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The Advanced Therapeutic Endoscopy Program at the Center for Digestive Health offers a multidisciplinary approach to patients with complex gastrointestinal disorders requiring advanced endoscopic procedures. Patients requiring these highly specialized procedures can expect that their care will be closely coordinated with their referring physicians as well as with medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists when appropriate.
Some of the disorders that frequently require advanced endoscopic procedures in their diagnosis or treatment include: complications of gallstone disease, bile duct stones, bile duct strictures, biliary cancers, pancreatic cancer, pancreatic cysts, chronic pancreatitis, early cancers of the gastrointestinal tract, large polyps of the colon, stomach, or small intestine, Barrett’s esophagus and esophageal cancer, submucosal lesions of the gastrointestinal tract, and bowel obstructions.
State-Of-The-Art Endoscopic Technology
Our interventional gastroenterologists utilize state-of-the-art endoscopic technology, which is often not available at community-level hospitals. All of our participating interventional gastroenterologists (aka, “therapeutic endoscopists”) have received advanced training beyond that of routine gastroenterology fellowship training in order to master these complex procedures. Most of these procedures provide a minimally invasive means for both diagnosing and treating complex gastrointestinal problems.
Procedures which our Center offers include:
- Biliary radiofrequency ablation for the palliation of non-resectable cholangiocarcinoma and malignant bile duct strictures
- Endoscopic suturing
- Endoscopic ultrasound (EUS)
- EUS with fine needle aspiration (FNA) or celiac plexus block/neurolysis
- Radiofrequency ablation of Barrett’s esophagus (BARRX®)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Cholangioscopy (SpyGlass® Direct Visualization System)
- Complex polypectomy
- Endoscopic mucosal resection (EMR)
- Metal stenting of obstructions of the esophagus, colon, stomach, and small intestine
- Esophageal dilation
- Pancreatic pseudocyst drainage
- Percutaneous endoscopic gastrostomy (PEG) or jejunostomy (PEJ) feeding tubes
- High-definition endoscopy with narrow band imaging (NBI)
- Stretta anti-reflux therapy
Clinical Endoscopic Research and Education
As part of the Center’s mission to improve patient care and remain on the cutting edge of technology, our gastroenterologists are continually involved in clinical endoscopic research and education. All procedures, however, are performed only by the attending gastroenterologist, without trainee involvement. Our gastroenterologists are often among the first to trial new equipment before or right after it becomes commercially available, and they have published numerous studies in the most prestigious medical journals in gastroenterology, as well as published numerous book chapters.
Rogart JN, Loren DE, Signu BS, Kowalski TE. Cyst Wall Puncture and Aspiration during EUS-guided Fine Needle Aspiration May Increase the Diagnostic Yield of Mucinous Cysts of the Pancreas. Journal of Clinical Gastroenterology 2011 Feb;45(2):164-9.
Rogart JN, Aslanian HR, Siddiqui UD. Narrow Band Imaging to Detect Residual or Recurrent Neoplastic Tissue During Surveillance Endoscopy. Digestive Diseases and Sciences 2011;56:472-478.
Rogart JN. The Plastic Biliary Stent: An Obsolete Device for Managing Pancreatic Cancer? (editorial) Journal of Clinical Gastroenterology 2010 Jul;44(6):389-90.
Lee DS, Kwok K, Gannon C, and Rogart J. Busulfan-associated asymptomatic type I Mirizzi’s Syndrome. American Journal of Gastroenterology 2010;105(S1):AB543; Presentation at ACG Annual Meeting 2010, San Antonio.
Rogart JN and Loren DE. Balloon Sphincteroplasty and Post-Sphincterotomy Balloon Dilation. In: Monkemuller K, Miguel Muñoz-Navas, Mel Wilcox and Todd Baron, eds. Interventional Therapeutic Endoscopy (Karger Publishing, Basel, Switzerland, 2010)
Loren, DE, Kavanaugh B, Kowalski TE, Etemad B, and Rogart JN. Section X: Pancreas and Biliary Diseases. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Review and Assessment, 9th ed. DiMarino AJ, ed. (Saunders, 2010)
Niedenthal A, Dancygier H, Rogart J. Endoscopic Ultrasonography (chapter 42). In: Dancygier H, ed. Clinical Hepatology: principles and practice of hepatobiliary diseases (Springer, 2010).
Rogart J, Stenscheke F. Cholangioscopy (chapter 41). In: Dancygier H, ed. Clinical Hepatology: principles and practice of hepatobiliary diseases (Springer, 2010).
Stenschke F, Dancygier H, Rogart J. Endoscopic Retrograde and Percutaneous Transhepatic Cholangiography (chapter 40). In: Dancygier H, ed. Clinical Hepatology: principles and practice of hepatobiliary diseases (Springer, 2010).
Rogart JN, Israel G, Jamidar P. Cystic duct stumpyema managed endoscopically. Clinical Gastroenterology & Hepatology 2009 Aug;7(8):e43-4.
Rogart JN and Aslanian HR. Massive hemobilia after transjugular liver biopsy treated endoscopically and angiographically. Clinical Gastroenterology & Hepatology 2008;6(12):A30.
Rogart JN, Jain D, Siddiqui UD, Oren T, Lim J, Jamidar P, Aslanian H. Narrow band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointestinal Endoscopy 2008;68(6):1136-45.
Rogart JN, Siddiqui UD, Jamidar PA, Aslanian HR. Fellow participation may increase adenoma detection rate during colonoscopy. American Journal of Gastroenterology 2008;103:2841–2846.
Rogart JN, Boghos A, Rossi F, Al-Hashem H, Siddiqui UD, Jamidar P, Aslanian H. Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center. Gastrointestinal Endoscopy 2008;68(4):676-682.
Rogart JN, Nagata J, Loeser CS, Roorda RD, Aslanian H, Robert ME, Zipfel WR, and Nathanson MH. Multiphoton imaging can be used for microscopic examination of intact human gastrointestinal mucosa ex vivo. Clinical Gastroenterology & Hepatology 2008;6(1):95-101.
Rogart JN, Perkal M, Nagar A. Successful multi-modality endoscopic treatment of gastric outlet obstruction caused by an impacted gallstone (Bouveret's syndrome). Diagnostic and Therapeutic Endoscopy 2008;2008:471512.
Rogart J, Greenwald A, Rossi F, Barret P , and Aslanian H. Aortoesophageal fistula following polyflex stent placement for refractory benign esophageal stricture. Endoscopy 2007;39:E321-22.
Rogart JN and Siddiqui UD. Inlet patch presenting with food impaction due to peptic stricture. Clinical Gastroenterology & Hepatology 2007;5(9):e35-6.