Advanced Therapeutic Endoscopy

Our team of specialists focuses on advanced endoscopic procedures that utilize specialized endoscopy, endoscopic ultrasonography and fluoroscopic imaging (X-rays) to achieve success where standard endoscopy and even surgery may not be successful or feasible.

We perform nearly 1,000 endoscopic retrograde cholangiopancreatography (ERCP) and nearly 2,000 endoscopic ultrasound (EUS) procedures every year. Our physicians have expertise in the most advanced endoscopic therapies, including interventional EUS, and use state-of-the-art equipment and novel endoscopic tools like endoscopic suturing and endoscopic cryotherapy. Our team has expertise in performing endoscopic resection procedures and focuses on endoscopic therapies for cancer.

Some of our work includes:

Endoscopic management of advanced gastrointestinal malignancies

  • Treatment of esophageal cancer with cryotherapy and esophageal stenting
  • Using stents to treat obstructive gastric, small bowel and colonic cancers
  • Using advanced ERCP techniques to access and selectively stent hilar biliary strictures
  • Treating unresectable biliary cancers with intraductal radiofrequency ablation
  • Advanced EUS and ERCP technique to manage concurrent biliary and duodenal obstructions in pancreatic cancer
  • EUS guided injection cholangiography, EUS guided rendezvous and direct EUS guided transduodenal biliary stenting for patients with cancer-related inaccessible or difficult-to-cannulate duodenal papillae
  • Palliate cancer-related pain symptoms by performing celiac plexus neurolysis through endoscopic ultrasound

Endoscopic management of precancerous gastrointestinal lesions and early cancers

  • Advanced ablative techniques for dysplastic (precancerous) Barrett’s like radio-frequency ablation, hybrid argon plasma coagulation and cryoablation
  • Endoscopic resection of advanced colorectal, esophageal, gastric and duodenal polyps. We have expertise and use advanced techniques such as endoscopic mucosal resection and endoscopic submucosal dissection to resect both precancerous polyps and early esophageal, gastric and colon cancers
  • Ampullary lesions, which require combined resection and ERCP with stenting to minimize procedure-related complications

Endoscopic management of advanced biliary and pancreatic disease

  • Advanced techniques like cholangioscopy and electrohydraulic lithotripsy to break up complicated bile duct stones
  • Advanced ERCP techniques to treat pancreatic stones, stricture, duct leaks, and disruptions with stenting
  • Management of pseudocysts by drainage through the stomach and duodenum under endoscopic ultrasound visualizations
  • Purely endoscopic techniques to perform debridement of walled- off pancreatic necrosis
  • Specialized endoscopic ultrasound techniques to achieve access to the bile duct in situations where standard ERCP through the duodenal papilla is not possible

Endoscopic therapy for patients who have altered gastrointestinal anatomy

  • Performing advanced pancreaticobiliary procedures in patients who have surgically altered anatomy like post Whipple anatomy, hepaticojejunostomy and Roux-en-Y gastric bypass
  • Laparoscopy-assisted ERCP
  • Endoscopic ultrasound directed transgastric ERCP (e.g. EDGE) and other transgastric interventions. In this procedure, the Roux-en-Y anatomy is temporarily reversed to gain access to the excluded stomach, endoscopic therapy such as ERCP is performed, and then the anatomy is reverted back to normal

Other advanced endoscopic techniques

  • Endoscopic ultrasound to stage and diagnose gastrointestinal and pancreaticobiliary cancers by needle biopsy
  • Gastrointestinal fistula closure including post-operative fistulas and acute gastrointestinal perforations. This is done using specialized stenting, large-caliber over-the-scope clips and endoscopic suturing techniques
  • Endoscopic suturing for stent fixation to prevent migration, close fistulas and alter luminal anatomy
  • Advanced procedures for nutritional support such as direct percutaneous endoscopic jejunostomy tube placement

Endoscopic research in ablation and resection

Our team also works closely with surgical and medical oncology and participates in a multidisciplinary cancer care. We also collaborate with interventional radiology on rendezvous procedures to facilitate biliary and pancreatic access. Our team works with surgeons to help manage post-operative complications, including anastomotic leaks. We perform specialized endoscopic procedures for pediatric patients who require advanced ERCP and endoscopic ultrasound.