Advanced therapeutic endoscopy is a subspecialty of gastroenterology dedicated to the diagnosis and treatment of digestive diseases using endoscopic procedures. As medicine becomes more sophisticated in identifying and defining certain disease processes, the lines between non-invasive medical treatments and invasive surgical treatments meet at therapeutic endoscopy. The Center for Digestive Health at Mount Sinai Beth Israel is home to some of the finest endoscopists in the world, performing complex endoscopic procedures at the highest level.
Endoscopy is the use of a thin, flexible tube with a light source and a camera that is passed through the mouth or anus and directed to the area of interest. These procedures are performed with the assistance of an anesthesiologist, who will provide medication for the patient to be asleep and comfortable throughout the procedure.
Below is a list of endoscopic treatments preformed by our physicians:
Endoscopic Mucosal Resection (EMR)
EMR is a procedure that results in the complete removal of a polyp or other growth anywhere within the digestive system. It is more than a biopsy, because the target is removed completely. EMR can often spare a patient from a major surgical procedure.
Some patients may have difficulty swallowing food because of a narrowing in the esophagus, or other obstruction to the free transit of food downstream through the gut. A stent is a plastic or metal tube that serves to open up a blocked space. A stent can be placed across the narrowed or blocked area to allow food to pass and facilitate swallowing and digestion. Stents can also be placed in the stomach, duodenum, small intestine and colon when there is a mechanical blockage impeding the passage of food through the alimentary canal. Patients with obstruction of the colon due to cancer or other causes of narrowing in the colon can be treated with a stent to traverse the lesion and allow for the free passage of colonic contents. The stent is passed as a thin catheter through the endoscope that opens up as it is deployed under direct visualization inside the colon. This can be done pre-operatively to make a surgical procedure easier, and it can be done as a comfort measure in some patients with an otherwise irreparable obstruction.
This technique is used to destroy precancerous cells before they become a cancer. A specialized probe is passed through or alongside the endoscope and aimed at the suspicious area. Radiofrequency energy refers to an electric current produced by radiowaves to burn the targeted cells and avoid injury to the surrounding tissue. This technique is usually applied to the esophagus in the setting of Barrett’s esophagus - a precancerous condition that may be related to chronic GERD.
Confocal Laser Endomicroscopy
This is a ‘virtual biopsy,' a novel technique that allows the physician to see the actual cells of the gastrointestinal tract in real time during endoscopy. A specialized laser light beam in a probe that is passed through the scope and directed at the area of “biopsy” inside the body allows this image to be created. This new method allows the physician to avoid taking many biopsies since the cellular features can be seen during the endoscopy.
Endoscopic Retrograde Cholangio Pancreatography (ERCP)
This is a specialized endoscopy that involves the combination of endoscopy and X-rays to study the bile ducts and pancreas. The bile ducts connect the liver to the small intestine. These ducts are the drainage system of the liver and gallbladder and serve to deliver bile, an important digestive fluid, from the liver to small intestine. ERCP is very useful in the diagnosis and treatment of gallstones and pancreatic diseases. Some gallstones can get lodged in the bile ducts and ERCP is able to remove them. Sometimes, more specialized techniques are required to facilitate the extraction of larger and harder gallstones such as mechanical, laser or electrohydraulic lithotripsy to break stones. When a narrowing is present in the bile duct or pancreas due to chronic diseases or cancer, ERCP allows for stents to be placed through the endoscope and into the pancreatic duct or the bile ducts to allow for proper drainage and excretion of important digestive fluids.
Endoscopic Ultrasound (EUS)
This is a specialized form of endoscopy that uses a built-in miniature ultrasound probe on the tip of the endoscope to inspect the anatomy of the gastrointestinal tract and other organs near it in great detail. This tool allows for the doctor to see your body from the inside out. Endoscopic ultrasound has allowed a minimally invasive means of taking biopsies of hard-to-reach lymph nodes, liver lesions, and pancreatic cysts and tumors. This specialized form of a sonogram is useful for examining organ structures and blood vessels from close range. It also serves to help stage cancerous conditions before planning surgery or chemotherapy.
Celiac Plexus Neurolysis and Block
These are endoscopic techniques in which a needle is used to target nerve fibers near the pancreas for the treatment of pain syndromes associated with pancreatic cancer and chronic pancreatitis. The territory of nerve fibers is identified using endoscopic ultrasound, which guides the safe administration of the analgesic therapy.
To learn more about the many services provided by the Center for Digestive Health at Mount Sinai Beth Israel or to make an appointment for a consultation, please call (212) 604-6822.