Endoscopic ultrasound (EUS) is an endoscopic procedure that examines the lining and the walls of the upper and lower gastrointestinal tract by combining endoscopy and high frequency ultrasound. EUS is also used to study and, when indicated, take tissue samples of the internal organs and other structures that lie next to the gastrointestinal tract, such as the gallbladder, bile duct, pancreas, and lymph nodes.
EUS can help further evaluate an abnormality, such as a growth, that was detected during a prior endoscopy, colonoscopy, or x-ray. EUS provides a detailed picture of the growth in addition to tissue biopsy samples, which can help your doctor determine its nature and decide upon the best treatment.
Advanced endoscopists can also use EUS to diagnose diseases of the pancreas, bile duct, and gallbladder when other tests are inconclusive. EUS also can be used to guide and facilitate endoscopic interventions.
An Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that combines the use of a flexible, lighted endoscope with x-ray pictures to examine the tubes that drain the liver, gallbladder, and pancreas. The endoscope is inserted through the mouth and gently moved down the throat into the esophagus, stomach, and duodenum (part of the small intestine) until it reaches the point called the ampulla, where the tubes from the pancreas (pancreatic ducts), and liver and gallbladder (bile ducts), drain into the duodenum.
ERCP can treat certain problems identified during the procedure. If an abnormal growth is seen, an instrument can be inserted through the endoscope to obtain a tissue sample for further testing (biopsy). If a stone is present in the bile duct, the doctor can usually remove the stone with instruments inserted through the endoscope. A narrowed bile duct can be opened by inserting a small wire-mesh tube or plastic tube (called a stent) through the endoscope and into the duct.
Advanced endoscopists use ERCP for treating: stones that are trapped in the main bile duct; blockage of the bile duct; jaundice, which turns the skin yellow and the urine dark; cancer of the bile ducts or pancreas; pancreatitis (inflammation of the pancreas); and various other pancreas, liver, gallbladder, and bile duct conditions.
Our advanced endoscopists have special expertise in using endoscopic mucosal resection (EMR) to remove large abnormal polyps in the esophagus, stomach, small intestine, and colon. Without EMR, the removal of such polyps would require surgery. Our endoscopists also were among the first in the nation to use confocal endomicroscopy imaging, which enables specialists to visualize the lining of the gastrointestinal tract at a cellular level – offering a much more detailed view of the tissue than provided with the magnification of a standard endoscope. This facilitates improved targeting of areas for biopsy and guides removal of tissue.
The radiofrequency ablation technique uses heat generated by radio waves to selectively destroy precancerous cells associated with Barrett’s esophagus. During the radiofrequency ablation procedure, a balloon-like device covered with electrodes is inserted into the esophagus. Once the balloon is properly situated, it is inflated so that the electrodes are brought into contact with the lining of the esophagus. A predetermined amount of energy is then delivered to eliminate abnormal tissue while preserving healthy tissue. An alternative technique allows for treatment of small or focal abnormalities by the direct placement of a device over the abnormal area.This endoscopic procedure has saved many patients from undergoing major surgery to remove their entire esophagus.
Endoscopic draining of pseudocyst is used to drain fluid collections caused by acute pancreatitis. Endoscopic necrosectomy is used to treat severe acute pancreatitis, which leads to the buildup of necrotic (dead) pancreas tissue and infection. During the procedure, an endoscope inserted into the stomach or the duodenum is passed through the gastric or duodenal wall into the collection of dead tissue to create a drainage tract. The endoscope is then used to remove the necrotic material and then deposit it in the stomach or duodenum for normal evacuation. Several procedures are typically needed to eliminate all the necrotic material. This endoscopic approach is advantageous over the open surgery approach in that it saves the patient from the trauma and scarring of surgical operations.
Enteral stents can be placed in the intestinal tract to alleviate symptoms of obstruction that can result from a narrowing or growth in the esophagus, stomach, small bowel, or colon. These stents are expandable metal mesh tubes that hold open the area of obstruction. During the procedure, an endoscope is inserted to the level of obstruction, and utilizing the endoscopic view in combination with live x-ray (fluoroscopy), the obstruction is traversed with a thin wire and a stent can be deployed over that wire.
Deep Enteroscopy (DE) is a procedure used to locate, evaluate and treat disorders of the small bowel. This technique is typically used when the area cannot be reached by either esophagogastroduodenoscopy (EGD) or colonoscopy. There are several different types of DE, including double balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy, and we have expertise in all of these modalities. The examination can be performed by mouth (antegrade) or rectum (retrograde), depending on the nature and source of the small bowel disorder. DBE can be used to evaluate and biopsy abnormalities seen on a capsule video endoscopy, a CT, or an MRI. DE can treat small bowel bleeding, such as from angioectasias or AV malformations, and remove polyps, such as in patients with Peutz-Jeghers Syndrome.
Pancreatic cysts are collections of fluid in the pancreas. The majority of pancreatic cysts are not cancerous, and most do not even cause symptoms. They are often discovered incidentally during abdominal x-rays ordered for other reasons. But because some pancreatic cysts can be cancerous or precancerous, sampling the cyst fluid to look for cancerous or precancerous cells may be beneficial. Sampling pancreatic cysts can be performed safely with endoscopic ultrasound. During this endoscopic procedure, a very small needle is inserted through the ultrasound endoscope into the cyst to withdraw fluid and tissue for analysis. These results may help decide whether the patient’s pancreatic cyst can be followed or should be removed by surgery.
If you’re a patient or a physician who would like to learn more about our advanced endoscopy services or schedule an appointment, please contact us at (617) 732-7442. Our office is open Monday–Friday, 8:30am–5pm.
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