Bethesda North Hospital specializes in the diagnosis and treatment of gastrointestinal – or upper GI – disorders that affect the esophagus, stomach and small bowel. Our dedicated team supports our patients though the diagnoses and treatment of many different gastrointestinal disorders.
Gastrointestinal Disorders We Treat
- Zollinger-Ellison Syndrome
- Stomach Cancer
- Hiatal Hernia
- Esophageal cancer
- Barrett’s Esophagus
Our gastrointestinal service is a collaboration between various specialists. Together, gastroenterologists, surgeons, radiologists, oncologists and nutritionists provide a unified approach of treating our patients. This approach includes a dedication to safety and quality, which is an integral part of our mission.
We also believe in a strong patient education program to support and improve our patients’ health. We understand that the more patients know about their disorder, the more likely there are to have a good response to therapy.
Specialized Services and Procedures
We use the latest in technology to provide a safe environment in which we deliver excellent care to our patients and their families. Our techniques include:
BARRX™ is a treatment for Barrett’s Esophagus, a precancerous condition that can lead to esophageal cancer. Using radiofrequency ablation (the use of heat energy to destroy tissue), specially trained gastroenterologists zero in on the diseased tissue to be destroyed while preserving underlying healthy tissue. Barrett’s Esophagus occurs when the esophagus is constantly exposed to acid from the stomach, known as gastroesophageal reflux disease, or GERD.
Historically Barrett’s Esophagus patients received surveillance endoscopies to look for the presence of dysplasia (abnormal cells) in the esophagus. If dysplasia was found, these patients underwent radical surgery to remove large parts of their esophagus. With radiofrequency ablative technology, dysplasia can be treated with a non-surgical procedure.
With BARRX™, patients undergo an outpatient endoscopic procedure that identifies Barrett’s Esophagus tissue and employs radiofrequency ablation to destroy the precancerous cells. This takes about 30 minutes. Patients typically return for two to three procedures, and they receive a final biopsy to ensure the precancerous cells have been destroyed. The treatment is so specific in targeting the thin layer of diseased tissue that normal, healthy tissue grows once the esophagus heals.
A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope.
The colonoscope has a small camera attached to a flexible tube that can reach the length of the colon.
Endoscopic Mucosal Resection (EMR)
With Endoscopic Mucosal Resection (EMR), a patient receives a sub-mucosal injection of saline to elevate the lesion from deeper tissue layers. The lesion is then removed with bands and snare cautery. This technique is used to treat gastrointestinal lesions that, in some cases, would have previously required a surgical resection. EMR is performed by a specially trained endoscopist as an outpatient endoscopy procedure.
Endoscopic retrograde cholangiopancreatography – or ERCP – is a technique that gives doctors the capability to gain access to the bile ducts and pancreas. It is performed with a flexible endoscope that is entered through the mouth and into the stomach and area of the upper intestine – called the ampulla – where the bile ducts and pancreas open. Through this technique, diseases of the bile ducts and the pancreas are diagnosed better and earlier than before.
There are several common uses for ERCP to treat the bile ducts. The most common is to detect the presence of stones within them. With ERCP, stones of almost any size and consistency now can be crushed and removed without having to open the abdomen.
ERCP also can be used to treat a bile duct injury after a gallbladder operation. Often, such injuries cause bile to leak into the abdomen. In the past, this very painful condition often required reparative surgery. ERCP allows doctors to place a stent in the bile duct to help it heal itself.
A stent also helps when cancers of the bile ducts cause obstructive jaundice. In these cases, placing the stent with ERCP helps bridge the obstruction and relieve the jaundice.
ERCP also is one of the best ways to access the pancreas for diagnostic purposes. It not only can help diagnose pancreatic cancer, but also help treat it by relieving jaundice and planning – if necessary – for major subsequent surgery.
ERCP also has a great use in accessing the pancreas for therapeutic purposes. Blockage of the pancreas leads to pancreatitis, which often is a debilitating condition. With ERCP, doctors can see the pancreas and determine the reason for such blockages and treat many causes of pancreatitis.
Esophagogastroduodenoscopy is the visual examination of the esophagus, stomach and duodenum – or small bowel. This procedure is done with a flexible video endoscope through which your physician may take specimens. An EGD is an outpatient procedure that takes approximately 15 to 30 minutes to complete. Patients usually recover in about 45 minutes.
