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A colonoscopy is an endoscopic procedure to examine the inner lining of your large intestine, rectum and colon.
A thin, flexible tube called a colonoscope is inserted into the rectum and steered through the colon by the physician to look at the lining for any abnormalities.
Biopsies may be performed to sample the tissue.
If identified, polyps may be removed through the scope.
Endoflip is an assessment of the esophageal motility performed during a sedated endoscopic procedure.
The technology utilizes impedance planimetry with a functional luminal imaging probe to provide information on the dimensions and the pressure in the GI tract.
We use it to characterize function of the esophageal body and lower esophageal sphincter, help tailor treatments and gauge adequacy of interventions.
Endomicroscopy provides real-time imaging of the gastrointestinal lining during an endoscopic procedure at the microscopic level.
Endomicroscopy may be used to better detect subtle abnormalities such as a precancerous change in the lining or outline the borders of a subtle lesion to plan therapy in real time.
Endomicroscopy systems that may be available include volumetric laser endomicroscopy and confocal laser endomicroscopy, and each offer different resolutions and field of view.
An endoscopic ultrasound is an endoscopic procedure that uses a specialized endoscope that has both a camera and an ultrasound at the end of the long flexible scope.
The ultrasound probe can image through the wall of the GI tract and adjacent organs in the chest and the abdomen.
A needle can be inserted to sample cells for analysis if needed.
An upper endoscopy is a procedure that allows your gastroenterologist to examine the lining of your upper gastrointestinal tract.
A flexible, lighted tube is inserted through your mouth and into the esophagus, stomach and the first part of the duodenum.
Typically, patients are sedated for the procedure. During this procedure, the physician may take biopsies (small tissue samples for analysis).
In some cases, your physician may discuss additional diagnostic or therapeutic maneuvers may be performed during an upper endoscopy.
This is a radiology test to assess the structure and the overall motor coordination of the esophagus.
During this test, you swallow liquid barium, which outlines the structure of the esophagus.
The radiologist may also be able to comment if there is a major motor coordination problem that may prompt additional testing.
Some studies also include swallowing a barium pill as part of the examination.
You are awake for the procedure.
High-resolution manometry is a diagnostic test performed to check the function of the esophagus and evaluate for a motility disorder of the esophagus.
High-resolution manometry measures pressures throughout your esophagus using a series of closely spaced pressure sensors on a thin catheter.
The thin catheter is inserted through the nose and runs down the esophagus into the stomach and is positioned to allow for the measurements throughout the esophagus.
You are awake for the procedure.
pH and impedance testing
A pH and impedance study is an outpatient test that measures the amount of acid or non-acid reflux of the stomach contents into the esophagus.
This is a catheter-based test. The catheter goes into your nose and is positioned along your esophagus with the end in the stomach.
The catheter is secured on the outside, and you are given a portable recording device.
The sensors along the catheter demonstrate the acid exposure, which reflects acid reflux and the fluid that comes up and may reflect weakly acidic or non-acidic reflux.
Wireless pH testing
Wireless pH testing allows your physician to evaluate the acid exposure in your esophagus while you continue your normal activities.
During an upper endoscopic procedure, the physician places a small capsule in your lower esophagus. The capsule records activity in that area for over a 48-hour period or 96-hour period and transmits acid levels to a wireless recording device which is worn on a belt.
You document meals and any symptoms during the study period. You return the recording device after the study period, and then your physician is able to download the data from the recording device and analyze the data to provide information about the severity of acid reflux.
The capsule will fall off on its own and does not need to be retrieved.
- Anti-reflux surgery/fundoplication
- Complex stricture dilation
- Cryotherapy ablation
- Endoscopic mucosal resection (EMR)
- Endoscopic submucosal dissection (ESD)
- Heller myotomy (laparoscopic)
- Hybrid argon plasma coagulation (hybrid APC)
- Magnetic lower esophageal sphincter augmentation (LINX)
- Peroral endoscopic myotomy (POEM)
- Pneumatic balloon dilation
- Radiofrequency ablation (RFA)
- Revisional surgery after fundoplication and hiatal hernia repairs
A surgical fundoplication is a surgical procedure to provide additional support the to lower esophageal muscles to reduce fluid from coming up from the stomach into the esophagus.
It is considered in some patients with acid reflux disease.
The surgeon wraps the top portion of the stomach around the junction of the esophagus and the stomach to reduce the reflux of contents back into the esophagus.
Complex stricture dilation
Some esophageal strictures may require multiple tools, multiple sessions or different approaches to provide improved caliber of the lumen.
Cryotherapy ablation is a procedure that is performed during endoscopy to destroy the lining of the superficial diseased tissue with the cycle of freezing and thawing the tissue.
The therapy exposes cells to extreme cold and then allows cells to thaw to cause the death of the cells in the targeted area.
