Endoscopy

Andrew Ofosu, MD, MPH, loves the variety that GI medicine offers on a day-to-day basis.

Some days are spent in the endoscopy suite, performing endoscopic retrograde cholangiopancreatography in patients with cholangitis, “which is usually a high-stakes situation,” he said. Other days he might be in clinic, helping to manage a patient with chronic pancreatitis. 

“The contrast of the immediate impact of a procedure combined with the continuity of long-term relationships, is special to me,” said Dr. Ofosu, an associate professor of medicine at Cincinnati College of Medicine, in Cincinnati, Ohio. He’s also a member of AGA’s Future Leaders program, which provides early career GI physicians with opportunities to network and develop leadership skills. 

In an interview, he discussed his research pursuits in the areas of pancreatic cancer and artificial intelligence (AI), and his unique methods for connecting with patients. The art of listening to patient concerns is crucial, he says, especially following a difficult diagnosis.

 

What’s it like to be part of the AGA Future Leaders Class of 2025-2026? How has the experience enriched your career?

Dr. Ofosu: My time being part of this group has been very transformative. It’s provided mentorship from national leaders. It’s enabled me to collaborate with peers across different institutions and given me opportunities to refine my leadership skills. It’s changed my perspective and created a network that has equipped me to contribute meaningfully to the gastroenterology community and to my institution.

What is the most challenging clinical case you’ve encountered?

Dr. Ofosu: One case that stands out was a young patient with recurrent idiopathic pancreatitis. We went through all the potential differential etiologies that includes genetics, autoimmune disease and structural etiologies. It became a long, diagnostic journey. The challenge wasn’t just the medical aspect of it, but the emotional aspect of it…when you don’t have all the answers available. We were eventually able to figure out what the cause of the pancreatitis was. It was genetic, and the patient is doing great now.

One of your research interests has been developing innovative ways to use AI in endoscopic ultrasound to identify and characterize lesions. Can you discuss some of those innovations?

Dr. Ofosu: It’s definitely an area that I’m looking to explore at this time; to leverage AI to improve diagnostic capability of endoscopic ultrasound. The whole idea is to be able to use AI to analyze images in real time that can help highlight features, which can ultimately help in distinguishing both benign and malignant tumors, and allowing AI to provide real time diagnostic support, improving accuracy of diagnosis and reducing unnecessary treatment.

In 2021, you conducted a study to investigate the demographics, clinical outcomes and survival outcomes of patients diagnosed with early and late onset pancreatic adenocarcinoma. What did your study reveal and what are the next steps?

Dr. Ofosu: Our study looked at over 136,000 patients with pancreatic adenocarcinoma and compared those diagnosed under age 40 to older patients. We found that although pancreatic cancer is rare in the young, both groups are presenting more often with advanced disease, and incidence is rising. Younger patients tend to have tumors in the head of the pancreas, while older patients more often show growth in the body and tail. Survival overall remains very poor—about 6 to 7 months—but slightly better in younger patients.

I think the next step is to better understand the biological drivers of early onset PAC to look at integrating molecular profiling to see if there are distinct genetic patterns that can guide therapy. Ultimately the goal is to improve early detection and tailor management strategy for this subset of patients. 

 

What is your approach to patient communication and education?

Dr. Ofosu: I aim for clarity and empathy. Some GI diagnoses can be intimidating, with all the terminologies, and so I use a lot of analogies and visuals to simplify complex conditions. I also ensure that patients understand what we are discussing because I found that what a patient hears isn’t always what they think I explained.

I believe being honest and compassionate should go hand in hand. I don’t shy away from delivering difficult news, but I always take time to pause, listen, and acknowledge emotions. I found that patients and families appreciate transparency even when the prognosis is tough, as long as they know I’m fully present with them. 

 

Can you share a memorable patient interaction that impacted you?

Dr. Ofosu: There was one patient with chronic pancreatitis due to alcohol who had limited economic and social support. Beyond the medical management, what made a difference was sitting and listening to the patient, helping them connect to resources and social support – a social network. I think this reinforces that medicine isn’t just about lab values. It’s all about restoring dignity and focus with the patient. 

What do you think is the biggest misconception about your specialty?

Dr. Ofosu: That gastroenterology is all about procedures, that all we do is scope. In reality, it’s a combination of technical expertise as well as the cognitive aspect of providing long-term management of complex diseases that affect patients, which takes a diverse skillset beyond endoscopy. 

Lightning Round

What’s your favorite season of the year?

Fall. I like the colors of changing leaves



What’s your favorite way to spend a weekend?

Watching soccer with family and friends



If you could have dinner with any historical figure, who would it be?

Nelson Mandela



What’s your go-to karaoke song?Don’t Stop Believin’ by Journey 



What’s one thing on your bucket list?

Travel to Europe, experience different cultures



What’s your favorite childhood memory?

When I learned how to fly a kite



If you could instantly learn any skill, what would it be?

Playing piano



Are you a planner or more spontaneous?

Planner



What’s your favorite holiday tradition?

Sharing Christmas dinner with family.

Andrew Ofosu, MD, MPH, loves the variety that GI medicine offers on a day-to-day basis.

Some days are spent in the endoscopy suite, performing endoscopic retrograde cholangiopancreatography in patients with cholangitis, “which is usually a high-stakes situation,” he said. Other days he might be in clinic, helping to manage a patient with chronic pancreatitis. 

“The contrast of the immediate impact of a procedure combined with the continuity of long-term relationships, is special to me,” said Dr. Ofosu, an associate professor of medicine at Cincinnati College of Medicine, in Cincinnati, Ohio. He’s also a member of AGA’s Future Leaders program, which provides early career GI physicians with opportunities to network and develop leadership skills. 

In an interview, he discussed his research pursuits in the areas of pancreatic cancer and artificial intelligence (AI), and his unique methods for connecting with patients. The art of listening to patient concerns is crucial, he says, especially following a difficult diagnosis.

 

What’s it like to be part of the AGA Future Leaders Class of 2025-2026? How has the experience enriched your career?

Dr. Ofosu: My time being part of this group has been very transformative. It’s provided mentorship from national leaders. It’s enabled me to collaborate with peers across different institutions and given me opportunities to refine my leadership skills. It’s changed my perspective and created a network that has equipped me to contribute meaningfully to the gastroenterology community and to my institution.

What is the most challenging clinical case you’ve encountered?

Dr. Ofosu: One case that stands out was a young patient with recurrent idiopathic pancreatitis. We went through all the potential differential etiologies that includes genetics, autoimmune disease and structural etiologies. It became a long, diagnostic journey. The challenge wasn’t just the medical aspect of it, but the emotional aspect of it…when you don’t have all the answers available. We were eventually able to figure out what the cause of the pancreatitis was. It was genetic, and the patient is doing great now.

One of your research interests has been developing innovative ways to use AI in endoscopic ultrasound to identify and characterize lesions. Can you discuss some of those innovations?

Dr. Ofosu: It’s definitely an area that I’m looking to explore at this time; to leverage AI to improve diagnostic capability of endoscopic ultrasound. The whole idea is to be able to use AI to analyze images in real time that can help highlight features, which can ultimately help in distinguishing both benign and malignant tumors, and allowing AI to provide real time diagnostic support, improving accuracy of diagnosis and reducing unnecessary treatment.

In 2021, you conducted a study to investigate the demographics, clinical outcomes and survival outcomes of patients diagnosed with early and late onset pancreatic adenocarcinoma. What did your study reveal and what are the next steps?

Dr. Ofosu: Our study looked at over 136,000 patients with pancreatic adenocarcinoma and compared those diagnosed under age 40 to older patients. We found that although pancreatic cancer is rare in the young, both groups are presenting more often with advanced disease, and incidence is rising. Younger patients tend to have tumors in the head of the pancreas, while older patients more often show growth in the body and tail. Survival overall remains very poor—about 6 to 7 months—but slightly better in younger patients.

I think the next step is to better understand the biological drivers of early onset PAC to look at integrating molecular profiling to see if there are distinct genetic patterns that can guide therapy. Ultimately the goal is to improve early detection and tailor management strategy for this subset of patients. 

 

What is your approach to patient communication and education?

Dr. Ofosu: I aim for clarity and empathy. Some GI diagnoses can be intimidating, with all the terminologies, and so I use a lot of analogies and visuals to simplify complex conditions. I also ensure that patients understand what we are discussing because I found that what a patient hears isn’t always what they think I explained.

I believe being honest and compassionate should go hand in hand. I don’t shy away from delivering difficult news, but I always take time to pause, listen, and acknowledge emotions. I found that patients and families appreciate transparency even when the prognosis is tough, as long as they know I’m fully present with them. 

 

Can you share a memorable patient interaction that impacted you?

Dr. Ofosu: There was one patient with chronic pancreatitis due to alcohol who had limited economic and social support. Beyond the medical management, what made a difference was sitting and listening to the patient, helping them connect to resources and social support – a social network. I think this reinforces that medicine isn’t just about lab values. It’s all about restoring dignity and focus with the patient. 

What do you think is the biggest misconception about your specialty?

Dr. Ofosu: That gastroenterology is all about procedures, that all we do is scope. In reality, it’s a combination of technical expertise as well as the cognitive aspect of providing long-term management of complex diseases that affect patients, which takes a diverse skillset beyond endoscopy. 

Lightning Round

What’s your favorite season of the year?

Fall. I like the colors of changing leaves



What’s your favorite way to spend a weekend?

Watching soccer with family and friends



If you could have dinner with any historical figure, who would it be?

Nelson Mandela



What’s your go-to karaoke song?Don’t Stop Believin’ by Journey 



What’s one thing on your bucket list?

Travel to Europe, experience different cultures



What’s your favorite childhood memory?

When I learned how to fly a kite



If you could instantly learn any skill, what would it be?

Playing piano



Are you a planner or more spontaneous?

Planner



What’s your favorite holiday tradition?

Sharing Christmas dinner with family.

Andrew Ofosu, MD, MPH, loves the variety that GI medicine offers on a day-to-day basis.

Some days are spent in the endoscopy suite, performing endoscopic retrograde cholangiopancreatography in patients with cholangitis, “which is usually a high-stakes situation,” he said. Other days he might be in clinic, helping to manage a patient with chronic pancreatitis. 

“The contrast of the immediate impact of a procedure combined with the continuity of long-term relationships, is special to me,” said Dr. Ofosu, an associate professor of medicine at Cincinnati College of Medicine, in Cincinnati, Ohio. He’s also a member of AGA’s Future Leaders program, which provides early career GI physicians with opportunities to network and develop leadership skills. 

