Dr. Ramberan is a board-certified Gastroenterologist with further sub-specialty fellowship training in Advanced Endoscopy and additional post-fellowship apprenticeship in new and evolving complex endoscopic interventions. His practice focuses exclusively on complex digestive diseases that require advanced diagnostic, therapeutic, and interventional endoscopy. Immediately after fellowship training and in his early years of practice, his services enabled the first area hospital in the region to offer this level of fellowship-trained expertise, and a full spectrum of new and advanced endoscopic techniques and procedures not previously available. This provided alternative minimally invasive options for diagnosis and treatment for people suffering from complex digestive disorders who previously either had to be referred out of town to other academic medical centers or pursue alternative local options as surgical intervention. A successful and very busy high volume service was established quickly during his tenure; and with a growing referral base, gain of trust and success and which was also readily recognized and mentioned by U.S. News And World Report as “high performing” in his subspecialty. His practice has been regarded as a referral practice of choice for patients from the surrounding region who have complex digestive disorders requiring advanced therapeutic endoscopic intervention. Dr. Ramberan provides a full spectrum services and evolving new techniques and procedures to a large health system and community in need. He strongly believes that these high-level and complex endoscopic interventions can also be effectively provided at the community level in a very focused manner and not necessarily be exclusive to the large academic medical centers as long as there are trained high-quality expertise and other supportive services backed by the sustained commitment from the hospital system providing best and value based care for community it serves. This allows patients the option to stay locally at home in their community and receive at the least, the comparable level of expertise and care as that from a tertiary or quaternary care University Hospital/Academic Medical Center and in many cases, better, personalized, and compassionate care with highly specialized unique services and excellent outcomes.
- Diagnostic, therapeutic, and interventional endoscopic ultrasound (EUS) including pancreatic pseudocyst drainage and necrosectomy with use of lumen apposing metal stent (Hot AXIOS™), cystic lesions of pancreas evaluation, ablation of pancreatic cysts in selected cases considered high risk for surgery, and secondary/rendezvous access to obstructed pancreatic and bile ducts because of malignancy or post-surgical obstruction and endoscopic gallbladder drainage. Evaluation, diagnosis, and staging of malignant neoplasms of the pancreas, foregut, and hindgut, celiac plexus block (CPB) for selected patients with chronic pancreatitis with disabling pain and celiac plexus neurolysis (CPN) for palliation of malignant disabling pain in patients with metastatic pancreatic cancer. And endoscopic anastomoses creation with lumen apposing metal stents (EUS Directed transGastic Interventions- EDGI procedures such as EUS guided Gastroenterostomy/gastrojejunostomy in carefully selected patients that are not optimal surgical candidates for palliation of malignant gastric outlet and duodenal obstruction).
- Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) inclusive of tertiary and quaternary level (Level 1-4) including per-oral cholangioscopy and pancreatoscopy (Spyglass™), complex hilar “Y” or trifurcation stents for malignant hilar bile duct obstruction, balloon enteroscopy assist in post-surgical altered anatomy and hybrid intraoperative or sequential trans-gastric (port or portless or staged via mature gastrostomy) or endoscopic access to remnant stomach with lumen apposing stent placement for trans-oral approach ERCP in patients with gastric bypass or other complex Roux en Y anatomy- EUS Directed transGastric ERCP/Interventions (EDGE/EDGI) procedures including drainage of malignant obstructive jaundice in patients with obstructed duodenum, management of complicated sequelae of chronic pancreatitis including intraductal stones and strictures.
- Intraductal Electrohydraulic and Holmium laser lithotripsy for biliary and pancreatic duct stones
- Sphincter of Oddi manometry.
- Radiofrequency ablation (RFA) – Intraductal and intratumoral for palliation of bile duct cancers and EUS guided for certain pancreatic tumors (primarily pancreatic neuroendocrine tumors-PNET) in patients who are not surgical candidates.
- Endoscopic eradication treatment of Barrett’s esophagus and superficial esophageal squamous cell neoplasms by multimodality individualized approach with endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) and adjunct ablative eradication therapy by RFA and Hybrid APC.
