Advanced Endoscopy

An endoscopy is a procedure used by physicians to look inside the body using an instrument equipped with a small camera. In some cases a specialized endoscopic procedure is needed as part of the diagnostic process. Certain endoscopy tests are able to better detect gastrointestinal abnormalities that a regular endoscopy may miss. Physicians at Yale New Haven Hospital have extensive experience and excellent outcomes. 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 diagnosis, 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 typically hard to reach areas.

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 passed through to the esophagus. Then, it enters the middle wall layer creating a tunnel down to the sphincter muscle and into the wall of the stomach. When this tract is made, the muscle layer can then be cut safely to help alleviate the spasm that is causing symptoms, thus allowing food to pass through easier.

Endoscopic Ultrasound (EUS) is minimally invasive advanced endoscopic technology where a special endoscope uses high frequency sound waves to produce detailed images of the gastrointestinal tract and nearby structures. Therauptic 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