Gastrointestinal Interventional Endoscopy: Services Offered
At the University of Chicago Center for Endoscopic Research and Therapeutics, our highly skilled team specializes in the diagnosis and treatment of complex gastrointestinal diseases. For many patients, we perform interventional endoscopy to prevent the need for colectomy--full or partial removal of the colon.
Our team offers a range of advanced interventional endoscopy procedures, including:
Probe-Based Confocal Laser Endomicroscopy (pCLE)
Endoscopic Ultrasound (EUS)
Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic Mucosal Resection (EMR)
Targeted Endoscopic-Guided Therapy for Pancreatic and Esophageal Cancers
A Precise Technique for Early Detection and Treatment of Cancer
We are the only hospital in the region offering probe-based confocal laser endomicroscopy (pCLE)--an advanced technique for early detection and treatment of cancerous and precancerous conditions. To perform this technique, our physicians use one of the world's smallest microscopes to view tissue cells in the digestive tract. Without removing a tissue sample from the patient's body, we are able to accurately pinpoint cancerous and noncancerous cells in organ tissue. If detected, cancerous tissue may be removed immediately during the endoscopic procedure. Or, in more complex cases, doctors may send a patient directly to surgery.
A Valuable Tool to Stage Cancers and Evaluate Other Conditions
In endoscopic ultrasound, the endoscope is fitted with a special device--called a transducer--that emits and detects sound waves as they bounce off tissue. The transducer sends this data to a computer to create an image of the tissue. In EUS-guided fine needle aspiration, the physician uses EUS to provide direction for collection of a tissue sample for examination in a lab.
Endoscopic ultrasound is most commonly used to diagnose and stage cancers. EUS is very effective at visualizing the individual layers of the gastrointestinal tract--aiding in the detection of precancerous lesions and early-stage cancerous lesions of the esophagus, stomach, and rectum. EUS also can be used to detect tumors present in other organs, such as the pancreas, lungs, and bile duct. EUS also can help physicians determine if cancer has spread to nearby lymph nodes. Noncancerous conditions, such as gallstones and pancreatitis, can be evaluated with EUS.
EUS helps our physicians plan the best treatment approach. EUS can help determine if a tumor can be successfully removed with endoscopic, laparoscopic, or conventional surgical techniques, thus sparing patients from unnecessary procedures.
At the Center for Endoscopic Research and Therapeutics, our physicians are performing EUS on some patients at high risk for cancer--with the hope of detecting problems early, at a more treatable stage. Patients with Barrett's esophagus and those with multiple family members with pancreatic or colon cancer can benefit from this proactive screening approach. Our endoscopists work closely with specialists in the University of Chicago Cancer Risk Clinic to identify patients with a genetic predisposition to cancers that can be detected with EUS.
For Evaluation and Treatment of Conditions of the Pancreas and Biliary Tree
An endoscopic retrograde cholangiopancreatography (ERCP) combines the use of an endoscope and X-rays to help physicians visualize problems such as tumors, blockages, or gallstones. ERCP can be used to treat conditions that would otherwise only be treatable with surgery. During the ERCP, the physician can insert special instruments to:
- Take tissue samples
- Remove or crush gallstones
- Drain cysts
- Place stents (hollow mesh tubes) to widen and prop open narrowed bile ducts
Treating Bleeding Problems in the Gastrointestinal Tract
There are many reasons why bleeding can occur within the gastrointestinal tract. There could be enlarged blood vessels (varices), abnormal vascular growths (arteriovenous malformations), radiation-induced inflammation, or post-procedure bleeding after removal of tissue.
There are a variety of ways that bleeding can be treated using endoscopic techniques. At the Center for Endoscopic Research and Therapeutics, our gastrointestinal endoscopists can insert small clips that close areas where bleeding occurs. Other options include using special tools to burn affected tissue, thus closing off the bleeding vessels.