In an interview, he discussed his research pursuits in the areas of pancreatic cancer and artificial intelligence (AI), and his unique methods for connecting with patients. The art of listening to patient concerns is crucial, he says, especially following a difficult diagnosis.

 

What’s it like to be part of the AGA Future Leaders Class of 2025-2026? How has the experience enriched your career?

Dr. Ofosu: My time being part of this group has been very transformative. It’s provided mentorship from national leaders. It’s enabled me to collaborate with peers across different institutions and given me opportunities to refine my leadership skills. It’s changed my perspective and created a network that has equipped me to contribute meaningfully to the gastroenterology community and to my institution.

What is the most challenging clinical case you’ve encountered?

Dr. Ofosu: One case that stands out was a young patient with recurrent idiopathic pancreatitis. We went through all the potential differential etiologies that includes genetics, autoimmune disease and structural etiologies. It became a long, diagnostic journey. The challenge wasn’t just the medical aspect of it, but the emotional aspect of it…when you don’t have all the answers available. We were eventually able to figure out what the cause of the pancreatitis was. It was genetic, and the patient is doing great now.

One of your research interests has been developing innovative ways to use AI in endoscopic ultrasound to identify and characterize lesions. Can you discuss some of those innovations?

Dr. Ofosu: It’s definitely an area that I’m looking to explore at this time; to leverage AI to improve diagnostic capability of endoscopic ultrasound. The whole idea is to be able to use AI to analyze images in real time that can help highlight features, which can ultimately help in distinguishing both benign and malignant tumors, and allowing AI to provide real time diagnostic support, improving accuracy of diagnosis and reducing unnecessary treatment.

In 2021, you conducted a study to investigate the demographics, clinical outcomes and survival outcomes of patients diagnosed with early and late onset pancreatic adenocarcinoma. What did your study reveal and what are the next steps?

Dr. Ofosu: Our study looked at over 136,000 patients with pancreatic adenocarcinoma and compared those diagnosed under age 40 to older patients. We found that although pancreatic cancer is rare in the young, both groups are presenting more often with advanced disease, and incidence is rising. Younger patients tend to have tumors in the head of the pancreas, while older patients more often show growth in the body and tail. Survival overall remains very poor—about 6 to 7 months—but slightly better in younger patients.

I think the next step is to better understand the biological drivers of early onset PAC to look at integrating molecular profiling to see if there are distinct genetic patterns that can guide therapy. Ultimately the goal is to improve early detection and tailor management strategy for this subset of patients. 

 

What is your approach to patient communication and education?

Dr. Ofosu: I aim for clarity and empathy. Some GI diagnoses can be intimidating, with all the terminologies, and so I use a lot of analogies and visuals to simplify complex conditions. I also ensure that patients understand what we are discussing because I found that what a patient hears isn’t always what they think I explained.

I believe being honest and compassionate should go hand in hand. I don’t shy away from delivering difficult news, but I always take time to pause, listen, and acknowledge emotions. I found that patients and families appreciate transparency even when the prognosis is tough, as long as they know I’m fully present with them. 

 

Can you share a memorable patient interaction that impacted you?

Dr. Ofosu: There was one patient with chronic pancreatitis due to alcohol who had limited economic and social support. Beyond the medical management, what made a difference was sitting and listening to the patient, helping them connect to resources and social support – a social network. I think this reinforces that medicine isn’t just about lab values. It’s all about restoring dignity and focus with the patient. 

What do you think is the biggest misconception about your specialty?

Dr. Ofosu: That gastroenterology is all about procedures, that all we do is scope. In reality, it’s a combination of technical expertise as well as the cognitive aspect of providing long-term management of complex diseases that affect patients, which takes a diverse skillset beyond endoscopy. 

Lightning Round

What’s your favorite season of the year?

Fall. I like the colors of changing leaves



What’s your favorite way to spend a weekend?

Watching soccer with family and friends



If you could have dinner with any historical figure, who would it be?

Nelson Mandela



What’s your go-to karaoke song?Don’t Stop Believin’ by Journey 



What’s one thing on your bucket list?

Travel to Europe, experience different cultures



What’s your favorite childhood memory?

When I learned how to fly a kite



If you could instantly learn any skill, what would it be?

Playing piano



Are you a planner or more spontaneous?

Planner



What’s your favorite holiday tradition?

Sharing Christmas dinner with family.

Manol Jovani, MD, MPH, has published more than 70 research papers on clinical GI research, some resulting in the publication of international guidelines. But the work he’s most proud of took place when he was a graduate student at Harvard, working on a master’s degree in epidemiology and biostatistics.

Jovani compared two different types of needles for tissue acquisition with endoscopic ultrasound. His finding that fine needle biopsy is better than fine needle aspiration for lesions isn’t groundbreaking, yet “the reason why I feel proud of that one is because it’s the first paper I did completely by myself,” said Jovani, medical director for advanced therapeutic endoscopy with Gastro Health Florida, in Miami, Florida. 

Dr. Jovani has since contributed to countless peer-reviewed articles and book chapters and has presented research findings at meetings across the globe. He will be program director of the upcoming gastroenterology fellowship program at Florida International University School of Medicine, Miami, and participates in several endoscopy panels in the U.S. and in Europe to set guidelines and improve the quality of endoscopic procedures. 

Therapeutic endoscopy is a clinical interest of his, specifically in the areas of third space, biliopancreatic and bariatric endoscopy. In an interview, he discussed how he used third space endoscopy to save a patient and improve her quality of life

Indeed, helping patients feel better is the most satisfying part of his career. 

“A lot of people may have acute pain or an early cancer or many other problems that they need solving. As a physician, you can be the one who solves it,” said Jovani.

But training in medicine involves hard work, he advised. In the interview, he explained why young doctors should never rely on shortcuts to solve problems.

 

Therapeutic endoscopy is a specific interest of yours. How has this field advanced since you’ve been practicing gastroenterology?

Dr. Jovani: In the last 10 to 15 years, significant improvements have come along. As an example, lumen-apposing metal stents have revolutionized the way we do therapeutic endoscopy. A lot of procedures were not possible beforehand and we would have to send patients to surgery. Now, these can be done with endoscopy.

Examples include drainage of pancreatic collections, gallbladder drainage, or gastrojejunostomy (a connection between the stomach and the intestine) or reversal of Roux-en-Y gastric bypass to reach and drain the bile duct. Many of these procedures can be done with these metal stents that were not possible beforehand. Bariatric endoscopy is a relatively new field, and that has significantly changed the management of obesity. 

There’s also third space endoscopy for the treatment of gastroparesis, achalasia, and early cancer. 

What is third space endoscopy and how are you applying it in your practice?

Dr. Jovani: Third space endoscopy refers to a new space that’s created between the mucosa and the muscularis propria into the submucosa. We go in the submucosa, we inject some fluid there, and we cut the submucosa and we separate the mucosa from the muscle.

This allows us to do a lot of procedures. For patients with achalasia, we can tunnel through the submucosa, get into the muscle and perform myotomy, meaning that we can cut the muscle. By doing so, we can treat achalasia with a minimally invasive method. Patients can either go home the next day or even on the same day. The same thing applies for gastroparesis. With early cancer, we can go through in the submucosa, and if the cancer is in the mucosa only, or if it is in the very superficial submucosa, we can treat it without a need for surgery. Sometimes the procedure is simple, but other times it can be very challenging. 

 

Can you discuss a challenging case where you applied third space endoscopy?

Dr. Jovani: It was a gastric cancer case. I did an endoscopic ultrasound for staging purposes. When I saw the lesion, it looked very superficial, like an early cancer of the stomach. I called the surgeon and said I could take it out with endoscopy. And it was in a very difficult location, so it was a very challenging procedure. It took about 12 hours to do it, but I was able to completely take it out. More than a year later, the patient was cancer free and more importantly, we preserved the stomach. Before I did this, she was prepared to undergo total gastrectomy, which meant I would have taken out her entire stomach.

Instead, with this minimally invasive procedure, I was able to take the cancer away and keep the stomach, which preserved her quality of life as well. 

When you don’t have the stomach, obviously you adapt, but the quality of life is never the same. The type of food you eat, the frequency of eating, the quality of food you eat is not the same. The fact that we could avoid that in this patient feels very good. 

What advice would you give to aspiring medical students?

Dr. Jovani: Do the hard work that’s required to be a doctor. Being a physician is a hard job, but it’s very rewarding. It’s like going to the gym—there really are no shortcuts. You have to do the work, you have to get tired, you have to study hard. You may study things you might not think will be useful to you necessarily in the future field that you choose. If it is GI, you still need to study all the other fields because sometimes patients may have GI diseases that are connecting with other diseases and you won’t know that if you haven’t studied the other diseases.

Patients are not only one disease, but they are also complex patients. Sometimes if you try to correct one disease, you create a complication with the other disease and you might not be aware of that. 

Don’t create shortcuts like ChatGPT, things that are becoming fashionable with younger people today. Do the hard work the old way in which you have to memorize things. Knowledge is the only thing that really can help the patient.

Go to GI meetings. Offer to meet people, collaborate, network. Don’t be shy about it. Even if it is not natural to you, just do it. It’ll become more natural as you do it. GI, like any other field, any other endeavor in human society, is something that also depends on interactions. Therefore, it’s good to learn how to interact, how to network, how to do research projects. Even with people from far away, communication is very easy. You don’t really need to do research projects only with people in your local environment. You can do research projects with people who are on the other side of the state or even on the other side of the world.

You place an emphasis on individualized patient care. Can you discuss what that means to you?

Dr. Jovani: It basically means that there isn’t one size fits all in the management of diseases. Obviously there are some general principles that are applicable to everybody, but sometimes for the single specific patient, what works for one patient might not necessarily work for the next patient.

With Endoscopic Retrograde Cholangiopancreatography (ERCP) for example, there are so many things that go into that. Most papilla are in a certain position and it’s relatively easy to cannulate. But there are others that are in very different positions or in different angulations and they might require specific techniques that are not applicable in the majority of cases. You have to adapt to the single patient.How you speak to the patient is also important. Some may prefer a certain type of communication and other patients may prefer another type of communication involving patients or family. You have to adapt to the single patient. You have to understand the different types of personalities and adapt how you explain things or how you communicate disease, or management of disease or even complications to the specific patient. Different approaches are more appropriate for different patients with different needs. At the end of the day, patients are single individuals after all. 

