Advanced Endoscopy

The physicians in City of Hope’s Division of Gastroenterology are experts in several procedures that aid in treating, managing, diagnosing and even preventing tumors and other growths in the gastrointestinal tract:

 

Advanced Endoscopic Procedures

City of Hope’s excellence in performing endoscopic procedures enables us to provide a slate of advanced techniques — and treatments that have the potential to cure without cutting.

ERCP

ERCP stands for “endoscopic retrograde cholangiopancreatography.” ERCP examines the bile duct by injecting a contrast agent, allowing the physicians to see the bile ducts on an X-ray scan. Blockages of the bile duct that may be due to tumors or stones can be diagnosed. The ERCP procedure allows for diagnostic and therapeutic interventions of the biliary tract.

Before Your ERCP

  • Make sure your physician knows about any allergies you may have. In particular, if you have a sensitivity to iodine, you should disclose it.
  • Follow your physician’s direction about any medicines you may be taking.

Day of Your ERCP

Refrain from eating for six to eight hours ahead of the procedure. This way, there won’t be food in your GI tract that could show up in imaging.

You should arrive one to two hours before the beginning of your procedure, bringing along an adult who can ensure that you get home safely. You will be asked to register and go over your medical history before your ERCP.

The ERCP Procedure

  • As you lie on your left side, your doctor will connect you to an IV that will keep you hydrated and sedate you for the ERCP.
  • A duodenoscope, a type of endoscope used to examine and treat the pancreas and bile ducts, will be placed into your mouth and moved downward until it’s positioned in your small intestine.
  • The physician will deliver dye to the pancreas and bile ducts using a catheter passed through the duodenoscope.
  • Images will be recorded using X-rays. Any abnormalities, including stones or tumors, will be highlighted by the dye.

After the procedure, when you have recovered from the sedative, the physician will talk to you about the results of the ERCP. Some patients leave the same day, while others may have to spend one night in the hospital to be observed.

EUS

EUS stands for “endoscopic ultrasound.” This procedure can be used for both diagnosis and treatment. The endoscope bears an attachment that sends sound waves bouncing through a patient’s gut, which can be translated into detailed imaging of the gastrointestinal tract. Additionally, your doctor may use EUS to collect a small sample of tissue through fine-needle aspiration.

Before Your EUS

  • Make sure your physician knows about any allergies you may have. In particular, if you have a sensitivity to iodine, you should disclose it.
  • Follow your physician’s direction about any medicines you may be taking.

Day of Your EUS

Refrain from eating for six to eight hours before an EUS of the upper gastrointestinal tract. For an EUS of the lower gastrointestinal tract, your physician will put you on a liquid diet followed by a laxative or enema.

You should arrive one to two hours before the beginning of your procedure, bringing along an adult who can ensure that you get home safely. You will be asked to register and go over your medical history before your EUS.

The EUS Procedure

  • The medical team will connect you to an IV to keep you hydrated and sedate you for the EUS.
  • Physicians locally anesthetize the throat to minimize discomfort for those undergoing an EUS of the upper gastrointestinal tract.
  • For an upper gastrointestinal tract EUS, the endoscope will enter via the mouth. For a lower gastrointestinal tract EUS, the instrument will enter via the rectum.
  • Your doctor will view the resulting images on a monitor in the room.
  • If a biopsy is necessary, the physician will perform one.

When the procedure is over, the physician will talk to you about the results of the EUS.

Small Bowel Enteroscopy

The small bowel enteroscopy can reach areas of the gastrointestinal tract that are otherwise hard to access. With this procedure, gastroenterologists can obtain tissue for biopsy, locate sources of and address bleeding, widen constricted areas of the GI tract or remove polyps. The tools involved are a long, flexible tube with a camera and other instruments on it. In one version of the small bowel enteroscopy, a single balloon is employed to see deeper into the body than otherwise possible.

Before Your Small Bowel Enteroscopy

  • Make sure your physician knows about any allergies you may have. In particular, if you have a sensitivity to iodine, you should disclose it.
  • Follow your physician’s direction about any medicines you may be taking.

Day of Your Small Bowel Enteroscopy

Before a small bowel enteroscopy, your physician will put you on a liquid diet followed by a laxative or enema.

Plan to show up to the clinic one to two hours before your small bowel enteroscopy, bringing along an adult who can ensure that you get home safely. You will be asked to register and go over your medical history before the procedure.

The Small Bowel Enteroscopy Procedure

  • The medical team will connect you to an IV that will sedate you for the procedure.
  • Your doctor will introduce the endoscope through the rectum and guide the tube through your body with help from imaging.
  • In a single-balloon enteroscopy, the physician will alternately inflate and deflate the balloon to anchor it within the GI tract and gain access to the region of interest.
  • Depending on the reason for the enteroscopy, probes will be used for tissue collection or therapy.

