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Advanced Endoscopy

Cleveland Clinic Digestive Disease Institute offers upper gastrointestinal endoscopy for esophageal, stomach and duodenal disorders, wireless capsule endoscopy and balloon-assisted enteroscopy for intestinal disorders, colonoscopy for diagnostic and therapeutic interventions for colonic disease and ERCP and endoscopic ultrasound for pancreatic and biliary disorders.

Endoscopic examinations allow physicians to diagnose and treat a variety of gastrointestinal disorders, including abdominal pain, vomiting, and bleeding from the intestinal tract. In addition, benign (non-cancerous) growths of the colon, which can lead to colon cancer, may be detected and removed with the help of an endoscope. Endoscopes are flexible tubes that can be passed through the mouth or rectum. They allow physicians to see and examine the surfaces of the esophagus (food pipe), stomach, intestine, and colon.

Our board certified, highly experienced gastroenterologists and surgeons collaborate on the various endoscopy procedures to achieve excellent medical outcomes for patients.

Balloon-assisted Enteroscopy

This is an examination of the small intestine using a flexible endoscope. At Cleveland Clinic, the technique for this examination uses an instrument with two balloons (double balloon enteroscopy or DBE) or one balloon (single balloon enteroscopy), which enables the endoscope to travel more easily deep into the small intestine. A thin endoscope is used, over which a flexible tube is also passed to help maintain the position of the endoscope. The endoscope relays images back the endoscopist on a TV screen. During the investigation, the endoscopist may need to take some tissue samples (biopsies) from the lining of your digestive tract for analysis, this is painless. Photographs and video recording may be taken for the records.

Why do I need to have an evaluation with a balloon-assisted enteroscopy?

You have been advised to undergo this investigation to try and find the cause for your symptoms, help with treatment and if necessary, to decide on further investigation.

Most patients having DBE will have already had another test such as a colonoscopy, X-ray, scan or small bowel capsule endoscopy examination.

Capsule Endoscopy
Identifying Diseases of the Small Bowel with Video Capsule Endoscopy

If you require an endoscopy, you may be a candidate for wireless capsule endoscopy. This new procedure, called Pillcam, is an alternative to traditional endoscopy. It is used in select patients to diagnose and evaluate esophagitis, gastroesophageal reflux disease (GERD), and Barretts esophagus. This procedure may not be covered by some insurance policies. For more information, call 216.444.1000.

A team of Cleveland Clinic gastroenterologists has also used Pillcam to identify diseases of the small bowel in approximately 800 patients since the technology was FDA-approved in 2001.

The Pillcam allows non-invasive visualization of the small intestine without many of the limitations associated with conventional endoscopic and X-ray procedures.

At The Cleveland Clinic, capsule endoscopy videos are view completely by a board-certified gastroenterologist specializing in capsule endoscopy. All videos are prescreened by a specially trained registered nurse. In a study performed at the Clinic and reported in the American Journal of Gastroenterology (2003; 98:2669-71), the nurses interpretations of studies were as accurate as the physicians interpretations.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a procedure used to diagnose diseases of the bile system, pancreas, and liver.

Cholangioscopy

A cholangioscopy is an examination of the bile ducts with the use of a special fiberoptic or digital endoscope for viewing the bile system during ERCP (Endoscopic Retrograde Cholangiopancreatography).

An examination of the bile ducts is often required for the appropriate diagnosis and management of patients with biliary diseases. ERCP is used as a primary method of diagnosing and treating many of these biliary diseases.

Cholangioscopy is a minimally invasive procedure in which your doctor will place a small tube down your throat into your esophagus and stomach until it reaches your bile duct system. The doctor will then place a small endoscope through the original tube to view your bile duct system. Small samples of the tissue may be collected to test for cancer (a biopsy) or stones may be fragmented for subsequent removal. A cholangioscopy may be an outpatient or inpatient procedure.

EUS (Endoscopic Ultrasound)

An ultrasound examination is common in medical practice. In this procedure, a device that generates sound waves is placed on the skin after a gel is applied to conduct the sound waves. The sound waves are harmless to human tissue, and allow examination of many organs of the body, including liver, kidneys, gallbladder, and ovaries. Sound waves are so safe they are often employed to assess babies as they develop in their mother’s wombs.

One limitation of ultrasound when employed from outside the body is that the sound waves may not always penetrate deeply enough to study structures of the gastrointestinal tract. A technology offered at Cleveland Clinic known as endoscopic ultrasound involves a special endoscope (an instrument used to view the inside of the body) with a sound wave transducer at the tip. As the endoscope is passed inside the body, it allows ultrasound examination of the esophagus, stomach, pancreas, bile duct, and colon with far greater detail than that which can be obtained from outside the body. This technology is very useful for accurately staging benign and malignant tumors of the gastrointestinal tract, so that appropriate therapy can be delivered.

Endoscopic ultrasound also allows detection of small nodules or masses within the pancreas, or subtle changes in the substance of the pancreas that might indicate chronic scarring or inflammation. Tissue samples may be obtained under direct vision from endoscopic ultrasound. Patients with difficult to diagnose abdominal pain may benefit from this type of detailed examination.

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Prabhleen Chahal, MD
 

Prabhleen Chahal, MD

Chahal, Prabhleen, MD
216.444.7000

Location(s): Cleveland Clinic Main Campus

Department: Gastroenterology and Hepatology

Specialties: Bile Duct Cancer, Bile Duct Diseases, Bile Duct Obstruction, Bile Duct Stones, Biliary Disorders, Duodenal Polyps, Esophageal Cancer more

Treats: Adults Only

Surgeon: No

Education: M.P. Shah Medical College & Hospital

 
Michelle Inkster, MD, PhD
 

Michelle Inkster, MD, PhD

Inkster, Michelle, MD, PhD
330.888.4000

Location(s): Twinsburg Family Health & Surgery Center, Cleveland Clinic Main Campus

Department: Gastroenterology and Hepatology

Specialties: Anemia, Celiac Disease (Celiac Sprue), Cirrhosis, Constipation, Diarrhea, General Gastroenterological Disorders, Hepatitis B more

Treats: Adults Only

Surgeon: No

Education: Case Western Reserve University School of Medicine

 
Sunguk Jang, MD
 

Sunguk Jang, MD

Jang, Sunguk, MD
216.444.7000

Location(s): Cleveland Clinic Main Campus, Strongsville Family Health Center

Department: Gastroenterology and Hepatology

Specialties: Barrett's Esophagus, Esophageal Cancer, Esophageal Diseases, Esophageal Stricture, Esophagus Disease, Gallbladder Cancer, Gallbladder Disease more

Treats: Adults Only

Surgeon: No

Education: University of Maryland Medical Center

 
Matthew D. Kroh, MD
 

Matthew D. Kroh, MD

Kroh, Matthew D., MD
216.444.6664

Location(s): Cleveland Clinic Main Campus

Department: General Surgery

Specialties: Bile Duct Diseases, Bile Duct Obstruction, Bile Duct Stones, Cancer, Carcinoid Syndrome, Esophageal Cancer, Esophagitis more

Treats: Adults Only

Surgeon: Yes

Education: The Mount Sinai School of Medicine

 
K. V. Narayanan Menon, MD
 

K. V. Narayanan Menon, MD

Menon, K. V. Narayanan, MD
216.444.7000

Location(s): Cleveland Clinic Main Campus

Department: Gastroenterology and Hepatology

Treats: Adults Only

Surgeon: No

Education: Coimbatore Medical College

 
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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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