 

Where do you see the field of GI medicine advancing internationally over the next 5 years?

Dr. Jovani: Artificial intelligence or AI is a big player. It will help with diagnostics primarily, at least over the short term. Potentially it can help with therapeutics as well. There’s a lot of investment and excitement and interest in artificial intelligence.

Therapeutic endoscopy robotics, especially in interventional endoscopy, third space endoscopy, is also gaining attention.

With regards to bariatric endoscopy, we should have a CPT code for it in January 2027. This will increase volume because it’ll be covered more by insurance. These are things that will help advance GI in the next five or 10 years.

Lightning Round

What’s one hobby you’d like to pick up?

Kite surfing



What’s your favorite season of the year?

Summer



What’s your favorite way to spend a weekend?

Traveling or going to the beach



If you could have dinner with any historical figure, who would it be?

Jesus Christ 



What’s your favorite holiday tradition?

New Year’s Eve



Are you a planner or more spontaneous?

Planner



What’s the best piece of advice you’ve ever received?

You can do it!



What’s your comfort food?

Lasagna

Manol Jovani, MD, MPH, has published more than 70 research papers on clinical GI research, some resulting in the publication of international guidelines. But the work he’s most proud of took place when he was a graduate student at Harvard, working on a master’s degree in epidemiology and biostatistics.

Jovani compared two different types of needles for tissue acquisition with endoscopic ultrasound. His finding that fine needle biopsy is better than fine needle aspiration for lesions isn’t groundbreaking, yet “the reason why I feel proud of that one is because it’s the first paper I did completely by myself,” said Jovani, medical director for advanced therapeutic endoscopy with Gastro Health Florida, in Miami, Florida. 

Dr. Jovani has since contributed to countless peer-reviewed articles and book chapters and has presented research findings at meetings across the globe. He will be program director of the upcoming gastroenterology fellowship program at Florida International University School of Medicine, Miami, and participates in several endoscopy panels in the U.S. and in Europe to set guidelines and improve the quality of endoscopic procedures. 

Therapeutic endoscopy is a clinical interest of his, specifically in the areas of third space, biliopancreatic and bariatric endoscopy. In an interview, he discussed how he used third space endoscopy to save a patient and improve her quality of life

Indeed, helping patients feel better is the most satisfying part of his career. 

“A lot of people may have acute pain or an early cancer or many other problems that they need solving. As a physician, you can be the one who solves it,” said Jovani.

But training in medicine involves hard work, he advised. In the interview, he explained why young doctors should never rely on shortcuts to solve problems.

 

Therapeutic endoscopy is a specific interest of yours. How has this field advanced since you’ve been practicing gastroenterology?

Dr. Jovani: In the last 10 to 15 years, significant improvements have come along. As an example, lumen-apposing metal stents have revolutionized the way we do therapeutic endoscopy. A lot of procedures were not possible beforehand and we would have to send patients to surgery. Now, these can be done with endoscopy.

Examples include drainage of pancreatic collections, gallbladder drainage, or gastrojejunostomy (a connection between the stomach and the intestine) or reversal of Roux-en-Y gastric bypass to reach and drain the bile duct. Many of these procedures can be done with these metal stents that were not possible beforehand. Bariatric endoscopy is a relatively new field, and that has significantly changed the management of obesity. 

There’s also third space endoscopy for the treatment of gastroparesis, achalasia, and early cancer. 

What is third space endoscopy and how are you applying it in your practice?

Dr. Jovani: Third space endoscopy refers to a new space that’s created between the mucosa and the muscularis propria into the submucosa. We go in the submucosa, we inject some fluid there, and we cut the submucosa and we separate the mucosa from the muscle.

This allows us to do a lot of procedures. For patients with achalasia, we can tunnel through the submucosa, get into the muscle and perform myotomy, meaning that we can cut the muscle. By doing so, we can treat achalasia with a minimally invasive method. Patients can either go home the next day or even on the same day. The same thing applies for gastroparesis. With early cancer, we can go through in the submucosa, and if the cancer is in the mucosa only, or if it is in the very superficial submucosa, we can treat it without a need for surgery. Sometimes the procedure is simple, but other times it can be very challenging. 

 

Can you discuss a challenging case where you applied third space endoscopy?

Dr. Jovani: It was a gastric cancer case. I did an endoscopic ultrasound for staging purposes. When I saw the lesion, it looked very superficial, like an early cancer of the stomach. I called the surgeon and said I could take it out with endoscopy. And it was in a very difficult location, so it was a very challenging procedure. It took about 12 hours to do it, but I was able to completely take it out. More than a year later, the patient was cancer free and more importantly, we preserved the stomach. Before I did this, she was prepared to undergo total gastrectomy, which meant I would have taken out her entire stomach.

Instead, with this minimally invasive procedure, I was able to take the cancer away and keep the stomach, which preserved her quality of life as well. 

When you don’t have the stomach, obviously you adapt, but the quality of life is never the same. The type of food you eat, the frequency of eating, the quality of food you eat is not the same. The fact that we could avoid that in this patient feels very good. 

What advice would you give to aspiring medical students?

Dr. Jovani: Do the hard work that’s required to be a doctor. Being a physician is a hard job, but it’s very rewarding. It’s like going to the gym—there really are no shortcuts. You have to do the work, you have to get tired, you have to study hard. You may study things you might not think will be useful to you necessarily in the future field that you choose. If it is GI, you still need to study all the other fields because sometimes patients may have GI diseases that are connecting with other diseases and you won’t know that if you haven’t studied the other diseases.

Patients are not only one disease, but they are also complex patients. Sometimes if you try to correct one disease, you create a complication with the other disease and you might not be aware of that. 

Don’t create shortcuts like ChatGPT, things that are becoming fashionable with younger people today. Do the hard work the old way in which you have to memorize things. Knowledge is the only thing that really can help the patient.

Go to GI meetings. Offer to meet people, collaborate, network. Don’t be shy about it. Even if it is not natural to you, just do it. It’ll become more natural as you do it. GI, like any other field, any other endeavor in human society, is something that also depends on interactions. Therefore, it’s good to learn how to interact, how to network, how to do research projects. Even with people from far away, communication is very easy. You don’t really need to do research projects only with people in your local environment. You can do research projects with people who are on the other side of the state or even on the other side of the world.

You place an emphasis on individualized patient care. Can you discuss what that means to you?

Dr. Jovani: It basically means that there isn’t one size fits all in the management of diseases. Obviously there are some general principles that are applicable to everybody, but sometimes for the single specific patient, what works for one patient might not necessarily work for the next patient.

With Endoscopic Retrograde Cholangiopancreatography (ERCP) for example, there are so many things that go into that. Most papilla are in a certain position and it’s relatively easy to cannulate. But there are others that are in very different positions or in different angulations and they might require specific techniques that are not applicable in the majority of cases. You have to adapt to the single patient.How you speak to the patient is also important. Some may prefer a certain type of communication and other patients may prefer another type of communication involving patients or family. You have to adapt to the single patient. You have to understand the different types of personalities and adapt how you explain things or how you communicate disease, or management of disease or even complications to the specific patient. Different approaches are more appropriate for different patients with different needs. At the end of the day, patients are single individuals after all. 

 

Where do you see the field of GI medicine advancing internationally over the next 5 years?

Dr. Jovani: Artificial intelligence or AI is a big player. It will help with diagnostics primarily, at least over the short term. Potentially it can help with therapeutics as well. There’s a lot of investment and excitement and interest in artificial intelligence.

Therapeutic endoscopy robotics, especially in interventional endoscopy, third space endoscopy, is also gaining attention.

With regards to bariatric endoscopy, we should have a CPT code for it in January 2027. This will increase volume because it’ll be covered more by insurance. These are things that will help advance GI in the next five or 10 years.

Lightning Round

What’s one hobby you’d like to pick up?

Kite surfing



What’s your favorite season of the year?

Summer



What’s your favorite way to spend a weekend?

Traveling or going to the beach



If you could have dinner with any historical figure, who would it be?

Jesus Christ 



What’s your favorite holiday tradition?

New Year’s Eve



Are you a planner or more spontaneous?

Planner



What’s the best piece of advice you’ve ever received?

You can do it!



What’s your comfort food?

Lasagna

Manol Jovani, MD, MPH, has published more than 70 research papers on clinical GI research, some resulting in the publication of international guidelines. But the work he’s most proud of took place when he was a graduate student at Harvard, working on a master’s degree in epidemiology and biostatistics.

Jovani compared two different types of needles for tissue acquisition with endoscopic ultrasound. His finding that fine needle biopsy is better than fine needle aspiration for lesions isn’t groundbreaking, yet “the reason why I feel proud of that one is because it’s the first paper I did completely by myself,” said Jovani, medical director for advanced therapeutic endoscopy with Gastro Health Florida, in Miami, Florida. 

Dr. Jovani has since contributed to countless peer-reviewed articles and book chapters and has presented research findings at meetings across the globe. He will be program director of the upcoming gastroenterology fellowship program at Florida International University School of Medicine, Miami, and participates in several endoscopy panels in the U.S. and in Europe to set guidelines and improve the quality of endoscopic procedures. 

Therapeutic endoscopy is a clinical interest of his, specifically in the areas of third space, biliopancreatic and bariatric endoscopy. In an interview, he discussed how he used third space endoscopy to save a patient and improve her quality of life

Indeed, helping patients feel better is the most satisfying part of his career. 

“A lot of people may have acute pain or an early cancer or many other problems that they need solving. As a physician, you can be the one who solves it,” said Jovani.

But training in medicine involves hard work, he advised. In the interview, he explained why young doctors should never rely on shortcuts to solve problems.

 

Therapeutic endoscopy is a specific interest of yours. How has this field advanced since you’ve been practicing gastroenterology?

Dr. Jovani: In the last 10 to 15 years, significant improvements have come along. As an example, lumen-apposing metal stents have revolutionized the way we do therapeutic endoscopy. A lot of procedures were not possible beforehand and we would have to send patients to surgery. Now, these can be done with endoscopy.

Examples include drainage of pancreatic collections, gallbladder drainage, or gastrojejunostomy (a connection between the stomach and the intestine) or reversal of Roux-en-Y gastric bypass to reach and drain the bile duct. Many of these procedures can be done with these metal stents that were not possible beforehand. Bariatric endoscopy is a relatively new field, and that has significantly changed the management of obesity. 

There’s also third space endoscopy for the treatment of gastroparesis, achalasia, and early cancer. 

What is third space endoscopy and how are you applying it in your practice?