The esophagus is the long, narrow food pipe (gullet) that carries food and liquid from the mouth to the stomach. It can become blocked or injured in a variety of ways. Esophageal dilatation is the technique used to stretch or open the blocked portion of the esophagus.
There are several causes of blockage or stricture of the esophagus. They all can make swallowing food and/or fluids difficult. The physician's first job is to find the reason for the stricture or narrowing. The answer can usually be provided by the medical history, physical exam, x-rays, and Endoscopy (a visual exam of the esophagus using a Flexible Fiberoptic tube). Causes may include:
- Acid Peptic Stricture
- Schatzki's Ring
- Ingestion of Caustic Agents
In most instances, the problem is a mechanical one with an obstruction acting like a dam across a stream. Therefore, the treatment must be mechanical. The dam must be broken. After a diagnosis is made, the physician determines the method of treatment that is in the patient's best interest. The physician has a variety of techniques available. Each has benefits and is appropriate in specific cases. The physician will always discuss these options with the patient.
- Simple Dilators (Bougies) - These are a series of flexible dilators of increasing thickness. One or more of these are passed down through the esophagus at a setting. The bougie is the simplest and quickest method of opening the esophagus.
- Guided Wire Bougie - In some instances, the physician performs Endoscopy and places a flexible wire across the stricture. The scope is removed and the wire left in place. A dilator with a hole through it from end to end is guided down the esophagus and across the stricture. One or more of these dilators are passed over the wire. At the end of the exam, the wire is removed. This type of treatment may be performed in the x-ray department under Fluoroscopy.
- Balloon Dilators - Flexible Endoscopy allows the physician to directly view the stricture. Deflated balloons are placed through the scope and across the stricture. When inflated, they become sausage shaped, stretch, and break the stricture.
- Achalasia Dilators - Achalasia is a special situation which requires a larger, balloon-type dilator. The procedure is always done under x-ray control. In this situation, the spastic muscle fibers in the lower esophagus are stretched and broken, which in turn allows easier passage of food and liquid into the stomach.
As mentioned, there are a number of dilating techniques available to the physician. Simple bougie dilatation may be done in the office, in a sitting position, and with only an anesthetic spray of the throat. If Endoscopy is performed at the same time, then it will be done in the endoscopy suite, usually under sedation. X-ray fluoroscopy equipment may be needed, so the procedure is also performed in the x-ray unit. Simple bougie dilatation may take only a few minutes. The other techniques require 20 to 30 minutes. Recovery is usually quick and the patient can soon begin eating and drinking to test the effectiveness of the treatment.
Esophageal dilatation is usually performed effectively and without problems. However, some complications can occur. A small amount of bleeding almost always happens at the treatment site. At times, it can be excessive, requiring evaluation and treatment. An uncommon but known complication is perforation of the esophagus. The wall of the esophagus is thin and, despite the best efforts of the physician, can tear. An operation may be required to correct this problem.
Esophageal manometry is a test that records muscle functioning of the esophagus that often is used to evaluate swallowing disorders of the esophagus. It also can be performed prior to surgical treatment of the esophagus and to uncover the cause of chest pain and heartburn. It usually is performed after structural abnormalities have been excluded by endoscopy or x-ray studies.
The benefit of this exam is that your physician will be able to evaluate swallowing problems and then decide on appropriate therapy. Treatment might consist of medications, endoscopy with injection of medicine into the esophagus, or possibly dilatation of the esophagus.
Esophageal manometry takes about an hour. You will have a thin tube placed through your mouth or nose into your stomach. Numbing spray is used to decrease any possible gagging. During the exam, you will be instructed to swallow saliva or water to help evaluate swallowing function. Since there is no sedation, you can resume normal activities immediately following the test.
During the Procedure:
Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will turn on the ultrasound attachment to produce sound waves that create visual images of the digestive tract.
Why It's Done:
Endoscopic ultrasound – or EUS – combines endoscopy and ultrasound to address the limitations of endoscopic technology. It not only can detect the presence of a mass within or outside the gastrointestinal wall, but also explain its character and obtain tissue to allow pathological diagnosis of it. EUS-guided tissue also allows sampling to help differentiate malignant from benign lesions.
