Procedure Articles

Collection of Procedure Articles

All documents are in Adobe PDF format.

Bravo/pH Testing
Bravo test involves endoscopically placing a pH-acid sensor in the distal esophagus.  The sensor transmits information about acid reflux in the esophagus to a receiver worn by the patient.  This enables the physician to correlate and document the patient’s symptoms with the degree of acid reflux into the esophagus.

Endoscopic Ultrasound (EUS)
EUS is a specialized endoscopic procedure used to diagnose disorders and stage cancers of the gastrointestinal tract and surrounding organs such as the esophagus, stomach, rectum, lung, pancreas, bile duct, and gallbladder. EUS requires specialized training and uses a special endoscope with an ultrasound probe at tip to allow examination of organs around the digestive tract.

EUS can rarely (1 in 2000) result in complications such as reactions to the medications, making a hole in the digestive wall (perforation), and bleeding. While these complications are not common, in certain cases they can be very serious and may require urgent treatment, an extended hospitalization, or even an operation. When FNA is performed, the following complications occur more often but are still uncommon (1 in 200). FNA performed on the pancreas can cause pancreatitis (inflammation of the pancreas). Pancreatitis treatment includes hospitalization, observation, rest, IV fluid, and medication for abdominal pain. It usually resolves spontaneously in a few days. Infection can occur with FNA when fluid is aspirated from a cyst, however; antibiotics during and after the procedure decrease this risk.

Endoscopic Ultrasound Therapy
Fine Needle Aspiration- 
The EUS may require FNA (Fine Needle Aspiration). FNA is a biopsy technique (through the endoscope channel) which uses a very small needle that can be passed through the digestive wall to sample lesions such as masses, cysts or lymph nodes.

Staging and Diagnosing Cancers

Evaluating cysts of the pancreas

Evaluation of Chronic Pancreatitis

Detecting Common Bile Duct Stones

Celiac Plexus Block/Neurolysis
Used to treat uncontrollable pain caused by pancreatic cancer or chronic pancreatitisthat is not able to be controlled by medications

ERCP (endoscopic retrograde cholangiopancreatography)
A procedure requiring special training which uses a special endoscope and xray simultaneously. The purpose is to diagnose and treat disorders of the bile duct and/or pancreatic duct.  Dye is injected into the duct directly to potentially diagnose the disorder. The patient is sedated with the assistance of an anasthesiologist. Click here for more information.

ERCP with sphincter of oddi manometry
A procedure using ERCP and a special pressure catheter to measure pressures of a sphincter muscle which regulates flow of pancreatic juice or bile.  It can be useful to diagnose sphincter of oddi dysfunction (SOD) which may cause gallbladder like pain in patients without a gallbladder.  Patients with multiple episodes of unexplained pancreatitis, abdominal pain and abnormal liver enzymes, or unexplained abdominal pain and enlarged bile duct(s) may also need this procedure.

ERCP with cholangioscopy
A procedure which uses ERCP and then utilizes a very small fiber optic scope that can be inserted into the bile duct or pancreatic duct.  It may allow better images of the duct after dye has been inserted during ERCP.  These higher quality views can aid in the diagnosis of disorders not clearly seen by ERCP alone.

Esophageal Motility Testing
Esophageal Motility involves placing a small catheter into the esophagus to measure the motility and contractions present in the esophagus.  This helps in the diagnosis the cause of non-cardiac chest pain, as well as swallowing disorders.  Disorders such as esophageal spasm, achalasia, reflux, dysphagia (or difficulty swallowing), and Scleroderma involving the esophagus can be diagnosed with the help of this procedure.

Liver Biopsy
Liver biopsies are usually preformed in the Radiology Department of the hospital.  An area on the right chest wall is optimally identified with ultrasound guidance.  The area is then anesthetized, and the biopsy is the obtained using a needle.  The tissue is the examined under a microscope by a Pathologist.  This method helps in the evaluation of abnormal liver tests and diagnosis of liver diseases such as Hepatitis, Cirrhosis and malignancies.