Dr. Jovani: Third space endoscopy refers to a new space that’s created between the mucosa and the muscularis propria into the submucosa. We go in the submucosa, we inject some fluid there, and we cut the submucosa and we separate the mucosa from the muscle.

This allows us to do a lot of procedures. For patients with achalasia, we can tunnel through the submucosa, get into the muscle and perform myotomy, meaning that we can cut the muscle. By doing so, we can treat achalasia with a minimally invasive method. Patients can either go home the next day or even on the same day. The same thing applies for gastroparesis. With early cancer, we can go through in the submucosa, and if the cancer is in the mucosa only, or if it is in the very superficial submucosa, we can treat it without a need for surgery. Sometimes the procedure is simple, but other times it can be very challenging. 

 

Can you discuss a challenging case where you applied third space endoscopy?

Dr. Jovani: It was a gastric cancer case. I did an endoscopic ultrasound for staging purposes. When I saw the lesion, it looked very superficial, like an early cancer of the stomach. I called the surgeon and said I could take it out with endoscopy. And it was in a very difficult location, so it was a very challenging procedure. It took about 12 hours to do it, but I was able to completely take it out. More than a year later, the patient was cancer free and more importantly, we preserved the stomach. Before I did this, she was prepared to undergo total gastrectomy, which meant I would have taken out her entire stomach.

Instead, with this minimally invasive procedure, I was able to take the cancer away and keep the stomach, which preserved her quality of life as well. 

When you don’t have the stomach, obviously you adapt, but the quality of life is never the same. The type of food you eat, the frequency of eating, the quality of food you eat is not the same. The fact that we could avoid that in this patient feels very good. 

What advice would you give to aspiring medical students?

Dr. Jovani: Do the hard work that’s required to be a doctor. Being a physician is a hard job, but it’s very rewarding. It’s like going to the gym—there really are no shortcuts. You have to do the work, you have to get tired, you have to study hard. You may study things you might not think will be useful to you necessarily in the future field that you choose. If it is GI, you still need to study all the other fields because sometimes patients may have GI diseases that are connecting with other diseases and you won’t know that if you haven’t studied the other diseases.

Patients are not only one disease, but they are also complex patients. Sometimes if you try to correct one disease, you create a complication with the other disease and you might not be aware of that. 

Don’t create shortcuts like ChatGPT, things that are becoming fashionable with younger people today. Do the hard work the old way in which you have to memorize things. Knowledge is the only thing that really can help the patient.

Go to GI meetings. Offer to meet people, collaborate, network. Don’t be shy about it. Even if it is not natural to you, just do it. It’ll become more natural as you do it. GI, like any other field, any other endeavor in human society, is something that also depends on interactions. Therefore, it’s good to learn how to interact, how to network, how to do research projects. Even with people from far away, communication is very easy. You don’t really need to do research projects only with people in your local environment. You can do research projects with people who are on the other side of the state or even on the other side of the world.

You place an emphasis on individualized patient care. Can you discuss what that means to you?

Dr. Jovani: It basically means that there isn’t one size fits all in the management of diseases. Obviously there are some general principles that are applicable to everybody, but sometimes for the single specific patient, what works for one patient might not necessarily work for the next patient.

With Endoscopic Retrograde Cholangiopancreatography (ERCP) for example, there are so many things that go into that. Most papilla are in a certain position and it’s relatively easy to cannulate. But there are others that are in very different positions or in different angulations and they might require specific techniques that are not applicable in the majority of cases. You have to adapt to the single patient.How you speak to the patient is also important. Some may prefer a certain type of communication and other patients may prefer another type of communication involving patients or family. You have to adapt to the single patient. You have to understand the different types of personalities and adapt how you explain things or how you communicate disease, or management of disease or even complications to the specific patient. Different approaches are more appropriate for different patients with different needs. At the end of the day, patients are single individuals after all. 

 

Where do you see the field of GI medicine advancing internationally over the next 5 years?

Dr. Jovani: Artificial intelligence or AI is a big player. It will help with diagnostics primarily, at least over the short term. Potentially it can help with therapeutics as well. There’s a lot of investment and excitement and interest in artificial intelligence.

Therapeutic endoscopy robotics, especially in interventional endoscopy, third space endoscopy, is also gaining attention.

With regards to bariatric endoscopy, we should have a CPT code for it in January 2027. This will increase volume because it’ll be covered more by insurance. These are things that will help advance GI in the next five or 10 years.

Lightning Round

What’s one hobby you’d like to pick up?

Kite surfing



What’s your favorite season of the year?

Summer



What’s your favorite way to spend a weekend?

Traveling or going to the beach



If you could have dinner with any historical figure, who would it be?

Jesus Christ 



What’s your favorite holiday tradition?

New Year’s Eve



Are you a planner or more spontaneous?

Planner



What’s the best piece of advice you’ve ever received?

You can do it!



What’s your comfort food?

Lasagna

Amandeep Shergill, MD, MS, AGAF, always thought she had good hand-eye coordination until she entered her gastroenterology fellowship.

“You’re learning how to scope and the endoscope just feels so awkward in the hands. It can be such a difficult instrument to both learn and to use,” said Dr. Shergill, professor of clinical medicine at University of California, San Francisco. 

Her attendings and mentors couldn’t give her the feedback she needed.

“I was told that I wasn’t holding it right. But every time I tried to do something that someone was trying to tell me, it seemed like my hands were too small. I couldn’t hold it the way that they were teaching me to hold it.” She began to wonder: Was this about her or the tool itself? 

A deep dive into hand tool interactions and medical device designs led her to human factors and ergonomics. Her fellowship mentor, Ken McQuaid, MD, AGAF, had gone to medical school with David Rempel, MD, MPH who was one of the top-funded ergonomists in the country. “He emailed David and wrote: I have a fellow who’s interested in learning more about ergonomics and applying it to endoscopy,” said Dr. Shergill.

Through her work with Dr. Rempel, she was able to uncover the mechanisms that lead to musculoskeletal disorders in endoscopists.

Over time, she has become a trailblazer in this field, helming the UC Berkeley Center for Ergonomic Endoscopy with Carisa Harris-Adamson PhD, CPE, her ergonomics collaborator. In an interview, she described the unique “timeout” algorithm she created to ease the process of endoscopy for GI physicians. 

 

What is your favorite aspect of being a GI physician?

I really love the diversity of patients and cases. You’re always learning something new. It’s an internal medicine subspecialty and a cognitive field, so we must think about differential diagnoses, risks and benefits of procedures for patients. But as a procedural field, we get to diagnose and immediately treat certain disorders. What’s exciting about GI right now is there’s still so much to learn. I think that we’re still discovering more about how the brain-gut interaction works every day. There’s been additional research about the microbiome and the immense influence it has on both health and disease. The field is continuing to evolve rapidly. There’s always something new to learn, and I think it keeps us fresh.

Tell me about your work in ergonomics and endoscopy.

Ken McQuaid connected me with David Rempel. I worked with David to approach this problem of endoscopy ergonomics from a very rigorous ergonomics perspective. Early in my fellowship, endoscopy ergonomics wasn’t well known. There were few survey-based studies, including one from the American Society for Gastrointestinal Endoscopy (ASGE) that documented a high prevalence of endoscopist injury. But not a lot was known about what was causing injury in endoscopists.

What were the risk factors for endoscopist injury? Instead of just doing another survey, I wanted to show that there was this potential for causation given the design of the endoscopes. I worked with David to do a pilot study where we collected some pinch forces and forearm muscle loads. I was able to collect some pilot data that I used to apply for the ASGE Endoscopic Research Award. And luckily, ASGE supported that work.

Another award I received, the ASGE Career Development Award, was instrumental in allowing me to become more proficient in the science of ergonomics. I was able to leverage that career development award to go back to school. I went to UC Berkeley and got a master’s in environmental health sciences with a focus on ergonomics. It really helped me to lay the foundation and understanding for ergonomics and then apply that to endoscopy to generate a more rigorous scientific background for endoscopy ergonomics and start that conversation within the field of GI.

 

What leads to musculoskeletal disorders in endoscopists and how can it be prevented?

Musculoskeletal disorders are associated with the repetitive procedures that we’re performing, often utilizing high forces and in non-neutral postures. This is because of how we’re interacting with our tools and how we’re interacting with our environments. The studies I have done with Carisa Harris-Adamson have been able to demonstrate and document the high forces that are required to interact with the endoscope. To turn the control section dials and to torque and manipulate the insertion tube, there are really high distal upper extremity muscle loads that are being applied. 

We were able to compare the loads and the forces we were seeing to established risk thresholds from the ergonomics literature and demonstrate that performing endoscopy was associated with moderate to high risk of development of distal upper extremity disorders. 

 

What research are you doing now?

We’re trying to focus more on interventions. We’ve done some studies on engineering controls we can utilize to decrease the loads of holding the scope. First, it was an anti-gravity support arm. More recently we’re hoping to publish data on whether a scope stand can alleviate some of those left distal upper extremity loads because the stand is holding the scope instead of the hand holding the scope. Can we decrease injury risk by decreasing static loading? 

Neck and back injuries, which have a high prevalence in endoscopists, are usually associated with how the room is set up. One of the things that I’ve tried to help promote is a pre-procedure ergonomic “timeout.” Before an endoscopist does a procedure, we’re supposed to perform a timeout focused on the patient’s safety. We should also try to advocate for physician safety and an ergonomic timeout. I developed a mnemonic device utilizing the word “MYSELF” to help endoscopists remember the ergonomic timeout checklist: M = monitor, Y = upside-down Y stance, S = scope, E = elbow/ bed position, L = lower extremities, F = free movement of endoscope/ processor placement. 

First, thinking about the monitor, “M”, and fixing the monitor height so that the neck is in neutral position. Then, thinking of an upside down “Y” standing straight with the feet either hip width or shoulder width apart, so that the physician has a stable, neutral standing posture. Then “S” is for checking the scope to ensure you have a scope with optimal angulation that’s working properly.

“E” is for elbows — adjusting the bed to an optimal position so that elbows and shoulders are in neutral position. “L” is for lower extremities — are the foot pedals within an easy reach? Do you have comfortable shoes on, an anti-fatigue floor mat if you need it? And then the “F” in “MYSELF” is for the processor placement, to ensure “free movement” of the scope. By placing the processor directly behind you and lining up the processor with the orifice to be scoped, you can ensure free movement of the scope so that you can leverage large movements of the control section to result in tip deflection. 

