While many conditions are diagnosed through endoscopy, interventional endoscopy offers effective options for treatment for more complex conditions. Utilizing endoscopic ultrasound, interventional endoscopy and wireless endoscopy, the team at PAMF is able to diagnose and treat a wide variety of complex diseases conditions including:
- Barrett's esophagus — A premalignant condition caused by chronic gastroesophageal reflux disease that can lead to the development of esophagus cancer (adenocarcinoma). The condition can be treated with procedures including radio frequency ablation (RFA), cryotherapy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).
- Early stage cancers — In the early stages, cancers of the gastrointestinal tract only involve the innermost layers of the esophagus, stomach or intestine. When cancers have not yet invaded into deeper layers, they can potentially be cured endoscopically. We can treat early stage cancers with procedures including endoscopic submucosal dissection (ESD).
- Obstructive cancers — Cancers may cause blockage anywhere along the gastrointestinal tract. Such blockage can cause severe symptoms and life-threatening complications including perforation, or bursting of the bowel, inability to eat or infection of the liver. Advanced interventional endoscopy treatments include expandable stents, endoscopic bypass procedures and ablative therapy.
- Benign stricture — Inflammation, scar tissue and poor healing from prior surgery or radiation therapy can result in non-cancerous blockages along the gastrointestinal tract. Benign stricture can be treated through expandable stents, dilation and stricturoplasty.
- Bile and pancreatic cancer — Bile and pancreatic cancers can be treated with expandable stents and radio frequency ablation (RFA).
- Bile and pancreatic stones — Bile and pancreatic stones can be treated with mechanical and electrohydraulic lithotripsy.
- Variceal bleeding — Cirrhosis, blood clots within the abdomen and other disorders can cause abnormally high pressure within the blood vessels that line the gastrointestinal tract, most frequently in the esophagus and stomach. This high pressure results in enlargement of these vessels, which are at risk of bursting and causing life-threatening bleeding. Variceal bleeding is treated through glue and coil injection and band ligation.
- Non-variceal bleeding — Inflammation, ulcers, blood vessel malformations, diverticulosis and cancers can all result in gastrointestinal bleeding. This condition is treated with thermal and injection therapy, suturing and hemospray.
- Fistulas and leaks — Endoscopic suturing is offered to treat fistulas and leaks.
- Zenker's diverticulum — A Zenker’s diverticulum is an abnormal pouch that can develop above the upper sphincter of the esophagus, interfering with swallowing and placing patients at risk of aspirating food into their airway. At Paul May and Frank Stein Interventional Endoscopy Center at CPMC, we provide septomyotomy to treat Zenker’s Diverticum.
- Obesity and Diabetes — Advanced interventional endoscopy treatments offered include endoscopic sleeve gastroplasty, transoral outlet reduction and bariatric surgery revision.
- GERD — Gastroesophageal reflux disease occurs when abnormal levels of acid reflux from the stomach go up into the esophagus, causing symptoms such as heartburn, acid regurgitation, chest pain, chronic cough and potentially exposing patients to increased risk for esophageal cancer. Medications may be used to suppress acid, but do not correct the underlying problem in GERD. The issue is an abnormality of the lower esophageal sphincter, which normally acts as a structural barrier to acid reflux. At the Paul May and Frank Stein Interventional Endoscopy Center, complex procedures are offered to address this structural problem including transoral fundoplasty (TIF), resection and plication (RAP) and anti-reflux mucosectomy.
- Achalasia — Achalasia is a disorder in swallowing that happens when the muscle along the esophagus fails to squeeze effectively. In addition, the sphincter muscle at the junction of the stomach and esophagus sphincter fails to relax, blocking passage and food and liquids into the stomach. The treatment for Achalasia (and other disorders involving the muscle of the esophagus) is known as Peroral Endoscopic Myotomy (POEM).
- Large polyps — Polyps are precancerous growths that develop in the gastrointestinal tract. Conventionally, large polyps have often required surgery for removal of the growth and surrounding portion of the intestine, but complex interventional endoscopic techniques can now spare patients from surgery. Treatment for large polyps at the Paul May and Frank Stein Interventional Endoscopy Center includes endoscopic mucosal resection (EMR).
- Submucosal tumors — Benign or cancerous growth may develop in the deeper layers of the gastrointestinal tract. These tumors conventionally have required surgery for removal since normal endoscopic resection techniques of deeper tumors would result in a perforation, or hole, left in the gastrointestinal wall. New techniques pioneered at Sutter Health’s Paul May and Frank Stein Interventional Endoscopy Center have enabled endoscopic removal of select submucosal tumors. Using advanced techniques, partial- and full-thickness resection is used to treat submucosal tumors.
- Pseudocysts, walled off necroses (WON) — Treatment options include EUS-guided pseudocyst drainage and necrosectomy.
- Acute cholecystitis and gallstones — At the Paul May and Frank Stein Interventional Endoscopy Center, EUS-guided gallbladder drainage and gallstone removal is offered.
- Gastric outlet obstruction — Our doctors may place expandable stents or perform EUS-guided gastrojejunostomy as a treatment for the condition.