Advanced Endoscopy Liver and Pancreas

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure used to diagnose and treat problems in the liver, gallbladder, bile ducts (which drain the liver and gall bladder), and pancreas. It combines the use of X-rays and a special ERCP endoscope. ERCP allows your doctor to look for conditions including tumors, pancreatitis, gallstones, infections and pancreatic cysts and pseudocysts.    

After you have received sedation, your doctor passes a special ERCP endoscope, a thin, flexible tube with a light and a camera on its end, through your mouth to the area of the small intestine where these ducts (or tubes) drain.

During an ERCP your doctor can pass special tools through the endoscope to take tissue and cell samples to examine for infection or cancer, perform sphincterotomy to open blocked ducts, break up or remove gallstones, insert plastic or metal thin tubes or stents into narrowed ducts to hold them open and restore flow of bile and pancreatic juice.

Our advanced endoscopists can utilize the SpyGlass™ miniature endoscope and catheter system to directly visualize and, if necessary take tissue specimens from your biliary duct system, and difficult to reach tiny ducts in the pancreas. Our doctors can also use SpyGlass™ to perform procedures such as electrohydraulic lithotripsy to break up larger, more complex gallstones into tiny fragments instead of removing them surgically.  

Our advanced endoscopists are also skilled in the technique of endoscopic ultrasound (EUS). This procedure uses a special echoendoscope that produces sound waves to create detailed images of the digestive tract. After you have received sedation, your doctor passes an echoendoscope, a thin, flexible tube with a light, camera and ultrasonic device on its end through your mouth or anus to the area to be examined. EUS may be used to diagnose the cause of conditions such as abdominal pain or abnormal weight loss and / or evaluate an abnormality, such as a growth, that was detected at a prior endoscopy or by x-ray. EUS can also help your doctor accurately assess the depth and extent of a digestive system cancer. During an EUS, your doctor can obtain tissue or cell samples using a special fine needle biopsy device.

Endoscopic ultrasound‐guided celiac nerve blocks can be used to treat pain associated with pancreatic cancer pain and chronic pancreatitis. 

EUS can also be used to place fiducial markers (bits of metal the size of a grain of rice) around a gastrointestinal tumor before radiation therapy. The markers show up on images (such as X-rays) to better pinpoint a tumor to help make sure radiation is aimed precisely at just the cancerous cells to minimize harm to healthy tissue.

Our advanced endoscopists offer various treatments to manage conditions of the pancreas.

Endotherapy options to treat pain resulting from chronic pancreatitis include pancreatic sphincterotomy, extraction of stones, stent placement and dilation of narrowed ducts.

A pancreatic pseudocyst is a sac of leaked pancreatic fluids made up of pancreatic enzymes, blood and necrotic, or dead tissue that may form next to the pancreas during pancreatitis. Our advanced endoscopists can endoscopically drain the pseudocyst to remove fluid or infection from the pseudocyst.

Deep small bowel enteroscopy has been available at John Muir Health since 2017. This procedure allows for extensive endoscopic examination and treatment of abnormalities found in the small bowel beyond the reach of an upper GI endoscope or a colonoscopes. This special long enteroscope relies on alternating balloon inflation / deflation like an accordion, to move forward deep within the small bowel to visualize and treat conditions including gastrointestinal (GI) bleeding, small bowel tumors, polyps and other small bowel diseases. Prior to the availability of deep small bowel enteroscopy, surgery was often the only alternative method to treat these conditions of the small bowel.

Endoluminal Stenting is a non-surgical endoscopic used to manage cancerous and non-cancerous blockages in the GI tract, including the esophagus, small bowel, bile and pancreatic ducts or the large bowel (colon). The procedure involves endoscopic placement of a flexible, self-expandable, hollow metal or plastic tube that is used to keep open an obstructed area of the GI tract.

GI bleeding can be an acute and life-threatening problem. Our gastroenterologists and specially trained endoscopy nursing team offer a variety of cutting-edge therapies to endoscopically manage blood loss from the GI tract. Depending on the location and severity of the bleeding, these innovative therapies to control bleeding may include:

• Sclerotherapy which involves the injection of medications directly into bleeding blood vessels.
• Hemostatic Clips or Loops (ligating bands) used to arrest or reduce bleeding.
• Variceal Banding one method of treatment for esophageal varices (abnormal or enlarged veins in the esophagus) that are at risk for rupturing.
• Argon Plasma Coagulator (APC) a noncontact thermal energy procedure that uses ionized argon gas to stop bleeding in the GI tract.
• Hemospray, a new endoscopic device that uses an aerosolized spray to deliver a specially formulated solution designed to cover large areas of bleeding in the GI tract.

Sometimes polyps may be too large, too flat (sessile) or located in difficult area to safely remove during a colonoscopy. These “complex” colon or rectal polyps usually require additional procedures to remove them. Patients are often referred to a colorectal surgeon If the polyp is found to be cancerous. If the polyp shows no signs of cancer (benign) our highly skilled gastroenterologists offer patients a non-surgical alternative for removal of the polyp instead of surgery including Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), a technique to remove complex polyps that invade deeper into the lining of the colon.

Our board-certified specialists offer the most advanced non-surgical endoscopic treatments to care for patients with Barrett’s esophagus, including:

• Endoscopic Mucosal Resection (EMR), a technique which is used to remove smaller sections of abnormal tissue from the digestive tract.
• Endoscopic Submucosal Dissection (ESD), a technique like EMR which is used to remove deep tumors from the GI tract.
• Radiofrequency Ablation (RFA), a technique that uses heat energy to destroy damaged tissue and any areas of abnormal growth.
• Endoscopic Cryotherapy, a process that uses extreme cold to destroy or ablate damaged tissue to freeze any abnormal tissue.
• Argon Plasma Coagulator (APC), a noncontact thermal energy procedure technique which uses ionized argon gas to stop bleeding or destroy abnormal tissue.

Peroral Endoscopic Myotomy (POEM) offers appropriately selected patients a minimally invasive therapeutic endoscopic alternative that most commonly treats patients with Achalasia, a swallowing disorder usually caused by failure of the muscles of the esophagus and the lower esophagus sphincter muscles not relaxing, making it hard to swallow and hard for the food to pass into the stomach. Performed in the endoscopy unit, the POEM procedure uses an upper GI endoscope through the mouth to cut the muscles of the esophagus, in contrast to a surgical myotomy, performed through incisions in the abdomen or chest.

Transoral incisionless fundoplication (TIF) offers appropriately selected patients a minimally invasive endoscopic therapeutic alternative to surgical procedures such as the Nissen/Dor/Toupet to treat gastroesophageal reflux disease (GERD). Our specialty trained TIF physicians use a state of the art, high-definition upper GI endoscope and a special endoscopic suturing device to strengthen the weakened area of the esophagus that causes stomach acid to flow up instead of down.

Endoscopic Bariatric Procedures. We are one of the few centers in the East bay to offer non-invasive procedures for weight loss. Unlike bariatric surgeries such as sleeve gastrectomy, endoscopic bariatric procedures are performed with an upper GI endoscope inserted through the mouth in contrast to surgical weight loss procedures performed through incisions in the abdomen. Highly trained endoscopy nursing staff assists advanced endoscopists with these procedures that may offer an excellent option for people who have decided not to pursue weight loss surgery, and for those who have had weight loss surgery and are now experiencing problems or weight regain.