Interventional Endoscopy

For some digestive conditions, you need more than a standard endoscopy. Interventional and surgical endoscopy (ISE) uses advanced tools and techniques to diagnose and treat complex benign and malignant (non-cancerous and cancerous) conditions of the digestive tract, pancreas, bile ducts and liver. With ISE, you may be able to receive the care you need through a thin, flexible procedure rather than traditional surgery.

At Banner Health, our interventional and surgical endoscopy teams provide advanced endoscopic care for many complex digestive conditions.

With these procedures, your care team may:

• Find what’s causing your symptoms
• Remove abnormal tissue (including pre-cancers and early cancers)
• Open blocked areas (in bile and pancreatic ducts, and digestive tract)
• Treat certain complex GI conditions

What is interventional and surgical endoscopy?

Interventional and surgical endoscopy (ISE) involves specialized minimally invasive procedures. Instead of open surgery, ISE experts use a thin, flexible tube with a camera and small tools. They reach difficult areas of the digestive tract, bile ducts, pancreas or liver that need treatment. This method can help you avoid or delay more painful and invasive surgery.

ISE is also called advanced endoscopy, therapeutic endoscopy or interventional gastroenterology.

Conditions managed by interventional and surgical endoscopy

ISE may be used for complex conditions that affect the esophagus, stomach, intestines, pancreas, bile ducts, liver and gallbladder area, including:

• Bile duct stones or narrowing
• Pancreatic cysts or masses
• Acute and Chronic Pancreatitis-related complications
• Gallbladder disease
• Bile duct or pancreatic disorders
• Barrett’s esophagus
• Esophageal swallowing disorders
• Achalasia, a rare swallowing disorder
• Gastroparesis
• Complex colon or stomach polyps
• GI bleeding
• Digestive tract strictures or narrowing
• Blockages in the esophagus, stomach, small intestine or colon
• Certain early-stage cancers or precancerous changes
• Collections or masses in the chest or abdominal cavity
• Feeding access needs

Procedures offered by ISE

Our ISE specialists offer a wide range of advanced procedures at several Banner Health locations. Your care team will recommend the right procedure based on your symptoms, diagnosis, imaging results and overall health.

Procedures include:

• Endoscopic retrograde cholangiopancreatography (ERCP): ERCP can diagnose and treat issues in the bile and pancreatic ducts. It can help remove stones, place stents or open narrowed ducts. This includes cholangioscopy and pancreatoscopy, which involve inserting ultra-slim scopes into the ducts for detailed examination.
• Endoscopic ultrasound (EUS): EUS combines endoscopy with ultrasound imaging. It can help doctors look closely at the pancreas, bile ducts, digestive tract wall and nearby lymph nodes. It may also be used to collect tissue samples or to drain collections in and around the pancreas, gallbladder and other areas of digestive tract.
• Complex polyp removal: Some polyps are too large, flat or hard to remove during a standard colonoscopy. With ISE techniques, it may be possible to remove these polyps without surgery.
• Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD): EMR and ESD can remove abnormal or pre-cancerous tissue as well as selected early cancers from the lining of the digestive tract.
• Barrett’s Esophagus treatments: Endoscopic therapies like radiofrequency ablation and cryoablation can treat some precancerous changes related to Barrett’s esophagus.
• Enteral stenting: Stents may help open narrow or blocked areas in the digestive tract, including the esophagus, stomach, duodenum or colon.
• Balloon Enteroscopy: Balloon enteroscopy uses balloons to help doctors examine and treat hard-to-reach areas of the small intestine.
• Per-oral endoscopic myotomy (POEM): POEM may be a treatment option for achalasia (esophageal-POEM), gastroparesis (gastric-POEM) or Zenker’s diverticulum (Zenker’s-POEM).
• Feeding tube placement: Endoscopic feeding tube placement can support nutrition.
• Third space procedures: Access to space between GI wall layers to remove deep tumors.
• EUS-guided drainage and lumen-apposing stenting: These procedures help drain pancreatic pseudocysts and dead (necrotic) tissue and also perform gallbladder and bile duct drainage. ISE physicians also use these methods to place expandable tubes to bypass obstructions and create artificial connections, such as connecting the stomach to the small intestine (gastro-jejunostomy).
• Transoral incisionless fundoplication (TIF): Reconstructs an anti-reflux valve to treat chronic acid reflux.
• Endoscopic weight loss procedures: Include endoscopic sleeve gastroplasty (ESG).

