Endoscopy is a procedure that uses an endoscope (a thin, flexible tube with a camera and light source at the end) to allow gastroenterologists to evaluate the digestive tract.
Advanced endoscopy utilizes minimally invasive endoscopic procedures to diagnose and treat a broad spectrum of digestive conditions.
Our board-certified gastroenterologists have additional fellowship training (beyond that of a general gastroenterologist) and can perform advanced/interventional endoscopy procedures, outside the scope of a normal endoscopy. Their expertise – combined with the latest technology and devices – ensures that all GI abnormalities are evaluated, even those that a regular endoscopy or imaging (CT scan or MRI) may miss.
With these procedures, our patients have an opportunity to choose a minimally invasive alternative. Some of the advanced endoscopy procedures we offer include:
- Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a procedure that combines endoscopy and fluoroscopy (x-ray) to diagnose and treat conditions of the bile ducts and pancreas. A specialized endoscope is passed through the mouth and positioned near the opening of the bile duct in the intestine. A catheter and guidewire are used for access and contrast material is injected into the ducts to help diagnose biliary and pancreatic disorders.
- Therapeutic ERCP: Several interventions can be performed based on the diagnostic findings. Sphincterotomy (cutting the muscle that surrounds the duct opening), Stone removal (stones that originate from the gallbladder that have migrated into the bile duct), Balloon dilation (stretching an area of narrowing), Tissue sampling, Stent placement (narrowing from inside the duct or from compression from outside).
- Cholangioscopy / Pancreatoscopy: Through the ERCP scope, an even smaller endoscope is inserted into the bile duct or pancreatic duct. This helps with direct visualization of large stones, strictures (narrowing), and tumors.
- Electrohydraulic Lithotripsy (EHL): This treatment uses high energy shock waves to break up large bile duct stones which cannot be removed through conventional approaches.
- Endoscopic ultrasound (EUS): EUS is a procedure that combines endoscopy and ultrasound (sound waves) to evaluate the digestive tract (esophagus, stomach, intestine, colon) as well as surrounding organs (mediastinum, liver, bile ducts, pancreas, lymph nodes).
- Fiducial marker placement: Fiducial markers serve as landmarks for image-guided radiotherapy. EUS can be used to place fiducial markers more easily than traditional surgical methods, allowing increased precision during radiation treatment for cancerous tumors.
- Abnormal Endoscopy / Imaging: Abnormalities seen on routine endoscopy such as nodules (lumps) can be evaluated by EUS to help determine if they are within the lining of the digestive tract or compression from adjacent organs.
- Tumor Staging: Loco-regional staging of newly diagnosed cancers involving the esophagus, stomach, pancreas, and rectum. EUS can determine the depth of tumor invasion and evaluate if the cancer has spread to nearby lymph nodes and organs.
- Cyst gastrostomy and necrosectomy: Acute pancreatitis can potentially lead to complications such as pseudocysts or walled off necrotic collections. A lumen apposing stent can be deployed under EUS guidance to facilitate a connection between the digestive tract and the collection. This allows natural drainage into the digestive tract. In more severe cases, a necrosectomy may need to be performed to debride and remove dead tissue within the collection.
- Endoscopic Mucosal Resection (EMR): This procedure is performed through an upper endoscope or colonoscope to remove pre-cancerous, early-stage cancers or abnormal tissue (lesions) from the digestive tract. This is commonly performed on larger polyps which cannot be removed safely during routine endoscopy. The lesion is demarcated, and a solution is injected into the submucosal space to create a cushion to help facilitate resection. The lesion is safely resected en bloc (in one piece) or piecemeal (several pieces).
- Radiofrequency Ablation (RFA): A device delivers high energy radio waves to burn and destroy pre-cancerous tissue. This is most performed for patients with Barrett’s esophagus – a pre-cancerous condition that results from long standing and poorly controlled gastroesophageal reflux disease (GERD).
- Luminal stenting: A device called a stent (hollow tube made of thin, flexible metal wires) is deployed endoscopically with fluoroscopic (x-ray) guidance to treat blockages within the digestive tract. Tumors can potentially obstruct the passage of food (cancers of the esophagus, stomach, pancreas) and stool (colorectal cancers) which can be relieved by placement of a luminal stent.
- Video Capsule Endoscopy: A device approximately the size of a pill with a camera is swallowed or deployed endoscopically to evaluate the small intestine. This camera takes pictures as it passes through the small intestine which are then transmitted to a small recording device.
- Deep Enteroscopy: A device that helps a thin endoscope to advance deeper into the small intestine. This is helpful in confirming an abnormality seen on imaging or video capsule endoscopy. This can also be utilized for treating lesions that could be contributing to anemia.
- Endoscopic Suturing: A device is temporarily fixed at the end of a specialized endoscope. This allows for full thickness endoscopic suturing. This can be used to treat large ulcers of the digestive tract, repair fistulas (holes or openings between tissues or organs), anchor endoscopic stents.