Advanced GI Endoscopy Center and Gastroenterology

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Conditions Treated
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What is Gastroenterology?

Gastroenterology is the practice of medicine that diagnoses and treats disorders and diseases of the digestive system, including the esophagus, liver, gallbladder, pancreas stomach, intestines and rectum. Our gastroenterologists are highly experienced, and many are fellowship-trained in gastroenterology and have extra training in advanced endoscopy. Our physicians use innovative diagnostic tools and treatments such as endoscopic ultrasound with fine needle aspiration, Spyglass technology and ablation techniques for Barrett’s esophagus.

Conditions Treated

Esophageal Motility Disorders

A condition where the muscles in your esophagus fail to contract and the esophagus does not properly propel food and liquids into your stomach. Esophageal motility disorders is an umbrella term for other swallowing disorders such as dysphasia, nutcracker esophagus or achalasia.

GERD and Barrett’s Esophagus Center

Barrett’s esophagus is a condition closely related to gastroesophageal reflux disease (GERD). It affects about 1 in 10 patients with acid reflux and occurs when acid-containing contents in your stomach persistently leak back up into your esophagus. This can happen when a valve at the end of your esophagus called the lower esophageal sphincter, doesn’t close properly when food arrives at your stomach.

Symptoms can include regurgitation, pain in the chest or heartburn, hoarseness, trouble swallowing, food stuck in your throat, dry cough or bad breath. GERD isn’t life-threatening or dangerous in itself, however long term GERD can lead to more serious health problems such as esophagitis, strictures (abnormal narrowing) of the esophagus, Barrett’s or esophageal cancer. GERD is usually controlled with medications and lifestyle changes. If these don’t work, or if you can’t take medications for an extended period, surgery may be a solution.

Even though most patients with Barrett’s esophagus will not develop esophageal cancer, patients with chronic GERD are at higher risk for esophageal cancer. Barrett’s is considered a precancerous condition. Our staff work closely with other specialties in a multidisciplinary way to approach and help resolve the patient’s problem with our Barrett’s Esophagus Center of Excellence.

Esophageal Varices

Enlarged veins in the esophagus often caused by obstructed blood flow from the portal vein which creates pressure. This can be caused by scar tissue in the liver from liver disease. Bleeding esophageal varices is a life-threatening condition and can be fatal in up to 50% of patients. People who have had an episode of bleeding esophageal varices are at risk for bleeding again. There are two different, non-surgical treatments available to stop variceal bleeding. Variceal ligation is typically performed by a gastroenterologist endoscopically, and a transjugular intrahepatic portosystemic shunt (TIPS) procedure which is done by a radiologist using x-ray.

Achalasia

Occurs when nerves in the esophagus become damaged. As a result, the esophagus becomes paralyzed and dilated over time and eventually loses the ability to squeeze food down into the stomach. Why your esophageal muscles fail to contract and relax normally is unknown. One theory is that achalasia is an autoimmune disease (your body attacks itself) that is triggered by a virus. More research is still needed. Symptoms may include a backflow of food in the throat (regurgitation), chest pain, and weight loss. Achalasia can usually be managed with minimally invasive (endoscopic) therapy or surgery.

Diverticular Disease

Can be made up of one or both conditions called diverticulosis and diverticulitis. Both of these conditions occur in the large intestine or colon when one or more pockets or bulges form in the wall of your colon causing bleeding, inflammation or other complications. Diverticulosis is very common in Western populations and occurs in 10% of people over age 40 and in 50% of people over age 60. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery.

Inflammatory Bowel Disease

A group of disorders that cause chronic inflammation in the intestines. IBD includes Crohn’s disease and ulcerative colitis. Up to three million Americans have some form of IBD. The condition affects all ages and genders. IBD most commonly occurs between the ages of 15 and 30. There are many different tests used to diagnose IBD. Some of those include stool and blood testing, endoscopy and imaging scans. There are also many different treatments for IBD depending on the condition and severity of disease. They include medication therapy such as anti-inflammatories, anti-biotics, biologics, immunomodulators, and surgical treatments such as a bowel resection or colectomy (removal of part of intestine). IBD is a lifelong condition, but it shouldn’t shorten your life expectancy. With proper treatment, you can prevent flares and have long periods of remission.

Pre-cancerous Conditions and Cancer of the Gastrointestinal System

We diagnose and treat an array of pre-cancerous and cancerous conditions of the gastrointestinal system. Some pre-cancerous conditions include Barrett’s esophagus, chronic gastritis with or without Helicobacter pylori infection, atrophic gastritis, and intestinal metaplasia of the gastric mucosa, epithelial dysplasia, and adenoma polyps.

Cancers of the GI tract include Esophageal, Stomach, Liver, Pancreatic, Colo-rectal, Anal, Carcinoid or Neuroendocrine, Gall bladder, Small Intestine, Bile duct, GIST (Gastrointestinal stromal).

Gastric Polyps

An unusual growth of tissue within the inner lining of the stomach. Most stomach polyps are not cancerous, but there are some types that have a higher risk to turn into cancer. Most stomach polyps can be removed endoscopically by a gastroenterologist. During the procedure, a biopsy of one or more of the polyps will be taken for examination to make sure that the tissue is not cancerous. If several polyps are found, the doctor may recommend surgery.

Gastroparesis

A condition that affects the normal movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach’s motility is slowed down or doesn’t work at all, preventing your stomach from emptying properly. Symptoms include heartburn, nausea, vomiting, and feeling full quickly when eating. Treatments include medications and possibly surgery.

