. I draw patients from 16 states besides Colorado for endoscopy interventions. A lot of that has to do with complex therapeutic procedures, as well as cancer staging treatment. And, of course, the GERD endotherapies: that’s a new field that is very exciting to me. I am interested in all areas of endoscopy, especially those that have a treatment component. I also have a lot of interest in prototype development, being on the cutting edge of new techniques and equipment, and I have a close interest in working closely with companies that are on the cutting edge in the field, [pioneering] new techniques of benefit to the patient. A lot of that stuff is probably very proprietary; but, broadly, [I] could mention endoscopic suturing devices; testing some of these devices and recommending modifications.
Body1: Can you define "cancer staging" for a lay audience?
Dr. Chen: A lot of times, a diagnosis is made of gastrointestinal cancer; but in order to determine the best modality of treatment--surgery, radiation therapy, chemotherapy, or endoscopic treatment--accurate [determination] of how advanced the tumor is very important. What I do, then, is first of all provide a level of sophistication for staging that is not available from routine imaging, such as CAT scans and ultrasound, because of the capability of endoscopic ultrasound. It’s the single best modality for the staging of tumors pre-operatively. It allows the physician to direct their care to a particular treatment modality without wasting time. The worst-case scenario, which is often the case with cancer, is [staging] the tumor intra-operatively. You open up the patient, and discover that the patient is not a good surgical candidate and have to close him back up. This could be avoided by better staging.
Body1: What do you feel is your greatest contribution to gastroenterology?
Dr. Chen: I don’t know that I can pinpoint it. I wear three hats: education, research, and patient care. In all of them, I seek to make a significant contribution. I draw my referral base because of my expertise in interventional endoscopy, in procedures not commonly available; something unique, or something that I’m well-known for being particularly good at. But education and research obviously drives quality of patient care. I want to be on the cutting edge of providing care, the best care possible for my patients, and the best way to do that is to be on the cutting edge of research and training other physicians in my specialty, and I do a lot of that. Over the years, I’ve directed scores of endoscopy courses, as well as other scientific courses. And as a professor, my focus is clinical research, particularly endoscopy research: anything that would help to make a procedure either safer or more efficacious using endoscopy tools. So I like to think that I’m contributing in all of those three fronts. It’s hard to be good in one of these areas, without impacting the others.
Body1: What is your current focus in patient care or research?
Dr. Chen: I have been involved in the arena of investigative research of multiple endotherapy devices, such as GERD therapy. People come to our center to learn these types of treatments. I am able to offer a full spectrum of options, of which Enteryx® is obviously one very promising one, but there are other things coming down the pipeline as well, other devices that have not yet been approved by the FDA.
We offered the very first Enteryx® training course in the country here at University of Colorado, and we continue to do that. We’ve done four or five in the last three months. They’re a combination of [doing] live demonstrations, with physicians in the conference room with a satellite connection or a cable connection, and getting them into the lab and supervising their learning.
We have probably one of the best-equipped labs in the world, in terms of state of the art equipment. We have three state-of-the-art endoscopy suites, which a lot of people come to visit when they’re designing their own labs. The newest one was built a little over two years ago. We continue to update them every year as new technology becomes available. I was basically recruited here to design the unit, and then I recruited for it.
Body1: So you’ve been at the University of Colorado for two years?
Dr. Chen: Actually, four years. It takes a couple of years to open a unit, when you’re trying to build something from the ground up.
Body1: Were you at a university hospital before that?
Dr. Chen: Yes, I was in California. I had a faculty appointment with Loma Linda University and I had a part-time teaching appointment with the University of California at Irvine, at the cancer center.
Body1: What do you see as the most important new trends in gastroenterology?
Dr. Chen: I think the single most important trend, from an endoscopic vantage point, is toward a minimally invasive approach to what are traditionally surgical procedures. I’m coming from a biased standpoint because I’m coming from the viewpoint of endoscopy, but I would say that less and less invasive techniques for achieving surgical results will blossom over the next five to ten years. GERD endotherapy is an obvious illustration, but there are other things such as intestinal bypass for obesity and endoscopic resection of very early gastrointestinal cancers.
Body1: In some ways, the answer to this question follows from your previous response; but how do you expect your practice to be different in five years?
Dr. Chen: I expect the line between surgery and endoscopy to blur. The traditional disciplines, with every discipline in its own [category]: all those boundaries are beginning to blur. It’s now more of a multidisciplinary approach. But that of course is not true of every gastroenterologist. For me, even though gastroenterology is traditionally a subspecialty, a lot of what I do is a surgical technique, so I’m not just an internist; I’m also a surgeon. A lot of the diagnostic procedures I do require ultrasound, and so in a sense I’m a radiologist; and I determine the pathology of specimens, so I need to have expertise in the area of cytopathology. To excel in the kind of gastroenterology we’re doing, we essentially cross several disciplines.