Endoscopic Retrograde Cholangiopancreatography (ERCP)

Utilized to diagnose and treat disorders such as bile duct stones, bile duct leak post surgery and biliary strictures in addition to providing diagnostic and palliative therapy in pancreatic and biliary cancers.

Gastrostomy tube placement

Often used as an adjunct to oncologic management of head and neck cancers to provide needed nutrition during radiation and chemotherapy.  Addition uses include temporary adjunct for nutritional therapy during extended hospitalizations and recovery as well as palliative use during end of life.  A feeding tube is placed endoscopically from the stomach to the abdominal wall allowing for liquid food to be administered by the patient or caregiver.

Small bowel Enteroscopy

A longer endoscope is either taken through the mouth or anus and guided into the small bowel and advanced through the small bowel by manipulation of the scope and at times a balloon on the scope. This can be a therapeutic maneuver aimed at addressing gastrointestinal bleeding sources in the small bowel or in may be used in the diagnosis of other concerning mass lesions or cancers.

Video capsule endoscopy

This method allows for the entire visualization of the small bowel from the duodenum to the end of the ileum. Utilized primary for iron deficiency anemia evaluations when chronic blood loss is suspected, however can also be quite useful for evaluation of chronic diarrhea, celiac disease, Crohn’s disease or abnormalities on CT scan or other imaging.

We use an updated GIVEN imaging system with advanced imaging capability and tracking through the small bowel. In addition to the equipment, we are pleased to have several physicians who are skilled at interpreting the images particularly in the context of small bowel mucosal diseases (Crohn’s, Celiac disease etc).

Endoscopic Ultrasound (Upper / Rectal)

This procedure is utilized to evaluate both luminal (inside the GI tract) and extra luminal (outside the GI tract) processes where the disease or abnormality is not able to be seen or evaluated by mucosal biopsy. The procedure is able to define individual wall layers of the GI tract to stage the depth of cancers or to define the layer in which a certain growth begins.  If there are concerning lymph nodes or masses outside the GI tract, we are able to take a small needle and precisely target the area of interest to obtain a diagnosis. These attributes of the procedure make this modality very important in the staging and management of esophageal, pancreatic and rectal cancers. We have also utilized this procedure for the evaluation of breast and lung cancers, lymphomas and other growths as found during routine endoscopy or by other modes of imaging.

We are at present the largest provider of endoscopic ultrasound services to the Triangle community with three of our physicians having undergone advanced post fellowship training in the use of this advanced diagnostic modality.  We are pleased to have Dr. Patel lead this group, having developed the Endoscopic Ultrasound Program from inception at REX hospital. The entire DHC physician group cumulatively provide a wealth of experience assisting in cancer diagnosis and management from the GI perspective.