Pancreatic & Biliary Disorders

Overview:

Bile duct leak stenting is an endoscopic treatment used to seal bile leaks that can occur after gallbladder or liver surgery. A small stent is placed through endoscopic retrograde cholangiopancreatography (ERCP) to divert bile flow and allow the leak site to heal naturally, avoiding open surgery.

Conditions Treated:

• Bile leaks after cholecystectomy or liver resection
• Post-traumatic bile duct injuries
• Minor bile duct disruptions or strictures

Overview:

Capsule endoscopy is a noninvasive diagnostic procedure that uses a small, pill-sized camera to capture images of the digestive tract, especially the small intestine, which is difficult to view with standard endoscopy. The capsule transmits thousands of pictures to a recording device as it passes naturally through the GI tract, helping identify bleeding, inflammation, or other abnormalities.

Conditions Evaluated:

• Unexplained gastrointestinal bleeding
• Crohn’s disease of the small bowel
• Celiac disease (to assess mucosal damage)
• Small bowel tumors or polyps
• Unexplained abdominal pain or anemia

Overview:

Endoscopic drainage uses ultrasound-guided tools to access and drain abnormal fluid collections, such as pancreatic pseudocysts or abscesses, through the stomach or intestinal wall. A stent or catheter may be placed for continued drainage. This minimally invasive approach helps avoid open surgery and speeds recovery.

Conditions Treated:

• Pancreatic pseudocysts
• Walled-off pancreatic necrosis
• Abdominal abscesses near GI tract
• Post-surgical fluid collections

Overview:

EMR and ESD are advanced endoscopic procedures used to remove abnormal or early-stage cancerous tissue from the lining of the digestive tract without surgery. EMR removes smaller, superficial lesions in pieces, while ESD allows en bloc (single-piece) removal of larger or deeper lesions. Both help preserve healthy tissue and reduce the need for open surgery.

Conditions Treated:

• Early gastric, esophageal, or colorectal cancer
• Large or precancerous polyps
• Barrett’s esophagus with dysplasia
• Superficial mucosal tumors

Overview:

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized endoscopic procedure used to diagnose and treat problems in the bile ducts, gallbladder, and pancreas. It combines endoscopy (using a flexible tube with a camera) with X-ray imaging.

During ERCP, a scope is guided through the mouth into the small intestine. A thin tube is then inserted into the bile or pancreatic ducts, and a contrast dye is injected to make these ducts visible on X-ray. This allows the doctor not only to see blockages or narrowing but also to treat them in the same procedure.

Conditions Treated:

• Bile duct stones (choledocholithiasis)
• Biliary strictures or obstructions
• Blockages from tumors (pancreatic, bile duct, or gallbladder cancer)
• Leaks in the bile or pancreatic ducts (after surgery or injury)
• Some cases of cholangitis (infection of the bile ducts)

Overview:

Endoscopic ultrasound (EUS) combines endoscopy (a thin flexible tube with a camera) and ultrasound imaging to create detailed pictures of the digestive tract and nearby organs. The scope is passed through the mouth or rectum, and an ultrasound probe at the tip provides high-resolution images from inside the body.

EUS can be used to both diagnose and treat various gastrointestinal conditions. As a diagnostic tool, it provides detailed imaging and enables tissue sampling. As a therapeutic tool, it offers minimally invasive alternatives to surgery for drainage, pain management, and targeted interventions. It’s commonly used to evaluate mediastinal lymphadenopathy of unknown origin, pancreatic masses, and biliary tract lesions.

Conditions Treated:

• Pancreatic cysts
• Pancreatitis (chronic and acute)
• Biliary strictures or obstructions
• Bile duct stones (choledocholithiasis)
• Primary sclerosing cholangitis
• Liver metastases
• Portal hypertension
• Gastrointestinal (GI) bleeding
• Unexplained abdominal pain or bloating
• Unexplained weight loss
• Colorectal cancer

Overview:

Feeding tube placement (gastrostomy or PEG tube) is a procedure that delivers nutrition directly into the stomach when oral intake is inadequate or unsafe. In pancreatic and biliary disorders, it supports patients with severe malnutrition, pain, obstruction, or impaired digestion from conditions such as pancreatitis, pancreatic cancer, or biliary obstruction. It does not treat the underlying disease but helps maintain nutrition and strength during illness or recovery.

Conditions Treated/Evaluated:

• Chronic pancreatitis
• Severe acute pancreatitis (prolonged course)
• Pancreatic exocrine insufficiency
• Pancreatic cancer
• Pancreatic pseudocyst with poor oral intake
• Post-pancreatic surgery nutritional failure (e.g., Whipple recovery)
• Cholangiocarcinoma (bile duct cancer)
• Obstructive jaundice with cachexia/malnutrition
• Primary sclerosing cholangitis (advanced disease)
• Severe biliary obstruction with weight loss
• Post-biliary surgery recovery (e.g., hepaticojejunostomy)

Overview:

The neurolytic celiac plexus block (NCPB), often referred to as celiac plexus neurolysis (CPN) or a celiac axis block, is a specialized procedure used in pain management. It involves intentionally damaging specific nerves in the abdomen. This is done to alleviate severe pain, particularly pain caused by pancreatic cancer or other cancers affecting the upper gastrointestinal tract.

Conditions Treated:

• Severe pain from pancreatic cancer
• Chronic pancreatitis pain unresponsive to medication
• Other upper abdominal malignancies causing nerve-related pain

Overview:

GI stent placement involves inserting a small mesh tube (stent) into a narrowed or blocked section of the esophagus, stomach, bile duct, or colon to keep it open. Performed endoscopically, it restores the passage of food or fluids and relieves obstruction caused by cancer, strictures, or scarring.

Conditions Treated:

• Esophageal or colorectal strictures
• Malignant obstructions (esophageal, biliary, duodenal)
• Post-surgical or inflammatory narrowing
• Biliary or pancreatic duct obstruction

Overview:

Peroral endoscopic myotomy, or POEM, is a minimally invasive endoscopic procedure to treat swallowing disorders caused by tight or spastic esophageal muscles. Using an endoscope inserted through the mouth, a small tunnel is created in the esophageal wall, and the inner muscle layer is cut (myotomy) to relax the esophagus and restore normal swallowing.

Conditions Treated:

• Achalasia
• Esophageal motility disorders (spasm, jackhammer esophagus)
• Zenker’s diverticulum (select cases)