For Removal of Early Stage Cancers and for Treating Barrett's Esophagus
Endoscopic mucosal resection (EMR) involves the use of special tools that lift and cut abnormal lesions or tumors from the superficial lining (mucosal and submuscosal layers) of the gastrointestinal tract. At the Center for Endoscopic Research and Therapeutics, we use EMR to diagnose and treat early stage cancers and precancerous lesions of the esophagus, colon, and duodenum.
Today, EMR provides an effective alternative to surgery for treatment of some conditions. For example, for superficial esophageal cancer, a patient may undergo endoscopic treatment and potentially avoid surgical removal of the esophagus and reconstruction of the digestive tract. Compared to surgery, recovery after EMR is quicker, and there is a lower risk for complications.
For patients with Barrett's esophagus--a condition that can progress to esophageal cancer--EMR can remove areas of pre-cancerous tissue without the need for complete removal of the esophagus. » Learn more about Barrett's esophagus care
Endoscopic mucosal resection offers several benefits over traditional surgical techniques, including:
- Faster recovery
- Less bleeding
- Shorter or no hospital stay
- Less pain
- Fewer complications
If surgery is recommended, but cannot be performed because of age or other concerns, EMR may be considered as an alternative therapy.
At the Center for Endoscopic Research and Therapeutics, our physicians are recognized experts in EMR, and are developing ways to improve this advanced treatment approach. Our specialists perform a high volume of cases each year, making them among the most experienced physicians to perform EMR in the United States.
Relieving Cancerous Obstructions of the Bile Duct, Esophagus, Duodenum, and Colon
Some cancers can obstruct the normal openings within the gastrointestinal tract. Obstructions may cause great discomfort and interfere with digestive function. To relieve obstructions, our physicians use endoscopes to insert special expandable mesh hollow tubes, called stents. The stent is placed within the narrowed opening and released to expand the area, thus relieving the obstruction. Enternal stenting does not cure the cancer; it is used to improve symptoms and quality of life.
A Camera in Pill Form
Thanks to innovations in technology, cameras can be inserted into very small, pill-sized capsules. After the patient swallows this capsule, the tiny camera takes thousands of pictures as it travels through the gastrointestinal tract. The camera transmits these images to a special recording device using wireless technology. These images can be transformed into a video, so the physician can see images of the full gastrointestinal tract. Capsule endoscopy is a safe, effective diagnostic procedure. Patients report that the capsule does not cause discomfort.
While capsule endoscopy uses no traditional endoscopes at all, it serves as a valuable tool for endoscopists. Capsule endoscopy is especially useful for its ability to image the small intestine, an organ that has been difficult to reach using endoscopes. Capsule endoscopies are considered when physicians suspect that an abnormality occurs in an area not easily reached with a traditional endoscope. Capsule endoscopies are only done for diagnostic purposes, they cannot treat disease.
A New Procedure to Visualize and Treat Conditions of the Small Intestine
Until recently, it was difficult for physicians to examine the entire inside of the small intestine. While capsule endoscopy (see above) allows physicians to take images inside the small intestine, the capsule cannot be maneuvered to specific locations, and it cannot be used to take biopsies or treat disease. New types of endoscopes--called double balloon endoscopes--have made this possible. University of Chicago physicians use double-balloon enteroscopy to diagnose and treat a wide array of disorders of the small bowel, including bleeding problems, cancers, malabsorption disorders, and inflammation.
The double balloon endoscope allows our physicians to:
- Visualize the entire small intestine
- Remove tissue for biopsy
- Remove or burn small tumors and abnormal growths
- Treat bleeding problems
- Treat abnormal blood vessels at risk for rupture
Before this technology was available, surgery was the only alternative method to treat these conditions of the small intestine.
University of Chicago interventional endoscopists are using advanced techniques to deliver anti-cancer drugs directly into tumors of the esophagus and pancreas. Our physicians use endoscopic ultrasound to visualize the location of a tumor so that the drug can be injected properly. This drug is an experimental medicine that combines gene therapy and radiation therapy techniques to kill cancerous cells. The Center for Endoscopic Research and Therapeutics is one of a handful of centers in the nation to participate in clinical trials of this approach. » Learn more