A new Advanced Procedure Room enhances the Northside Hospital Advanced Center for GI Therapeutics’ ability to provide diagnostic and treatment modalities that are offered at few other facilities in the Atlanta area.
While Northside has long delivered quality GI care to patients from around the region, the new Advanced Center for GI Therapeutics and its physicians are constantly striving to incorporate the latest technology and techniques. With that goal in mind, Girish Anand, MD, Chief of Gastroenterology for Northside Hospital, worked with other gastroenterologists at the Center to research top-tier GI facilities around the nation. The result was a “wish list” for advanced technology housed in a multidisciplinary setting.
“A few months ago, we underwent a complete renovation, creating a state-of-the-art endoscopy room,” Dr. Anand says. “The facility includes fluoroscopy and endoscopic retrograde cholangiopancreatography (ERCP) capabilities, as well as on-site cytology for endoscopic ultrasound. In one room, we can perform complex procedures including stent placement, stricture dilation, balloon enteroscopy, gallstone extraction and even drainage of complex pancreatic cysts.”
Hybrid capabilities, including anesthesia, permit surgeons to transition between procedures when necessary. Additionally, physicians can transmit cytology images to the pathology lab and receive real-time feedback from Northside’s pathologists.
“Northside Hospital stands out because we have advanced endoscopists who are extensively trained. For example, endoscopic ultrasound requires an additional year of training. Therefore, it’s limited to high-volume centers. Outcomes are better when physicians who train aggressively and do the same tasks every day perform procedures.”
— Girish Anand, MD, Chief of Gastroenterology, Northside Hospital
“We have one of probably few rooms in the nation equipped to perform all these complex procedures in one place,” Dr. Anand says.
A minimally invasive endoscopic technique, balloon enteroscopy is a relatively new approach that helps Northside physicians diagnose and treat conditions of the small bowel. It has often been difficult for physicians to identify the exact locations of structures, lesions and bleeds in the small bowel, and balloon enteroscopy helps solve this dilemma.
The physician uses an endoscope introduced through the patient’s mouth or rectum into the small intestine. One or two balloons accompanying the endoscope alternately inflate and deflate, “pleating” the bowel and permitting greater access than would be possible otherwise.
“This is a novel technique; only a few places in the world offer it,” Dr. Anand says. “It makes a huge difference in allowing physicians to perform biopsies on lesions that would have been inaccessible before. We can use the same procedure to ablate lesions, care for GI bleeding and stabilize patients.”
Wireless Video Capsule Endoscopy
An even less invasive technique for visualizing the small intestine involves a tiny camera packaged inside a “pill.” Known as wireless video capsule endoscopy, this procedure aids diagnosis of multiple conditions.
“Patients swallow a camera encased in a capsule,” says Flavio Manela, MD, hepatologist and gastroenterologist at Northside Hospital. “The camera takes pictures of the small bowel, allowing us to localize the presence of bleeding outside the stomach, as well as diagnose conditions such as Crohn’s disease and celiac disorder.”
Two endoscopic modes for seeing the bile ducts — ERCP and cholangioscopy — may also be utilized in conjunction with procedures such as electrohydraulic or laser lithotripsy. While these minimally invasive techniques have been used for decades, cholangioscopy has recently been enhanced by the SpyGlass System, which offers improved guidance. Cholangioscopy permits a physician to diagnose indeterminate strictures or narrowings, as well as bile duct stones, and to provide therapy for them. Additionally, research shows that biopsy guided by cholangioscopy is extremely accurate in distinguishing benign from malignant lesions.
“The SpyGlass technology allows us direct visualization of the bile duct,” Dr. Manela says. “With it, we have been able to see and destroy stones that otherwise would require surgical removal and obtain bile duct tissue sampling by direct visualization, improving diagnostic accuracy.”
To increase the number of diagnostic tools at a GI physician’s disposal, ultrasound can be combined with endoscopy for detailed, up-close images of structures near the stomach and intestinal tract, helping physicians identify gallstones and pancreatic lesions. Endoscopic ultrasound is not available everywhere due to the limited number of skilled practitioners, but it is becoming an integral part of many advanced GI units, Dr. Manela says, and is performed regularly at Northside Hospital.
“In the GI program, we use endoscopic ultrasound for the workup of pancreatic lesions and tumors of the stomach lining, duodenum, colon and rectum,” he says. “The procedure allows physicians to get a closer view of the area and also to perform fine-needle aspiration if necessary. As we evolve in our field, we are adapting this procedure for many uses, including the staging of lung and other cancers.”
Endoscopic Mucosal Resection
Once physicians have located and biopsied lesions in the GI tract, endoscopic mucosal resection provides a minimally invasive means of staging and removing certain malignancies in patients with esophageal and gastric cancers.
Physicians use endoscopic ultrasound to create an image of the mucosal wall of the esophagus, stomach, or the small or large intestine. The ultrasound helps determine how deeply the lesion has penetrated. The physician then injects a solution under the lesion to raise it, after which it can be removed with a snare and cauterized.
Patients with Barrett’s esophagus, a precancerous condition often seen in people with acid reflux, can find effective treatment at Northside Hospital, as well, Dr. Anand says.
To treat Barrett’s esophagus, Northside’s physicians use radiofrequency ablation, a procedure in which a catheter delivers radiofrequency energy to remove a diseased layer of the esophageal lining. This safe procedure cures the condition in most patients, according to research.
Navigator Service for Patients and Referrers
The care at the Center for GI Therapeutics isn’t just advanced — it’s accessible. Northside Hospital’s GI patient navigator provides streamlined service, personal care, and complete information about procedures and results.
“Our patients need communication and support, as do their referring physicians,” says Kelly Shields, BS-B/M, Interventional Gastroenterology Program Coordinator. “As the patient navigator, I answer questions, coordinate scheduling and provide prompt, comprehensive follow-up, including pathology, imaging studies and operative reports.”
Marc Sonenshine, MD, a gastroenterologist, refers many patients to the Center. He has nothing but praise for the experience.
“The Advanced Center for GI Therapeutics offers patient-centered medicine in a caring environment,” he says. “Scheduling is extremely timely. Communication with patients and referring physicians is prompt and ample. Even in the context of a highly specialized center, the physicians care for the patient, not the disease.”
For additional information, visit www.northside.com/GIcenters.