Advanced Endoscopy Procedures for Adults and Children

Leaders in Minimally Invasive Endoscopic Procedures

Your doctor may recommend an advanced endoscopy (AE) procedure to help diagnose or treat a problem in your digestive tract. There are many benefits to getting an advanced endoscopic procedure instead of undergoing invasive surgery, it requires a shorter recovery and less time under anesthesia.

University Health System in partnership with UT Health San Antonio offers a premiere endoscopy program that performs more leading-edge endoscopic procedures than any other medical facility in South Texas. Through our therapeutic advanced endoscopy services, we’re able to diagnose and treat GI disorders for hundreds of children and adults.

Innovative Therapeutic Endoscopy by Fellowship-Trained Physicians

You receive personalized care from some of the most talented endoscopists in the country – our group of gastrointestinal (GI) doctors are all fellowship-trained in advanced endoscopic techniques. Our medical team is well-known for achieving maximum outcomes with this less invasive form of treatment.

We provide exceptional healthcare for those who need medical treatment for common GI issues. Additionally, we perform advanced endoscopy to treat and manage the most complex conditions.

Our medical group is dedicated to improving the lives of those challenged with various gastroenterological, biliary and pancreatic disorders.

Advanced Endoscopic Services for GI Conditions

We use advanced endoscopy to diagnose and treat conditions of the esophagus, stomach, small intestines, pancreas, gallbladder, bile duct, liver, colon and rectum.

If you want to request an appointment for any of the following AE services, please call 210-743-4324. Or email us with any questions you may have at AdvancedEndoscopyClinic@uhs-sa.com.

Celiac Plexus Block

A celiac plexus block is often used to help patients manage pain. Those who have pancreatic cancer or advanced pancreatitis frequently need assistance controlling the symptoms of this disease.

An endoscopic ultrasound-guided celiac plexus block is conducted using an instrument that combines flexible endoscopy with ultrasound. A transducer is fitted on the tip of an endoscope. Your doctor guides the transducer down the esophagus through your body to the area of concern within your GI tract. The ultrasound transducer, a device that acts as a transmitter and receiver of ultrasound information is turned on so images can be taken.

Once positioned at the celiac plexus, just above the celiac trunk, a needle is passed through the scope to administer medicine which often has anti-inflammatory properties which helps you with extended pain relief.

Endoscopic Balloon Dilation (EBD) of Strictures

An endoscopic balloon dilation is used for patients who need medical intervention to open up a narrowing part (stricture) of the digestive tract. We use ERCP catheters fitted with dilating balloons on the end of this high-tech endoscopic tool. The ERCP tube is passed through your mouth, esophagus, stomach until the stricture is found.

For example, this procedure is often used on strictures to make it easier to complete other endoscopic procedures that you may need, such as a stent placement or endoscopic ultrasonographic tumor staging. In this scenario, your doctor may need to use a balloon dilation procedure to open up a narrow area of the GI tract to go deeper with the endoscope in order to get a complete picture of structures near your pancreas to determine if your cancer has spread.

Endoscopic Mucosal Resection (EMR)

An endoscopic mucosal resection is performed with a long, thin tube with a light and camera attached to it. Your doctor passes the endoscope down your throat to carefully examine one or several areas of your upper digestive tract including your esophagus, stomach or the upper part of your small intestine. If your colon is being examined, then the endoscope is passed through your anus.

This advanced endoscopic procedure is typically used to treat cancer and to determine if it has spread. As an example, it can help your doctor determine if cancer has spread to tissue underneath the digestive tract lining. An EMR is also used to access small pieces of tissue for analysis to help a doctor make an initial diagnosis.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

During an endoscopic retrograde cholangio-pancreatography (ERCP) procedure, an endoscope (tube outfitted with a miniature camera) is passed through your mouth and stomach into your duodenum (first part of your small intestine) to reach your bile ducts, pancreas and gallbladder.

A contrast dye is added to enable your doctor so see your organs more clearly using a special type of X-ray (fluoroscopy). Your doctor can diagnose and treat problems and blockages with this minimally invasive procedure.

An ERCP procedure is performed under sedation using a side viewing endoscope, called a duodenoscope. The specially shaped scope has the capacity to allow flexible instruments to be passed through it into the bile or pancreatic ducts to diagnose and treat various pancreatic diseases.

ERCPs are one of the most frequently performed procedures advanced endoscopists provide. Doctors within our advanced endoscopy group work with medical device leaders to help develop new tools and technology to help further the advancement of numerous types of ERCP techniques to lead to better outcomes and treatments for our patients.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with Stent Placement

An endoscopic retrograde cholangio-pancreatography (ERCP) procedure with stent placement is a procedure that helps bile flow properly in your body. A specially equipped ERCP endoscopic catheter is passed through your mouth and into your digestive tract and used to aid in the placement of a stent in the bile duct or pancreatic duct where a blockage or obstruction has occurred.

A biliary stent, a thin hollow tube made of metal or plastic, is put in place to hold open the sides of the common bile duct or pancreatic duct to allow fluids, such as bile, to move along the tract. Putting a stent in opens up the duct passageway and helps the bile reach the intestines so it can do its job and help digest food.

Endoscopic Submucosal Dissection (ESD)

An endoscopic submucosal dissection is used to remove polyps or deep tumors from the gastrointestinal tract. Once the tumor or growth is located, the layer beneath it (the submucosa) is injected with a solution which allows your gastroenterologist to gently separate it from the muscle wall.

