Bo Shen, MD, AGAF, Medical Director of the Inflammatory Bowel Disease Center at NewYork-Presbyterian/Columbia, is laser-focused on advancing the field of interventional inflammatory bowel disease (IBD) and finding new and better ways to manage complex IBD and ileal pouch disorders. Known internationally as the preeminent expert in pouchitis, ileal pouch disorders, and endoscopic management of IBD, Dr. Shen has dedicated his over 40-year career to finding less invasive, endoscopic ways to diagnose and manage complications in patients with Crohn’s disease, ulcerative colitis, and other gastrointestinal disorders.
His interest in IBD dates to his gastroenterology fellowship at the Cleveland Clinic. At the time, Dr. Shen was working side-by-side with the late Victor Fazio, MD, who was Chair of the Department of Colorectal Surgery at the Cleveland Clinic, a master colorectal surgeon, educator, and innovator who had one of the busiest IBD surgery practices in the country. Dr. Fazio is credited with revolutionizing ileal pouch surgery and quickly became one of Dr. Shen’s mentors. The two doctors spent countless hours together researching, studying cases, and performing procedures, building more than just a medical partnership. “Dr. Fazio had a heavy influence on me and attracted me to IBD and ileal pouch disorders,” he says. “I’m indebted to his legacy.”
It was during his time at the Cleveland Clinic that he uncovered a knowledge gap in the management of ileal pouch conditions. Patients would undergo successful life-changing pouch surgery only to experience post-surgical pouch complications of unknown etiology and pathogenesis. Physicians tried to understand why certain patients experienced these complications and others didn’t. Being witness to the extent to which patients suffered from these disorders and complications, Dr. Shen was inspired to further his understanding of the pathophysiology of these conditions and find new ways to use endoscopy to treat the complications he was seeing in his patients.
Interventional IBD: The New Frontier in IBD Treatment
IBD has traditionally been managed with medical therapies and surgical procedures. Patients often try a variety of medications to manage their symptoms and treat the underlying abnormal inflammatory response occurring in their body. However, when those options fail, many undergo surgery to remove part or the entirety of their small and/or large intestine. But those surgeries come with risks and high rates of complications and disease recurrence, as Dr. Shen noted early on in his training. Recognizing the issues patients face with medical and surgical treatment, he moved to establish an interventional approach using therapeutic endoscopy to treat these immune-mediated diseases and surgery-associated complications. Dr. Shen established the first pouchitis clinic and interventional IBD unit in the United States at the Cleveland Clinic with the goal of providing less invasive modalities to treat IBD-related and pouch complications.
What makes interventional IBD different from medical or surgical treatment is that IBD interventionalists use less invasive, endoscopic techniques to precisely treat a specific location within the GI tract and reduces the risk for complications. Dr. Shen rigorously studied Dr. Fazio’s innovative pouch surgery techniques and began to develop his own unique approaches to address IBD complications endoscopically.
Initially, Dr. Shen used therapeutic endoscopy to treat patients with ulcerative colitis who had a restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) and were experiencing pouch complications, such as pouchitis and pouch leaks. After endoscopically treating pouch complications, like strictures, fistulas, pouchitis, cuffitis, de novo Crohn’s disease-like conditions of the pouch, and irritable pouch syndrome, Dr. Shen extrapolated that those techniques could be used to address issues in IBD patients without pouches.
“Endoscopy is the tool we use to deliver the therapy to your disease,” says Dr. Shen. “Not medicine, not open or laparoscopic surgery, we just use endoscopy to reach the different parts of the [GI tract],” says Dr. Shen. “In interventional IBD, we treat the structural disease and provide a minimally invasive approach for those with mechanical complications, mostly in an outpatient setting.”
In interventional IBD, we treat the structural disease and provide a minimally invasive approach for those with mechanical complications, mostly in an outpatient setting.
— Dr. Bo Shen
In a September 2022 article in Gastroenterology Report, Dr. Shen wrote, “The field of interventional IBD is evolving with a better understanding of the underlying disease process, advances in endoscopic technology, and interest and proper training of next-generation IBD interventionalists.”
Dr. Shen uses existing treatment modalities and applies them using interventional endoscopic methods. “I had a patient with a tight stricture at their surgical anastomosis,” says Dr. Shen. “You can remove that stricture with another bigger surgery but after that, there is a high chance that the stricture will come back. Instead, I use balloon dilation or a special small knife to treat it endoscopically. This approach comes with a low risk of complications, and, in most cases, the patient can avoid further surgeries.”
Dr. Shen is also exploring new interventional treatment approaches including:
- Drug-coated balloons to treat strictures
- Endoscopic clips to straighten the bowel in people with angulated or twisted bowels
- An endoscopic suturing device to fix surgical leaks
- Injecting doxycycline directly into bowel fistulas and sinuses
- Spray topical agents to control IBD or IBD-surgery associated bleeding
The field of interventional IBD is evolving with a better understanding of the underlying disease process, advances in endoscopic technology, and interest and proper training of next-generation IBD interventionalists.
