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Innovative Care Unique to Suffolk County and Beyond
Endoscopy refers to the procedure of inserting a medical device into the body’s natural orifices (nose, mouth, and rectum) to enable a physician to examine a person’s organs and cavities. The device consists of a thin, flexible or rigid tube with an attached light and a small video camera. With recent advances in technology, surgery is becoming more minimally invasive and endoscopy’s role as a diagnostic tool has expanded; it is being used more as a tool for therapeutic treatment as well. Because sophisticated technology and advanced training are now available to conclusively diagnose many complex GI conditions, patients are often referred to an advanced endoscopy center by their gastroenterologist.

A Comprehensive, Multidisciplinary Approach
Our highly-skilled, highly-trained Interventional Endoscopy team also calls upon other key specialists, as needed, such as expert surgeons, interventional radiologists, medical oncologists, radiologists, pathologists and radiation oncologists. Together, this multidisciplinary team works closely and meets frequently to discuss the needs of each patient and is committed to delivering the latest advances in endoscopic care with effectiveness, compassion and safety. The team is committed to timely communication with patients and their referring physicians.

Jonathan Buscaglia, MD, Director of the Interventional Endoscopy Center
Dr. Buscaglia is a recognized expert in advanced endoscopy, his pioneering research in natural orifice transluminal endoscopic surgery (NOTES) is considered the newest frontier in minimally invasive surgery by endoscopy experts. He specializes in endoscopic retrograde cholangiopancreatopography (ERCP), diagnostic and interventional endoscopic ultrasound (EUS), endoscopic mucosal resection (EMR), endoluminal stent placement, and deep small bowel enteroscopy. He is an Assistant Professor of Medicine, Division of Gastroenterology and Hepatology at Stony Brook School of Medicine.

Juan Carlos Bucobo, MD, Director of Endoscopy
Dr. Bucobo is an advanced endoscopy expert, specializing in endoscopic ultrasound (EUS), endoscopic mucosal resection (EMR), endoscopic retrograde cholangiopancreatopography (ERCP), endoluminal stent placement and deep small bowel enteroscopy. He is an Assistant Professor of Medicine, Division of Gastroenterology and Hepatology at at Stony Brook School of Medicine.

Satish Nagula, MD
Dr. Nagula is an advanced endoscopy expert specializing in endoscopic ultrasound (EUS), endoscopic mucosal resection (EMR) endoscopic retrograde cholangiopancreatography (ERCP), and endoluminal stent placement. He also has expertise in gastroesophageal reflux (GERD) and Barrett’s esophagus. Dr. Nagula is an Assistant Professor of Medicine, Division of Gastroenterology and Hepatology at Stony Brook School of Medicine.

Isabelle von Althen, MD, Director of the Gastrointestinal Women’s Center
Dr. von Althen is an advanced endoscopist specializing in women’s gastrointestinal health and has an expertise in endoscopic retrograde cholangiopancreatopography (ERCP). She is an Assistant Professor of Medicine, Division of Gastroenterology and Hepatology at Stony Brook School of Medicine.

• Barrett’s esophagus is a precancerous condition in the lower esophagus, often due to repeated exposure to stomach acid. It is most often diagnosed in people with chronic gastroesophageal reflux disease (GERD) and is characterized by a change in the color of lining of the lower esophagus.
• Complex biliary diseases are caused by a combination of genetic, environmental, and lifestyle factors that affect the bile duct, which carries bile, a fluid that is excreted by the liver and required for the digestion of fats.
• Cystic neoplasms of the pancreas are common lesions within the pancreas that may have the potential to turn into a cancer.
• Chronic pancreatitis is the swelling or inflammation of the pancreas that leads to scarring and loss of the pancreas’ function.
• Endoscopic oncology is the diagnosis and treatment of cancerous tumors requiring endoscopic medical and surgical treatment.
• Esophageal cancer is a malignant tumor found in the esophagus, which is the long tube that runs from your throat to your stomach and carries food you swallow to be digested. This type of cancer can occur in any part of the esophagus, but for the U.S. population, the disease occurs in the lower portion of the esophagus in the majority of cases.
• Gastric cancer is also known as stomach cancer, which is a rare form of cancer that can develop in any part of the stomach and spread to other organs, particularly the esophagus, lungs, lymph nodes and the liver.
• Pancreatic cancer is a malignant tumor found in the pancreas, which is a gland organ located behind the stomach that produces insulin to help control the amount of sugar in the blood, as well as other important juices and enzymes to aid in the digestive process.
• Pancreatic disorders pertain to the pancreas, which is a gland organ located behind the stomach that produces insulin to help control the amount of sugar in the blood, as well as other important juices and enzymes to aid in the digestive process.
• Stomach cancer, refer to Gastric Cancer.

