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Advanced Endoscopy, also known as interventional endoscopy, is a specialized procedure that is used to diagnosis and treat complex pancreatic and biliary disorders and potentially cancerous tissue in the gastrointestinal tract. Advanced endoscopy is performed by gently inserting a scope down the patient’s throat to examine the area of interest in the digestive tract, but unlike a regular endoscopy, it also involves the use of other equipment to open blockages, drain fluid, take tissues samples or destroy precancerous tissue. These minimally invasive procedures do not require incisions so they generally result in faster recovery, less pain and patients typically return home the same day.

We have highly specialized and experienced physicians who perform a variety of advanced endoscopy procedures. They evaluate patients with a range of symptoms and diseases including those with pancreatitis, biliary strictures and stones, unexplained abdominal pain, or anything gastrointestinal that seems abnormal. They work closely with referring physicians to promptly perform procedures, consultations, and discuss management options. For complex cases, they use a multidisciplinary approach by consulting with other specialists and surgeons.

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Examples of Advanced Endoscopy Procedures

Diagnostic and Therapeutic Endoscopic Ultrasound

Endoscopic Ultrasound (EUS) is an advanced endoscopic technique which combines the power of regular endoscopy with an ultrasound to allow for effective imaging of the digestive tract and surrounding organs and tissues, as well as the chest and abdomen. This procedure uses an endoscope with high-frequency sound waves to produce detailed images of the lining and walls of your digestive tract, pancreas, liver and lymph nodes. This procedure is used to diagnose, evaluate and determine the stage of several gastrointestinal diseases including cancer, pancreatic masses, pancreatic cysts and liver disease. Additionally, the use of EUS guided fine needle biopsy allows the safe and effective collection of tissue from difficult to reach areas.

Therapeutic EUS is rapidly expanding with a variety of therapeutic applications such as:

  • Drainage of pancreatic fluid collections
  • Drainage of other abnormal fluid collections and abscess in the abdomen
  • Fully internal EUS-guided bile duct and gall bladder drainage
  • Precise targeting and direct delivery of medications into the pancreas, liver and other adjacent organs
  • Nerve block for pain management in pancreatic diseases
  • Treatment of subepithelial (located beneath an epithelial layer) lesions and gastric varices

Endoscopic Mucosal Resection (EMR)

This procedure uses a specialized endoscope to insert dye into the bile ducts (tubes that drain bile from the liver and gallbladder into the intestine) and pancreatic duct (tube that drains pancreatic juice into the intestine) under X-ray guidance. The dye allows the bile ducts, gallbladder, and the pancreatic duct to be seen in the X-rays. Several therapies are available through ERCP if a defect is identified. Common conditions in which ERCP is performed is for the removal of common bile duct stones, placement of stents in pancreatic cancer and bile duct cancers and treatment of chronic pancreatitis.

Endoscopic Submucosal Dissection (ESD)

The Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure performed to remove cancer (tumors) from the deeper layers of the gastrointestinal tract. This procedure has many benefits for those diagnosed with esophageal or gastric cancer.

Per Oral Endoscopic Myotomy (POEM)

During a Peroral Endoscopic Myotomy (POEM) procedure, a flexible tube, or endoscope, is inserted through the mouth and passed into the esophagus. Then, it enters the middle wall layer creating a tunnel down to the sphincter muscle and into the wall of the stomach. When this tract is made, the muscle layer can then be cut safely to help alleviate the spasm that is causing symptoms, thus allowing food to pass through easier.

Yale School of Medicine

Yale New Haven Health is proud to be affiliated with the prestigious Yale University and its highly ranked Yale School of Medicine.