We studied the MYSELF mnemonic device for a pre-procedure ergonomic timeout in a simulated setting and presented our results at Digestive Disease Week (DDW) 2024, where we showed a reduction in ergonomic risk scores based on the Rapid Entire Body Assessment tool.

We presented the results of the scope stand study at DDW 2025 in San Diego this May.

 

What has been the feedback from physicians who use these supportive tools?

While physicians are very grateful for bringing attention to this issue, and many have found utility in some of the tools that I proposed, I think we still have so much work to do. We’re just all hoping to continue to move this field forward for better tools that are designed more with the breadth of endoscopists in mind. 

How do you handle stress and maintain work-life balance?

A few years ago, during DDW I gave a talk entitled “Achieving Work-Life Harmony.” I disclosed at the beginning of the talk that I had not achieved work-life harmony. It’s definitely a difficult thing to do, especially in our field as GI proceduralists, where we’re frequently on call and there are potentially on-call emergencies.

One of the key things that I’ve tried to do is create boundaries to prioritize both things in my personal life and my professional life and really try to stay true to the things that are important to me. For instance, things like family time and mealtimes, I think that’s so critical. Trying to be home on evenings for dinnertime is so important. 

One of my GI colleagues, Raj Keswani, MD, MS gave a talk about burnout and described imagining life as juggling balls; trying to figure out which balls are glass balls and need to be handled with care, and which balls are rubber balls. 

More often, work is the rubber ball. If you drop it, it’ll bounce back and the work that you have will still be there the next day. Family, friends, our health, those are the glass balls that if they fall, they can get scuffed or shatter sometimes. That image helps me think in the moment. If I need to decide between two competing priorities, which one will still be here tomorrow? Which is the one that’s going to be more resilient, and which is the one that I need to focus on? That’s been a helpful image for me. 

I also want to give a shout out to my amazing colleagues. We all pitch in with the ‘juggling’ and help to keep everyone’s ‘balls’ in the air, and cover for each other. Whether it’s a sick patient or whatever’s going on in our personal lives, we always take care of each other. 

 

What advice would you give to aspiring GI fellows or graduating fellows?

GI is such an amazing field and many people end up focusing on the procedural aspect of it. What I think defines an exceptional gastroenterologist and physician in general is adopting both a “growth mindset” and a “mastery mindset.” I would really encourage GI fellows to lean into that idea of a mastery mindset, especially as they’re identifying that niche within GI that they may be interested in pursuing. And really, it starts out with when you’re exploring an area of focus, listening to what consistently draws your attention, what you’re excited about learning more about. 

Finding mentors, getting involved in projects, doing deep learning, and really trying to develop an expertise in that area through additional training, coursework, and education. I think that idea of a mastery mindset will really help set you up for becoming deeply knowledgeable about a field.

Lightning Round

Coffee or tea?

Coffee



What’s your favorite book?

Project Hail Mary (audiobook)



Beach vacation or mountain retreat?

Mountain retreat



Early bird or night owl?

Night owl 



What’s your go-to comfort food?

Chaat (Indian street food) 



Do you prefer dogs or cats?

Dogs



What’s one hobby you’d like to pick up?

Sewing



If you could have dinner with any historical figure, who would it be?

Ruth Bader Ginsburg 



What’s your go-to karaoke song?

I Wanna Dance with Somebody



What’s one thing on your bucket list?

To see the Northern Lights

Amandeep Shergill, MD, MS, AGAF, always thought she had good hand-eye coordination until she entered her gastroenterology fellowship.

“You’re learning how to scope and the endoscope just feels so awkward in the hands. It can be such a difficult instrument to both learn and to use,” said Dr. Shergill, professor of clinical medicine at University of California, San Francisco. 

Her attendings and mentors couldn’t give her the feedback she needed.

“I was told that I wasn’t holding it right. But every time I tried to do something that someone was trying to tell me, it seemed like my hands were too small. I couldn’t hold it the way that they were teaching me to hold it.” She began to wonder: Was this about her or the tool itself? 

A deep dive into hand tool interactions and medical device designs led her to human factors and ergonomics. Her fellowship mentor, Ken McQuaid, MD, AGAF, had gone to medical school with David Rempel, MD, MPH who was one of the top-funded ergonomists in the country. “He emailed David and wrote: I have a fellow who’s interested in learning more about ergonomics and applying it to endoscopy,” said Dr. Shergill.

Through her work with Dr. Rempel, she was able to uncover the mechanisms that lead to musculoskeletal disorders in endoscopists.

Over time, she has become a trailblazer in this field, helming the UC Berkeley Center for Ergonomic Endoscopy with Carisa Harris-Adamson PhD, CPE, her ergonomics collaborator. In an interview, she described the unique “timeout” algorithm she created to ease the process of endoscopy for GI physicians. 

 

What is your favorite aspect of being a GI physician?

I really love the diversity of patients and cases. You’re always learning something new. It’s an internal medicine subspecialty and a cognitive field, so we must think about differential diagnoses, risks and benefits of procedures for patients. But as a procedural field, we get to diagnose and immediately treat certain disorders. What’s exciting about GI right now is there’s still so much to learn. I think that we’re still discovering more about how the brain-gut interaction works every day. There’s been additional research about the microbiome and the immense influence it has on both health and disease. The field is continuing to evolve rapidly. There’s always something new to learn, and I think it keeps us fresh.

Tell me about your work in ergonomics and endoscopy.

Ken McQuaid connected me with David Rempel. I worked with David to approach this problem of endoscopy ergonomics from a very rigorous ergonomics perspective. Early in my fellowship, endoscopy ergonomics wasn’t well known. There were few survey-based studies, including one from the American Society for Gastrointestinal Endoscopy (ASGE) that documented a high prevalence of endoscopist injury. But not a lot was known about what was causing injury in endoscopists.

What were the risk factors for endoscopist injury? Instead of just doing another survey, I wanted to show that there was this potential for causation given the design of the endoscopes. I worked with David to do a pilot study where we collected some pinch forces and forearm muscle loads. I was able to collect some pilot data that I used to apply for the ASGE Endoscopic Research Award. And luckily, ASGE supported that work.

Another award I received, the ASGE Career Development Award, was instrumental in allowing me to become more proficient in the science of ergonomics. I was able to leverage that career development award to go back to school. I went to UC Berkeley and got a master’s in environmental health sciences with a focus on ergonomics. It really helped me to lay the foundation and understanding for ergonomics and then apply that to endoscopy to generate a more rigorous scientific background for endoscopy ergonomics and start that conversation within the field of GI.

 

What leads to musculoskeletal disorders in endoscopists and how can it be prevented?

Musculoskeletal disorders are associated with the repetitive procedures that we’re performing, often utilizing high forces and in non-neutral postures. This is because of how we’re interacting with our tools and how we’re interacting with our environments. The studies I have done with Carisa Harris-Adamson have been able to demonstrate and document the high forces that are required to interact with the endoscope. To turn the control section dials and to torque and manipulate the insertion tube, there are really high distal upper extremity muscle loads that are being applied. 

We were able to compare the loads and the forces we were seeing to established risk thresholds from the ergonomics literature and demonstrate that performing endoscopy was associated with moderate to high risk of development of distal upper extremity disorders. 

 

What research are you doing now?

We’re trying to focus more on interventions. We’ve done some studies on engineering controls we can utilize to decrease the loads of holding the scope. First, it was an anti-gravity support arm. More recently we’re hoping to publish data on whether a scope stand can alleviate some of those left distal upper extremity loads because the stand is holding the scope instead of the hand holding the scope. Can we decrease injury risk by decreasing static loading? 

Neck and back injuries, which have a high prevalence in endoscopists, are usually associated with how the room is set up. One of the things that I’ve tried to help promote is a pre-procedure ergonomic “timeout.” Before an endoscopist does a procedure, we’re supposed to perform a timeout focused on the patient’s safety. We should also try to advocate for physician safety and an ergonomic timeout. I developed a mnemonic device utilizing the word “MYSELF” to help endoscopists remember the ergonomic timeout checklist: M = monitor, Y = upside-down Y stance, S = scope, E = elbow/ bed position, L = lower extremities, F = free movement of endoscope/ processor placement. 

First, thinking about the monitor, “M”, and fixing the monitor height so that the neck is in neutral position. Then, thinking of an upside down “Y” standing straight with the feet either hip width or shoulder width apart, so that the physician has a stable, neutral standing posture. Then “S” is for checking the scope to ensure you have a scope with optimal angulation that’s working properly.

“E” is for elbows — adjusting the bed to an optimal position so that elbows and shoulders are in neutral position. “L” is for lower extremities — are the foot pedals within an easy reach? Do you have comfortable shoes on, an anti-fatigue floor mat if you need it? And then the “F” in “MYSELF” is for the processor placement, to ensure “free movement” of the scope. By placing the processor directly behind you and lining up the processor with the orifice to be scoped, you can ensure free movement of the scope so that you can leverage large movements of the control section to result in tip deflection. 

We studied the MYSELF mnemonic device for a pre-procedure ergonomic timeout in a simulated setting and presented our results at Digestive Disease Week (DDW) 2024, where we showed a reduction in ergonomic risk scores based on the Rapid Entire Body Assessment tool.

We presented the results of the scope stand study at DDW 2025 in San Diego this May.

 

What has been the feedback from physicians who use these supportive tools?

While physicians are very grateful for bringing attention to this issue, and many have found utility in some of the tools that I proposed, I think we still have so much work to do. We’re just all hoping to continue to move this field forward for better tools that are designed more with the breadth of endoscopists in mind. 

How do you handle stress and maintain work-life balance?

A few years ago, during DDW I gave a talk entitled “Achieving Work-Life Harmony.” I disclosed at the beginning of the talk that I had not achieved work-life harmony. It’s definitely a difficult thing to do, especially in our field as GI proceduralists, where we’re frequently on call and there are potentially on-call emergencies.

One of the key things that I’ve tried to do is create boundaries to prioritize both things in my personal life and my professional life and really try to stay true to the things that are important to me. For instance, things like family time and mealtimes, I think that’s so critical. Trying to be home on evenings for dinnertime is so important. 

One of my GI colleagues, Raj Keswani, MD, MS gave a talk about burnout and described imagining life as juggling balls; trying to figure out which balls are glass balls and need to be handled with care, and which balls are rubber balls. 

