Over the last few decades, endoscopy has evolved from mostly a diagnostic tool to one of the most rapidly growing interventional therapies in Medicine. At El Camino Hospital, the gastrointestinal (GI) endoscopy unit has grown significantly over the last two years and stands today as a pioneer in the field.

Endoscopic Mucosal Resection (EMR) of Early Cancers

EMR is a minimally invasive procedure for the curative treatment of early stage cancers in the esophagus, stomach, and colon. Using an endoscope--a long, flexible lighted tube--the doctor injects a saline solution under the area that contains abnormal cells. A blister forms under these cells, allowing the physician to cut or suction the abnormal area away from the underlying tissue without damaging the rest of the organ.

"This is an important procedure for early-stage cancer," says Dr. Triadafilopoulos. "If the cancer is still localized, we can expect an excellent outcome."

Radiofrequency Ablation for Barrett's Esophagus

For the treatment of Barrett's esophagus, a condition that can lead to esophageal cancer, the endoscopist uses radiofrequency ablation to burn away abnormal, precancerous cells.

"Barrett's esophagus occurs as a result of gastroesophageal reflux disease, or GERD," says Dr. Triadafilopoulos. "The repetitive exposure of the esophagus to stomach acid erodes the esophageal lining and causes chronic damage and precancerous changes. We can use the endoscope not only to make the diagnosis, but also to ablate abnormal tissue."

El Camino Hospital has been a pioneer in the Bay Area in using such an advanced endoscopic device to treat Barrett’s esophagus. The HALO360 System (BARRx Medical, Sunnyvale, CA) delivers a uniform depth of ablation without damaging underlying tissue.

"The clinical trials for this device from El Camino or other hospitals around the world are very promising," says Dr. Triadafilopoulos. "more than 90 percent of patients can expect complete resolution of the precancerous changes."

Endoscopic Ultrasound

Endoscopic ultrasound (EUS) is a minimally invasive method of high-resolution abdominal imaging. It involves a special endoscope that is equipped at its tip with an ultrasound probe to perform studies from inside the GI tract, thereby visualizing beyond the gastrointestinal cavity, and permitting tissue sampling using biopsy needles.

"Since 2005 when we implemented EUS, the indications have expanded," says Dr. Ramrakhiani. "We can now drain cysts, stage esophageal, stomach and lung cancers, and offer palliative pain relief in patients with pancreatic cancers."

There are now more than a thousand clinical studies establishing the value of endoscopic ultrasound in diagnosis and accurate staging of cancers of lung, esophagus, stomach, pancreas, and rectum. In addition, EUS can obtain diagnostic biopsies from the chest or the abdomen avoiding the need for more invasive techniques like mediastinoscopy or laparoscopy. "It is the most accurate method of pancreatic cancer staging, especially for small tumors," says Dr. Ramrakhiani. "Furthermore, it adds additional information even when CT, angiography, and laparoscopy suggest that the tumor may be resectable."

Endoscopic ultrasound has also proven useful for diagnosis of common condition like gallstones and pancreatitis, Dr. Ramrakhiani says. "We see many patients with abdominal pain where the standard diagnostics--imaging and blood tests--don’t show anything. But in up to a third of the cases we can find gallstones blocking the bile ducts."

Double Balloon Enteroscopy

Later this year, El Camino Hospital will become one of only three hospitals in the Bay Area to offer double balloon enteroscopy, a technique that allows a clinician to navigate the entire small bowel.

"Until now, the small bowel has been a no-man’s land," says Dr Ramrakhiani. There are a wide range of endoscopic diagnostic and therapeutic procedures that have been available for treatment of stomach and colonic diseases. However, until now it was not possible to examine and treat lesions in the small bowel, which is more than 20 feet long. A revolutionary new device is now available that allows for endoscopic examination of the entire small bowel. Dr. Ramrakhiani first worked with this new device in Toronto in 2003, when it was in the developmental phase. He feels that this technology will allow for resection of small bowel tumors, treatment of bleeding vessels, placement for stents for bowel obstruction, minimally invasive placement of feeding tubes etc.

"The small bowel is notoriously difficult to visualize," says Dr. Triadafilopoulous. "This technology makes not only diagnosis but also non-surgical treatment of the entire small intestine a reality."

It uses two balloons, one attached to the distal end of the scope and the other attached to a transparent tube sliding over the endoscope. When inflated with air, the balloons can grip sections of the small intestine and "shorten" the small intestine by pleating it over the endoscope.

Third Eye Retroscope

El Camino Hospital was the first in the world to use this exciting new technology. Over the past year, Dr. Triadafilopoulos and Dr. Li at El Camino Hospital have been embarking on a research program that is part of a multi-center trial to assess a new endoscopic device for colorectal cancer screening and surveillance. They hope to present their findings at the annual meeting of the American Society for Gastrointestinal Endoscopy (ASGE) in Washington, DC, in May.

This innovative device is passed through the instrument channel of a standard colonoscope until it extends beyond its tip. As it emerges, the device automatically turns around 180 degrees to aim "backward" toward the tip of the colonoscope. Then, as the colonoscope is slowly pulled out from the colon, the Third Eye comes along with it, providing a continuous retrograde view to complement the forward view of the colonoscope.