Gastroenterology Procedures

Dr. Joseph has over 30 years experience in the practice of gastroenterology, including mentoring other gastroenterologists in advanced GI procedures. All procedures are done in fully accredited outpatient or inpatient facilities with experienced teams of specialized anesthetists and nurses.

These procedures include the following:

EGD (esophagogastroduodenoscopy). This procedure is also known as an upper GI endoscopy. It has a multitude of diagnostic and therapeutic uses. For example, it can be used to retrieve foreign bodies that have been ingested, stop bleeding by cauterizing tissues, manipulate pincers to acquire tissue for biopsy, do ligation of esophageal varices, and cut off polyps with a snare device, as well as many other uses.

EUS (endoscopic ultrasound). This procedure combines endoscopy with ultrasound. It uses a small ultrasound transducer installed on the tip of the endoscope to produce very accurate, high quality images of the esophagus, liver, gallbladder, bile ducts, stomach, pancreas and intestines. In the hands of a highly trained, skilled endoscopist, it can provide very detailed and cost-effective assessment and treatment of certain diseases without the need for surgery. Under EUS guidance, biopsies can be done of the tissues in the digestive organs, fluid collections in the pancreas and pelvis can be drained, and celiac plexus blocks can be administered for intractable abdominal pain. EUS is also very useful for the staging of cancer, evaluating pancreatitis and studying bile duct abnormalities.

ERCP (endoscopic retrograde cholangiopancreatography).endoscope
This procedure combines EGD with fluoroscopy. It is very useful for detecting abnormal conditions in the ducts, such as blockages or narrowing. The endoscope is advanced from the mouth to the small intestine for access to the ductal openings. If necessary, instruments can be passed through the endoscope to remove stones or other blockages. Stents may also be used for drainage and for widening a narrowed area. Post surgical complications like biliary leaks, retained stones, etc. can be managed by ERCP.

Stool Transfer. This procedure is used for patients suffering from chronic relapsing and potentially life-threatening Clostridium difficile diarrhea. A preparation of fecal bacteria processed from fully tested healthy donors is used as the "ultimate probiotic" to restore the intestinal flora and prevent C. diff. recurrence. This treatment provides a much safer and very highly successful alternative to antibiotic dependence or risky surgical intervention.

Chromoendoscopy. This procedure involves the use of extremely high magnification/high resolution state of the art scopes with chromoendoscopy capabilities in order to perform tissue differentiation using select staining techniques. This tool provides the endoscopist a very high accuracy, in-vivo, optical biopsy capability at the cellular resolution level. It is especially useful in the diagnosis of depressed lesions which are often more difficult to diagnose than protruding lesions.

Balloon Assisted Enteroscopy. This procedure is specifically designed for the diagnosis and treatment of conditions deep within the small intestine. Because the small intestine is approximately 20 feet long, an extra-long scope must be used. The scope is advanced through the length of the small bowel by alternately inflating and deflating either one or two balloons which then pleats the small bowel over an insertion tube, allowing the scope to move forward. It can be used to treat bleeding lesions, dilate strictures, remove polyps, masses or foreign objects and to do biopsies.

ERS (endoscopic retrograde sphincterotomy). This procedure is used to cut the sphincter muscle that lies at the junction of the small intestine with the common bile and pancreatic ducts. Once the muscle is cut, a stent is often inserted to prevent the reoccurrence of narrowing and blockages.

Radiofrequency Treatment of LES (lower esophageal sphincter). This procedure is used to treat the appropriate patients for GERD (gastroesophageal reflux disease). The endoscopic delivery of radiofrequency energy causes tissue constriction and increased muscle thickness in the lower esophageal sphincter and uppermost part of the stomach. The result is a reduction in acid reflux because the LES is no longer over-relaxed.

Radiofrequency Ablation of Barrett's Esophagus. This procedure is used to destroy the abnormal cells in the esophagus which sometimes occur when parts of the lining of the esophagus are exposed to too much stomach acid. Barrett's esophagus results when the damaged cells are replaced by new tissue which more closely resembles intestinal tissue, instead of the normal esophagus tissue. These abnormal cells can sometimes lead to esophageal cancer. Radiofrequency ablation is a very effective, non-invasive treatment for destroying these abnormal cells.

Colonoscopy. This procedure is used to examine the entire large intestine, from the rectum all the way up through the colon to the lower end of the small intestine. It can detect polyps, inflamed tissue, ulcers, bleeding and early signs of cancer. If necessary, instruments can be passed through the scope to remove any polyps or other suspicious tissue for biopsy. If bleeding is detected, special probes or medicines can also be passed to staunch the bleeding.

Sigmoidoscopy. This procedure is used to examine just the lower one-third of the large intestine. A short scope is used through which instruments can be passed to obtain tissue for biopsies or to remove polyps or hemorrhoids. It can also help identify the causes of abdominal pain, bleeding, diarrhea and constipation.

GI Stenting. Esophageal/Duodenal/Colonic/Pancreaticobiliary stenting procedures are used to treat obstructions of the digestive tract. Palliative endoscopic treatment with stents can be an alternative treatment to palliative surgery for patients with gastrointestinal cancer.