The Combined Power of Advanced Endoscopy Tools
At Lankenau Medical Center, advanced endoscopy techniques are being combined to enhance early detection and treatment of cancerous conditions of the digestive tract.
For example, by combining endoscopy with probe-based laser endomicroscopy, it is possible to review live images of the digestive tract at the cellular level and to detect dysplasia (precancer) or early cancer. If abnormal tissue is found and determined to be on the surface only, our specialists often can use other advanced endoscopic techniques to remove the tissue.
Having specialized tools to detect abnormal cells, to determine that removal is possible, and then to proceed directly to removal allows detection and treatment in one endoscopy session.
Advanced endoscopy techniques are revolutionizing the care of many digestive diseases and are available now at Lankenau Medical Center. These procedures are performed using sophisticated endoscopes equipped with tiny specialized tools and devices, often in combination with imaging or other technologies.
We offer expertise in a broad range of advanced diagnostic and therapeutic endoscopy techniques. Therapeutic endoscopy—also known as interventional endoscopy—is the use of an endoscope to treat an identified problem from inside the digestive tract, thus avoiding more invasive treatment.
At Lankenau Medical Center, advanced endoscopic tools and techniques are allowing earlier detection and improved diagnosis of many conditions as well as treatment for some disorders that would otherwise require traditional or laparoscopic surgery. Our advanced endoscopic armamentarium includes:
Probe-based confocal laser endomicroscopy
Lankenau Medical Center is the only hospital in the region to offer this advanced technique for early detection of precancerous conditions of the digestive tract. The technique, called Cellvizio, involves the use of a tiny microscope that fits into an endoscope and allows examination of the digestive tract at the cellular level—similar to biopsy but without removing a tissue sample. Because the tool is used during endoscopy (upper or lower digestive tract), it provides immediate identification of abnormal, precancerous, or cancerous tissue and helps inform decisions about the best treatment, which may occur the same day or shortly thereafter. Cellvizio is currently used at Lankenau Medical Center for monitoring patients with Barrett’s esophagus and for evaluation of precancerous conditions of the colon.
Endoscopic ultrasound (EUS)
In EUS, an endoscope with a built-in ultrasound device is used to examine the lining of the digestive tract and tissues extending beyond this layer as well as nearby organs such as the gallbladder, bile ducts, and pancreas. EUS is performed under sedation; the endoscope can be inserted at the mouth or rectum, depending on which area of the digestive tract needs to be visualized. EUS has many diagnostic and therapeutic purposes. For example, it allows improved detection and staging of early cancers, more conclusive evaluation of lesions detected on endoscopy or colonoscopy, and evaluation and treatment of problems in the pancreas and gallbladder. During EUS, a tiny needle can be used to obtain tissue, fluid, or cell samples for evaluation.
Endoscopic retrograde cholangiopancreatography (ERCP)
In ERCP, endoscopy and x-ray imaging are used together to examine and, with the use of specialized tools and other techniques, treat disorders of the liver, pancreas, bile ducts, and gallbladder. For example, ERCP can be used to visualize tumors, stones, or other blockages in pancreatic or bile ducts; obtain tissue for biopsy; remove or crush stones; or place a stent (small cylindrical tube) to open a blockage. During ERCP, a procedure called sphincter of Oddi manometry can be done to assess the function of the muscle that controls drainage through the pancreatic and bile ducts. This test aids in the evaluation of suspected acute pancreatitis.
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are related techniques that combine the use of an endoscope and specialized tools to remove precancerous lesions, early-stage cancers, or other abnormal tissues confined to the surface layers of the digestive lining. Essentially, EMR and ESR are microsurgery performed from inside the digestive tract. These techniques can be used to treat precancerous lesions or early cancer found in the lining of the esophagus (including Barrett’s esophagus), stomach, duodenum, intestine, or colon.
Radiofrequency (thermal) ablation is another endoscopic procedure for removing precancerous lesions (Barrett’s esophagus) or early-stage (noninvasive) cancers from the lining of the esophagus. The technique uses heat generated by radio waves to target and destroy abnormal tissue while sparing normal tissue. New, healthy tissue then grows where the abnormal tissue had been.
Double-balloon enteroscopy uses a specially equipped endoscope that allows examination of the entire length of the small intestine—a long segment of the digestive tract that is out of reach of standard upper endoscopy and colonoscopy. Double-balloon enteroscopy is an important tool for identifying a source of intestinal bleeding and, in some cases, treating a bleeding problem—for example by cauterizing a vessel or closing a bleeding area with clips. The procedure also is used to biopsy lesions, detect and remove polyps, and remove or ablate (burn off) abnormal tissues.
Transoral incisionless fundoplication (TIF) is a relatively new treatment for GERD that has not responded well to medications and continues to cause symptoms or other problems. TIF is an endoscopic alternative to a laparoscopic surgical procedure called a Nissen fundoplication. Both procedures involve creating a tighter barrier between the esophagus and stomach to prevent reflux. Learn more about TIF >
Stenting refers to opening a blocked or narrowed passageway with the placement of a tiny expandable and hollow mesh tube (stent). Stents can be placed endoscopically to open a duct or segment of the digestive tract that has been obstructed or narrowed by disease. Stenting helps to relieve symptoms and improve digestive function but does not treat the underlying disease.
Endoscopic management of pancreatic pseudocysts
Inflammation or injury of the pancreas can cause fluid to collect and form a cyst-like abnormality called a pseudocyst. These can cause abdominal pain and other symptoms and lead to serious complications. Pancreatic pseudocysts can be evaluated and drained endoscopically in some patients; others may require surgical drainage.
Endoscopic evaluation of pancreatic cysts
Pancreatic cysts are a different type of fluid collection in the pancreas. Some pancreatic cysts can be cancerous or precancerous, although most are not. Cyst fluid can be extracted with a tiny needle during endoscopic ultrasound and analyzed to check for the presence of abnormal or cancerous cells. Results from the fluid analysis are used to guide decisions about whether to monitor the cyst or remove it.
© 2014 Main Line Health
Copyright 2011 Main Line Health
Printed from: www.mainlinehealth.org/oth/Page.asp?PageID=OTH006994