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Endoscopy Services at El Camino Hospital

At El Camino Hospital, our specialized endoscopy center was among the first to offer leading-edge interventional pulmonology and endoscopic ultrasound procedures in the Bay Area. Only a handful of doctors are trained with these technologies, and our center is among the few offering these advanced procedures. We are a full-service endoscopy center.

Procedures available at the El Camino Hospital Endoscopy Center:

Bronchoscopy and Interventional Pulmonology

BronchoscopyBronchoscopy is a diagnostic procedure that allows the physician to examine, diagnose and treat problems in the lungs. The physician inserts a bronchoscope--a long, flexible, lighted tube--through the patient's nose or mouth, and then guides it through the windpipe (trachea) into the lungs. In addition to performing a visual examination of the lungs with the bronchoscope, the physician can insert instruments through the scope to obtain tissue samples for endobronchial biopsy, transbronchial needle/forceps biopsies and bronchial alveolar lavage, or perform therapeutic procedures such as airway stent placement, argon plasma coagulation, balloon dilation, bronchial thermoplasty, bronchoplasty, cryotherapy, electromagnetic navigation (EMN), endobronchial ultrasound (EBUS), endoscopic lung volume reduction (IBV valve system), fiducial marker placement, pleuroscopy, transbronchial cryobiopsy, and jet ventilation. For information regarding these procedures, see Interventional Pulmonology.

Colonoscopy

Colonoscopy is a diagnostic procedure that allows the physician to examine, diagnose and treat problems in the large intestine. The physician inserts a colonoscope--a long, flexible, lighted tube--through the anus, and then guides it through the entire length of the colon. In addition to performing a visual examination of the colon with the colonoscope, the physician can insert instruments through the it to obtain tissue samples for biopsy, remove foreign objects, instill air or fluid, give injections, or stop bleeding (by clipping, banding, injection, cautery, or argon plasma coagulation), or to perform therapeutic procedures such as endoscopic surgery, removal of polyps, dilation (stretching), decompression, and stent placement.

Endoscopic Mucosal Resection (EMR)

Endoscopic Mucosal Resection, or EMR, is a minimally invasive procedure for diagnosis, staging, and curative treatment of early-stage cancers of the esophagus, stomach, and colon. The physician guides a long, flexible, lighted tube to the abnormal area. The physician 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 damage to the underlying normal structures. EMR can help determine if the cancer has invaded the underlying tissue and structures for staging of cancers, which aids in determining treatment options.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

LiverEndoscopic Retrograde Cholangiopancreatography, or ERCP, is a diagnostic procedure that allows the physician to examine, diagnose and treat problems of the pancreas, bile ducts, liver and gallbladder. The physician inserts a duodenoscope--a long, flexible, lighted tube--through the patient's mouth and throat, then guides it through the esophagus, stomach and first part of the small intestine to the opening where the bile and pancreatic ducts empty into the small intestine. X-Ray dye is injected into the ducts and fluoroscopy is used to study them. In addition to performing visualization of the ducts, the physician can insert instruments through the scope to obtain tissue samples for biopsy, remove stones, utilize spyglass technology (which involves using a smaller scope to access ducts), or perform therapeutic procedures such as dilation (stretching), spincterotomy (opening the ampulla), and stent placement or removal, and holmium yag laser therapy.

Endoscopic Ultrasound (EUS), Upper or Lower

Upper endoscopic ultrasound (EUS) is a diagnostic procedure that allows the physician to examine, diagnose, and treat problems with the bile ducts and pancreas. The physician uses a long, flexible, lighted tube called an endoscope. The endoscope is inserted through the patient's mouth and throat, and then guided through the esophagus, stomach and first part of the small intestine. At the tip of the scope is an ultrasound device that uses sound waves that bounce into the nearby areas including the gallbladder, liver, pancreas, and bile ducts. A computer creates an image from the sound waves that bounce back. The images can visualize tumors, cysts, stones, and blockages, and they can be used for staging of cancers to determine treatment options. In addition to visualization, the physician can insert an instrument through the scope to obtain tissue samples for biopsy, drainage, or fiducial marker placement, or give an injection for pain relief (called celiac plexus neurolysis during upper EUS only).

EUS can be used to obtain biopsies from the chest and abdomen, thereby avoiding the need for more invasive procedures like mediastinoscopy or laparoscopy. Clinical studies show that EUS is better for spotting small tumors and gallstones than computerized tomography (CT) and adds valuable information when planning treatment options. For Lower EUS, the physician uses the same type of endoscope but it is inserted through the anus.

Double-Balloon Enteroscopy

Double-balloon enteroscopy, also known as push-and-pull enteroscopy, is an endoscopic technique used to examine, diagnose and treat problems in the small bowel. During the procedure the physician inserts the enteroscope--a long, flexible, lighted tube--into the mouth for an upper approach or into the anus for a lower approach, and then guides it through into the small bowel. In addition to performing a visual examination of the small bowel, the physician can insert instruments through the scope to obtain tissue samples for biopsy, instill air or fluid, give injections, or stop bleeding (by clipping, injection, cautery, or argon plasma coagulation).