• Endoscopic mucosal resection (EMR) – A procedure to remove a small, polyp-like growth using a small wire loop that fits on the end of an endoscope.
• Endoluminal stent placement – A procedure to insert a stent (a thin expandable tube) to keep the esophagus open.
• Endoscopic ultrasound (EUS) – A procedure that allows for the detailed evaluation of pancreatic and biliary abnormalities. EUS-guided treatments we perform include:
  • Celiac nerve block — The injection of a local anesthetic into and around the celiac nerves to provide relief for disabling pain associated with chronic pancreatitis (swelling or inflammation of the pancreas).
  • Drainage of abscesses — A novel approach to treating and draining abscesses in the gastrointestinal tract without the use of surgery.
  • Evaluation of pancreatic cysts — A procedure used to examine collections of pancreatic duct fluid (cysts) to diagnose chronic or acute pancreatitis.
  • Evaluation of subepithelial lesions — Examination of any mass or bulge that is found within a layer of the gastrointestinal tract wall or outside of the wall during an endoscopy
  • Fine needle aspiration (FNA) — A diagnostic procedure used to investigate lumps or masses using a thin, hollow needle.
  • Placement of fiducial markers for XRT — A fine needle is inserted into a tumor to implant a marker (fiducial) as a reference point to target for future radiation therapy (XRT).
  • Pseudocyst drainage — An alternative to surgery, this advanced procedure drains fluid from pancreatic cysts using multiple drains through one puncture site.
  • Staging of gastrointestinal (GI) and lung malignancies — Use of EUS-guided staging in the GI tract is considered the gold standard in grouping (staging) GI-related cancers based on the size of the tumor and extent of its progression in other parts of the body (metastasis).
• Electrohydraulic lithotripsy (EHL) — A procedure that use an electric current from a miniature endoscope, which breaks up bile duct stones and urinary tract stones that are too large to be extracted whole, so they can pass out of the body through urine.
• Enteroscopy — A form of endoscopy that uses a thin, flexible endoscopy to capture images to definitively diagnose symptoms like obscure bleeding in the small intestine and sometimes treats conditions on the spot.
  • Spiral enteroscopy — Incorporates the use of a soft, smooth spiral tip that slides over the endoscope and is rotated by the endoscopist to help move more deeply into and more quickly through the small.
  • Single-balloon enteroscopy — Refers to a flexible tube with a latex balloon that slides over the endoscope and can be inflated to anchor positioning of the endoscope at a certain point in the small intestine, or be deflated to move deeper into the small intestine.
• ERCP with Spyglass™ Cholangioscopy and Pancreatoscopy — ERCP stands for endoscopic retrograde cholangiopancreatography, a test that combines the use of endoscopy and fluoroscopy (dye injected into the bile or pancreatic duct and shows up on an x-ray) to definitively diagnose and treat abnormalities in the pancreas. ERCP with Spyglass technology is a procedure that uses state-of-the-art equipment, which enables the endoscopist to view deeper into the bile duct and pancreas to definitively diagnose a malignant tumor or determine the need for laser therapy. In Suffolk County, Spyglass technology is available only at Stony Brook.
• Management of obscure bleeding — Diagnostic endoscopic evaluations including capsule endoscopy, and endoscopic therapies used to manage uncommon, chronic, unexplained bleeding, which is most common in the elderly.
• Mechanical lithotripsy  — Using a catheter, this technique, which is often used in combination with EHL and ERCP, removes bile duct stones from the bile duct.
• Pancreatic endotherapy — Therapy that is delivered endoscopically for pancreatic diseases such as chronic pancreatitis (swelling or inflammation of the pancreas that leads to scarring and loss of the pancreas’ function).
• Radiofrequency ablation (RFA) of Barrett’s esophagus — This leading-edge procedure burns away precancerous lesions associated with Barrett’s esophagus.
• Sphincter of oddi manometry — An advanced ERCP technique that measures and evaluates pressure in the bile duct to definitively diagnose abnormal liver tests, unexplained pancreatitis, upper abdominal pain, or complex biliary and pancreatic disorders.
• Wireless capsule endoscopy — Also known as a “pill cam,” this non-invasive test uses a pill-size capsule that contains a camera to record images of the digestive tract and diagnoses obscure (unexplained and persistent) gastrointestinal bleeding.

Barrett’s esophagus is a precancerous condition that develops as a consequence of long-standing gastroesophageal reflux disease (GERD). Treatment for this condition with radiofrequency ablation (RFA) is quite effective and helps to prevent development of esophageal cancer. RFA is a minimally invasive procedure that uses highly targeted heat energy to irradiate and eliminate precancerous tissue in the esophagus. The patient shown here has a long history of GERD, and was diagnosed with Barrett’s esophagus several years ago. Previous biopsies demonstrated early signs of dysplasia. She underwent RFA last year at Stony Brook, and her most recent endoscopy demonstrated that her Barrett’s esophagus has been successfully eradicated. The experts at Stony Brook have been performing RFA for Barrett’s esophagus for the past 18 months. More than 50 patients have been successfully treated, including those with dysplasia and nondysplastic Barrett’s esophagus.

Additional Sources of Information

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Recent Breakthroughs in the Treatment of Upper Gastrointestinal Cancers by Kevin Watkins, MD, and Jonathan Buscaglia, MD – June 2011