GASTROENTEROLOGY

Endoscopy Laboratory

The Lab has top-notch equipment such as a Full High Definition endoscopy tower and high-resolution video-endoscopes using the latest techniques in Chromoendoscopy and Νarrow Βand Ιmaging for higher diagnostic accuracy.

Diagnostic upper GI (gastroscopies and duodenoscopies) and lower GI endoscopies (colonoscopies and capsule endoscopies) are performed.

Upper and lower GI interventional endoscopies

1. Dilation of stenosis in the esophagus-stomach-bowels, either with bougie- or balloon-dilation.
2. Stent placement in stenoses of the esophagus-duodenum-colon. Emergency stent placement in colonic ileus (preoperatively performed to serve as a bridge with the surgery: reduction of morbidity – shorter hospital stay – enterectomy and end-to-end anastomosis, all performed at the same time).
3. Endoscopic treatment of esophageal achalasia
4. Foreign body removal from the upper and lower GI.
5. Management of varicose- or non varicose-related bleedings present in the upper of lower GI, utilizing the full spectrum of hemostatic techniques (infusions of adrenaline-acrylic adhesives-firming agents / Argon Plasma Coagulation (APC) thermopexy / bipolar or monopolar electrosurgery / clips placement / variceal banding.
6. Esophageal varices banding: chronic and preventive treatment
7. Mucosal resection of early neoplasms and precancerous lesions (mucosectomy)
8. APC-assisted endoscopic therapy of gastric antral vascular ectasia syndrome (GAVE-Watermelon stomach)
9. Upper and lower GI polypectomies

ERCP- Endoscopic retrograde cholangiopancreatography

• Diagnostic (though endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are preferred on safety as well as on precision grounds)
• Interventional ERCP (sphincterectomy- stones removal-lithotripsy- placement of plastic and metallic stents with auto-dilating capacity-placement of drainage catheters)

Endoscopic Ultrasonography (EUS)

What is an Endoscopic Ultrasound?

An Endoscopic Ultrasound (EUS) is method combining endoscopy with ultrasounds.

It is performed with special endoscopic instruments which have an ultrasound head at the one end. During upper or lower GI tract endoscopy the assistance of the ultrasounds enables us to view the outer lumen of the tract. Therefore, we can thoroughly study the wall structure of the GI tract as well as all the details of tissues and organs adjacent to the tract, such as pancreas, liver, spleen, biliary ducts, lymph nodes and vessels. What is the advantage of the method?

The advantage lies within the ability to place the ultrasound head very closely to the organs and tissues we want to study, as it delivers high-resolution images. Thus, the Endoscopic Ultrasound can well-define and characterize any findings from other imaging tests, such as CT-scan or MRI-scan, with high precision, and in a number of cases detect very small lesions, measuring only millimeters, which are not detectable by traditional imaging methods.

Fine needle aspiration and Doppler

With the Endoscopic Ultrasound we can check the vascular perfusion (Doppler) as well as obtain specimen from the lymph nodes, and suspicious masses with the assistance of an ultrasound-guided fine needle. The collected specimen can then be studied by a specialized Cytologist for the establishment of the diagnosis. The procedure is called Fine Needle Aspiration-FNA, and compared to other methods, it is less invasive and safer.

Cutting-edge technology – Elastography

Metropolitan General’ state-of-the-art Endoscopic Ultrasonography equipment has the capacity of conducting Elastography, i.e. a pioneering technique which helps us evaluate the hardening of the examined tissues.

It is known that some conditions, such as cancer, can result in tissue hardening. Elastography, a technique which allows the evaluation of tissue hardening during an Endoscopic Ultrasound, provides us with this additional information which can serve in the diagnosis. With the assistance of Elastography, we can guide the fine biopsy needle to the most hardened part of the lesion we study and thus, maximize the likelihood of a successful test.

How is the Endoscopic Ultrasound performed?

In the majority of cases, the Endoscopic Ultrasound is performed with the patient lightly sedated (i.e. drowsy but still able to be woken). In this way, the patient does not feel any discomfort and the biopsy procedure is painless. Most of the times, the patient can go home on the same day after the procedure while the results are readily available. However, in case a biopsy specimen has been collected, there may be a slight delay until the results of the cytology examination are delivered.

Diagnostic Applications

• Diagnosis and staging of tumors present in the esophagus, pancreas and rectum
• Lung cancer staging
• Chronic pancreatitis assessment
• Pancreatic masses and cysts evaluation
• Study of biliary conditions, such as lithiasis or tumors in the gall bladder, biliary ducts or liver
• Study of the anal sphincters as part of the investigation for urinary incontinence
• GI submucosal tumors investigation
• Enlarged lymph nodes study

Therapeutic applications

• Cysts and abscesses drainage
• Abdominal mesh neurolysis (in cases of surgically untreatable pancreatic cancer, as part of pain adjuvant treatment)

Surgical management  

Μetropolitan General cooperates with the most experienced surgeons for the investigation and surgical management (utilizing the most advanced surgical techniques) of diseases, such as:

• Ulcerative colitis
• Familial adenomatous polyposis
• Crohn’s disease
• Malignant neoplasias in the colon, rectum and anal
• Chronic constipation
• Rectum prolapse, rectocele, etc
• Benign perianal conditions (hemorrhoids, fistulae, fissures, etc)