Therapeutic GI procedures

[VCMM414]

To my admittedly uninformed mind, GI procedures seem mostly diagnostic in nature. Other than ERCP/sphincterotomy, colon polypectomy, PEG placement, and the various LES dilation methods for achalasia, what are some of the other therapeutic procedures that GI doctors perform? Thanks.

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[bariume]

To my admittedly uninformed mind, GI procedures seem mostly diagnostic in nature. Other than ERCP/sphincterotomy, colon polypectomy, PEG placement, and the various LES dilation methods for achalasia, what are some of the other therapeutic procedures that GI doctors perform? Thanks.

just off the top of my head, how about....
Esophageal dilation for rings, webs with savory and balloon dilators
Esophageal variceal banding
Gastric varices cyanoacrylate injection
Stent placement for various reasons (esophagus, small bowel, colon, CBD, pancreatic duct)
Argon plasma coagulation for GAVE, radiation procitis, AVMs
Botox injection of the pylorus for gastroparesis
Endoscopic cystgastrostomy
Endoscopic mucosal resection
Pancreatic duct coil or fibrin glue injection for ductal disruptions
Ampullectomy for ampullary tumors
Early gastric cancer resection by insulated tip knife
Anti-relfux procedures, Stretta, Endoscopic fundoplication
..and so on

just to name a few

 

[redpoint]

From a GI fellow.....
1) Upper
-Balloon dilation of benign and malignant eosphageal strictures
-Achalasia dilation
-Esophageal stent placement
-Cauterization and clipping of bleeding ulcers
-Argon plasma coagulation of vascular lesions in the stomach and GAVE
-Endoscopic mucosal resection of HGD Barrett's lesions and some stomach tumors
-PEG
-PEJ
2) Lower
-Polypectomy (a lot of these....some are quite large and require piecemeal resection over multiple procedures with APC of residual adenomatous tissue)
-APC of vascular colonic lesions
-Colonic stricture dilation
-Colonic stent placement
3) ERCP
-too many interventions to mention
4) EUS
-the same as above
-

 

[mysophobe]

From someone that isn't in IM or GI, I'm curious as to what the ratio of dx:tx procedures is. How often are you doing those things you mentioned as opposed to dx upper or lowers?

 

[redpoint]

1/3 to 1/2 the time. On almost all procedures, you are at least taking biopsies.

 

[mysophobe]

Hmm. Interesting. That always seemed neat to me that they could do all that stuff endoscopically.

 

[june015b]

To name the other few things missed:

endoscopic PDT (photodynamic therapy) for esophageal cancer, endoscopic bariatric surgery, rectal ultrasound, colonic ultrasound, endoscopic ultrasound for cancer staging/celiac plexus block (pain management)/pancreatic ca radioactive seed implanting, Anti-reflux procedures/Stretta/Endoscopic fundoplication, chromoscopes, magnifying scopes, liver biopsies, double-ballon enteroscopy, and more...

Also, GI runs an infusion center for remicaide/other immunomodulating agents for IBD --> similar to oncology and rhematology folks do~ ($$).

Also, give interferon-based therapy (peg-IFN, RBV) for HCV ($$).

Transplant medicine (hepatology, pancreas, small bowel, erc.) does a good amount of small bowel endocopies/ileoscopies.


R1

 

[mysophobe]

How do they do the bariatrics endoscopically?