Services Offered

ERCP (Endoscopic Retrograde Cholangiopancreatography). All levels of intervention including:
◊ peroral cholangioscopy and pancreatoscopy (SpyGlass™ DS Direct Visualization System).  https://www.bostonscientific.com/content/dam/bostonscientific/endo/portfolio-group/SpyGlass%20DS/SpyGlass-DS-System-ebrochure.pdf
◊ Holmium laser lithotripsy for bile duct and pancreatic duct stones.
◊ Evaluation of suspected Sphincter of Oddi dysfunction Type 1 and 2 only (No longer performing Sphincter of Oddi Manometry for previously suspected Type 3 patients based on recent EPISOD Study).                                  http://www.ncbi.nlm.nih.gov/pubmed/24867013
◊ Endoscopic ampullectomy
◊ ERPC in post-surgical anatomy such as in post Billroth II, Whipple’s and Roux-en-Y gastric bypass.
◊ Biliary and pancreatic intraductal radiofrequency ablation (RFA) for
◊ Minor papilla cannulation and papillotomy for pancreas divisum
◊ Endotherapy for strictures of chronic pancreatitis and pancreatic duct stones.

• EUS (Endoscopic Ultrasound). Diagnostic and Therapeutic including:
◊ Cancer diagnosis and staging
◊ FNA/FNB (fine needle aspiration/biopsy)
◊ Celiac plexus blocks and neurolysis
◊ Pseudocyst drainage and necrosectomy of walled of pancreatic necrosis.
◊ Peri-rectal and pelvic abscesses/fluid collection drainage
◊ Interventional rendezvous hybrid EUS/ERCP procedures
◊ EUS guided fiducials placement for targeted radiation (CyberKnife®) therapy.
◊ Medical/chemical ablation of high-risk cystic neoplasm in patients who are not surgical candidates.

• EMR/ESD (Endoscopic Mucosal Resection/ Endoscopic Submucosal Dissection) including:
Hybrid EMR/deep dissection for large and sessile colorectal polyps. superficial gastric neoplasms and duodenal adenomas, dysplastic Barrett’s esophagus and early intramucosal cancer.
ESD is an evolving new technique now being adapted in the western countries and cases are carefully selected on an individual basis with the current indication for this procedure limited to the stomach, rectum, certain esophagus, and proximal colon lesions.

◊ Third Space Endoscopy: in addition to ESD for mucosal lesions, submucosal endoscopy is also utilized for removing certain subepithelial lesions/tumors, performing myotomies for symptomatic Zenker’s diverticulum or cricopharyngeal bar in patients with moderate to severe dysphagia and pyloromyotomy for refractory gastroparesis in selected cases.

• Esophageal, Enteral and Colonic Stents placement. For treatment and palliation of:
◊ Strictures
◊ Obstruction
◊ Malignancies
◊ Certain types of upper GI fistulas and leaks.

• Endoscopic Incision Therapy. For:
◊ Refractory and complex Schatzki’s ring
◊ Benign peptic esophageal strictures
◊ Post-EMR strictures
◊ Anastomotic esophageal and colonic strictures.

• Barretts’ esophagus: diagnosis and treatment of dysplasia and intramucosal cancer including, chromoendoscopy,  EMR/ESD and other adjunct ablative endoscopic eradication therapy.

• Endoscopic Suturing (OverStitch™): for endoscopic revision of post surgical anastomosis after gastric bypass weight loss surgery, closure of certain refractory fistulas and leaks including post PEG tube and gastro-gastric fistulas.

• PEG/PEJ/PEGJ

• Deep enteroscopy: Diagnostic evaluation and therapeutic interventions in small bowel lesions, particularly treatment of bleeding lesions and tissue acquisition for diagnosis and access for therapeutic ERCP.

• Gastric Variceal Bleeding Treatment: with EUS and non-EUS guided cyanoacrylate injection and EUS guided coil embolization.

• Colonosocpy and EGD’s: utilizing advanced processors with Narrow Band Imaging (NBI) and high definition (HD).
◊ High quality Screening colonoscopy for colorectal cancer/polyps in average risk and high risk individuals.
◊ Diagnostic EGD’s/upper endoscopy.
◊ Bravo wireless esophageal pH device placement and management of GERD.
◊ Endoscopic hemorroidal banding.

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