- Third Space Endoscopy /Flexible Endoscopic Surgery, including EMR, ESD, Peroral endoscopic myotomy, Submucosal Tunnel Endoscopic Resection (STER) for sub-epithelial tumors, hybrid resections and Endoscopic Full Thickness Resection (EFTR) in carefully selected cases (EFTR certified).
- Endoluminal Tissue Resections, Endoscopic Mucosal Resection (EMR)/hybrid deep dissection, Endoscopic Submucosal Dissection (ESD) of esophageal, gastric, duodenal and colorectal lesions in carefully selected cases with large, defiant polyps/neoplasic lesions.
- Luminal Stent placement for therapy of benign and malignant strictures in esophagus, duodenum and colon.
- Device Assisted Single Balloon Deep Enteroscopy (antegrade and retrograde) to evaluate and treat obscure small bowel bleeding and procurement of tissue for diagnosis of abnormalities identified at Video Capsule (PillCam). Also to aid other therapeutic interventions in patients with postsurgical anatomy that included ERCP and access to excluded stomach remnant in patients who had gastric bypass or other similar types of “stomach surgery”.
- Bariatric Endoscopic Interventions for obesity including management of post-surgical complications, transoral gastric outlet reduction (ToGR) of dilated gastric outlet by endoscopic suture revision; and primary endoscopic sleeve gastroplasty (ESG) in selected patients under collaborative multidisciplinary management with bariatric surgery services.
- High-quality direct access personalized screening colonoscopy for average-risk and high-risk individuals for colorectal cancer utilizing current generation high definition endoscopes and processors and advanced imaging techniques with colonoscopy and panchromoendocopy for patients with longstanding inflammatory bowel disease.
- Screening and surveillance endoscopy for individuals that are high risk for cancers of the esophagus, stomach and duodenum including individual with certain known risk factors such as ethnicity, hereditary and genetic predisposition.
- Pancreatic Cancer Screening, peronalized screening evaluation and long-term follow up for individuals that are at high risk for pancreatic cancer (based on family history or genetic risk association from other cancers) and who have cystic lesions/neoplasms of the pancreas that require a high-quality evaluation and close follow up to guide the need for surveillance incorporating dedicated high quality EUS and cross sectional imaging or surgery working collaboratively with medical and surgical oncologists.
Excellence in Endoscopy
Dr. Ramberan’s goal is to continue to establish new partnerships and work collaboratively with gastroenterology colleagues and other specialists to build and grow a reputable program of quality and excellence in advanced therapeutic and interventional digestive endoscopy while embracing and adopting new technologies, new techniques, and cutting-edge intervention. Quality metrics are prospectively collected for all procedures and periodically reviewed to ensure quality and safety outcomes. He continues to strive to maintain consistent success in achieving the desired goal, exceeding the recommended minimum threshold of defined quality metrics such and adenoma and sessile serrated adenoma detection rate (ADR/SSADR), cannulation of desired ducts, and success at therapy during ERCP procedures and low rates of post ERCP pancreatitis, high yield cellular adequacy and the diagnostic yield on a single pass during EUS fine-needle biopsy (EUS FNB) with rapid in-room evaluation; and effective technique in complex endoluminal resections of neoplasms to reduce risk of recurrence. Additionally, the goal of facilitating easy patient access with not only seamless, expeditious, and compassionate but also personalized care and follow-up remains a consistent top priority of Dr. Ramberan for the service he provides.
Dr. Ramberan strives to provide the best care possible to all patients under his care and takes pride in being a patient advocate. He encourages patients to partner with him in this advocacy as he believes an individual is their best advocate. As a result of his commitment and continued high level of dedicated and personalized care, he has been recognized by his professional specialty societies with advancement to designated Fellow status (American Society of Gastrointestinal Endoscopy and American College of Gastroenterology), an honor bestowed for significant professional achievement and superior competence in the field of Gastroenterology and Endoscopy. Additionally, he is recognized continuously by his peers and nationally recognized rating organizations in their “Top Doctors” list, such as Castle Connolly’s America’s Top Doctors and Philadelphia Magazine Top Doctors over the years.
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