More often, work is the rubber ball. If you drop it, it’ll bounce back and the work that you have will still be there the next day. Family, friends, our health, those are the glass balls that if they fall, they can get scuffed or shatter sometimes. That image helps me think in the moment. If I need to decide between two competing priorities, which one will still be here tomorrow? Which is the one that’s going to be more resilient, and which is the one that I need to focus on? That’s been a helpful image for me. 

I also want to give a shout out to my amazing colleagues. We all pitch in with the ‘juggling’ and help to keep everyone’s ‘balls’ in the air, and cover for each other. Whether it’s a sick patient or whatever’s going on in our personal lives, we always take care of each other. 

 

What advice would you give to aspiring GI fellows or graduating fellows?

GI is such an amazing field and many people end up focusing on the procedural aspect of it. What I think defines an exceptional gastroenterologist and physician in general is adopting both a “growth mindset” and a “mastery mindset.” I would really encourage GI fellows to lean into that idea of a mastery mindset, especially as they’re identifying that niche within GI that they may be interested in pursuing. And really, it starts out with when you’re exploring an area of focus, listening to what consistently draws your attention, what you’re excited about learning more about. 

Finding mentors, getting involved in projects, doing deep learning, and really trying to develop an expertise in that area through additional training, coursework, and education. I think that idea of a mastery mindset will really help set you up for becoming deeply knowledgeable about a field.

Lightning Round

Coffee or tea?

Coffee



What’s your favorite book?

Project Hail Mary (audiobook)



Beach vacation or mountain retreat?

Mountain retreat



Early bird or night owl?

Night owl 



What’s your go-to comfort food?

Chaat (Indian street food) 



Do you prefer dogs or cats?

Dogs



What’s one hobby you’d like to pick up?

Sewing



If you could have dinner with any historical figure, who would it be?

Ruth Bader Ginsburg 



What’s your go-to karaoke song?

I Wanna Dance with Somebody



What’s one thing on your bucket list?

To see the Northern Lights

Amandeep Shergill, MD, MS, AGAF, always thought she had good hand-eye coordination until she entered her gastroenterology fellowship.

“You’re learning how to scope and the endoscope just feels so awkward in the hands. It can be such a difficult instrument to both learn and to use,” said Dr. Shergill, professor of clinical medicine at University of California, San Francisco. 

Her attendings and mentors couldn’t give her the feedback she needed.

“I was told that I wasn’t holding it right. But every time I tried to do something that someone was trying to tell me, it seemed like my hands were too small. I couldn’t hold it the way that they were teaching me to hold it.” She began to wonder: Was this about her or the tool itself? 

A deep dive into hand tool interactions and medical device designs led her to human factors and ergonomics. Her fellowship mentor, Ken McQuaid, MD, AGAF, had gone to medical school with David Rempel, MD, MPH who was one of the top-funded ergonomists in the country. “He emailed David and wrote: I have a fellow who’s interested in learning more about ergonomics and applying it to endoscopy,” said Dr. Shergill.

Through her work with Dr. Rempel, she was able to uncover the mechanisms that lead to musculoskeletal disorders in endoscopists.

Over time, she has become a trailblazer in this field, helming the UC Berkeley Center for Ergonomic Endoscopy with Carisa Harris-Adamson PhD, CPE, her ergonomics collaborator. In an interview, she described the unique “timeout” algorithm she created to ease the process of endoscopy for GI physicians. 

 

What is your favorite aspect of being a GI physician?

I really love the diversity of patients and cases. You’re always learning something new. It’s an internal medicine subspecialty and a cognitive field, so we must think about differential diagnoses, risks and benefits of procedures for patients. But as a procedural field, we get to diagnose and immediately treat certain disorders. What’s exciting about GI right now is there’s still so much to learn. I think that we’re still discovering more about how the brain-gut interaction works every day. There’s been additional research about the microbiome and the immense influence it has on both health and disease. The field is continuing to evolve rapidly. There’s always something new to learn, and I think it keeps us fresh.

Tell me about your work in ergonomics and endoscopy.

Ken McQuaid connected me with David Rempel. I worked with David to approach this problem of endoscopy ergonomics from a very rigorous ergonomics perspective. Early in my fellowship, endoscopy ergonomics wasn’t well known. There were few survey-based studies, including one from the American Society for Gastrointestinal Endoscopy (ASGE) that documented a high prevalence of endoscopist injury. But not a lot was known about what was causing injury in endoscopists.

What were the risk factors for endoscopist injury? Instead of just doing another survey, I wanted to show that there was this potential for causation given the design of the endoscopes. I worked with David to do a pilot study where we collected some pinch forces and forearm muscle loads. I was able to collect some pilot data that I used to apply for the ASGE Endoscopic Research Award. And luckily, ASGE supported that work.

Another award I received, the ASGE Career Development Award, was instrumental in allowing me to become more proficient in the science of ergonomics. I was able to leverage that career development award to go back to school. I went to UC Berkeley and got a master’s in environmental health sciences with a focus on ergonomics. It really helped me to lay the foundation and understanding for ergonomics and then apply that to endoscopy to generate a more rigorous scientific background for endoscopy ergonomics and start that conversation within the field of GI.

 

What leads to musculoskeletal disorders in endoscopists and how can it be prevented?

Musculoskeletal disorders are associated with the repetitive procedures that we’re performing, often utilizing high forces and in non-neutral postures. This is because of how we’re interacting with our tools and how we’re interacting with our environments. The studies I have done with Carisa Harris-Adamson have been able to demonstrate and document the high forces that are required to interact with the endoscope. To turn the control section dials and to torque and manipulate the insertion tube, there are really high distal upper extremity muscle loads that are being applied. 

We were able to compare the loads and the forces we were seeing to established risk thresholds from the ergonomics literature and demonstrate that performing endoscopy was associated with moderate to high risk of development of distal upper extremity disorders. 

 

What research are you doing now?

We’re trying to focus more on interventions. We’ve done some studies on engineering controls we can utilize to decrease the loads of holding the scope. First, it was an anti-gravity support arm. More recently we’re hoping to publish data on whether a scope stand can alleviate some of those left distal upper extremity loads because the stand is holding the scope instead of the hand holding the scope. Can we decrease injury risk by decreasing static loading? 

Neck and back injuries, which have a high prevalence in endoscopists, are usually associated with how the room is set up. One of the things that I’ve tried to help promote is a pre-procedure ergonomic “timeout.” Before an endoscopist does a procedure, we’re supposed to perform a timeout focused on the patient’s safety. We should also try to advocate for physician safety and an ergonomic timeout. I developed a mnemonic device utilizing the word “MYSELF” to help endoscopists remember the ergonomic timeout checklist: M = monitor, Y = upside-down Y stance, S = scope, E = elbow/ bed position, L = lower extremities, F = free movement of endoscope/ processor placement. 

First, thinking about the monitor, “M”, and fixing the monitor height so that the neck is in neutral position. Then, thinking of an upside down “Y” standing straight with the feet either hip width or shoulder width apart, so that the physician has a stable, neutral standing posture. Then “S” is for checking the scope to ensure you have a scope with optimal angulation that’s working properly.

“E” is for elbows — adjusting the bed to an optimal position so that elbows and shoulders are in neutral position. “L” is for lower extremities — are the foot pedals within an easy reach? Do you have comfortable shoes on, an anti-fatigue floor mat if you need it? And then the “F” in “MYSELF” is for the processor placement, to ensure “free movement” of the scope. By placing the processor directly behind you and lining up the processor with the orifice to be scoped, you can ensure free movement of the scope so that you can leverage large movements of the control section to result in tip deflection. 

We studied the MYSELF mnemonic device for a pre-procedure ergonomic timeout in a simulated setting and presented our results at Digestive Disease Week (DDW) 2024, where we showed a reduction in ergonomic risk scores based on the Rapid Entire Body Assessment tool.

We presented the results of the scope stand study at DDW 2025 in San Diego this May.

 

What has been the feedback from physicians who use these supportive tools?

While physicians are very grateful for bringing attention to this issue, and many have found utility in some of the tools that I proposed, I think we still have so much work to do. We’re just all hoping to continue to move this field forward for better tools that are designed more with the breadth of endoscopists in mind. 

How do you handle stress and maintain work-life balance?

A few years ago, during DDW I gave a talk entitled “Achieving Work-Life Harmony.” I disclosed at the beginning of the talk that I had not achieved work-life harmony. It’s definitely a difficult thing to do, especially in our field as GI proceduralists, where we’re frequently on call and there are potentially on-call emergencies.

One of the key things that I’ve tried to do is create boundaries to prioritize both things in my personal life and my professional life and really try to stay true to the things that are important to me. For instance, things like family time and mealtimes, I think that’s so critical. Trying to be home on evenings for dinnertime is so important. 

One of my GI colleagues, Raj Keswani, MD, MS gave a talk about burnout and described imagining life as juggling balls; trying to figure out which balls are glass balls and need to be handled with care, and which balls are rubber balls. 

More often, work is the rubber ball. If you drop it, it’ll bounce back and the work that you have will still be there the next day. Family, friends, our health, those are the glass balls that if they fall, they can get scuffed or shatter sometimes. That image helps me think in the moment. If I need to decide between two competing priorities, which one will still be here tomorrow? Which is the one that’s going to be more resilient, and which is the one that I need to focus on? That’s been a helpful image for me. 

I also want to give a shout out to my amazing colleagues. We all pitch in with the ‘juggling’ and help to keep everyone’s ‘balls’ in the air, and cover for each other. Whether it’s a sick patient or whatever’s going on in our personal lives, we always take care of each other. 

 

What advice would you give to aspiring GI fellows or graduating fellows?

GI is such an amazing field and many people end up focusing on the procedural aspect of it. What I think defines an exceptional gastroenterologist and physician in general is adopting both a “growth mindset” and a “mastery mindset.” I would really encourage GI fellows to lean into that idea of a mastery mindset, especially as they’re identifying that niche within GI that they may be interested in pursuing. And really, it starts out with when you’re exploring an area of focus, listening to what consistently draws your attention, what you’re excited about learning more about. 

Finding mentors, getting involved in projects, doing deep learning, and really trying to develop an expertise in that area through additional training, coursework, and education. I think that idea of a mastery mindset will really help set you up for becoming deeply knowledgeable about a field.

Lightning Round

Coffee or tea?

Coffee



What’s your favorite book?

Project Hail Mary (audiobook)



Beach vacation or mountain retreat?

Mountain retreat



Early bird or night owl?

Night owl 



What’s your go-to comfort food?

Chaat (Indian street food) 



Do you prefer dogs or cats?

Dogs



What’s one hobby you’d like to pick up?

