Esophagus And Stomach Procedures

• EGD is performed to examine the esophagus, stomach and duodenum. It is frequently used evaluate patients with symptoms such as abdominal pain, reflux, nausea or difficulty swallowing.
• Our practice is focused on Therapeutic EGD that allows for removal or ablation of dysplastic Barrett’s esophagus, various nodules, polyps or early cancer using Endoscopic Mucosal Resection (EMR), Endoscopic Submucosal Dissection (ESD) or Radiofrequency Ablation (RFA).
• These procedures are routinely performed at one of our outpatient endoscopy units in the hospital as they require specialized equipment and well-trained staff.

• EUS is an endoscopic procedure that combines standard endoscopy with ultrasound to obtain images of internal organs in the chest, abdomen and pelvis. EUS can be used to visualize the wall of the esophagus, stomach and colon/rectum in addition to allowing the visualization of adjacent structures such as the liver, pancreas, bile ducts and lymph nodes.
• When combined with a procedure called fine-needle aspiration (FNA), EUS allows your doctor to sample (biopsy) fluid and/or tissue for analysis. EUS with FNA can be a minimally invasive alternative to exploratory surgery.
• EUS techniques can also be used in certain therapeutic procedures such as the drainage of pancreatic pseudocysts or obstructed bile ducts.

• RFA utilizes heat therapy that is applied through a catheter that is advanced alongside or through the endoscope. RFA is primarily used to eradicate dysplastic Barrett’s esophagus, a precancerous condition of the esophagus that is due to chronic reflux.
• RFA can also be used in the bile ducts for the palliative treatment of bile duct cancer.
• https://www.youtube.com/watch?v=iu4kv90cOII

• Cryoablation utilizes liquid nitrogen to generate extremely cold temperatures to destroy tissue and is part of our armamentarium for the treatment of dysplastic Barrett’s esophagus.
• Liquid nitrogen is sprayed over the area of interest and consequently will lead to superficial cell death while protecting the deep layer of the esophagus. Unlike burning heat (RFA), the tissue injury continues over several days.
• Cryoablation can used in combination with EMR, ESD, and RFA to manage dysplastic Barrett's esophagus or early esophageal cancer.

• EMR is a delicate technique that allows for the removal of lesions involving the mucosa or lining of the gastrointestinal tract. This technique is frequently used to remove large polyps in the colon but can also be used in the esophagus or stomach.
• During EMR, the mucosa is first lifted off of the wall of the gastrointestinal tract by carefully injecting fluid in the space between the mucosa and muscle layer. This creates a space in which the mucosa and associated lesion to be safely excised using a snare or metal loop that has electrocautery.
• In the hands of an Interventional Endoscopist, the majority of patients with large colon polyps can be treated adequately with Endoscopic Mucosal Resection avoiding the need for surgery.

• ESD is an intricate technique that allows for the removal of lesions involving the mucosa or lining of the gastrointestinal tract. This technique is used to remove early cancers that are limited to the lining of the esophagus and stomach and can also be used to remove large colon polyps.
• Similar to EMR, the mucosa is first lifted off of the wall of the gastrointestinal tract by carefully injecting fluid into the space between the mucosa and muscle layer. Expansion of this space allows for the safe dissection and removal of the mucosa and associated abnormal tissue using a specialized device called a needle knife.
• In the hands of an expert Interventional Endoscopist, ESD can be performed safely and potentially allow for curative resection of early esophageal/gastric cancers and very large colon/rectal polyps. This can also prevent the need for surgery.

POEM is a minimally invasive endosurgical procedure for the treatment of achalasia. During this procedure the endoscope is used to create a small tunnel underneath the lining of the esophagus through which the inner muscle layer of the lower esophageal sphincter is released. This relieves esophageal pressures and allows for the improved passage of food.

• What conditions are treated with POEM?
• Achalasia (poor relaxation of Lower Esophageal Sphincter –LES)
• Spastic esophageal disorders that fail to respond to medical therapies (e.g. diffuse esophageal spam, nutcracker esophagus, EGJ –esophagogastric junction- obstruction)
• https://youtu.be/IPaLOKT6IWE

• This new technique allows for the endoscopic treatment of a Zenker’s diverticulum which can cause difficulty swallowing. Using an endoscope the septum between the diverticulum and the esophagus is released making room for the passage of food. This procedure is safe and well tolerated with most patients going home post procedure on a liquid diet that is then slowly advanced.
• In the hands of an expert Interventional Endoscopist, cricopharyngeal myotomy can be performed safely and effectively leading to resolution of symptoms in the vast majority of patients and preventing the need for more invasive surgery.
• https://youtu.be/FLVqICeFxjc