The goal is to treat by destroying the diseased tissue, and the lining that regrows is the normal esophageal lining.
Endoscopic mucosal resection (EMR)
Endoscopic mucosal resection (EMR) is a procedure that is performed during an endoscopy to remove the superficial tissue.
The physician may remove tissue through the scope in pieces that are larger and deeper than standard biopsy samples.
EMR can be used in superficial precancerous or cancerous disease in the gastrointestinal tract to both allow for a more accurate diagnosis and also for treatment by removing the diseased tissue.
Endoscopic submucosal dissection (ESD)
Endoscopic submucosal dissection is an endoscopic procedure that is used for superficial cancers of the GI tract. The physician uses endoscopic knives and specialized techniques to remove the lesion through the scope. The goal in appropriately selected patients is to perform a curative resection through the scope without the need for surgery.
Esophagectomy is a complex surgery in which the esophagus is removed due to esophageal cancer or severe damage due to perforation or end-stage achalasia. Reconstruction of a new food pipe is often performed with another organ such as the stomach or part of the large intestine.
Heller myotomy (laparoscopic)
A laparoscopic Heller myotomy is a minimally invasive surgical procedure used to treat achalasia.
This surgical procedure uses several small incisions to utilize small cameras and instruments to cut the muscle of the lower esophagus in patients with achalasia.
Hybrid argon plasma coagulation (hybrid APC)
Hybrid APC allows for tissue destruction in the GI tract with thermal energy delivered after a submucosal cushion is created to decrease deeper injury.
Magnetic lower esophageal sphincter augmentation (LINX)
Magnetic lower esophageal sphincter augmentation is a novel minimally invasive surgical procedure in which the surgeon places a ring of magnetic beads around the lower portion of the esophagus to create more support to reduce the reflux of contents back into the esophagus.
Peroral endoscopic myotomy (POEM)
Peroral endoscopic myotomy (POEM) is a novel therapeutic endoscopic procedure used to treat achalasia.
The procedure is a minimally invasive alternative to a surgical procedure that uses the endoscope to enter the wall of the esophagus to access and cut the muscle of the lower esophagus in patients with achalasia.
Pneumatic balloon dilation
Larger caliber balloon dilation is considered in the setting of treatment of achalasia and some post-surgical states. In addition to the standard pneumatic balloon dilations, we also have available the EsoFLIP dilation system which allows for incremental adjustments and real-time feedback of the dilation.
Radiofrequency ablation (RFA)
Radiofrequency ablation (RFA) is a procedure that is performed during endoscopy to destroy the lining of superficial diseased tissue with thermal energy.
Your physician may use a balloon catheter or different-sized probes depending on the area that needs to be treated.
The goal is to treat by destroying the diseased tissue and the lining that regrows is the normal esophageal lining.
Revisional surgery after fundoplication and hiatal hernia repairs
Sometimes an anti-reflux surgery may have unexpected symptoms or outcomes after surgery. Revisional surgery requires a thorough evaluation and are more complex than the initial surgery.
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Clinical studies coordinator
Elizabeth Cook, H.T. (ASCP)
Faculty of The Center For Esophageal Research
- Stuart J. Spechler MD, Co-Director
- Rhonda F. Souza, MD, Co-Director
- Vani J.A. Konda, MD
- Qiuyang (Daniel) Zhang, Ph.D.
- Xi Zhang, MD
Yadlapati R, Vaezi MF, Vela MF, Spechler SJ, Shaheen NJ, Richter J, Lacy BE, Katzka D, Katz PO, Kahrilas PJ, Gyawali CP, Gerson L, Fass R, Castell DO, Craft J, Hillman L, Pandolfino JE. Management options for patients with GERD and persistent symptoms on proton pump inhibitors: recommendations from an expert panel. Am J Gastroenterology. 2018 Apr 24. [Epub ahead of print]
Mosher CA, Brown GR, Weideman RA, Crook TW, Cipher DJ, Spechler SJ, Feagins LA. Incidence of colorectal cancer and extracolonic cancers in veteran patients with inflammatory bowel disease. Inflammatory Bowel Disease 2018; 24:617-623.
Spechler SJ. Speculation as to why the frequency of eosinophilic esophagitis is increasing. Curr Gastroenterology Rep 2018; 20:26.
Spechler SJ. Cardiac Metaplasia: Follow, Treat, or Ignore? Dig Dis Sci 2018 Apr 18. [Epub ahead of print]
Spechler SJ, Katzka DA, Fitzgerald RC. New screening techniques in Barrett's esophagus: Great ideas or great practice? Gastroenterology 2018; 154:1594-1601.
Konda VJA, Spechler SJ. Endoscopic eradication therapy and the test of time. Gastrointestinal Endoscopy 2018; 87:85-87.