Esophagogastroduodenoscopy (EGD, or Oral Endoscopy)

Esophagogastroduodenoscopy and upper GI tractEsophagogastroduodenoscopy, or EGD, is a diagnostic procedure that allows the physician to examine, diagnose and treat problems in the upper gastrointestinal (UGI) tract. The physician insert san endoscope--a long, flexible, lighted tube through the patient's mouth and throat, then guides it through the esophagus, stomach, and first part of the small intestine. In addition to performing a visual examination of the UGI tract with the endoscope, the physician can insert instruments through the scope to obtain tissue samples for a biopsy, remove foreign objects, instill air or fluid, give injections, or stop bleeding (by clipping, banding, injection, cautery, or argon plasma coagulation), or to perform therapeutic procedures such as endoscopic surgery, removal of polyps, cricopharyngeal myotomy or Endoscopic Mucosal Resection (EMR), dilation (stretching), ablation of tissue, and stent placement. Catheters may be placed for manometry or motility studies, gastrostomy or jejunostomy; tubes may be placed, replaced or removed; and capsules may be placed for capsule endoscopy.

Radiofrequency Ablation for Barrett's Esophagus

Gastroesophageal Reflux Disease (GERD) and HeartburnBarrett's Esophagus is a pre-cancerous condition affecting the lining of the esophagus--the swallowing tube that carries foods and liquids from the mouth to the stomach--as a result of gastroesophageal reflux disease (GERD). Repeated exposure of the esophagus lining to stomach acids and enzymes from the reflux causes chronic damage and pre-cancerous changes. Barrett's esophagus increases the risk for a patient to develop esophageal adenocarcinoma (a type of cancer). Diagnosis and treatment of the abnormal tissue is performed during an upper endoscopy. Radio frequency energy is delivered in a precise and highly controlled manner to heat the abnormal tissue until it is no longer viable or alive (called ablation).

Ablative therapy is capable of achieving complete removal of the diseased tissue without damage to the underlying normal structures. Clinical studies demonstrate that in 98.4 percent of patients treated with radiofrequency ablation, the Barrett's tissue is completely eliminated. An additional upper endoscopy is required to assess the response to treatment and if any residual Barrett's tissue remains; additional therapy may be recommended. Successful elimination of the Barrett's esophagus tissue does not cure the pre-existing GERD. The physician will guide the patient regarding long-term GERD therapy.

Secca and Stretta

These procedures use radio frequency energy to improve function by tightening the muscles in the upper and lower gastrointestinal tract during endoscopic procedures. The Secca procedure is based on the concept that the radio frequency energy changes tissue compliance and collagen disposition, and the subsequent scarring may increase one's ability to recognize and retain stool, resulting in improved continence. The Secca procedure offers a less invasive option for the management of anal incontinence as compared to surgical alternatives and can be used as a first-line therapy. However, it does not preclude subsequent retreatments or surgical alternatives if further treatment is needed.

Stretta is used after an oral endoscopy is performed. A catheter is used to deliver the radio frequency energy to the lower esophageal sphincter, muscle and gastric cardia to create four rings of treated tissue. The mechanisms thought responsible for the tightening of the lower esophageal sphincter and the prevention of reflux are the shrinkage of collagen fibrils, remodeling of the stretch fibers in the gastric cardia, and interruption of the signals to the brainstem that trigger relaxation of the sphincter. Most patients receive maximum benefit over a period of two to six months, or when fibrosis, collagen disposition, and wound healing are complete.

Third Eye Retroscope

This innovative device is used during a colonoscopy, a diagnostic procedure that enhances the physician's ability to examine, diagnose and treat problems in the large intestine. The physician uses a long, flexible, lighted tube called a colonoscope. The dual view from in front of and behind the folds of the colon allows for the identification of many more colonic problems. El Camino Hospital was the first in the world to use this exciting new technology and participated in the research program to assess this new endoscopic device for colorectal cancer screening and surveillance. Learn more about the Third Eye colonoscopy.

Transesophageal Echocardiogram (TEE)

Transesophageal Echocardiogram, or TEE, is a diagnostic procedure that uses echocardiography to assess the heart's function. The physician uses a probe with a transducer (a component that emits ultrasonic sound waves). The probe is inserted through the patient's mouth and throat into the esophagus, rather than placing the transducer on the patient's chest. Conditions of the heart, such as mitral valve disorders, blood clots or masses inside the heart, dissections (tears) of the lining of the aorta, and implanted prosthetic (artificial) heart valves, are better visualized and assessed with TEE.

Other Procedures include: liver biopsy, paracentesis or thoracentesis (for drainage of fluid) and secretin stimulation test for gastrinoma (a blood draw).