Gastroenterology/Hepatology Treatments at the Center for Diseases of the Liver and Pancreas, Denver

Cholangioscopy System

Used to directly visualize the pancreatic and biliary ducts. This is performed in addition to the ERCP procedure, described below. A tiny camera fiber is guided into the pancreatic and/or common bile duct to allow for a more in-depth view and more precise tissue sampling. The gastroenterologist uses this technique when the X-ray image does not give enough information about what is going on in the biliary or pancreatic ducts.

ERCP, or Endoscopic Retrograde Cholangiopancreatography

Provides an endoscopic view of biliary and pancreatic system and is used to help diagnose problems either by visualization or by obtaining tissue samples in the liver, gallbladder, bile ducts, and pancreas by injecting the common bile duct and/or the pancreatic duct with dye. This provides visualization of abnormalities via an X-ray image. Certain ductal problems (such as strictures, obstructions and gallstones) can be addressed during ERCP. Structures can be dilated and diagnosed, obstructions can be removed and/or diagnosed, stones within the duct can be removed and stents can be placed to facilitate drainage of bile through obstructed or structured areas.

Endoscopic Ultrasound or EUS

EUS uses both endoscopy and ultrasound to obtain images and information about the liver and pancreas; both the endoscope and ultrasound (one tool) are inserted into the patients mouth for diagnosis. EUS allows the gastroenterologist to examine the lining and the walls of your upper and lower gastrointestinal tract, and is used to study internal organs that lie next to the gastrointestinal tract such as the gall bladder and pancreas. EUS is also used to evaluate an abnormality such as a growth that was detected at a prior endoscopy or by X-ray. This procedure provides a detailed picture of the growth, which can help determine its nature and decide upon the best treatment, especially when other tests are inconclusive. EUS helps determine the extent of certain cancers by allowing the physician to accurately assess the cancer's depth and whether it has spread to adjacent lymph glands or nearby vital structures such as major blood vessels. In some patients, EUS can be used to obtain tissue samples (through Ultrasound-Guided Fine-Needle Aspiration, described below) to help the physician determine the proper treatment.

Ultrasound-Guided Fine-Needle Aspiration

During the EUS procedure a technique called fine-needle aspiration can be used to safely withdraw cells from a suspected cancer within the gallbladder or pancreas.