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Surgical Endoscopy

Overview

Cleveland Clinic Florida’s Digestive Disease Institute offers upper gastrointestinal endoscopy for esophageal, stomach and duodenal disorders, and colonoscopy for diagnostic and therapeutic interventions for colonic disease. Our board certified, highly experienced general surgeons, colorectal surgeons and gastroenterologists collaborate on the various surgical endoscopy procedures to achieve excellent medical outcomes for patients.

You may schedule an appointment online or by calling 877.463.2010.

Gastroparesis
Gastroparesis

Also called delayed gastric emptying, gastroparesis is a disorder in which the stomach takes too long to empty its contents. It often occurs in people with Type 1 or Type 2 diabetes. Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Because blockage of the stomach or small bowel can produce the same symptoms as gastroparesis, an endoscopy or x-ray study must be performed initially.

Endoscopic treatment options for gastroparesis:

  • Insertion of feeding tubes
  • Placement of temporary gastric pace-makers


Hiatal Hernias and Gastroesophageal Reflux Disease (GERD)
Hiatal Hernias and Gastroesophageal Reflux Disease (GERD)

There are two main types of hiatal hernias:

  • Sliding Hiatal Hernia - the most common type, it occurs when the junction of the stomach and the esophagus herniates (slide) up into the chest through the hiatus.
  • Paraesophageal Hernia - less common, but it is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, placing it next to the esophagus. Although this type of hernia can exist without any symptoms, the danger is that the stomach can become "strangled," which means its blood supply is cut off.

    Often, people with a hiatal hernia also have heartburn or gastroesophageal reflux disease (GERD). Although there is a link, one condition does not necessarily cause the other, because some people can have a hiatal hernia without having GERD, and vice versa.

    A hiatal hernia can be diagnosed with a barium study, a special X-ray that allows visualization of the esophagus, or with esophagoscopy, a procedure in which the upper digestive system is examined with an endoscope (long-thin flexible instrument).

    If the hiatal hernia is complicated by severe symptoms of GERD, trouble swallowing, pain, gastrointestinal bleeding with anemia, and recurrent pneumonias, or if the symptoms and tests suggest that a paraesophageal hernia (part of the stomach squeezes through the hiatus) may be present, surgery may be recommended. The endoscopy can provide an accurate diagnosis and treat the bleeding area, when present.

Gastroesophageal Reflux Disease (GERD) / Barrett’s Esophagus
Gastroesophageal Reflux Disease (GERD) / Barrett’s Esophagus

People with severe, chronic esophageal reflux may need surgery to correct gastroesophageal reflux disease (GERD) if their symptoms are not relieved by medications that reduce acid in the stomach, or by lifestyle changes, including losing weight, avoiding certain foods and quitting smoking. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis, esophageal ulcers, bleeding, scarring of the esophagus or Barrett’s esophagus.

Laparoscopic antireflux surgery is used in the treatment of GERD when medicines are not successful. Laparoscopic antireflux surgery is a minimally-invasive procedure that corrects gastroesophageal reflux by reducing the hiatal hernia, reconstructing the esophageal hiatus and reinforcing the lower esophageal sphincter.

Barrett’s Esophagus
Barrett’s Esophagus

Barrett’s esophagus is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. A premalignant condition, Barrett's esophagus may lead to the development of cancer of the esophagus in a small number of patients.

Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus. Barrett’s esophagus is diagnosed using a procedure called an upper endoscopy to examine the esophagus and remove tissue samples.

Similar to the treatment of GERD, Barrett’s esophagus may be treated using laparoscopic anti-reflux surgery. Ablation therapy may be used as a way to damage the lining of the esophagus with heat or laser light. This causes normal cells to develop because of a decrease in acid production. This type of therapy holds great promise for the future, although it is still in the testing phase.

Endoscopy for Bariatric Surgery Patients
Endoscopy for Bariatric Surgery Patients

One of the most common complications of gastric bypass surgery for weight loss is narrowing (stricture) at the junction between the gastric pouch and the intestine. Symptoms include vomiting, nausea, and pain. The diagnosis is made either by radiologic swallow test or upper endoscopy. At the time of endoscopy the narrowing can be treated by balloon dilatation in a high percentage of cases. Sometimes multiple sessions are required.

Bleeding ulcer after bariatric surgery can also be effectively treated by upper endoscopy. Endoscopy is also utilized to diagnose and treat ulcer of the stomach and small intestine that can develop after gastric bypass and sleeve gastrectomy. Symptoms can include pain, gastrointestinal bleeding with anemia, nausea and vomiting. Gastric banding can result in migration into the gastrointestinal tract (erosion). The diagnosis is made by endoscopy. In some cases, the eroded band can be removed endosopically as well.

Cleveland Clinic Florida routinely participated to clinical trials for newer endoscopic devices for revision after gastric bypass in patients with weight regain.

Biliary Tract
Biliary Tract

Transcystic Duct Common Bile Duct Exploration - The common bile duct (CBD) is a tube connecting the liver, gallbladder, and pancreas to the small intestine that helps deliver fluid to aid in digestion. The CBD exploration is a procedure used to see if a stone or other obstruction is blocking the flow of bile from the liver and gallbladder to the intestine.

Surgeons at Cleveland Clinic Florida use laparoscopic transcystic CBD techniques to treat patients with common duct stones. Treatment can be done in one session. The minimally invasive technique is the fastest, safest and least invasive initial approach to CBD exploration compared with laparoscopic choledochotomy.

Choledochotomy
Choledochotomy

A choledochotomy is a surgical approach, in which the common bile duct is opened, to search for or to remove stones within it.

Transremnant ERCP
Transremnant ERCP

The endoscopic access to the biliary tree via the gastrointestinal tract is limited after gastric bypass surgery. The combination of a laparoscopic and endoscopic approach through the part of the stomach disconnected from the alimentary tract allow for very successful diagnostic and therapeutic interventions in this category of patients. Common problems in the biliary tree include stones (choledocholithiasis), biliary dyskinesia and occasionally malignancies.

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