Complex Interventional Endoscopy Procedures

Interventional endoscopy allows the endoscopist to use an endoscope to perform surgical-type procedures from the inside. A channel within the endoscope provides a conduit to introduce miniature instruments to perform a variety of therapies. Utilizing multiple imaging modalities and a collection of advanced endoscopic tools, the Paul May and Frank Stein Interventional Endoscopy Center’s specialized team, led by Dr. Kenneth Binmoeller, is able to diagnose conditions and treat disease using techniques not available in most medical facilities. The Center at California Pacific Medical Center utilizes and has developed many innovative endoscopic procedures that replace the need for surgery. Depending on your diagnosis, your doctor will explain your treatment options and develop a treatment plan with you that may include one or more of the following procedures.

Bile and Pancreatic Duct Procedures

Dr. Binmoeller and the interventional endoscopy services (IES) team at the Paul May and Frank Stein Interventional Endoscopy Center have pioneered many of the techniques that are used to manage “difficult” endoscopic retrograde cholangiopancreatography (ERCP). (For example, performing procedures for those with prior failed cannulation, complex bile and pancreatic duct stones and strictures, Mirizzi syndrome and advanced cancers.) More recently, the IES doctors have developed endoscopic ultrasound (EUS) for bile and pancreatic duct access and treatment when the conventional transpapillary ERCP approach fails or is not possible due to surgically altered anatomy (for example, after gastric bypass). EUS-guidance has the added advantage of avoiding ionizing radiation exposure, which is particularly important for pregnant patients.

Coil and Glue Injection Treatment

This innovative approach was developed at the Paul May and Frank Stein Interventional Endoscopy Center to prevent and treat bleeding from gastric (stomach) varices through the deployment of a combination of coils and cyanoacrylate glue under EUS-guidance. Without intervention, this issue can cause severe and sometimes fatal bleeding. The treatment avoids the more invasive shunt procedure that is performed either under radiological guidance (TIPS) or by open surgery.

Peroral Endoscopic Myotomy (POEM)

Certain swallowing disorders are caused by abnormally tight or hyperactive muscles in the esophagus. The POEM procedure involves creating a tunnel in the wall of the esophagus to safely reach and treat the deeper, abnormal muscle layer. The IES team developed a modification of the POEM procedure using water submersion (“Underwater POEM”) to improve the safety and outcomes of POEM.

Endoscopic Mucosal Resection and Submucosal Dissection

This procedure is used for the curative treatment of precancerous and early cancerous growths of the esophagus, stomach and colon such as Barrett's esophagus associated with high-grade dysplasia. It’s also used in the colon for the removal of large, flat polyps. Dr. Binmoeller pioneered endoscopic resection of large and giant colon polyps in 1994 and more recently developed the “underwater” technique for polyp resection.

Endoscopic Ampullectomy

This treatment was created by Dr. Binmoeller and first used in 1994. Surgery is avoided by performing curative excision of precancerous and cancerous growths involving the Ampulla of Vater, as well as excision of tumors extending into the bile or pancreatic ducts.

EUS-Guided Drainage of Pancreatic Fluid Collections

Dr. Binmoeller was the first to perform and report EUS-guided pseudocyst drainage in 1992. Since then, he and the IES team have been at the forefront of endoscopic management of pancreatic fluid collections (pseudocysts and walled-off necroses) that can develop after pancreatitis or pancreatic surgeries. He also invented the AXIOS™ lumen-apposing stent and delivery system, which has revolutionized the treatment of pancreatic fluid collections by enabling endoscopic treatment in cases that previously required surgical management.

EUS-Guided Bypass Procedures

The IES team provides bypass procedures, such as enteric bypass, gallbladder bypass and biliary bypass, using lumen-apposing stents include gallbladder drainage (cholecystoenterostomy), bile duct drainage (choledochoenterostomy) and relief of intestinal blockage (gastroenterostomy). These bypass procedures save patients from undergoing surgical bypass. Often patients receiving these procedures are in need of palliation for symptoms of an underlying cancer and are at high risk for surgery.

Septomyotomy for Zenker’s Diverticulum

A Zenker’s diverticulum is an abnormal pouch that can develop above the upper sphincter of the esophagus, interfering with swallowing and placing patients at risk of aspirating food into their airway. Endoscopic septomyotomy involves treatment of the upper esophageal sphincter muscle to correct this problem.

Closure of Fistula and Leaks

The IES team have pioneered various techniques for full-thickness closure of tissue defects that can lead to fistulas and leaks. The group was the first to perform endoscopic suturing in Northern California in 2006. This technique has evolved over time and outcomes have improved to the point that suturing has become the approach of choice for the management of fistulas and leaks by the IES doctors. Most patients with this problem are referred by surgeons after they have developed fistulas and leaks in various locations of the GI tract as a complication of prior surgery.

Endoscopic Bariatric Therapies

The IES team uniquely offers pouch and stoma reduction using endoscopic techniques for patients that have had significant weight regain after gastric bypass surgery. The group was also the first to perform endoscopic sleeve gastroplasty in Northern California, which is an endoscopic alternative to weight loss surgeries.   

Transoral Incisionless Fundoplication (TIF)

This procedure is a minimally invasive endoscopic method used to treat gastroesophageal reflux disease (GERD) by repairing the valve between the esophagus and stomach, helping to restore the body’s natural protection against acid reflux. The procedure is successful in reducing or eliminating the need for chronic medications while avoiding the long-term complications of invasive surgery such as chronic difficulty swallowing or gas-bloat syndrome.

Ongoing Clinical Research

The IES team at the Paul May and Frank Stein Interventional Endoscopy Center continue to innovate new procedures and have published multiple papers on their extensive contributions to interventional endoscopy.