Endoscopy Laboratory

The Metropolitan General Endoscopic Laboratory performs diagnostic endoscopies of the upper digestive tract (gastroscopy and duodenoscopy) and lower digestive tract (colonoscopy and capsule endoscopy).

The department is equipped with advanced technology, such as a full high definition endoscopic tower and high definition video endoscopes, applying the latest techniques of Chromoendoscopy and Narrow Band Imaging for higher diagnostic accuracy.

It is also equipped with Medtronic's Gi Genius AI system, a computer-aided polyp diagnosis system using artificial intelligence. It works with digital endoscopy systems, offering the ability to identify and classify colonic polyps, regardless of their shape and size, during endoscopy of the lower digestive tract. In addition, the use of this technology in colonoscopies increases Adenoma Detection Rate by 14%.

Upper and lower GI interventional endoscopies

Dilation of stenosis in the esophagus-stomach-bowels, either with bougie- or balloon-dilation.
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).
Endoscopic treatment of esophageal achalasia
Foreign body removal from the upper and lower GI.
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.
Esophageal varices banding: chronic and preventive treatment
Mucosal resection of early neoplasms and precancerous lesions (mucosectomy)
APC-assisted endoscopic therapy of gastric antral vascular ectasia syndrome (GAVE-Watermelon stomach)
Upper and lower GI polypectomies

ERCP

ERCP is applied by specialized invasive endoscopes in the presence of an anesthesiologist in a special radioscopy room of the Clinic. Metropolitan General has a state-of-the-art, fully digital remote-controlled X-ray machine with a flat digital detector (flat panel) which provides the best image quality and high resolution, with the least possible dose of radiation.

- Diagnostic (although the use of Endoscopic Ultrasound (EUS) and Magnetic Regression Cholangiopancreatography (MRCP) is preferred for both safety and increased accuracy)

- Interventional ERCP (clamping-stone removal-lithotripsy-placement of plastic and metal self-expanding stents - installation of drains)

ENDOSCOPIC ULTRASOUND (EUS)

What is Endoscopic Ultrasound?

Endoscopic ultrasound or EUS is an innovative method, which combines endoscopy and ultrasound.

It is performed with special endoscopes, which have an ultrasound transducer at their tip. During the ultrasound-assisted endoscopy of the upper or lower gastrointestinal tract, we have the ability to examine in great detail both the structure of the gastrointestinal wall, and neighboring tissues and organs, as for example the pancreas, liver, spleen, bile ducts, lymph nodes, vessels, et al.

Advanced endoscopic ultrasound system

Metropolitan General has the most advanced endoscopic ultrasound system in Greece, combining the last generation Pentax EUS J10 endoscope with the Hitachi Arietta V60 ultrasound platform.

The Pentax EUS J10 endoscope design offers increased flexibility, precision and greater handling, thus improving diagnosis, treatment efficiency and safety.
Its ergonomics guarantees increased stability and intubation ease, while the Pentax-Hitachi image resolution features incomparable imaging quality rendering precise diagnostic results.

In addition to classic ultrasound tomography, our system is capable of using contrast-enhanced EUS for maximum diagnostic precision, as well as third-generation elastography for assessment of tissue firmness.

Where is this method better?

The possibility to place the ultrasound transducer in close proximity to the organs and tissues that we want to study, gives us images of extremely high definition. Thus, endoscopic ultrasound (echoendoscopy) has the ability to clarify and better describe findings from other imaging modalities, such as CT scans or M.R.I, with great precision and to locate frequently small lesions of a few millimeters, which do not appear in classic imaging methods.

Fine needle biopsies

With endoscopic ultrasound we can collect specimens from tissues, cystic or solid masses, with the help of an ultrasound-guided fine needle. Then, the specimens we collect can be studied by a specialized physician in order to make the diagnosis. This procedure is called Fine Needle Aspiration – FNA or Fine Needle Biopsy – FNB) and in comparison to other methods is less invasive and thus safer.

Cutting-edge technology

It is known that some diseases such as cancer, result in increased tissue hardness. The modern Endoscopic Ultrasound device at Metropolitan General has the possibility of Elastography, an innovative technique, with which we can perceive the hardness of the tissues that we examine; an additional piece of information, which can aid the diagnosis. With the help of Elastography, we can guide the biopsy needle to the hardest point of the lesion we study and maximize the possibility for a successful diagnosis.

Also, the equipment of the department allows the use of intravenous microbubbles, which act as contrast agents and facilitate the identification and localization of suspicious lesions, which may not be visible with conventional methods.

How is the Endoscopic Ultrasound performed?

The Endoscopic Ultrasound is performed, with the patient under conscious sedation. In this way, the examination is comfortable for the patient and the procedure of biopsy is painless. Most of the times, the patient can return home the same day after the completion of the examination and he may receive the results immediately. However, in case that a biopsy was taken, there is a delay of few days until the completion of the cytological or histological examination.

Diagnostic Applications

Diagnosis and staging of esophageal, gastric, pancreatic, and rectal cancer.
Lung cancer staging.
Assessment of chronic pancreatitis.
Assessment of pancreatic cysts and masses.
Investigation of biliary diseases, such as lithiasis or tumors of the gallbladder, the bile ducts, or the liver.
Investigation of fecal incontinence.
Investigation of submucosal tumors of gastrointestinal tract.
Investigation of enlarged lymph nodes.

Therapeutic Applications

Drainage of cysts and abscesses.
Drainage of necrotic pancreatic collections and pseudocysts.
Placement of metal indicators (fiducials) for guided / targeted radiotherapy.
Celiac plexus neurolysis (in case of inoperable pancreatic cancer as palliative therapy for pain).

Head of Endoscopic Ultrasound Department: Dimitrios Panagiotakopoulos Gastroenterologist

Working Hours: Monday - Friday 07.00 - 17.00

Contact number: +30 210 650 2624