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. He began his practice at the University of Tennessee/Erlanger Medical Center, Chattanooga, Tennessee. His practice 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 there. 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 university facility or pursue other local options as surgical intervention. A successful and very busy high volume service was established during his five-year tenure and with a growing referral base, gain of trust and success and which was also 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 has since pursued other opportunities bringing the expertise of similar 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 be provided at the community level in a very focused manner and not necessarily be exclusive to the large university hospitals as long as there are trained high-quality expertise and the other supportive services backed by the sustained commitment from the hospital system. 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 and in many cases, better and personalized care with highly specialized unique services.
- 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).
- Tertiary and quaternary level (Level 1-4) therapeutic endoscopic retrograde cholangiopancreatography (ERCP) including per-oral cholangioscopy and pancreatoscopy (Spyglass™), bilateral hilar “Y” 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 trannsGastric 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.
- Biliary intraductal radiofrequency ablation (RFA) for palliation of bile duct cancers.
- Multimodality individualized endoscopic eradication treatment of Barrett’s esophagus and esophageal squamous cell neoplasms by endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) and adjunct ablative eradication therapy by RFA and Hybrid APC.
- Endoscopic Submucosal Dissection (ESD) of gastric, colorectal and esophageal lesions in carefully selected cases.
- Submucosal Tunnel Endoscopic Resection (STER) for sub-epithelial tumors and Endoscopic Full Thickness Resection (EFTR)in selected cases.
- Endoscopic Mucosal Resection (EMR)/hybrid deep dissection of colorectal (complex endoluminal polyp resection for large, defiant, and flat polyps) and duodenal lesions.
- 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 in selected patients under collaborative multidisciplinary management with bariatric surgery services.
- High-quality direct access screening colonoscopy for average-risk and high-risk individuals utilizing current generation high definition endoscopes and processors.
- Individualized EUS 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 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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