Yale’s Advanced Endoscopy Program at Yale New Haven Hospital and Smilow Cancer Hospital is one of the leading referral centers in the Northeast.
Yale’s advanced endoscopic physicians are experts in performing highly sophisticated procedures, such as endoscopic ultrasound (EUS) with fine needle aspiration (FNA) and biopsy (FNA/B) of pancreatic masses, cysts, and lymph nodes. EUS is an important tool for the diagnosis and staging of malignancies of the esophagus, rectum, and pancreas. The physicians also perform EUS-guided celiac plexus nerve block (neurolysis) for palliation of cancer-related pain.
The Yale Advanced Endoscopy Team is nationally recognized as experts in minimally invasive EUS procedures that are available at very few select centers worldwide. These procedures include EUS-guided hepaticogastrostomy and pancreaticogastrostomy and EUS-guided access of the surgically bypassed stomach to access the bile duct. These procedures allow physicians to remove obstructions and perform procedures to help bile and pancreatic fluids drain without patient discomfort. The EUS-guided procedures are used when a traditional endoscopy approach isn’t feasible.
In addition to endoscopic ultrasound, the advanced endoscopy program has extensive expertise in endoscopic retrograde cholangiopancreatography (ERCP), with excellent outcomes. ERCP is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It is highly complex with a long learning curve and may carry a significant risk of serious complications especially in less experienced hands. This mostly therapeutic procedure is performed in a variety of situations including treatment of bile and pancreatic duct stones and cancers.
Advanced Endoscopy Team Members
Director of Endoscopy Priya Jamidar, FACG, FASGE, MBChB, professor of medicine at Yale School of Medicine (YSM), Department of Internal Medicine (Digestive Diseases), is one of the world’s leading experts in biliary and pancreatic disease treatment and research. Jamidar underwent advanced ERCP training at the world-renowned Indiana University Medical Center under the tutelage of Glen Lehman, one of the leading luminaries in ERCP. Among Jamidar’s contributions to the field is the endoscopic management of biliary disorders in pregnancy, and the treatment of pancreatitis. He was an investigator in the EPISOD study that was paradigm-changing in terms of evaluation and management of Sphincter of Oddi dysfunction. Jamidar published one of the largest single-center experiences on performing ERCP in pregnant patients. Specialized ERCP procedures performed by Jamidar include cholangioscopy and pancreatoscopy, electrohydraulic lithotripsy for difficult bile duct and pancreatic duct stones, endoscopic ampullectomy and radiofrequency ablation for bile duct cancers. He also has a strong interest in the endoscopic treatment of pancreatitis and is currently the principal investigator at Yale in the SHARP study, a National Institutes of Health-sponsored multicenter trial evaluating endosocopic sphinctertomy in patients with pancreas divisum and recurrent acute pancreatitis. Jamidar, who is among the most experienced ERCP practitioners in the world, is dedicated to providing patient-centered care.
What led to your interest in the endoscopic management of biliary disorders in pregnancy?
“Gallstones and complications related to gallstone disease are common in pregnancy. We were able to confirm that ERCP had an important role and could be performed safely in pregnant patients.”
What do you enjoy the most about your practice?
“I enjoy the ability to work with a highly skilled team, and to help many patients with biliary and pancreatic disease by providing an accurate diagnosis and being able to cure their health problem or, in many cases, significantly improve their quality of life.”
Harry Aslanian, MD, FACG, FASGE, AGAF, professor of medicine at YSM, Department of Internal Medicine, (Digestive Diseases), is the Director of Endoscopic Ultrasound; associate director of endoscopy; and director, Yale Advanced Endoscopy Fellowship. Dr. Aslanian is an advanced endoscopist who specializes in pancreas and biliary disorders including evaluation of pancreas cysts, masses, chronic pancreatitis, and bile duct stones and strictures. He has expertise in the endoscopic diagnosis and treatment of precancerous and early cancers including Barrett’s esophagus with dysplasia, gastric and duodenal lesions and difficult colon polyps. He performs advanced endoscopic resection techniques including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).
What do you find most rewarding about advanced endoscopy?
“The ability to treat and prevent early cancer with the endoscope has been a great advancement and makes the performance of advanced endoscopy very rewarding. These techniques can also be used to perform endoscopic myotomy -- peroral endoscopic myotomy (POEM) -- to treat achalasia.”
James Farrell, MD, professor of medicine at YSM, Department of Internal Medicine, (Digestive Diseases), is director of the Yale Medicine for Pancreatic Diseases Program, which brings together an expert team of pancreatic specialists including gastroenterologists, surgeons, oncologists, and nurses who focus on pancreatic disease. The program provides a multidisciplinary approach to the diagnosis and management of pancreatic disease. Farrell is an internationally recognized expert in pancreatic disease treatment and research. In addition to his clinical work on the endoscopic evaluation of autoimmune pancreatitis and pancreatic cysts, he is also known for his development of personalized therapy approaches for pancreatic cancer and early detection biomarkers for pancreatic cancer.
Additionally, he is an advanced endoscopist who specializes in pancreas and biliary disorders including pancreas cysts, masses, chronic pancreatitis, bile duct stones and strictures, diagnosis and treatment of Barrett's esophagus, early esophageal and gastric cancer, stenting of the esophagus and small bowel, and difficult colonoscopy and polypectomy. He performs EUS, and EUS-FNA, FNB (fine needle aspiration and biopsy), celiac neurolysis and pseudocyst drainage, ERCP, enteral stenting, endoscopic mucosal resection (EMR).
