Led by Dr. Kenneth Binmoeller, who founded Interventional Endoscopy Services (IES) at California Pacific Medical Center in 2001, the Paul May and Frank Stein Interventional Endoscopy Center in San Francisco, has become the premier referral center in Northern California for patients requiring complex endoscopic diagnosis and therapy.

At the Center, Dr. Binmoeller and his team of interventional endoscopy specialists provide the most advanced minimally invasive approach that endoscopy affords, providing an enormous benefit to patients who wish to avoid surgery, as well as substantial healthcare cost savings.

What Is Flexible Endoscopy?

Gastrointestinal endoscopy using a flexible endoscope allows the doctor to access the gastrointestinal tract and surrounding structures through the natural orifices of the mouth and anus. A channel within the endoscope facilitates introduction of miniature instruments into the gastrointestinal tract to perform a variety of procedures. The gastrointestinal tract includes the bile and pancreatic ducts, which are accessed after the endoscope is advanced into the stomach or small intestine. Using endoscopic ultrasound, organs and structures outside the gastrointestinal tract can also be accessed and treated.

What Is Complex Interventional Endoscopy?

A variety of diagnostic and therapeutic endoscopic procedures are widely performed at community hospital and outpatient surgery centers. Examples include procedures such as screening colonoscopy and polypectomy. The procedures performed at IES differ from those routinely performed in the community by their complexity and the specialized expertise needed to perform them successfully and achieve the best outcomes.

Subspecialization in Complex Interventional Endoscopy

IES doctors are subspecialized in complex interventional endoscopy. The Paul May and Frank Stein Interventional Endoscopy Center is unique in that procedural work is 100 percent tertiary and quaternary care, and referred by gastroenterologists and gastrointestinal surgeons. The Center has historically served patients who wish to avoid surgery or are too high risk for surgery, have failed prior endoscopic treatment attempts or do not have any other treatment options. The Center provides such critical service to not only all hospitals within the Sutter system, but also deals with the most complicated patients of external hospital systems and the surrounding academic centers. Referrals are received from across the country as well. While fulfilling this need, the Center provides significant savings in healthcare resources by avoiding costly surgery, reducing costs of hospitalization and minimizing costs of management of post-surgical complications.

Which Conditions Can Be Treated?

Utilizing the most cutting-edge technology not available in most medical facilities, the Paul May and Frank Stein Interventional Endoscopy Center diagnoses and treats an ever-growing list of conditions including:

• Barrett's esophagus
• Benign and malignant stricture
• Bile and pancreatic cancer
• Bile and pancreatic stones
• Variceal bleeding
• Non-variceal bleeding
• Fistulas and leaks
• Zenker's diverticulum
• Obesity and diabetes
• GERD
• Achalasia
• Large polyps and early stage cancers
• Submucosal tumors
• Pseudocysts, walled off necroses (WON)
• Acute cholecystitis and gallstones
• Gastric outlet obstruction

What Procedures Do We Offer?

The Paul May and Frank Stein Interventional Endoscopy Center is dedicated to providing advanced endoscopic treatment for the most complex conditions. The procedures offered—some of which were developed by Dr. Binmoeller himself—are extremely specialized and provide options not generally available at community hospitals, including:

• Internal gallbladder drainage and stone extraction
• Complex billiary and pancreatic duct therapy (ERCP)
• EUS-guided tissue sampling and nerve blocks
• Tumor ablative therapies (RFA, cryotherapy)
• Pancreatic fluid collection, drainage, and necrosectomy
• Complex stricture dilation and stricturoplasty
• Underwater endoscopy and therapy (UEMR, UESD)
• Advanced hemostasis coil and glue therapy
• Endoscopic sleeve gastroplasty (ESG)
• Transoral incisionless fundoplasty (TIF)
• Edoluminal fundoplication
• Peroral endoscopic myotomy (POEM)
• Endoscopic partial-thickness resection (EMR and ESD)
• Endoscopic full-thickness tissue resection
• Ampullectomy
• Endoscopic submucosal dissection (ESD)
• Transoral outlet reduction/bariatric surgery revision
• Advanced endoscopic imaging
• Deep enteroscopy

The IES Team

The four doctors at the Center, including founder and director Dr. Kenneth Binmoeller, are pioneers and specialists in advanced interventional endoscopy. Our supporting nursing and technical staff are also highly specialized, hand-picked for the contribution they make to the state-of-the-art procedures and technologies provided at this unique facility.

Over the past decades the IES doctors have invented and pioneered many of the instruments and procedures used in their daily work. An example is the lumen-apposing metal stent (LAMS), invented by Dr Kenneth Binmoeller. The LAMS is used to relieve blockages of various kinds and create a direct connection (“bypass”) between neighboring structures, such as a direct connection between the gallbladder and bowel. The IES doctors have published over 300 papers and have held over 500 presentations at national and international meetings.

IES Research

The Paul May and Frank Stein Interventional Endoscopy Center is one of the pre-eminent endoscopic research laboratories in the world. New endoscopic technology is thoroughly evaluated in the pre-clinical setting using simulator models and animals where appropriate. Dr Binmoeller uses models to test the technical functionality of new devices and biological variables, such as injury and healing.

The research agenda at the Center ensures excellence of treatment as well as clinical advances.

Educational and Academic Efforts

The Paul May and Frank Stein Interventional Endoscopy Center offers the International Scholars Program in Advanced Endoscopy training endoscopy fellows from across the world. The Center also provides part of the curriculum for the CPMC Gastroenterology Fellowship. The curriculum is designed to help fellows learn the knowledge, skills and personal attributes necessary to succeed and excel in their chosen career path and to be fully prepared for the ever-changing demands of modern gastroenterology.