After the enteroscopy is over and you have recovered from the sedative, the physician will talk to you about the procedure results.

EMR

EMR stands for “endoscopic mucosal resection.” In this outpatient procedure, doctors remove lesions and polyps of the gastrointestinal tract — conditions that previously required surgery.

Before Your EMR

  • Make sure your physician knows about any allergies you may have. In particular, if you have a sensitivity to iodine, you should disclose it.
  • Follow your physician’s direction about any medicines you may be taking.

Day of Your EMR

Refrain from eating for 12 hours before an EMR of the upper gastrointestinal tract. For an EMR of the lower gastrointestinal tract, your physician will put you on a liquid diet followed by a laxative or enema.

You should arrive no less than three hours before the beginning of your procedure, bringing along an adult who can ensure that you get home safely. You will be asked to register and go over your medical history before your EMR.

The EMR Procedure

  • The medical team will connect you to an IV that will sedate you for the EMR.
  • Depending on the location of the lesion, the endoscope will enter via the mouth or the rectum.
  • Your doctor will view the resulting images on a monitor in the room.
  • The physician may move a tumor away from healthy tissue using suction.
  • A thin wire will then be fed through the endoscope and positioned at the base of the lesion.
  • In one action, the electrified wire extracts the lesion and seals up the tissue.
  • The doctor will remove the resected tissue from your body using either suction or an endoscopic tool.
  • Your medical team will have the excised tissue examined to confirm that the growth has been taken out completely.

After the procedure, when you have recovered from the sedative, the physician will talk to you about the results of the EMR.

ESD

ESD stands for “endoscopic submucosal dissection.” City of Hope is one of only a few centers to offer this advanced endoscopic procedure. We can use this technique to treat conditions of the esophagus, stomach and colon. In some patients, ESD can be used to remove precancerous growth or even early-stage cancer at once, without the need for surgery.

Before Your ESD

  • Make sure your physician knows about any allergies you may have. In particular, if you have a sensitivity to iodine, you should disclose it.
  • Follow your physician’s direction about any medicines you may be taking.

Day of Your ESD

Refrain from eating for 12 hours before an ESD of the upper gastrointestinal tract. For an ESD of the lower gastrointestinal tract, your physician will put you on a liquid diet followed by a laxative or enema.

You should arrive no less than three hours before the beginning of your procedure, bringing along an adult who can ensure that you get home safely. You will be asked to register and go over your medical history before your ESD.

The ESD Procedure

  • The medical team will connect you to an IV that will sedate or anesthetize you, depending on the location of the lesion.
  • Depending on the location of the lesion, the endoscope will enter via the mouth or the rectum.
  • Your doctor will view the resulting images on a monitor in the room.
  • Once the tumor is located, the physician will delineate its border with an endoscopic tool.
  • In order to protect nearby, healthy tissue, your doctor will inject a fluid into the layer below the lesion that allows it to be separated from the muscle wall.
  • The physician will sever the lesion’s connection to the gastrointestinal tract wall, then cut away the lesion altogether, using an electrosurgical knife that resects and seals in one action.
  • The doctor will remove the lesion from your body.
  • Your medical team will have the excised tissue examined to confirm that the growth has been taken out completely.

After the procedure, when you have recovered from the sedative, the physician will talk to you about the results of the ESD. Some patients leave the same day, while others may have to spend one night in the hospital.

RFA

RFA stands for “radiofrequency ablation.” As part of upper endoscopy or endoscopic ultrasound, RFA employs pulses of high-frequency electricity to generate heat that eradicates precancerous tissue seen in conditions such as Barrett’s esophagus. It is generally conducted as an outpatient procedure. At City of Hope, gastroenterologists use the advanced Barrx Halo system, which research findings show to be an especially effective tool for RFA.

Before Your RFA

  • Make sure your physician knows about any allergies you may have. In particular, if you have a sensitivity to iodine, you should disclose it.
  • Follow your physician’s direction about any medicines you may be taking.

Day of Your RFA

The evening before your procedure, refrain from eating or drinking after midnight.

You should arrive one to two hours before the beginning of your procedure, bringing along an adult who can ensure that you get home safely. You will be asked to register and go over your medical history before your RFA.

The RFA Procedure

  • The medical team will connect you to an IV that will sedate you for the procedure.
  • An endoscope will be placed into your mouth and moved downward until it’s positioned by the precancerous tissue.
  • The doctor will use electrodes at the end of the scope to burn off the precancerous tissue.
​After the procedure, when you have recovered from the sedative, the physician will talk to you about the results of the RFA and dietary restrictions for the following week.