Digestive Health

Therapeutic Endoscopy

At Stanford’s Benign Pancreas Program, it is our priority to provide maximally beneficial treatment while minimizing patient discomfort and recovery time. Advances in therapeutic endoscopy, some of which our own physicians have played a major role in developing, have helped us to achieve this goal. A therapeutic endoscopist is an MD, usually a gastroenterologist, who has advanced specialized training in the practice of endoscopy.  Their training extends beyond standard endoscopy training for the gastroenterologist in upper endoscopy and colonoscopy and includes procedures such as endoscopic retrograde cholangio-pancreatography (ERCP), endoscopic ultrasound (EUS), and double-balloon endoscopy.

The Benign Pancreas Program offers the following therapeutic endoscopy procedures:

Your physician will provide you with preparation instructions for your procedure. You may also review preparation instructions online.

Direct Visualization of the Pancreatic Duct

Our therapeutic endoscopists use miniature endoscopes to directly visualize disease in the main pancreatic duct (also called pancreatoscopy).  This miniature camera can be passed through the working channel of a standard endoscope during endoscopic retrograde cholangio-pancreatography (ERCP)

Drainage of Pancreatic Cysts

We offer a minimally-invasive, scarless solution to treating large pancreatic pseudocysts by draining them through the stomach or small bowel with the use of stents.  Safe access which minimizes puncturing of major vessels is possible with the use of endoscopic ultrasound, a technology in which our endoscopists have recognized expertise.

Treatment for Pain from Pancreatitis

Therapeutic endoscopists at the Benign Pancreas Program use endoscopic ultrasound guided technology to directly visualize nerve bundles that transmit pain signals.  These bundles can then be treated with injection of anesthetics, steroids, and alcohol to reduce pain from chronic pancreatitis. 

Treatment of Pancreatic Cystic Tumors

Our therapeutic endoscopists are recognized experts in the use of endoscopic ultrasound to visualize and treat pancreatic cysts. Under direct visualization with ultrasound technology, thin needles are passed into the cyst cavities in order to aspirate fluid for diagnosis, and in appropriate patients, inject  alcohol or chemotherapeutic agents for treatment.

Treatment of Pancreatic Stones

Therapeutic endoscopists at the Benign Pancreas Program have unique expertise in the endoscopic treatment of pancreatic stones within the pancreatic duct.   These stones can be removed mechanically or in refractory cases with the assistance of electrohydraulic energy.  This minimally invasive procedure can potentially alleviate pain and prevent the need for surgery.

Endoscopic Diagnosis and Treatment of Pancreatic Diseases in Patients with Altered Intestinal Anatomy

Our therapeutic endoscopists have the expertise to provide endoscopic diagnosis and treatments for patients with altered intestinal anatomy.  Common examples include patients who have had gastric bypass surgery or previous surgery on the pancreas, stomach, or small bowel.  Endoscopic therapy can be achieved using double-balloon endoscopy technology.

Other Complex Endoscopic Procedures

In many instances, access to the main pancreatic duct or bile duct by standard endoscopic retrograde cholangio-pancreatography (ERCP) is difficult.  Stanford therapeutic endoscopists have the expertise to provide alternative approaches to obtain access including using endoscopic ultrasound technology to access the ducts.  With this approach, guidewires can be placed for rendezvous to facilitate ERCP, or in select cases, access and treatment of disease in the pancreatic duct can be performed entirely under endoscopic ultrasound guidance (also called EUS-guided anterograde cholangio-pancreatography.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is a tool used to treat a number of pancreatic diseases.

ERCP is a specialized technique used to view the pancreas, gallbladder, and bile ducts and treat complications of acute and chronic pancreatitis including gallstones, narrowing or blockage of the pancreatic duct or bile ducts, leaks in the bile ducts, and pseudocysts.

ECRP is performed by Therapeutic Endoscopists from the Benign Pancreas Program. Therapeutic Endoscopists are gastroenterologists who have specialized training in ECRP.

How is ERCP performed?

After administering sedation, the doctor inserts an endoscope—a thin, flexible, lighted tube—down the throat, through the stomach, and into the small intestine. The doctor turns on an ultrasound attachment to the scope that produces sound waves to create visual images of the pancreas and bile ducts.

The physician guides the endoscope and injects a special dye into the pancreatic or bile ducts that helps the pancreas, gallbladder, and bile ducts appear on the screen while x rays are taken. This is very helpful to evaluate for any abnormalities that could be causing pancreatitis, including stones in the bile and/or pancreatic duct, or strictures in the bile and/or pancreatic duct. If abnormalities are identified, we can perform appropriate treatments or diagnostic tests while the patient remains under anesthesia.

Procedures performed using ERCP


People who undergo therapeutic ERCP are at slight risk for complications, including severe pancreatitis, infection, bowel perforation, or bleeding. Complications of ERCP are more common in people with acute or recurrent pancreatitis. A patient who experiences fever, trouble swallowing, or increased throat, chest, or abdominal pain after the procedure should notify a doctor immediately.

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