What led you to specialize in advanced endoscopy in regards to pancreatic disease?
“A combination of defining experiences with patients with pancreatic disease, exposure to clinical and research experts in the field of pancreatic disease, and the opportunity to train in advanced endoscopic techniques, led me to dedicate my professional career to caring for patients with all forms of pancreatic disease (benign and neoplastic) using advanced endoscopic and medical approaches.”
What do you enjoy the most about your practice?
“Our rapidly evolving understanding of the pancreatic diseases we manage, combined with the multidisciplinary nature of their management, including interaction with other specialists in surgery and radiology, combined with the practical ability to have a positive impact on a patient’s quality of life and medical condition, make my clinical practice both exciting and rewarding.”
Thiruvengadam Muniraj, MD, PhD, FRCP, is the associate chief for endoscopy for Yale New Haven Health and an assistant professor of medicine at YSM, Department of Internal Medicine, (Digestive Diseases). Muniraj also is the director of bariatric endoscopy and the Yale Center for Pancreatitis. He is an advanced endoscopist and a nationally recognized expert in pancreatic diseases, including acute and chronic pancreatitis. He is involved in many national and international research studies in the field of pancreas and interventional endoscopy.
Muniraj performs a full range of advanced endoscopic procedures such as ERCP, confocal endomicroscopy, cholangioscopy, pancreatoscopy, electro-hydraulic lithotripsy (EHL), endoscopic ultrasound (EUS), fine needle aspiration and biopsy (FNA/FNB), celiac plexus block, pancreatic pseudocyst drainage, pancreatic necrosis, pancreatic stones and strictures, Barrett's esophagus treatment with RFA, EMR, cryotherapy, endoscopic suturing, fistula closure, ulcer closure, enteral stents, single balloon enteroscopy, ampullectomy, and high-risk colon polypectomy with endoscopic mucosal resection (EMR).
Muniraj directs the endoscopic bariatric program where he performs endoscopic sleeve gastroplasty, stoma narrowing, and PEG placement for weight loss. Muniraj introduced several novel endoscopic EUS/ERCP procedures in Connecticut, such as ERCP for patients with gastric bypass, EUS-based gastrojejunostomy, and pancreatic/hepatic anastomoses.
What led you to specialize in complex interventional endoscopy procedures?
This is a huge area of unmet need, bridging the gaps between surgery and interventional radiology. I am thrilled that we can help the patients with these novel endoscopic techniques in a minimally invasive way with excellent outcomes. We have an extraordinarily talented surgical and interventional radiology team, which empowers me to adapt to these complex procedures.
What do you enjoy the most about your practice?
We have a fantastic team at our center for advanced endoscopy. The team members are all extremely motivated to make meaningful changes in patients' lives. I enjoy working so much and feel like this is my second home.
Hillary Drumm APRN, MSNMPH, assesses and evaluates patients before and after complex endoscopic procedures, helping to medically optimize patients for their procedures and ensure they understand the treatment plan. She also reviews complicated procedure and biopsy results, educates patients and families, and coordinates clinical resources for patients of the Advanced Endoscopy Team. She helps care for patients with diseases of the pancreas and bile ducts, pancreas cysts, choledolchal (bile duct) cysts, and bile duct stones, and patients receiving endoscopic therapy for cancer, or undergoing procedures such as ERCP, EUS, RFA for Barrett's esophagus, Sphincter of Oddi dysfunction, and PSC.
What is advanced endoscopy’s greatest benefit to patients?
“Advanced Endoscopy offers prompt, accurate, complex, minimally invasive medical care for complicated issues of the digestive tract. We have an efficient and compassionate team that offers incredible care to help treat biliary and pancreas issues, and who helps support and guide patients to the next step of their medical journey.
What do you enjoy the most about your work?
“The healthcare system can seem very complicated, confusing, and stressful. Patients coming to Advanced Endoscopy are often undergoing a very trying time during the diagnosis of a suspected new cancer diagnosis or a highly complex digestive issue. It is a privilege to be able to support patients and their families during this time, and to help to translate complicated medical information and diagnoses so that important care decisions can be made. This allows patients and their families to feel respected, empowered, and to be true partners in their care.”
Karin Koval, PA-C, MHS, helps to care for patients with complex diseases of the GI tract including Barrett’s esophagus, neuroendocrine tumors, biliary strictures, large polypoid lesions, pancreatitis, pancreatic cysts, and various GI malignancies. She evaluates patients being referred for advanced procedures such as EUS, ERCP, and radiofrequency ablation to ensure they are medically optimized and informed about their procedure. She sees both new patients in consultation and established patients for follow-up or post-procedure visits. Koval reviews imaging, labs, and complex biopsy results with patients and their families and helps coordinate additional care.
What is advanced endoscopy’s greatest benefit to patients?
“In advanced endoscopy, we provide specialized treatment and care to patients with complex GI illnesses. Our physicians can provide treatment and obtain diagnostic information using cutting-edge minimally invasive endoscopic techniques.”
What do you enjoy the most about your work?
“Working with a team, and organization, that strives to provide exceptional patient care.”