Sewing



If you could have dinner with any historical figure, who would it be?

Ruth Bader Ginsburg 



What’s your go-to karaoke song?

I Wanna Dance with Somebody



What’s one thing on your bucket list?

To see the Northern Lights

As the COVID-19 crisis unfolded in early 2020, Tossapol Kerdsirichairat, MD, faced another challenge: his mother’s ovarian cancer diagnosis.

“She chose to remain in Thailand, so I decided to relocate to care for her,” said Dr. Kerdsirichairat, an interventional endoscopist who completed fellowships at the University of Michigan, Ann Arbor, and Johns Hopkins University in Baltimore. The move to Bangkok turned out to be one of the best decisions of his life, he said, as he could support his mother while introducing advanced endoscopic techniques and devices to the region.

“Bangkok is a hub for medical innovation in Asia, offering opportunities to work with a diverse patient population and access to cutting-edge technology,” said Dr. Kerdsirichairat, who works at Bumrungrad International Hospital as a clinical associate professor. 

Establishing a high-risk GI cancer program that included pancreatic cancer screening for high-risk individuals was one of his core achievements at Bumrungrad. The program is the first of its kind in Thailand and one of the few in the Asia-Pacific region. 

“I guide patients and families through understanding their risks and implementing preventive strategies, collaborating with multidisciplinary teams to ensure comprehensive care. It’s incredibly rewarding to see the impact of early tumor detection,” said Dr. Kerdsirichairat, an international member of AGA who was a participant in the AGA Young Delegates Program.

He has set several records in Thailand for the smallest tumor detected, including a 0.3-millimeter (mm) esophageal tumor, a 0.8-mm tumor for stomach cancer, a 5-mm pancreatic tumor, and a 1-mm tumor for colon cancer. 

“These were detected through high-standard screening programs, as patients often do not develop symptoms from these subtle lesions,” said Dr. Kerdsirichairat, who discussed in an interview the unique challenges of practicing overseas.

 

Why did you choose GI?

Gastroenterology is a specialty that uniquely integrates procedural skill, clinical decision making, and a deep understanding of complex biological systems. I was drawn especially to the ability to make a direct and meaningful impact in patients’ lives through advanced endoscopic procedures, while also addressing both acute and chronic diseases, and focusing on cancer prevention. It is incredibly rewarding to perform an endoscopic retrograde cholangiopancreatography (ERCP) for cholangitis and see a patient return to normal the very next day, or to perform an endoscopic ultrasound (EUS) for pancreatic cancer screening in high-risk individuals and detect a sub-centimeter pancreatic tumor.

Realizing that early detection can improve survival by threefold after surgery is a powerful reminder of the difference we can make in patients’ lives. This specialty requires a delicate balance of precision and empathy, which perfectly aligns with my strengths and values as a physician.

You have a wide variety of clinical interests, from endoscopic procedures to cancer research to GERD. What’s your key subspecialty and why?

My primary specialty is advanced endoscopy, which includes techniques such as EUS, ERCP, and endoscopic resection of precancerous and early cancerous lesions. I also focus on cutting-edge, evidence-based techniques recently included in clinical guidelines, such as Transoral Incisionless Fundoplication (TIF). These minimally invasive options allow me to diagnose and treat conditions that once required surgery. The precision and innovation involved in advanced endoscopy enable me to effectively manage complex cases—from diagnosing early cancers to managing bile duct obstructions and resecting precancerous lesions.

Can you describe your work in cancer genetics and screening?

I am deeply committed to the early detection of gastrointestinal cancers, particularly through screening for precancerous conditions and hereditary syndromes. During my general GI training at the University of Michigan, I had the privilege of working with Grace Elta, MD, AGAF, and Michelle Anderson, MD, MSc, renowned experts in pancreatic cancer management. I was later trained by Anne Marie Lennon, PhD, AGAF, who pioneered the liquid biopsy technique for cancer screening through the CancerSEEK project, and Marcia (Mimi) Canto, MD, MHS, who initiated the Cancer of the Pancreas Screening project for high-risk individuals of pancreatic cancer.

I also had the distinction of being the first at Bumrungrad International Hospital to perform endoscopic drainage for pancreatic fluid collections in the setting of multi-organ failure. This endoscopic approach has been extensively validated in the medical literature as significantly improving survival rates compared to surgical drainage. My training in this specialized procedure was conducted under the guidance of the premier group for necrotizing pancreatitis, led by Martin Freeman, MD, at the University of Minnesota.

Later, I contributed to overseeing the Inherited Gastrointestinal Malignancy Clinic of MyCode, a large-scale population-based cohort program focused on cancer screening in Pennsylvania. By December 2024, MyCode had collected blood samples from over 258,000 individuals, analyzed DNA sequences from over 184,000, and provided clinical data that benefits over 142,000 patients. It’s not uncommon for healthy 25-year-old patients to come to our clinic for colon cancer screening after learning from the program that they carry a cancer syndrome, and early screening can potentially save their lives.

 

What are the key differences between training and practicing medicine in the United States and in an Asian country?

The U.S. healthcare system is deeply rooted in evidence-based protocols and multidisciplinary care, driven by an insurance-based model. In contrast, many Asian countries face challenges such as the dependency on government approval for certain treatments and insurance limitations. Practicing in Asia requires navigating unique cultural, economic, and systemic differences, including varying resource availability and disease prevalence.

What specific challenges have you faced as a GI in Thailand?

As an advanced endoscopist, one of the biggest challenges I faced initially was the difficulty in obtaining the same devices I used in the U.S. for use in Thailand. With support from device companies and mentors in the U.S., I was able to perform groundbreaking procedures, such as the TIF in Southeast Asia and the first use of a full-thickness resection device in Thailand. I am also proud to be part of one of the first few centers worldwide performing the combination of injectable semaglutide and endoscopic sleeve gastroplasty, resulting in a remarkable weight reduction of 44%, comparable to surgical gastric bypass.

In addition, Bumrungrad International Hospital, where I practice, sees over 1.1 million visits annually from patients from more than 190 countries. This offers a unique opportunity to engage with a global patient base and learn from diverse cultures. Over time, although the hospital has professional interpreters for all languages, I have become able to communicate basic sentences with international patients in their preferred languages, including Chinese, Japanese, and Arabic, which has enriched my practice.

 

What’s your favorite thing to do when you’re not practicing GI?

I enjoy traveling, exploring new cuisines, and spending quality time with family and friends. These activities help me recharge and offer fresh perspectives on life.

Lightning Round

Texting or talking?

Talking. It’s more personal and meaningful.



Favorite city in the U.S.?

Ann Arbor, Michigan 



Cat or dog person?

Dog person 



Favorite junk food?

Pizza 



How many cups of coffee do you drink per day?

Two – just enough to stay sharp, but not jittery.



If you weren’t a GI, what would you be?

Architect 



Best place you went on vacation?

Kyoto, Japan 



Favorite sport?

Skiing 



Favorite ice cream?

Matcha green tea 



What song do you have to sing along with when you hear it?

“Everybody” by Backstreet Boys 



Favorite movie or TV show?

Forrest Gump and Friends 



Optimist or pessimist?

Optimist. I believe in focusing on solutions and possibilities.

As the COVID-19 crisis unfolded in early 2020, Tossapol Kerdsirichairat, MD, faced another challenge: his mother’s ovarian cancer diagnosis.

“She chose to remain in Thailand, so I decided to relocate to care for her,” said Dr. Kerdsirichairat, an interventional endoscopist who completed fellowships at the University of Michigan, Ann Arbor, and Johns Hopkins University in Baltimore. The move to Bangkok turned out to be one of the best decisions of his life, he said, as he could support his mother while introducing advanced endoscopic techniques and devices to the region.

“Bangkok is a hub for medical innovation in Asia, offering opportunities to work with a diverse patient population and access to cutting-edge technology,” said Dr. Kerdsirichairat, who works at Bumrungrad International Hospital as a clinical associate professor. 

Establishing a high-risk GI cancer program that included pancreatic cancer screening for high-risk individuals was one of his core achievements at Bumrungrad. The program is the first of its kind in Thailand and one of the few in the Asia-Pacific region. 

“I guide patients and families through understanding their risks and implementing preventive strategies, collaborating with multidisciplinary teams to ensure comprehensive care. It’s incredibly rewarding to see the impact of early tumor detection,” said Dr. Kerdsirichairat, an international member of AGA who was a participant in the AGA Young Delegates Program.

He has set several records in Thailand for the smallest tumor detected, including a 0.3-millimeter (mm) esophageal tumor, a 0.8-mm tumor for stomach cancer, a 5-mm pancreatic tumor, and a 1-mm tumor for colon cancer. 

“These were detected through high-standard screening programs, as patients often do not develop symptoms from these subtle lesions,” said Dr. Kerdsirichairat, who discussed in an interview the unique challenges of practicing overseas.

 

Why did you choose GI?

Gastroenterology is a specialty that uniquely integrates procedural skill, clinical decision making, and a deep understanding of complex biological systems. I was drawn especially to the ability to make a direct and meaningful impact in patients’ lives through advanced endoscopic procedures, while also addressing both acute and chronic diseases, and focusing on cancer prevention. It is incredibly rewarding to perform an endoscopic retrograde cholangiopancreatography (ERCP) for cholangitis and see a patient return to normal the very next day, or to perform an endoscopic ultrasound (EUS) for pancreatic cancer screening in high-risk individuals and detect a sub-centimeter pancreatic tumor.

Realizing that early detection can improve survival by threefold after surgery is a powerful reminder of the difference we can make in patients’ lives. This specialty requires a delicate balance of precision and empathy, which perfectly aligns with my strengths and values as a physician.

You have a wide variety of clinical interests, from endoscopic procedures to cancer research to GERD. What’s your key subspecialty and why?

My primary specialty is advanced endoscopy, which includes techniques such as EUS, ERCP, and endoscopic resection of precancerous and early cancerous lesions. I also focus on cutting-edge, evidence-based techniques recently included in clinical guidelines, such as Transoral Incisionless Fundoplication (TIF). These minimally invasive options allow me to diagnose and treat conditions that once required surgery. The precision and innovation involved in advanced endoscopy enable me to effectively manage complex cases—from diagnosing early cancers to managing bile duct obstructions and resecting precancerous lesions.

Can you describe your work in cancer genetics and screening?

