The Ohio GI & Liver Institute has several endoscopists trained in advanced endoscopic procedures. These procedures may be diagnostic (to evaluate) or therapeutic (to treat), and employ minimally invasive techniques to minimize the need for surgical intervention. A brief description of representative procedures are listed below.
Endoscopic ultrasound (EUS) – EUS uses an endoscope with a built-in ultrasound probe. EUS allows detailed imaging of tumors of the chest and gastrointestinal tract, and can be used to obtain tissue to determine a diagnosis. In addition to obtaining tissue for diagnosis, EUS is able to accurately assess the stage of a tumor. EUS can also be used to deliver medication to areas outside the gastrointestinal tract. EUS also offers a minimally invasive approach to evaluating the bile duct for gallstones and the pancreas for changes associated with chronic inflammation or cancer. An example of when EUS is used is a patient who has an x-ray showing an abnormality of the pancreas. EUS is used to get a detailed evaluation of the pancreas and obtain a biopsy with a needle.
Endoscopic Retrograde Cholangiopancreotography (ERCP) – ERCP uses a specially designed endoscope to evaluate and treat disorders of the bile ducts, the pancreas, and the gallbladder. An example of when ERCP is used is when a patient has severe abdominal pain and evaluation suggests that there is a gallstone in the bile duct. The bile duct is the tube connecting the liver to the bowel (the gallbladder comes off the middle of the bile duct). ERCP is utilized in this situation to make a small incision internally and remove the stone to relieve the pain and prevent future episodes from occurring. ERCP is also used when there is a narrowing in the bile duct resulting in jaundice. ERCP can place a plastic or metal stent across the narrowing to allow bile to flow more easily into the small bowel.
Radiofrequency Ablation (RFA) – RFA uses a specially designed piece of equipment attached to an endoscope to burn pre-cancerous cells in the esophagus called Barrett’s esphagus. Barrett’s espohagus results from chronic reflux inducing a change in the type of cells lining the esophagus. This change is associated with an increase in the risk of developing espohageal cancer. Some patients develop further changes (called dysplasia) increasing their risk substantially more. In this situation RFA is utilized to burn the changed tissue in an attempt to revert the cells back to normal esophageal type cells. This is often done over 2-3 sessions. Rfa is a treatment that offers a minimally invasive alternative to major surgery. Patients may experience chest pain after the procedure for a few days and must maintain a “soft food” diet for a week after the procedure. RFA may also be used to treat bleeding areas of the stomach and rectum.
Enteral Stenting – Plastic or metal stents may be placed throughout the gastrointestinal tract and bile ducts. Stents are typically placed for patients with cancer to allow passage of food through or around a tumor. Stents may also be used as treatment for benign conditions resulting in narrowing of the gastrointestinal tract as well. An example of enteral stenting is in patients with esophageal cancer causing obstruction of the esophagus. A temporary (removable) or permanent (not removable) stent can be placed to open up a passage in the esophagus to allow food and liquids through and maintain nutrition and the pleasure of eating.