— Dr. Bo Shen
To further the adoption of interventional IBD techniques globally, Dr. Shen founded the Global Interventional IBD Group and Special Interest Group of Interventional IBD in American Society for Gastrointestinal Endoscopy (ASGE) to train clinicians in this novel approach to treating IBD. He also established the International Ileal Pouch Consortium, which has published five guidelines for the management of pouch disorders and IBD complications.
Extending a Legacy of Collaboration and Innovation
After the passing of his mentor, Dr. Shen was motivated to take what he learned from his mentor and develop his expertise beyond Cleveland Clinic. Building his legacy at a health care system that that could offer integrated care to IBD patients was eventually what led him to NewYork-Presbyterian/Columbia where he joined others who previously trained under and worked with Dr. Fazio, including Ravi P. Kiran, MD, Chief of the Division of Colorectal Surgery, and James Church, MD, Director of Research in the Division of Colorectal Surgery. To further extend the legacy of Dr. Fazio, Dr. Shen organizes NewYork-Presbyterian/Columbia’s Annual Dr. Victor Fazio Ileal Pouch Symposia, which is hosted in addition to the center’s Annual Conference in Medical, Interventional, and Surgical IBD.
Under the leadership of Dr. Shen, IBD is managed by a multidisciplinary medical, surgical, and interventional team. The close partnership among specialists provides IBD patients with the full spectrum of care and is an approach unique to NewYork-Presbyterian/Columbia. “We are the largest center in New York that offers endoscopic therapy for IBD,” Dr. Shen says. “We also offer the most advanced experience in the various kinds of pouch disorders.” The IBD Center he has created is comprised of experts from adult and pediatric gastroenterology, colorectal surgery, GI radiology, GI pathology, clinical nutrition, and obstetrics and gynecology as well as wound and ostomy nurses, nurse practitioners, and physician assistants. By working together, he believes he can build the IBD program at NewYork-Presbyterian/Columbia into one of the top comprehensive treatment centers in the world.
We are the largest center in New York that offers endoscopic therapy for IBD. We also offer the most advanced experience in the various kinds of pouch disorders.
— Dr. Bo Shen
His establishment of a specialized IBD board at Columbia is further evidence of how Dr. Shen has built a culture of collaboration and partnership to advance IBD treatment and innovation. The IBD board is modeled after oncology tumor boards that convene regularly to review and discuss complex cases. Dr. Shen’s board brings together some of the brightest minds in the field from not only Columbia but also NewYork-Presbyterian/Weill Cornell Medicine to review five to seven extremely complex cases each month and problem solve together. A variety of questions are posed with the goal of collaboratively coming up with the best treatment approach for each individual case.
“The IBD board meets once a month for an hour] to review very difficult cases. The IBD board typically consists of 20-30 experts in the field from the medical side, surgical side, GI pathology, GI radiology, and pediatric gastroenterology,” says Dr. Shen. “We present tough cases and generate discussion and feedback on how to manage them. Finally, we get some consensus of what the best approach would be to solve those complex medical or surgical problems.”
Dr. Shen and the other IBD Center doctors use the treatment consensus and apply it in the clinical setting. Dana Lukin, MD, a gastroenterologist and Clinical Director of Translational Research for the Jill Roberts Center for Inflammatory Bowel Disease at NewYork-Presbyterian/Weill Cornell Medicine, is one of the clinicians who participates in the program. “Having the IBD [board] is an excellent tool to allow for discussion of complex cases where patients fall outside the inclusion criteria of clinical trials which led to the approval of the medications we use for treatment,” he says. “There is not always a single treatment plan for these patients, and the conference allows for a platform to discuss the issues to weigh the risks and benefits of different treatment options. Patients find reassurance that their case will be discussed by experts who will collectively devise a cohesive plan, and this is moving forward the standard of care.”
Dr. Shen’s work has been a catalyst for growing the IBD program since he joined NewYork-Presbyterian four years ago. The center’s patient/IBD endoscopy volume has increased four-fold and the endoscopic procedure volume is approaching 1,000 procedures performed annually. His contributions can be seen through his receipt of awards, authoring of publications, and frequent speaking engagements. Earlier this year, he was awarded the prestigious Distinguished Clinician Award in Academic Practice from the American Gastroenterological Association (AGA), recognizing his contributions to the medical and endoscopic management of complex IBD and pouch disorders. The AGA recognizes two individuals each year with this award who combine medicine with the skills demanded by the scientific body of knowledge in serve to patients. He has authored over 600 peer-reviewed scientific articles as well as many books on IBD and lectures extensively across the country and abroad.
Dr. Shen is proud of the culture he has created and the synergy that exists within the IBD Center and strives to continue fostering innovation to provide the best care possible to patients. “I want to make NewYork-Presbyterian our patients’ last stop for complex IBD care and IBD surgical complications,” he says. “I think we are well on the way to doing that.”