Yale Interventional Endoscopy Program
The Yale Interventional Endoscopy Program is a tertiary referral system focusing on diseases of the pancreas, biliary tree, and the gastrointestinal tract. Patients with a variety of symptoms and diseases are evaluated, and include those with pancreatitis, biliary strictures and stones, post-cholecystectomy complications, unexplained abdominal pain, and suspected gastrointestinal malignancies. The majority of the referred patients require advanced endoscopic procedures, including therapeutic ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasound). Many patients are sent to Yale for these procedures which are either not performed elsewhere or may have been unsuccessful.
Our interventional gastroenterologists have extensive experience in complex ERCP procedures. Therapeutic ERCP capabilities include sphincter of Oddi manometry, endoscopic sphincterotomy of both biliary and pancreatic ducts, biliary and pancreatic stent insertion, stricture dilation, pseuodocyst drainage, and complex bile duct stone extractions. Techniques requiring specialized equipment are also performed and include choledochoscopy with mother-daughter scopes, electrohydraulic lithotripsy, and extracorporeal wave lithotripsy which are used for fragmentation and extraction of large common bile duct and pancreatic duct stones.
Physicians also have a great deal of expertise in performing EUS with fine needle aspiration (FNA) of masses, cysts, and lymph nodes located within the digestive tract, as well as adjacent to it. This highly sophisticated technique is utilized for the staging of malignancies of the esophagus, rectum, and pancreas. Furthermore, detailed imaging can be obtained with EUS and targeted FNA can then be performed on lesions as small as five millimeters in size. FNA can be performed on mediastinal lymph nodes, pancreatic masses or cysts, and gastrointestinal stromal tumors. Therapeutic options of EUS include celiac plexus nerve block (neurolysis) for palliation of pain associated with pancreatic cancer. The EUS program is among the largest of its kind in New England performing around 1500 procedures annually
Other outpatient endoscopic procedures performed at Yale, include: esophagogastroduodenoscopy (EGD), enteroscopy, colonoscopy with difficult polyp removal, sigmoidoscopy, argon plasma coagulation (APC) of GAVE (gastric antral vascular ectasias) and radiation proctitis, and stenting of the esophagus, duodenum, and colon. The members of the interventional team work closely with referring physicians in terms of promptly performing procedures, consultations, and discussing management options. A multidisciplinary approach to complex patients also involves discussions with pathologists, cytologists, surgeons, oncologists and radiologists.
Associate Professor of Medicine (Digestive Diseases)
Associate Director, Endoscopy
Director, Yale Advanced Endoscopy Fellowship
Director of Gastroenterology, Yale Health Plan
Research Interests:Advanced endoscopic techniques; Gastrointestinal bleeding; Colonoscopic polyp detection; Evaluation of pancreas cysts; Diagnosis of pancreas cancer; Pancreatic and biliary disorders; Therapy of bile duct obstruction via ERCP; Endoscopic ultrasound (EUS); Fine-needle aspiration (FNA); Advanced endoscopic imaging; Sedation for endoscopy
Clinical Interests:Pancreatic and biliary disease; Endoscopic ultrasound (EUS), including fine needle aspiration (FNA); Intestinal submucosal lesions; Endoscopic diagnosis, staging and therapy of gastrointestinal malignancy including Esophageal, pancreatic and rectal cancer, EUS-guided celiac plexus block and neurolysis; Evaluation of pancreatic cysts; Endoscopic Retrograde Cholangiopancreatography (ERCP): Therapeutic and interventional endoscopy; Esophageal, duodenal and biliary stent placement; Gastrointestinal bleeding including treatment of GAVE; Endoscopic mucosal resection (EMR), Colonoscopy and polypectomy; Radiofrequency ablation of Barrett's esophagus with dysplasia
Director, Yale Center for Pancreatic Diseases
Research Interests:Pancreatic Cancer Early Diagnosis; Pancreatic Cystic Neoplasms, Pancreatic Biomarkers, Personalized Medicine, Pancreatic Disease, Gastrointestinal Oncoloy
Clinical Interests:ENDOSCOPIC PROCEDURES:Endoscopic Ultrasound (EUS) including fine needle aspiration, fine needle core biopsy, fine needle tatooing and EUS-guided celiac plexus block and neurolysis. Endoscopic Retrograde Cholangiopancreatography (ERCP) including stone removal and stent placement, and cholangioscopy/pancreatoscopy. Therapeutic and Interventional endoscopy including esophageal, duodenal colon and biliary stent placement; Endoscopic mucosal resection (EMR), Complex Colonoscopy and polypectomy; Radiofrequency ablation of Barrett's esophagus with dysplasia Endoscopic ampullectomy and pancreatic pseudocyst drainage Endoscopic diagnosis, staging and therapy of gastrointestinal malignancy including esophageal, stomach, pancreatic, ampullary, and rectal cancer Gastrointestinal bleeding including treatment of GAVE (Watermelon Stomach) DISEASES:Pancreatic Diseases including pancreatic cysts ( including pancreatic cystic neoplasms and pseudocysts), pancreatic cancer, pancreatic endocrine neoplasms, and pancreatitis (acute, chronic, autoimmune, hereditary) Biliary Tract Disease including bile duct stones, biliary stricture, and malignant biliary obstruction. Intestinal submucosal lesions including leiomyoma and GIST; Esophageal, stomach, pancreatic, bile duct, colon, and rectal cancer. High Risk Family Cancer Screening: Hereditary Gastric Cancer, Hereditary Pancreatic Cancer, Hereditary Colon Cancer. Barrett's Esophagus including dysplasia and early mucosal cancer.
Professor of Medicine (Digestive Diseases)
Research Interests:Optimal application of advanced endoscopic techniques to clinical problems; Gastrointestinal bleeding; Graft-versus-host disease, pancreatic and biliary disorders
Clinical Interests:Gallstone disease; pancreatitis; bile-duct cancers; pancreatic cancer; unexplained upper abdominal pain (sphincter of Oddi dysfunction); treatment of giant common bile duct stones; endoscopic retrograde cholangiopancreatography (ERCP); endoscopic sphincterotomies (including minor papilla, precut and pancreatic duct); biliary and pancreatic stent insertions; stricture dilations and common bile duct stone extractions; therapeutic pancreaticobiliary endoscopy and sphincter of Oddi manometry (SOMS); mother-daughter endoscopy