By doing this, it helps to ensure that tissue surrounding the area won’t be damaged. An electrosurgical knife with a high-frequency current is used to remove the tumor and surrounding tissue. This high-tech knife is also used to stop any bleeding that may occur after the tumor is cut away.

Patients who have a complicated medical condition can often be helped with this advanced endoscopic technique and avoid having an open surgery or laparoscopic procedure. The benefit is that you recover more quickly with less pain.

This is a newer procedure that takes longer but for many patients provides better long-term outcomes. Only a few centers in the country provide this type of endoscopic procedure because it requires such a high-degree of proficiency.

Endoscopic Ultrasound (EUS)

Your doctor passes an endoscope equipped with an ultrasound transducer into your stomach through your mouth. This allows your doctor to see your pancreas, liver, gallbladder, upper intestines and the areas around them. This state-of-the-art technology allows our endoscopy team to detect problems and take tissue samples through the endoscope for examination.

EUS requires extensive experience and skill to help patients get an accurate diagnoses. Our advanced endoscopists have performed hundreds of EUS procedures and are among the most experienced in the region.

Endoscopic Sphincterotomy

An endoscopic sphincterotomy is a procedure in which a catheter with a wire is passed down the throat into the GI tract to cut the muscle between the common bile duct and the pancreatic duct at the intersection with the duodenum (the first part of the small intestines).

The area effected is called the sphincter of Oddi. An incision can be made into the bile duct (biliary sphincterotomy) or pancreatic duct (pancreatic sphincterotomy).

An endoscopic sphincterotomy can also be applied to treat certain diseases such as papillary stenosis or sphincter of Oddi dysfunction. The sphincter of Oddi is where contractions regulate bile and pancreatic juice flow. This type of procedure can also be applied to remove gallstones or other blockages.

Laser Lithotripsy

Your doctor uses an endoscope to deliver laser energy in the form of light to areas of your pancreas and biliary ducts to break apart large stones. The smaller pieces that remain can then pass naturally through your digestive system.

Treating the stones can reduce your risk for liver, pancreas and gallbladder disease. Our GI specialists are well trained in using lasers to treat biliary and pancreas stones that would otherwise require surgical removal.

Overstitch Endoscopic Suturing

An overstitch endoscopic suturing procedure is a minimally invasive way to close an opening. Surgeons insert a long, flexible tube into your mouth and down your esophagus. The tube is equipped with durable sutures and specialized instruments used to close openings and incisions after therapeutic treatments have been performed.

By using this advanced endoscopic procedure, your doctor can use a curved needle to control the depth of the sutures and reload sutures while looking at the site on a monitor allowing for better precision and control. Today, this type of suturing system is used to close up after numerous types of advanced endoscopic treatments for a wide range of pancreatic diseases and disorders.

Peroral Endoscopic Myotomy (POEM)

A peroral endoscopic myotomy (POEM) is typically performed for patients who have Achalasia, a type of swallowing disorder. The POEM procedure can also be beneficial to patients with various spastic esophageal conditions, unresolved heartburn, weight loss issues or for those who have difficulty digesting food.

A bendable endoscope is passed through the mouth and into the throat. A small opening is made into the deepest layer of the esophagus. The endoscope is then carefully guided down the length of the esophagus.

The gastroenterologist cuts the muscle fibers of the lower esophageal sphincter allowing the non-functioning part of the esophagus to relax and allow food to be digested more easily and to move forward into the stomach.

Radiofrequency Esophageal Ablation (RFA)

Endoscopic radiofrequency ablation (RFA) uses heat to remove precancerous tissue from patients who have Barrett’s esophagus. Your doctor uses an endoscope to insert a thin tube down your esophagus. The tube or catheter has an electrode covered balloon at the end of it. Once the balloon is properly positioned, it’s inflated so the electrodes come in contact with the abnormal tissue. The electrodes destroy targeted layers of the diseased esophagus.

This minimally invasive treatment therapy is often used to help people who have adenocarcinoma, the most common form of Barrett’s esophagus.

RFA is a relatively new endoscopic technique and is also used to treat early stage T1a intramucosal cancer among other cancerous and precancerous conditions.

SpyGlass® Intraductal Endoscopy

Your doctor uses an endoscope with fiberoptic imaging capabilities to view small areas of your pancreas, bile ducts and gallbladder to diagnose and treat problems. Intraductal endoscopy is a relatively new technology that uses the SpyGlass® Direct Visualization System. This device allows your doctor to take tissue samples for biopsy and perform laser therapy instead of invasive surgery.

Our endoscopists are internationally recognized for their expertise and their level of skill using intraductal endoscopic techniques to help improve patients’ outcomes. We’ve developed new ways to treat stones in the bile duct and pancreas.

Transluminal Drainage of Pancreatic Pseudocysts

A specialized endoscope equipped with an ultrasound probe is passed through your mouth into your stomach and small intestine. A needle, attached at the end of the endoscope, is used to drain the cysts.

A transluminal drainage of pancreatic pseudocysts is performed by your doctor when cysts on your pancreas cause uncomfortable symptoms such as stomach pain, fever, a bloated abdomen or nausea. They’re called pseudocysts because technically they don’t have a wall or lining like a typical cyst. Pseudocysts are sacs filled with fluid made up of pancreatic enzymes, blood and dead tissue.

Many pseudocysts go away over time and don’t require medical intervention. But when they cause a patient problems or grow too big, they can be surgically removed or drained through this transluminal drainage process - from the inside of the cyst.