I am deeply committed to the early detection of gastrointestinal cancers, particularly through screening for precancerous conditions and hereditary syndromes. During my general GI training at the University of Michigan, I had the privilege of working with Grace Elta, MD, AGAF, and Michelle Anderson, MD, MSc, renowned experts in pancreatic cancer management. I was later trained by Anne Marie Lennon, PhD, AGAF, who pioneered the liquid biopsy technique for cancer screening through the CancerSEEK project, and Marcia (Mimi) Canto, MD, MHS, who initiated the Cancer of the Pancreas Screening project for high-risk individuals of pancreatic cancer.

I also had the distinction of being the first at Bumrungrad International Hospital to perform endoscopic drainage for pancreatic fluid collections in the setting of multi-organ failure. This endoscopic approach has been extensively validated in the medical literature as significantly improving survival rates compared to surgical drainage. My training in this specialized procedure was conducted under the guidance of the premier group for necrotizing pancreatitis, led by Martin Freeman, MD, at the University of Minnesota.

Later, I contributed to overseeing the Inherited Gastrointestinal Malignancy Clinic of MyCode, a large-scale population-based cohort program focused on cancer screening in Pennsylvania. By December 2024, MyCode had collected blood samples from over 258,000 individuals, analyzed DNA sequences from over 184,000, and provided clinical data that benefits over 142,000 patients. It’s not uncommon for healthy 25-year-old patients to come to our clinic for colon cancer screening after learning from the program that they carry a cancer syndrome, and early screening can potentially save their lives.

 

What are the key differences between training and practicing medicine in the United States and in an Asian country?

The U.S. healthcare system is deeply rooted in evidence-based protocols and multidisciplinary care, driven by an insurance-based model. In contrast, many Asian countries face challenges such as the dependency on government approval for certain treatments and insurance limitations. Practicing in Asia requires navigating unique cultural, economic, and systemic differences, including varying resource availability and disease prevalence.

What specific challenges have you faced as a GI in Thailand?

As an advanced endoscopist, one of the biggest challenges I faced initially was the difficulty in obtaining the same devices I used in the U.S. for use in Thailand. With support from device companies and mentors in the U.S., I was able to perform groundbreaking procedures, such as the TIF in Southeast Asia and the first use of a full-thickness resection device in Thailand. I am also proud to be part of one of the first few centers worldwide performing the combination of injectable semaglutide and endoscopic sleeve gastroplasty, resulting in a remarkable weight reduction of 44%, comparable to surgical gastric bypass.

In addition, Bumrungrad International Hospital, where I practice, sees over 1.1 million visits annually from patients from more than 190 countries. This offers a unique opportunity to engage with a global patient base and learn from diverse cultures. Over time, although the hospital has professional interpreters for all languages, I have become able to communicate basic sentences with international patients in their preferred languages, including Chinese, Japanese, and Arabic, which has enriched my practice.

 

What’s your favorite thing to do when you’re not practicing GI?

I enjoy traveling, exploring new cuisines, and spending quality time with family and friends. These activities help me recharge and offer fresh perspectives on life.

Lightning Round

Texting or talking?

Talking. It’s more personal and meaningful.



Favorite city in the U.S.?

Ann Arbor, Michigan 



Cat or dog person?

Dog person 



Favorite junk food?

Pizza 



How many cups of coffee do you drink per day?

Two – just enough to stay sharp, but not jittery.



If you weren’t a GI, what would you be?

Architect 



Best place you went on vacation?

Kyoto, Japan 



Favorite sport?

Skiing 



Favorite ice cream?

Matcha green tea 



What song do you have to sing along with when you hear it?

“Everybody” by Backstreet Boys 



Favorite movie or TV show?

Forrest Gump and Friends 



Optimist or pessimist?

Optimist. I believe in focusing on solutions and possibilities.

As the COVID-19 crisis unfolded in early 2020, Tossapol Kerdsirichairat, MD, faced another challenge: his mother’s ovarian cancer diagnosis.

“She chose to remain in Thailand, so I decided to relocate to care for her,” said Dr. Kerdsirichairat, an interventional endoscopist who completed fellowships at the University of Michigan, Ann Arbor, and Johns Hopkins University in Baltimore. The move to Bangkok turned out to be one of the best decisions of his life, he said, as he could support his mother while introducing advanced endoscopic techniques and devices to the region.

“Bangkok is a hub for medical innovation in Asia, offering opportunities to work with a diverse patient population and access to cutting-edge technology,” said Dr. Kerdsirichairat, who works at Bumrungrad International Hospital as a clinical associate professor. 

Establishing a high-risk GI cancer program that included pancreatic cancer screening for high-risk individuals was one of his core achievements at Bumrungrad. The program is the first of its kind in Thailand and one of the few in the Asia-Pacific region. 

“I guide patients and families through understanding their risks and implementing preventive strategies, collaborating with multidisciplinary teams to ensure comprehensive care. It’s incredibly rewarding to see the impact of early tumor detection,” said Dr. Kerdsirichairat, an international member of AGA who was a participant in the AGA Young Delegates Program.

He has set several records in Thailand for the smallest tumor detected, including a 0.3-millimeter (mm) esophageal tumor, a 0.8-mm tumor for stomach cancer, a 5-mm pancreatic tumor, and a 1-mm tumor for colon cancer. 

“These were detected through high-standard screening programs, as patients often do not develop symptoms from these subtle lesions,” said Dr. Kerdsirichairat, who discussed in an interview the unique challenges of practicing overseas.

 

Why did you choose GI?

Gastroenterology is a specialty that uniquely integrates procedural skill, clinical decision making, and a deep understanding of complex biological systems. I was drawn especially to the ability to make a direct and meaningful impact in patients’ lives through advanced endoscopic procedures, while also addressing both acute and chronic diseases, and focusing on cancer prevention. It is incredibly rewarding to perform an endoscopic retrograde cholangiopancreatography (ERCP) for cholangitis and see a patient return to normal the very next day, or to perform an endoscopic ultrasound (EUS) for pancreatic cancer screening in high-risk individuals and detect a sub-centimeter pancreatic tumor.

Realizing that early detection can improve survival by threefold after surgery is a powerful reminder of the difference we can make in patients’ lives. This specialty requires a delicate balance of precision and empathy, which perfectly aligns with my strengths and values as a physician.

You have a wide variety of clinical interests, from endoscopic procedures to cancer research to GERD. What’s your key subspecialty and why?

My primary specialty is advanced endoscopy, which includes techniques such as EUS, ERCP, and endoscopic resection of precancerous and early cancerous lesions. I also focus on cutting-edge, evidence-based techniques recently included in clinical guidelines, such as Transoral Incisionless Fundoplication (TIF). These minimally invasive options allow me to diagnose and treat conditions that once required surgery. The precision and innovation involved in advanced endoscopy enable me to effectively manage complex cases—from diagnosing early cancers to managing bile duct obstructions and resecting precancerous lesions.

Can you describe your work in cancer genetics and screening?

I am deeply committed to the early detection of gastrointestinal cancers, particularly through screening for precancerous conditions and hereditary syndromes. During my general GI training at the University of Michigan, I had the privilege of working with Grace Elta, MD, AGAF, and Michelle Anderson, MD, MSc, renowned experts in pancreatic cancer management. I was later trained by Anne Marie Lennon, PhD, AGAF, who pioneered the liquid biopsy technique for cancer screening through the CancerSEEK project, and Marcia (Mimi) Canto, MD, MHS, who initiated the Cancer of the Pancreas Screening project for high-risk individuals of pancreatic cancer.

I also had the distinction of being the first at Bumrungrad International Hospital to perform endoscopic drainage for pancreatic fluid collections in the setting of multi-organ failure. This endoscopic approach has been extensively validated in the medical literature as significantly improving survival rates compared to surgical drainage. My training in this specialized procedure was conducted under the guidance of the premier group for necrotizing pancreatitis, led by Martin Freeman, MD, at the University of Minnesota.

Later, I contributed to overseeing the Inherited Gastrointestinal Malignancy Clinic of MyCode, a large-scale population-based cohort program focused on cancer screening in Pennsylvania. By December 2024, MyCode had collected blood samples from over 258,000 individuals, analyzed DNA sequences from over 184,000, and provided clinical data that benefits over 142,000 patients. It’s not uncommon for healthy 25-year-old patients to come to our clinic for colon cancer screening after learning from the program that they carry a cancer syndrome, and early screening can potentially save their lives.

 

What are the key differences between training and practicing medicine in the United States and in an Asian country?

The U.S. healthcare system is deeply rooted in evidence-based protocols and multidisciplinary care, driven by an insurance-based model. In contrast, many Asian countries face challenges such as the dependency on government approval for certain treatments and insurance limitations. Practicing in Asia requires navigating unique cultural, economic, and systemic differences, including varying resource availability and disease prevalence.

What specific challenges have you faced as a GI in Thailand?

As an advanced endoscopist, one of the biggest challenges I faced initially was the difficulty in obtaining the same devices I used in the U.S. for use in Thailand. With support from device companies and mentors in the U.S., I was able to perform groundbreaking procedures, such as the TIF in Southeast Asia and the first use of a full-thickness resection device in Thailand. I am also proud to be part of one of the first few centers worldwide performing the combination of injectable semaglutide and endoscopic sleeve gastroplasty, resulting in a remarkable weight reduction of 44%, comparable to surgical gastric bypass.

In addition, Bumrungrad International Hospital, where I practice, sees over 1.1 million visits annually from patients from more than 190 countries. This offers a unique opportunity to engage with a global patient base and learn from diverse cultures. Over time, although the hospital has professional interpreters for all languages, I have become able to communicate basic sentences with international patients in their preferred languages, including Chinese, Japanese, and Arabic, which has enriched my practice.

 

What’s your favorite thing to do when you’re not practicing GI?

I enjoy traveling, exploring new cuisines, and spending quality time with family and friends. These activities help me recharge and offer fresh perspectives on life.

Lightning Round

Texting or talking?

Talking. It’s more personal and meaningful.



Favorite city in the U.S.?

Ann Arbor, Michigan 



Cat or dog person?

Dog person 



Favorite junk food?

Pizza 



How many cups of coffee do you drink per day?

Two – just enough to stay sharp, but not jittery.



If you weren’t a GI, what would you be?

Architect 



Best place you went on vacation?

Kyoto, Japan 



Favorite sport?

Skiing 



Favorite ice cream?

Matcha green tea 



What song do you have to sing along with when you hear it?

“Everybody” by Backstreet Boys 



Favorite movie or TV show?

Forrest Gump and Friends 



Optimist or pessimist?

Optimist. I believe in focusing on solutions and possibilities.