It allows your doctor to examine your stomach lining as well as the walls of your upper and lower gastrointestinal tract. The upper tract is the esophagus, stomach and duodenum; the lower tract includes your colon and rectum.
The preparation, sedation and risks associated with EUS are essentially the same as other endoscopic procedures. Your doctor can use EUS to evaluate and diagnose the cause of a variety of disorders, including abdominal pain, abnormal weight loss, or an abnormality, such as a lump, that was detected at a prior endoscopy. It can also diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive. The complete list includes:
- Subepithelial mass definition
- Mediastinal mass definition
- Lung cancer staging
- Large gastric folds
- Esophageal cancer: local and regional staging
- Gastric cancer: local and regional staging
- Ampullary cancer: local and regional staging
- Pancreatic cancer: evaluation of respectability
- Pancreatic endocrine tumors: preoperative localization
- Other abdominal masses (adrenal, lymphoma)
- Chronic pancreatitis: diagnosis
- Choledocholithiasis: diagnosis
- Rectal cancer: local staging
- Anal sphincter defects (incontinence)
- Endoscopic mucosal resection
- Treatment of vascular lesions
- Transmural pseudocyst drainage
- Celiac plexus neurolysis
In addition, using a tool called endoscopic ultrasound-fine needle aspiration – or EUS-FNA – doctors can make diagnoses in the mediastinum and abdomen:
- Primary tumors
- Subeptithelial tumors of the esophagus
- Lung cancer
- Spindle cell tumor
- Malignant histiocytoma
- Neuroendocrine tumor
- Lymph nodes
- Metastases from primary tumors
- Primary tumors
- Primary and secondary tumors
- Gastric and duodenal supepithelial tumors
- Pancreatic tumors/carcinoma
- Neuroendocrine tumors
- Metastatic tumors
- Primary hepatobiliary and hepatocellular tumors
- Liver metastases
- Subepithelial tumors of the rectum
- Primary and secondary tumors of the adrenal glands, prostate and seminal vesicles
- Lymph nodes
- Metastases from primary tumors
- Capsule endoscopy
- Primary and secondary tumors
Capsule endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, otherwise known as the small bowel.
The most common reason your doctor will recommend capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, ulcers, and tumors of the small intestine, as well as Crohn’s disease.
Capsule endoscopy utilizes a pill-sized video capsule with its own lens and light source to capture images that are then displayed on a video monitor. Non-invasive and painless, it provides valuable help in examining the small intestine and searching for problems that could be difficult to diagnose, since most of this area cannot be reached by upper endoscopy or colonoscopy.
Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive. The capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder that you wear on your belt for about eight hours. At the end of the procedure you will return the data recorder and the images will be downloaded to a computer for your physician to review.
Potential risks of capsule endoscopy include complications from obstruction. This usually relates to a stricture or tumor that is diagnosed for the first time during treatment.
Fecal Microbiota Transplant for C. Diff
Clostridium Difficile, or C. Diff for short, is a severe intestinal infection of the colon. Symptoms of C. Diff may include frequent watery diarrhea, abdominal pain, nausea, weight loss and fever.
If left untreated it can lead to severe dehydration and may be fatal in extreme cases.
Medtronic Bravo™ pH Monitoring System
The Medtronic Bravo™ pH Monitoring System is the first catheter-free system used to measure acidity levels in patients who have gastroesophageal reflux disease.
Your physician may order this test to determine whether symptoms of heartburn, chest discomfort, difficulty swallowing, hoarseness, or coughing are reflux related. Additionally, measurement of pH may be helpful in determining the success of medications you are taking for acid reflux.
This test takes two days to complete. While you are sedated during an endoscopy, your physician will attach a small capsule the size of a gelcap to the distal part of the esophagus. The capsule contains a miniature sensor that measures acid in the esophagus and is able to transmit that information to a portable recorder that is carried on the waist.
Patients can eat and drink normally and engage in their usual activities during testing. However, you should review all the medications you are taking prior to the procedure to determine if any need to be discontinued prior to testing.
The study is completed after 48 hours, when you will return the recorder to the hospital and the data is then analyzed to determine your course of treatment. The capsule then passes harmlessly through the digestive tract.