Interventional Endoscopy

UCLA has more interventional endoscopy specialists than any hospital in Los Angeles. Our interventional endoscopy team provides advanced diagnosis and treatment without surgery.

What Is Endoscopy?

During this procedure, doctors insert a thin, flexible tube with a camera (endoscope) down your throat and into the digestive tract. This allows doctors to see the pancreas and surrounding organs without open surgery.

Recent advances have allowed specialists to manage many conditions endoscopically that once required surgery. In addition to being an imaging tool, doctors can also use endoscopy to take tissue samples and even relieve symptoms. Best of all, you can often get all of this done in a single visit, which speeds up your treatment and helps you avoid the potential complications of surgery.

Interventional Endoscopy Services Available at UCLA

Our interventional endoscopists are nationally recognized experts. They help train doctors from other facilities and even write national guidelines for endoscopic procedures.

Because reusing endoscopes carries infection risks, we have developed an extremely strict reprocessing program for cleaning and disinfecting these tools. Our reprocessing program for endoscopes is extremely strict. Our rigorous standards have led other centers to model their reprocessing programs after ours.

Because endoscopy is a minimally invasive procedure, patients can get multiple tests and even symptom relief in a single visit to our clinic.

Interventional endoscopy is used for both advanced imaging and diagnosis and pancreatic disease treatment. Endoscopic diagnosis techniques include:

• EUS (endoscopic ultrasound)
• ERCP (endoscopic retrograde cholangiopancreatography)
• Pancreatoscopy (Spyglass™ procedure)
• Intracystic endoscopy

Endoscopic therapies can also help treat patients without surgery. Endoscopic treatment techniques include:

• ERCP (endoscopic retrograde cholangiopancreatography)
• Pain relief
• Stent (hollow tube) placement to remove obstructions
• Marking tumors for radiation therapy (fiducial marker placement)
• Endoscopic necrosectomy (removing pancreatic necrosis, infected pancreatic tissue)

EUS (Endoscopic Ultrasound)

EUS uses sound waves to create detailed images of the pancreas. Specialists use EUS for:

• Detecting lesions: EUS is the most reliable test available for detecting small pancreatic tumors and pancreatic cysts, including those missed by CT (computerized tomography) scans. EUS catches 95 percent of tumors, giving peace of mind to patients with negative EUS results.
• Biopsy: Specialists may use EUS to take tissue samples (biopsy). Lab analysis allows doctors to personalize your treatment plan based on molecular analysis of biopsy samples.
• Pain relief: For patients with pancreatic cancer and chronic pancreatitis, specialists use EUS to inject anesthetic directly into pancreatic nerves. This treatment can eliminate the need for narcotic pain medication, which can have unpleasant side effects and may lead to addiction.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP is used for both diagnosis and treatment of pancreatic disease. Our team of interventional endoscopists uses ERCP for several purposes, including:

• Taking X-ray images: An endoscope delivers contrast dye to the bile duct, helping identify abnormalities. Doctors can also take X-ray images and identify blockages.
• Collecting biopsy samples: During an ERCP, specialists may biopsy tumors for lab analysis. This allows medical oncologists to tailor the combination of chemotherapy drugs given to you based on what is most effective for the tumor.
• Removing bile duct stones: ERCP lets doctors pinpoint bile duct stones and break them up with a laser, without the need for surgery.
• Stent placement: Stents are small tubes used to treat blockages in the pancreatic and bile ducts, as well as the duodenum (the first part of the small intestine). Placing stents across obstructions allows digestive fluids to flow more freely, relieving jaundice (yellowing of the skin and eyes) caused by bile backup. It can also help patients who struggle to eat normally due to tumors blocking their digestive tract.

Pancreatoscopy (Spyglass™ procedure)

Pancreatoscopy involves placing a small camera through an endoscope to give specialists detailed images of the pancreatic duct.

Our specialists primarily use the Spyglass™ device when performing pancreatoscopy. This device provides high-resolution digital images. It’s also disposable, minimizing infection risks.

UCLA is one of the top two largest centers in the country using Spyglass™ for pancreatoscopy, even training other doctors how to use it.

Intracystic Endoscopy

Intracystic endoscopy is a non-surgical technique that allows doctors to diagnose and treat pancreatic cysts. The procedure involves using endoscopic procedures to insert a small needle directly into the cyst. It is used for:

• Draining cysts: Specialists may use intracystic endoscopy to drain fluid from pancreatic cysts.
• Collecting samples: This procedure also allows doctors to biopsy the cyst wall to determine whether a cyst poses a cancer risk. 
• Cystoscopy: Interventional endoscopists can insert a camera through a needle to look directly inside a pancreatic cyst.
• CLE (confocal laser endomicroscopy): CLE uses a small laser to obtain microscopic images of individual cells. These images help specialists understand what type of cyst you have and whether it needs to be removed.

Marking Tumors for Radiation Therapy (Fiducial Marker Placement)

In fiducial marker placement, interventional endoscopists place small markers on the edges of tumors. These markers help radiation oncologists target tumors during radiation therapy.

Endoscopic Necrosectomy

Patients with acute pancreatitis may need surgery to remove infected pancreatic tissue. In some cases, our interventional endoscopists can remove the necrotized (dead) tissue endoscopically.