Cleveland Clinic Digestive Disease and Surgery 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.

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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.

Bariatric Endoscopy Program

Bariatric Endoscopy expands the treatment options for patients with obesity: Endoscopic Bariatric and Metabolic Therapies (EBMTs) are non-surgical, minimally invasive procedures performed using an endoscope without any scars or incisions. By using an endoscope, which is a small flexible tube with a camera that is introduced through the patient’s mouth into the stomach and small bowel; we are able to deliver weight loss therapies safely, leading to excellent outcomes and fast recovery.

Cleveland Clinic’s Bariatric Endoscopy program offers a comprehensive range of incision-less endoscopic procedures to address various needs of patients suffering from obesity such as:

  1. Primary therapies for patients with obesity.
  2. Secondary treatment when patients have regained weight after bariatric surgery.
  3. To address complications stemming from bariatric surgery.

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.


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.

Peroral Endoscopic Myotomy (POEM)

Peroral Endoscopic Myotomy (POEM) is an endoscopic procedure used to treat swallowing disorders, most commonly for Achalasia. POEM is a relatively new procedure that uses endoscopic technology and stands for Peroral Endoscopic Myotomy. This is an in-patient procedure and can take between one to three hours to complete.

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