Hernias

Occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue. Some types of gastrointestinal hernias may include hiatal, umbilical or incisional/ventral hernias. Hernias are generally repaired surgically and can be done laparoscopically, robotically or by an open surgical procedure. Our specialists work together to surgically repair all types of hernias. Our team performs a wide range of hernia surgeries, including robotic abdominal wall reconstruction.

Esophageal Strictures

An abnormal tightening or narrowing of the esophagus. The most common cause is from long-term chronic acid reflux disease. Some less common causes are from eosinophilic esophagitis, radiation therapy, treatment for esophageal varices (banding or sclerotherapy), corrosive ingestions, esophageal surgeries, cancer, and rare dermatologic diseases that involve the esophagus. The main symptom of an esophageal stricture is difficulty in swallowing. Esophageal dilation is the treatment of choice. This is usually done endoscopically by stretching the esophagus with different dilators. Other options may include corticosteroid injections into the esophageal stricture after dilation or temporary placement of esophageal stents.

Ulcers

A sore on the lining of your stomach or the first part of your small intestine (duodenum). The two most common causes of ulcers are infection with Helicobacter pylori (H. Pylori) and over use of a group of medications known as NSAIDs. Ulcers are typically diagnosed by a procedure called an EGD (upper endoscopy) or with an x-ray test called an “upper GI series”. An upper GI series involves drinking a white chalky substance called barium, and then taking a number of x-rays to look at the lining of the stomach. Treatment can include making lifestyle changes, taking medicines, or in some cases having surgery.

Tests and Procedures Offered

Esophagogastroduodenoscopy (EGD or Upper Endoscopy)

An outpatient procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area in the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy if necessary.

Colonoscopy

An outpatient procedure that allows the doctor to examine the inside of large intestine (colon and rectum). The examination uses an instrument called a colonoscope. This flexible instrument is very long and includes a camera and has the ability to remove tissue (biopsies) if necessary. A colonoscopy is commonly used to investigate abnormal gastrointestinal symptoms or for colon cancer screening.

Endoscopic Ultrasound (EUS)

A specialized technique which combines endoscopy and ultrasound to create images of the digestive tract and its surrounding organs and tissues. Your doctor may also use EUS to help diagnose a number of digestive disorders including tissue sampling for cancer detection, staging of gastrointestinal cancers, and diagnosing problems in the bile ducts and gallbladder.

Endoscopic Retrograde Cholangiopancreatography/Spyglass (ERCP)

A specialized endoscopic technique used to study the bile ducts, pancreatic duct and gallbladder. Your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum, then inject a contrast material (dye) into the pancreatic or biliary ducts and will take x-rays. Some reasons ERCP’s are performed are to break up and remove stones, place stents to open blocked or narrowed ducts and to remove tumors or tissue samples for biopsy.

Push Enteroscopy

A medical test that uses a special tool to look at the inside of the small intestine. It is a type of endoscopy procedure that may be used to help diagnose and manage several different types of digestive conditions such as bleeding, malnutrition, severe diarrhea or suspected tumors. This advanced procedure is often used as an addition to other diagnostic testing such as an upper endoscopy, colonoscopy, capsule endoscopy, or various radiology testing.

Capsule Endoscopy (Pill Cam)

A procedure that uses a tiny wireless camera to take pictures of your digestive tract. A capsule endoscopy camera sits inside a vitamin-size capsule that you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist. The capsule endoscopy procedure is complete after eight hours or when you see the camera capsule in the toilet after a bowel movement, whichever comes first. Capsule endoscopy helps doctors see inside your small intestine, an area that isn’t easily reached with more traditional endoscopy procedures. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.

Chromoendoscopy

An endoscopic technique that uses stains during an endoscopy to visualize differences in tissue such as abnormal or malignant changes that may not be apparent in white light.

Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement

Feeding tubes which allow you to receive nutrition directly through your stomach. You may need a PEG tube if you have difficulty swallowing or can’t get all the nutrition you need by mouth. PEG tubes are typically placed endoscopically under anesthesia, and most patients will go home the same day. After your feeding tube is placed, you’ll be able to see the tube outside your body. You will need to clean the tube daily and keep it dry between cleanings. If a PEG tube falls out or moves, see a healthcare provider within 24 hours. PEG tubes can last for months or years and may be temporary or permanent.

Flexible Sigmoidoscopy

A screening test that use a thin flexible tube with a camera at the end to look at the lower part of the colon, also known as the rectum and sigmoid colon. Sigmoidoscopy is one option for colon cancer screening, but there are other options that allow your doctor to view your whole colon, such as colonoscopy. Talk with your doctor about which option is best for you.

Botox Injections

A powerful inhibitor of muscle contraction. BOTOX can be injected through an endoscope to relax certain muscles in the GI tract. This procedure may be used in patients with achalasia or gastroparesis.

Polyp Removal

Polyps can be removed through open abdominal surgery, but more commonly it is performed during an endoscopy or colonoscopy.

Esophageal Stent Placement

A tube made of metal mesh, plastic, or silicone. A stent is placed in the esophagus to keep a blocked area open so the patient can swallow soft food and liquids. This procedure is usually performed endoscopically.

Dilation

Typically done endoscopically by stretching the esophagus with different dilators. If this technique fails to help patients become symptom free, other options may include corticosteroid injections into the esophageal stricture after dilation or temporary placement of esophageal stents.

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