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Digestive Conditions of the Pancreas and Biliary System

The Center for Digestive Health at Beth Israel provides a detailed and focused approach to diseases of the pancreas and biliary system. These disease processes are often complicated and many patients are referred from other GI specialists, regional institutions, other states and countries. We offer internationally-recognized expertise in the surgical, gastroenterological, endoscopic and medical management of these disorders. We work closely with our highly skilled radiologic and oncologic colleagues, when necessary, to provide the most appropriate therapeutic program with a patient-centered approach.

Conditions we treat:

Diagnostic Tools
Treatment Options


Gallbladder Disease
Gallbladders that cause pain are typically removed, usually requiring laparoscopic cholecystectomy (a procedure designed to remove the gallbladder) which, for many patients, is now a one day procedure.


Bile Duct Stone Disorders
Bile duct stone disorders, which often present as emergencies, are almost entirely treated today by our expert endoscopists.


Liver Duct Stone Disease
A common condition in people from South-East Asia. The disease is amenable to endoscopic treatment although some patients may require a special type of radiology or surgery.


Sclerosing Cholangitis
A narrowing of the bile ducts, often associated with inflammatory bowel disease.


Bile Duct Cysts
Cysts in the bile duct are congenital (a condition you are born with) but require accurate diagnosis and surgical treatment because of the cancer risk.


Sphincter of Oddi Dysfunction
A condition in which the muscle at the end of the bile duct (sphincter) does not perform normally and can cause pain, bile duct blockage or pancreatitis.


Pancreatic Cancer
Cancer of the pancreas is increasingly more common and requires the correct combination of accurate diagnosis, staging and therapy. The surgeons at the Center for Digestive Health work closely with the Continuum Cancer Centers of New York when treating patients diagnosed with pancreatic cancer. Surgery, chemotherapy and radiation are all part of our arsenal when battling cancer. This multidisciplinary approach provides the best chance of survival for this difficult disease.



Chronic Pancreatitis
A chronic inflammation of the pancreas producing pain, poor digestion and diabetes. Like cancer, this requires a multi-disciplinary approach to provide the correct therapy.


Pancreatic Cysts
Pancreatic cysts (fluid-containing spaces in the pancreas) are now very common because of the increasing use of abdominal imaging used to detect them. Accurate diagnosis is essential to distinguish cysts that require no treatment from those that need to be kept under observation or surgically removed.


Neuroendocrine Tumors of the Pancreas
These tumors are rare and difficult to diagnose but can cause a wide variety of hormonal problems. Detection and surgical removal is the cornerstone of early treatment.


Pancreatic Necrosis and Pseudocysts
Pancreatic necrosis (dead tissue around the pancreas) and pseudocysts (large fluid collections in, near or around the pancreas) occur after an attack of acute pancreatitis. Not all require treatment, but increasingly this is done without open surgery and the Center has considerable expertise in this area.


Diagnostic Tools for Conditions of the Pancreas and Biliary System

Endoscopic Ultrasound (EUS)
This procedure uses a flexible endoscope with a small ultrasound probe attached to its tip to visualize organs, or to look at adjacent structures.


Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is a specialized form of endoscopy that involves the combination of flexible endoscopy and X-rays to study and treat disorders of the bile ducts and the pancreas.


Biopsy
Pathologists analyze tissue removed at the time of endoscopy or surgery to make a diagnosis.


Imaging
Scans such as ultrasound, CT (computed tomography), PET (positron emission tomography) or MRI (magnetic resonance imaging)


Blood tests


Treatment Options
Treatment strategies for conditions of the pancreas and biliary system vary depending on the type of condition and its progression.

Endoscopy
ERCP and EUS (see above) are essential endoscopic techniques performed by our expert physicians to define the problems to be treated and, in many situations, treat them during the procedure.


Surgery
Surgery (both minimally invasive and traditional open procedures) to correct structural anomalies or remove cancer or parts of a diseased organ.

  • Pancreatic surgery is complex and is best performed by experienced surgeons in centers with high volume. The Center satisfies these criteria and has an excellent record of success and safety, especially in the resection of cancers in the head of the pancreas (Whipple Operation) and tumors elsewhere in the pancreas.
  • A laparoscopic approach to the resection of pancreatic tumors can be offered to some patient. Laparoscopy is a less-invasive surgical procedure using small telescope-like tubes that can be placed through small incisions in the abdominal wall to permit surgery.
  • Surgery on the pancreatic duct is often done in cases of severe chronic pancreatitis. Decisions for surgery are made at a Center conference involving all disciplines.

Other

  • Interventional radiology - specially trained radiologists pass needles and tubes under imaging guidance to allow diagnosis and therapy in cases where endoscopic or surgical management is undesirable or not possible.
  • Radiation or chemotherapy
  • Nutritional guidance and other support
  • Psychosocial services


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.

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