Endoscopic Procedures

What is interventional endoscopy?

Interventional endoscopy encompasses a variety of endoscopic procedures used to diagnose and treat diseases that are typically beyond the scope of regular endoscopic techniques. By combining advanced imaging and device technology with technical expertise, our physicians are helping patients to avoid more invasive traditional treatment approaches such as surgery. These procedures are minimally invasive, meaning they are performed using thin flexible tubes advanced through the body's natural orifices such as the mouth and rectum, thus avoiding the complications associated with surgery and providing faster recovery times. Interventional endoscopy is utilized in the treatment of bile duct stones, stenting of the gastrointestinal tract, treatment of gastrointestinal bleeding, and the diagnosis and treatment of tumors involving the esophagus, stomach, biliary system, pancreas, small bowel and colon. The procedures are typically performed on an outpatient basis, and most patients may return home the same day.

Endoscopic procedures

Argon Plasma Coagulation (APC)
Argon plasma coagulation uses electricity to ionize argon gas and generate heat in a controlled matter to coagulate or cauterize (burn) tissue in the gastrointestinal tract. The heat energy deliver by APC is used to treat bleeding sites such as vascular malformations (AVMs) or to debulk/shrink tumors in the GI tract.

Bariatric Endoscopy for Weight Loss
Bariatric endoscopy includes procedures and devices that are placed via endoscopic through the mouth to the stomach. These procedures are minimally invasive and require no external incisions. Bariatric endoscopy procedures are offered as part of a team-based approach to weight loss, and we work closely with medical weight loss experts, dieticians, bariatric surgeons, and other providers to ensure an individualized and comprehensive approach to weight loss. Examples of bariatric endoscopy procedures are the transoral outlet reduction (TORe) which can help if you have regained weight after gastric bypass surgery, and endoscopic sleeve gastroplasty (ESG) which uses a suturing device to change the shape of your stomach and help you lose weight.

Capsule Endoscopy (PillCam™)
Video capsule endoscopy uses a miniature camera about the size of a large pill in order to take internal pictures of the small intestine of areas normally beyond the reach of regular endoscopes. After the camera is swallowed, it begins to take pictures of the small bowel at regular intervals. The picture data is continuously delivered to a recording device worn as a belt that can be taken home. At the end of the procedure (~typically 8-12 hours), the belt is returned and the pictures are uploaded to a computer for review by a physician. Capsule endoscopy can be used to identify sources of blood loss from the GI tract, tumors or polyps of the small bowel, and assess for inflammatory conditions such as Crohn's disease.

Celiac Plexus Block/Neurolysis
Celiac plexus block and neurolysis are used to relieve pain associated with chronic pancreatitis and pancreatic cancer. Endoscopic ultrasound (EUS) is used to identify the celiac plexus, a network of nerve tissue that sends signals of pain from the pancreas. Using a small needle advanced under real-time EUS guidance, a physician delivers medications to interrupt the pain signals and reduce the pain sensation. The goal is to provide comfort and reduce dependence on pain medications. These procedures can be performed as an outpatient, and you can return home the same day.

Cholangioscopy
Blockage of the bile duct may be caused by large stones or tumors that may be difficult to diagnose or treat. Cholangioscopy utilizes a mini camera that is passed through a regular endoscope and up into the biliary tree (a camera within a camera). Cholangioscopy provides direct visualization of the bile ducts, allowing for targeted biopsies of bile duct strictures and tumors. Local therapies may also be delivered, including electrohydraulic lithotripsy for the treatment of large, difficult stones.

Chromoendoscopy
Pre-cancerous lesions and early-stage tumors are often difficult to detect visually during traditional endoscopy, leading to missed diagnoses. Chromoendoscopy uses specialized light filters and dyes to enhance the appearance of superficial mucosal architecture and blood vessels resulting in improved detection of early cancers.

Cryotherapy
Cryotherapy uses extreme cold to ablate and/or shrink diseased tissue in the GI tract. Liquid nitrogen or carbon dioxide is delivered using a catheter passed through an endoscope to freeze the target tissue. Cryotherapy has been used in the treatment of Barrett's esophagus and esophageal cancer.

Drainage of Pancreatic Pseudocysts and Walled-Off Necrosis
Pseudocyst drainage is performed by passing stents or drainage tubes through the wall of the stomach or small intestine into the cavity. This allows the physician to drain or remove any built-up fluid or debris and over time, promote eventual healing of the cavity. The procedure is performed by using endoscopic ultrasound (EUS) and sometimes fluoroscopy (x-rays).

Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)
EMR and ESD are two minimally invasive techniques to remove pre-cancerous polyps or early cancers of the esophagus (including Barrett’s esophagus), stomach, small intestine, colon, and rectum to avoid surgical treatment of these lesions. Your physician will assess your lesion to determine the best treatment.

Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is an advanced endoscopic technique used to examine and treat disorders of the bile duct and and pancreatic duct. Small catheters are passed through the endoscope into the ducts, and x-rays are used to obtain images of the anatomy. ERCP is used to breakdown and/or remove stones, relieve blockages, and place temporary or permanent stents to maintain drainage of bile and pancreatic juices (digestive juices). Cholangioscopy can be performed during endoscopy to pass a camera into the duct itself to break apart stones or to diagnose a potential bile duct tumor.

Endoscopic Ultrasound (EUS)
EUS combines traditional endoscopy with ultrasound imaging to visualize structures within the wall of the GI tract and beyond. A miniature ultrasound transducer is housed at the tip of an endoscope, allowing for visualization of a broad range of structures from the esophagus to rectum. From within the esophagus, the mediastinum and associated lymph nodes can be seen, and diseased nodes can be sampled using fine-needle aspiration (FNA). From the stomach and duodenum, the abdominal vessels can be identified, along with nearly all the organs of the abdomen including the liver, bile ducts, pancreas, spleen, adrenal glands, and kidneys. FNA is often performed, and interventional EUS drainage procedures such as pseudocyst drainage are possible. From the rectum and colon, tumors colorectal cancers can be staged, and disorders of the anorectal sphincter complex can be diagnosed. Throughout the GI tract, lesions arising from within the wall of the GI tract (submucosal tumors) can be characterized by EUS and tissue can be obtained via FNA for diagnosis.

Enteral Stenting
Processes such as advanced tumors, radiation therapy, gastroesophageal reflux (GERD), and gastrointestinal surgery may result in symptomatic narrowing of the GI tract leading to problems such as stricture, pain, vomiting and malnutrition. Enteral stents are used to restore and maintain patency of the GI tract. They are either plastic or metal fibers arranged in a tubular meshwork and come in removable or permanent varieties.

Enteroscopy
Enteroscopy is the endoscopic evaluation of the small bowel using specialized endoscopes. Traditional endoscopes and colonoscopes are only able to evaluate a limited length of the beginning and end of the GI tract. Deep enteroscopy (eg, single-balloon enteroscopy) uses specialized equipment navigate through the length of the small bowel to evaluate sources of bleeding or treat polyps and tumors.

Lithotripsy
Lithotripsy is used to fracture and dissolve large recalcitrant obstructing stones of the bile or pancreatic ducts. Several techniques are available, including electrohydraulic, extracorporeal shock-wave lithotripsy, and laser lithotripsy. The choice of technique normally dictated by the type of stone and its location. This procedure can be repeated until the stone is dissolved.

Per-oral Endoscopic Myotomy (POEM)
POEM means cutting the muscle of the lower esophageal sphincter (LES) with an endoscope. It is an incision-less endoscopic procedure that aims to recreate the Heller myotomy in a less invasive way. It follows similar surgical principles but is able to accomplish the myotomy less invasively.

Radiofrequency Ablation (RFA)
RFA is a thermal ablative technique that utilizes current that is delivered through a balloon catheter or probe to treat Barrett's esophagus and early esophageal cancer. RFA is a safe, minimally invasive treatment that may prevent the need for esophageal surgery. This procedure can be performed as a come-and-go procedure.

Resection of Colonic Polyps
Colon polyps are precancerous growths that develop due to a variety of factors. When polyps become very large, the associated risk of developing cancer increases, and the polyp may be difficult to resect using traditional methods. Large polyps may be removed using a combination of mucosal resection techniques.

Stone Extraction
Stones are concretions that develop within the biliary tree or pancreatic ducts. Stones may cause obstruction leading to pain and occasionally, a life-threatening infection known as cholangitis. Stones are extracted during ERCP using extraction baskets and/or balloons. Lithotripsy and cholangioscopy may be used to extract large stones.

Stricture Dilation
A stricture is a symptomatic narrowing in the GI tract that may cause symptoms of obstruction including abdominal pain, bloating, nausea, vomiting, and malnutrition. Dilation is performed using specialized balloons that gradually stretch the narrowed area during an endoscopy. High-grade strictures may require serial endoscopic dilations that are performed on an outpatient basis.

Transoral Incisionless Fundoplication (TIF)
TIF is a minimally invasive treatment for acid reflux / GERD is performed via endoscopy by mouth into the stomach and can be performed without incisions or in combination with a minimally invasive surgical hiatal hernia repair. The procedure offers fast recovery, no metal implants, and helps restore the anti-reflux “valve” between the esophagus and stomach towards a more natural state in order to help improve symptoms and reduce or eliminate the need for anti-reflux medications.

Zenker's Diverticulum Septotomy
A specialized needle knife is used to incise the septum of the diverticulum thus relieving the dysphagia, or difficulty swallowing associated with Zenker's diverticulum.