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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.