Advanced Endoscopy

Advanced Endoscopy, also known as interventional endoscopy, is a specialized procedure that is used to diagnosis and treat complex pancreatic and biliary disorders and potentially cancerous tissue in the gastrointestinal tract. Advanced endoscopy is performed by gently inserting a scope down the patient’s throat to examine the area of interest in the digestive tract, but unlike a regular endoscopy, it also involves the use of other equipment to open blockages, drain fluid, take tissues samples or destroy precancerous tissue. These minimally invasive procedures do not require incisions so they generally result in faster recovery, less pain and patients typically return home the same day.

We have highly specialized and experienced physicians who perform a variety of advanced endoscopy procedures. They evaluate patients with a range of symptoms and diseases including those with pancreatitis, biliary strictures and stones, unexplained abdominal pain, or anything gastrointestinal that seems abnormal.

Our skilled advanced endoscopy team works closely with referring physicians to promptly perform procedures (with 24/7 availability), consultations, and discuss management options. We use a multidisciplinary approach to complex cases including discussions with other specialists and surgeons. Our team dedicates time into expanding their capabilities through conducting research, training others in the advanced endoscopy field and apply their learnings to the treatment and care of their patients. This continuous training and education helps to assure our patients have access to the best treatments available.

The following are examples of a few of the advanced endoscopy procedures we offer:

Endoscopic Ultrasound (EUS) is an advanced endoscopic technique which combines the power of regular endoscopy and an ultrasound to allow for effective imaging of the digestive tract and surrounding organs and tissues, as well as the chest and abdomen. This procedure uses an endoscope with high-frequency sound waves to produce detailed images of the lining and walls of your digestive tract, pancreas, liver and lymph nodes. This procedure is used to diagnose, evaluate and determine the stage of several gastrointestinal diseases including cancer, pancreatic masses, pancreatic cysts and liver disease. Additionally, the use of EUS guided fine needle biopsy allows the safe and effective collection of tissue from difficult to reach areas.

Therapeutic EUS is rapidly expanding with a variety of therapeutic applications such as:

  • Drainage of pancreatic fluid collections
  • Removal of pancreatic necrosis (dead tissue)
  • Drainage of other abnormal fluid collections and abscess in the abdomen
  • Fully internal EUS-guided bile duct and gall bladder drainage
  • ERCP for gastric bypass patients
  • Precise targeting and direct delivery of medications into the pancreas, liver and other adjacent organs
  • Nerve block for pain management in pancreatic diseases
  • Localized therapy for pancreatic tumors/cysts
  • Treatment of subepithelial (located beneath an epithelial layer) lesions and gastric varices

Endoscopic mucosal resection is performed to remove a lesion just below the gastrointestinal tract. This is a minimally invasive procedure where the organ with the lesion is not removed. EMR can treat Barrett’s esophagus, precancerous or superficial tumors or early-stage esophageal cancer. An EMR can help prevent or treat esophageal and gastric cancer.

This procedure uses a specialized endoscope to insert dye into the bile ducts (tubes that drain bile from the liver and gallbladder into the intestine) and pancreatic duct (tube that drains pancreatic juice into the intestine) under X-ray guidance. Several therapies are available through ERCP if a defect is identified. Common conditions in which ERCP is performed is for the removal of common bile duct stones, placement of stents in pancreatic cancer and bile duct cancers and treatment of chronic pancreatitis.

ERCP is a highly complex procedure. The success rate and outcomes are better when the procedure is performed by highly experienced physicians and teams. On average, our team performs more than double the number of ERCPs than any other program in Connecticut and with significantly higher outcomes.

The Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure performed to remove cancer (tumors) from deep in the gastrointestinal tract. This procedure has many benefits for those diagnosed with esophageal or gastric cancer.

During a Peroral Endoscopic Myotomy (POEM) procedure, a flexible tube, or endoscope, is inserted through the mouth and when it reaches the esophagus, an incision is made from the esophageal wall to the muscle. Once the muscle is reached, the endoscopist creates a downward tunnel towards the connection between the esophagus and the stomach. Certain muscles are divided to help ease the passing of food and drink into the stomach from the esophagus. After the procedure, a barium contrast study is performed to ensure normal swallowing function has returned.