Digestive Diseases - Gastroenterology

Endoscopy Procedures

Mount Sinai's skilled specialists perform a wide range of advanced therapeutic endoscopic procedures to diagnose and treat the most complex digestive disease.

Endoscopic Ultrasound 

Endoscopic ultrasound (EUS) allows your doctor to examine the esopagheal and stomach linings as well as the walls of the upper gastrointestinal tract.  EUS is also used to study organs near the gastrointestinal tract including the lungs, liver, gallbladder, and pancreas.

At Mount Sinai our endoscopists are experts in very specific advanced EUS procedures, many of which are not done routinely by other medical practices. They include processes to relieve pain, drain hard to reach cysts, remove and take difficult to reach biopsies and even help with tracking radiation treatments for cancer. 

About the procedure: Your endoscopist will use a thin flexible tube called an endoscope that has a built-in miniature ultrasound probe. The endoscope is passed through your mouth to the area that needs to be examined. Your doctor will then use sound waves to create visual images of the digestive tract.  

There are different types of EUS procedures: upper and lower EUS. Upper EUS examines the upper GI tract including the esophagus, the stomach, and the beginning of the small intestines (duodum). Lower EUS examines the colon and rectum. 

Reasons for an EUS: EUS is performed for both diagnostic and therapeutic treatment purposes. EUS can help diagnose the cause of abdominal pain or abnormal weight loss. It also closely examines with a fine needle biopsy any lumps or lesions.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and X-rays to examine bile and pancreatic duct problems.

Reasons for an ERCP: Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked due to:

  • Acute pancreatitis
  • Chronic pancreatitis
  • Gallstones that form in your gallbladder and become stuck in your common bile duct
  • Infection
  • Pancreatic pseudocysts 
  • Trauma or surgical complications in your bile or pancreatic ducts
  • Tumors or cancers of the bile ducts or pancreas

Endoscopic Mucosal Resection (EMR) 

EMR is a minimally invasive, endoscopic removal of benign and early malignant lesions in the gastrointestinal (GI) tract.

About the Procedure: EMR is performed with a long, narrow tube equipped with a light, video camera, and other instruments. It is used during endoscopic removal of pre-cancerous or cancerous cells (mucosal resection). For the upper digestive tract, it is passed down your throat. To remove lesions from the lower digestive tract, the EMR tube is guided up through the anus.

Endoscopic Submucosal Dissection (ESD)

ESD is an advanced endoscopic procedure used to remove gastrointestinal tumors that have not entered the muscle layer. ESD may be done in the esophagus, stomach, or colon.

About the Procedure: While you are under anesthesia, a long narrow tube is passed through the throat to reach the lesion in the stomach, or the tube is passed through the anus to reach the lesion in the colon.

The procedure takes place in three steps:

  1. Injecting fluid into the layer of tissue below the mucus membrane (submucosa) to elevate the abnormal cells (lesion)
  2. Cutting the surrounding mucus membrane (mucosa) of the lesion
  3. Cutting apart (dissecting) the submucosa beneath the lesion

Endoscopic Fistula Closure

An endoscopic fistula closure is a safe way to close perforations or holes in the gastrointestinal (GI) tract. A fistula is an abnormal connection between two organs or between an organ and another surface. It can be caused by benign inflammatory diseases, malignancies, or from surgery suturing.

About the Procedure: During this procedure, metal clips or stents are placed to hold fistulas together.

Cholangioscopy and Pancreatoscopy

Cholangioscopy is a non-invasive technique primarily used for the diagnosis and treatment of stones. It is also used to evaluate biliary narrowing of the bile duct (strictures). Your bile ducts carry bile from the liver and gallbladder through the pancreas to the intestines.

With pancreatoscopy, your doctor can evaluate and treat stones, tumors, and strictures involving the main pancreas duct.

If X-ray imaging from an ERCP is insufficient to make an adequate diagnosis, or therapeutic intervention requires direct visualization, a cholangioscopy is used.

About the Procedure: Using a miniature digital video probe, your physician will be able to visualize and examine the biliary (pancreas) and hepatic (liver) ducts.

Balloon-Assisted Enteroscopy

Balloon-assisted enteroscopy is a procedure used to find and treat hard-to-reach areas of the colon that have polyps or bleeding. By using balloons at the end of an endoscope, your doctor can compress and expand certain parts of your intestines to reveal hidden polyps. Mount Sinai is one of the few places where double-balloon enteroscopy is performed.

Reasons for a balloon enteroscopy: This procedure can effectively provide access to the small bowel (small intestines) which is very long and can be difficult to access.

By using balloon-assisted enteroscopy, our gastroenterologists can:

  • Enlarge a narrowed pathway (stricture) in the upper or lower GI tract
  • Identify and treat the source of GI bleeding
  • Remove small bowel polyps or a foreign object
  • Take tissue samples to examine for a laboratory diagnosis (biopsy)

Radiofrequency Ablation (RFA) 

Radiofrequency ablation (RFA) is an endoscopic treatment for Barrett's esophagus. Barrett’s esophagus replaces normal cells in the esophagus with those that come from the small intestine as a result of gastrointestinal reflux (GERD). These cells can often become cancerous. The RFA removes these pre-cancerous and cancerous cells in a minimally invasive way.

About the Procedure: Diseased tissue is exposed to heat and destroyed. The procedure is performed during a routine upper endoscopy and requires an average of three to four treatment sessions. Each treatment takes about 30 to 45 minutes. Studies suggest that this technique is highly effective in removing Barrett's cells therefore preventing the progression of the disease.


Cryoablation is another endoscopic treatment for Barrett’s esophagus.  This method uses a specially-designed balloon which exposes the tissue to extreme cold.  This creates a freezing process in the cells which removes the pre-cancerous and cancerous cells in a minimally invasive way. 

Endoscopic stent placement

In situations where a tumor or scar tissue is causing a blockage, an expandable stent can be placed through the endoscope into the blocked area.  The stent will open up and relieve the blockage, allowing normal gastrointestinal function to return.  Endoscopic stents can be placed in the esophagus, stomach, small intestine, colon, rectum, pancreas, and bile ducts.

Endoscopic Full Thickness Resection (EFTR)

EFTR is an endoscopic procedure to remove growths deep in the wall of the gastrointestinal (GI) tract. Our skilled physicians can use EFTR to remove tumors without surgery. The result may be a shorter treatment time and faster recovery. EFTR is very effective for removing tumors located deep in the GI wall. Because of the location of these growths, other procedures could cause complications, such as tearing or perforation of tissue.

Contact us for more information about the most advanced and expert therapeutic endoscopy for diagnosis and treatment.