INTERVENTIONAL ENDOSCOPY

REMOVAL OF FOREIGN BODIES

Removal of foreign bodies from the esophagus, stomach and duodenum

Children, the elderly and persons with intellectual disabilities may swallow coins, spoons, batteries, pins and pencils (a common event among the elderly is that they swallow their dentures). A foreign body can be endoscopically removed with the use of suitable forceps for removing foreign bodies. If a sharp object is swallowed, our Department uses a special protective cover at the end of the endoscope for the patient’s complete protection.

BLEEDING FROM THE ESOPHAGUS, STOMACH, DUODENUM

Bleeding due to ulcers, perforation or angiodysplasias

In case of hematemesis, coffee ground emesis or tarry stools, the patient must be transferred to hospital. Upon arrival at our Hospital, an endoscopy of the upper digestive tract is performed, pursuant to US standards, to determine the site and cause of the bleeding. If the bleeding is active, we intervene endoscopically for its successful hemostasis.

Hemostasis, which involves the injection of hemostatic and sclerosing agents via the endoscopic biopsy channel, is simple, painless and safe when performed by experienced endoscopists. Adrenaline, which is dissolved in normal saline solution (1/10,000), is used around the vessel, at the base of the bleeding ulcer.

The bleeding vessel is then cauterized using the Argon-Plasma Laser, the latest achievement in photodynamic treatment.
If the blood is gushing out, hemostatic clips are used with absolute success and safety. It has been internationally proven that with this combined method, 95% of bleeds stop.

Bleeding esophageal varices

Hemostasis is achieved either with the injection of a sclerosing agent (ethanolamine oleate or polidocanol) or with rubber band ligation, with the assistance of a special device which is placed at the tip of the endoscope and is guided to the bleeding site. Bleeding is controlled at a rate of 90%. The injection of a sclerosing agent or rubber band ligation is also performed on patients who are not bleeding, but present potential bleeding sites.

Esophageal dilation

Patients that present benign esophageal strictures (Grade IV esophagitis in remission, swallowing of caustic substances) undergo dilations with various types of dilators (Savary and pressure balloons). In case of esophageal achalasia, dilations are performed using special achalasia balloon dilators.

Percutaneous endoscopic gastrostomy

It is widely applied to patients who are unable to swallow for a long period of time due to neurological or tracheal disorders. It is performed by two experienced endoscopists using an endoscope, without general anesthesia. Twenty-four hours after placement of the gastrostomy, the patient is fed normally from the plastic tube that has been placed in their stomach and comes out of the abdominal wall. It is a simple, fast, safe and effective method.

Malignant esophageal tumors

Aided by the gastroscope, the tumor is debulked and the lumen in opened with the Argon-Plasma Laser. In order for the lumen to remain patent after being opened, self-expandable metallic stents are placed to ensure that the patient’s oral intake can be maintained.

Removal of polyps from the digestive tract

This is performed by way of polypectomy snares and laser photocoagulation. The Endoscopy Department uses all the contemporary polyp removal methods with disposable polypectomy devices for the patient’s greatest safety. The Department also undertakes the removal of flat villous polyps and large polyps with a broad base or thick stalk, by applying the piecemeal polypectomy method.

Placement of self-expandable metallic stents

Aided by the endoscope, via which a guidewire passes, self-expandable metallic stents are placed in strictures of the 2^nd or 3^rd part of the duodenum, as well as in rectal and sigmoid strictures to maintain lumen patency.

LASER

Laser treatment bases its therapeutic potential on its heating effect on the various body tissues. It is applied with the assistance of endoscopes and special catheters. In gastroenterology, it is used for the following cases:

• Bleeding of the upper digestive system, by creating a clot in the bleeding vessels. Globally, more than 3,000 bleeding episodes have been treated with laser treatment, with a success rate that ranges between 90% and 100%.
• Large intestinal bleeding due to angiodysplasia or radiation deterioration due to radiation colitis. Successful hemostasis of angiodysplasias using laser treatment ranges from 80% to 100%.
• Malignant esophageal and large bowel tumors, which cause bleeding or stricture and are inoperable due to delayed diagnosis or generalized carcinomatosis. Laser treatment helps in restoring lumen patency, hemostasis is performed and a passage is found for the placement of self-expandable metallic stents, to ensure a permanent result.

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ECRP)

When other diagnostic tests are negative, obstructive jaundice, acute pancreatitis due to lithiasis and chronic epigatsric pain can be resolved with Endoscopic Retrograde Cholangiopancreatography. By using a side-viewing endoscope, the ampulla of Vater is found and cannulated.

Sphincterotomy

During this procedure, the ampulla of Vater and the sphincter muscle that surrounds the end of the bile duct are cut using a sphincterotome and diathermy cutting wire.

Indications

Bile duct stones, sphincter of Oddi dysfunction, pancreatitis due to lithiasis, early stage of stent placement (plastic or self-expandable metallic stents) in bile duct, pancreatic head or ampulla of Vater cancer, early stage of naso-bile drainage catheter, sump syndrome (following a side-to-side choledochoduodenostomy, repeated episodes of cholengitis, pacreatitis or abscesses).

DIGESTIVE SYSTEM MOTILITY LAB

Motility disorders of the gastrointestinal tract are quite common in the general population. They usually manifest with symptoms that are indicative of the disease, but many times the typical clinical manifestations may be absent. It is for this reason that the systemic investigation of these patients is required for the better and most effective treatment of the underlying disease. The Digestive System Motility Lab aims to diagnose, document as well as evaluate the various therapeutic interventions of digestive system motility disorders.

The Digestive System Motility Lab boasts abundant and state-of-the-art equipment and is staffed by internationally renowned, qualified scientific staff, who have clinical and research experience.

Endoscopy Department Nursing Station

These two elements guarantee the Lab’s significant potential for offering top-quality medical services in this field. Below is a codified list of the various digestive system motility diseases, and the diagnostic and therapeutic potential offered by the Lab.

Esophagus / Diseases

• Gastroesophageal reflux
• Esophageal achalasia
• Diffuse esophageal spasm
• Symptomatic peristalsis
• Esophageal involvement in connective tissue diseases (e.g. scleroderma)
• Investigation of non-cardiac chest pain
• Cricopharyngeal dysfunction
• Duodenal gastroesophageal reflux

Tests

• Static esophageal manometry
• 24-hour ambulatory pH test
• Esophagogram
• Esophageal transit scintigraphy
• 24-hour ambulatory alkaline reflux test

Stomach / Diseases

• Idiopathic gastroparesis
• Diabetic gastroparesis
• Primary duodenal gastro reflux
• Postgastrectomy syndromes, such as dumping syndrome, slow bowel movements, duodenal(entero) gastric reflux, Roux syndrome, mixed gastric motility syndromes

Tests

• Dumping challenge test
• Gastric emptying of radioactively-labeled solid food
• Assessment of duodenal(entero) gastric reflux with HIDA

Gallbladder / Diseases

• Gallbladder dyskinesia
• Diabetic cholecystoparesis

Tests

• Ultrasonography and scintigraphy of the gallbladder emptying at fasting phase and eating phase

Tests

Therapeutic interventions