Huo X., Zhang X.. Yu C., Cheng E., Zhang Q., Dunbar K.B., Pham T.H., Lynch J.P., Wang D.H., Bresalier R.S., Spechler S.J., Souza R.F. Aspirin Prevents NF-kB Activation and CDX2 Expression Stimulated by Acid and Bile Salts in Oesophageal Squamous Cells of Barrett's Oesophagus Patients. Gut, 67: 606-615, 2018.
Choi S., Cui C., Luo Y., Kim S-H., Ko J-K., Huo X., Ma J., Fu L-W., Souza R.F.,Korichneva I., Pan Z. Selective Zinc Inhibitory Effect on Cell Proliferation in Esophageal Squamous Cell Carcinoma through Orail1. FASEB Journal, 32: 404-416, 2018.
Wang J., Park J.Y., Huang R., Souza R.F., Spechler S.J., Cheng E. Obtaining Adequate Lamina Propria for Subepithelial Fibrosis Evaluation in Pediatric Eosinophilic Esophagitis. Gastrointestinal Endoscopy, 87: 1207-1214, 2018.
Han J., Jackson D., Holm J., Turner K., Ashcraft P., Wang X., Cook B., Arning E., Genta R.M., Venuprasad K., Souza R.F., Sweetman L., Theiss A.L. Elevated D-2-Hydroxyglutarate during Colitis Drives Progression to Colorectal Cancer. PNAS, 30: 1057-1062, 2018.
Odiase E., Schwartz A., Souza R.F., Martin J., Konda V., Spechler S.J. New Eosinophilic Esophagitis Concepts Call for Change in Proton Pump Inhibitor Management Before Diagnostic Endoscopy. Gastroenterology, 154: 1209-1214, 2018.
Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, Spechler SJ, Attwood SE, Straumann A, Aceves SS, Alexander JA, Atkins D, Arva NC, Blanchard C, Bonis PA, Book WM, Capocelli KE, Chehade M, Cheng E, Collins MH, Davis CM, Dias JA, Di Lorenzo C, Dohil R, Dupont C, Falk GW, Ferreira CT, Fox A, Gonsalves NP, Gupta SK, Katzka DA, Kinoshita Y, Menard-Katcher C, Kodroff E, Metz DC, Miehlke S, Muir AB, Mukkada VA, Murch S, Nurko S, Ohtsuka Y, Orel R, Papadopoulou A, Peterson KA, Philpott H, Putnam PE, Richter JE, Rosen R, Rothenberg ME, Schoepfer A, Scott MM, Shah N, Sheikh J, Souza RF, Strobel MJ, Talley NJ, Vaezi MF, Vandenplas Y, Vieira MC, Walker MM, Wechsler JB, Wershil BK, Wen T, Yang GY, Hirano I, Bredenoord AJ. Updated international consensus diagnostic criteria for eosinophilic esophagitis: Proceedings of the AGREE conference. Accepted, Gastroenterology, 2018. Epub.
Spechler SJ, Konda V, Souza RF. Can Eosinophilic Esophagitis Cause Achalasia and Other Esophageal Motility Disorders? Accepted, American Journal of Gastroenterology, 2018.
Agoston AT, Pham TH, Odze RD, Wang DH, Das KM, Spechler SJ, Souza RF. Columnar-Lined Esophagus Develops via Wound Repair in a Surgical Model of Reflux Esophagitis. Accepted, Cellular and Molecular Gastroenterology and Hepatology, 2018.
Souza R.F. and Spechler S.J. A New Candidate for the Progenitor Cell of Barrett's Metaplasia. Nature Reviews Gastroenterology and Hepatology, 15: 7-8, 2018.
Souza R. F., Rubenstein J, Kao J, Hirano I. Contributions from Gastroenterology: Acid Peptic Disorders, Barrett's Esophagus and Eosinophilic Esophagitis. Gastroenterology, 154: 1209-1214, 2018.
Souza R.F. Esophageal Adenocarcinomas: A Need for Speed Driven by Immune Pathways That Have Druggable Targets. Cellular and Molecular Gastroenterology and Hepatology, 5:652-653, 2018.
Konda V.J.A., Souza R.F. Biomarkers of Barrett's Esophagus: From the Laboratory to Clinical Practice. Digestive Diseases and Sciences, 63: 2070-2080, 2018.
Congratulations Dr. Spechler on being named the 2019 recipient of the AGA Institute Council Esophageal, Gastric and Duodenal Disorders (EGD) Section Research Mentor Award!
- Read Dr. Souza's published article on Barrett's esophagus
- Watch Dr. Spechler and Dr. Souza discuss their latest research on GERD
Congratulations Dr. Spechler on being named the 2019 recipient of the AGA Institute Council Esophageal, Gastric and Duodenal Disorders (EGD) Section Research Mentor Award! This award recognizes and expresses the appreciation of our section and AGA for your outstanding contributions to the mentoring and training of new investigators in the field.