Endoscopic Services
The Paul May and Frank Stein Interventional Endoscopy Center at California Pacific Medical Center offers a wide variety of endoscopic expertise.
Barrett's Esophagus
Barrett’s esophagus is a disorder of the esophagus (swallowing tube) in which the normal inner lining of the esophagus changes to resemble the lining of the stomach and the intestine (specialized intestinal metaplasia). This change is in response to chronic irritation from the reflux of gastric and small bowel contents into the esophagus.
Barrett’s esophagus is a premalignant condition and can lead to the development of esophagus cancer, known as adenocarcinoma. Fortunately, the majority of patients with Barrett’s esophagus will not develop cancer and the rate of developing cancer is only about .5% each year.
Cancer in Barrett’s esophagus generally develops in a step-wise fashion, starting with low-grade dysplasia and progressing to high-grade dysplasia and finally to cancer. With endoscopic surveillance of Barrett’s, it’s usually possible to detect the transformation towards cancer before cancer develops.
Bilio-pancreatic Endoscopy
Cholangio-pancreatoscopy
- Access to bile and pancreatic ducts by endoscopic retrograde (ERCP) and EUS-guided anterograde (EACP) routes
- 'Ductoscopes' for endoscopy-guided diagnosis and therapy
Complex interventions in the biliary and pancreatic ducts relating to the management of stone disease, benign or malignant strictures, and sphincter of Oddi dysfunction are performed. Endoscopy of the bile duct (cholangioscopy) and pancreatic duct (pancreatoscopy) are used in selected cases for diagnosis and therapy.
Endoscopic Ultrasonography
- Evaluation of submucosal tumors, extraintestinal masses and lymph nodes
- Staging of tumors (esophagus, stomach, pancreas, bile duct, colo-rectal)
- Fine needle aspiration and biopsy
- Transenteric drainage of fluid collections (pseudocysts, abscesses)
- Transenteric gallbladder, bile and pancreatic duct drainage
Using a tiny ultrasound transducer incorporated at the endoscope tip, endoscopic ultrasonography (EUS) enables the endoscopist to see into the bowel wall and surrounding organs, such as the pancreas and bile duct, with high spatial resolution. EUS is used to stage gastrointestinal and pancreatic cancers and to diagnose diseases of the bile duct and pancreas. A spectrum of interventional applications such as fine-needle aspiration, celiac ganglion blockade, and pseudocyst drainage are routinely performed.
Enteroscopy
Push-pull" enteroscopes equipped with balloons and special over-tubes to enable endoscopic access to the small bowel.
Esophago-gastro-duodenoscopy (EGD) and Colonoscopy
- Magnification (optical zoom) and enhanced (narrow- and multi-band) imaging for early detection of neoplasia
- 'Therapeutic' endoscopes (large- and double-channel)
Treatment of Bleeding (Hemostasis)
A spectrum of hemostatic techniques are used to arrest bleeding from varices and non-variceal lesions (ulcers, arteriovenous malformations, vascular ectasias, diverticula, tears). Novel hemostatic techniques include hemoclipping, endolooping, and argon plasma coagulation.
Early Cancer Detection & Treatment (Mucosectomy)
Esophago-gastro-duodenoscopy (EGD) and Colonoscopy
- Magnification (optical zoom) and enhanced (narrow- and multi-band) imaging for early detection of neoplasia
- 'Therapeutic' endoscopes (large- and double-channel)
Special "zoom" magnification endoscopes are used in conjunction with chromoendoscopy (dye staining) to improve detection of pre-malignant and early malignant lesions in the upper and lower gastrointestinal tract. In suitable candidates, mucosectomy is performed to curatively treat cancers of the esophagus, stomach and colon as well as high risk "Barrett's esophagus," a premalignant condition caused by chronic gastroesophageal reflux disease.
Endoscopic Anti-reflux Techniques
A novel endoscopic treatment (Gatekeeper reflux-repair system) is used for the treatment of chronic gastroesophageal reflux disease. The treatment is FDA approved. We are evaluating this treatment in the context of an investigative protocol.
Paul May and Frank Stein Interventional Endoscopy Center
California Pacific Medical Center
The Paul May and Frank Stein Interventional Endoscopy Center in San Francisco features some of the top-rated gastrointestinal disease doctors and interventional endoscopy specialists in the San Francisco Bay Area, Marin county and Northern California who use the most successful GI non-surgical treatment options available.
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