How is ISE different from standard endoscopy

Gastroenterology physicians often use standard endoscopy to look for the cause of symptoms, screen for GI disease or take small tissue samples. ISE goes a step beyond. Our experts use advanced tools to treat certain problems during the procedure:

• Remove abnormal tissue
• Open narrowed areas
• Drain fluid collections
• Place stents
• Treat bleeding
• Remove stones
• Take advanced tissue samples
• Treat some swallowing, reflux-related or stomach-emptying disorders

Benefits of ISE compared to traditional surgery

• Minimally invasive
• No external/skin incision and a small internal GI tract incision
• Shorter recovery time
• Diagnosis and treatment during the same procedure
• Reduced need for surgery
• Helps experts reach areas that are hard to evaluate with standard testing

ISE isn’t right for everyone. For some conditions, you may still need surgery, medication or other treatments. Your care team will explain the safest and most effective option for your needs.

What to expect before, during and after your procedure

Before your procedure

Your care team will explain how to prepare. Depending on the procedure, you may need to:

• Stop eating or drinking beforehand (usually overnight nil per oral)
• Adjust medications
• Complete blood work or imaging
• Follow special bowel prep instructions

During your procedure

Most ISE procedures use deep sedation or anesthesia to help you stay comfortable. During the procedure, your doctor passes a thin, flexible scope through your mouth or rectum, depending on the area being treated.

After your procedure

Most people go home the same day, while few may need monitoring or a short hospital stay. Your recovery depends on the type of procedure and your overall health. Your care team will tell you:

• When you can eat and drink
• When you can return to normal activities
• What symptoms to watch for
• When to expect results
• Whether you need follow-up care

When your doctor may refer you for interventional and surgical endoscopy

Your primary care provider, gastroenterologist, surgeon or cancer care team may refer you for ISE if you need advanced diagnosis or treatment due to factors like:

• Abnormal imaging of the pancreas, bile ducts or digestive tract
• A complex polyp
• Unexplained GI bleeding
• Trouble swallowing
• Suspected bile duct blockage
• Pancreatic cyst or mass
• Barrett’s esophagus with abnormal cells
• A digestive tract narrowing or blockage
• Symptoms that have not improved with standard treatment
• Need for advanced biopsy or staging

A team-based approach to complex digestive care

Banner Health ISE often supports care across several specialties. Depending on your condition, your care team may include:

• General gastroenterologists
• Surgeons
• Cancer specialists
• Radiologists
• Pathologists
• Nutrition specialists
• Primary care providers

Interventional and surgical endoscopy and cancer care

ISE can play an important role in diagnosing, staging and treating some digestive cancers and precancerous conditions.

It is used to:

• Evaluate pancreatic, bile duct, stomach, esophageal or colorectal concerns
• Take tissue samples
• Stage certain cancers
• Remove some early abnormal tissue
• Place stents to relieve blockages
• Support nutrition with feeding tube placement

Why choose Banner Health for interventional and surgical endoscopy (ISE)?

Banner Health’s ISE teams, endoscopy centers and hospital-based programs offer advanced endoscopic care. Our trained specialists use advanced tools to diagnose and treat complex digestive conditions with a focus on safe, coordinated care.

Find a Banner Health ISE specialist near you.

FAQs on Interventional and surgical endoscopy

What is interventional and surgical endoscopy?

Interventional and surgical endoscopy (ISE) is an advanced type of endoscopy used to diagnose and treat digestive conditions. It uses a thin, flexible scope with a camera and small tools to reach areas inside the digestive tract.

Is ISE the same as advanced endoscopy?

The terms are often used interchangeably. ISE may also be called advanced endoscopy, therapeutic endoscopy or interventional GI because it can be used to treat certain conditions, not just diagnose them.

Is ISE the same as surgery?

ISE is not traditional open surgery. Many procedures are minimally invasive and do not require large incisions. However, they are still medical procedures and may have risks.

What conditions can ISE treat?

It may help treat bile duct problems, pancreatic conditions, Barrett’s esophagus, complex polyps, GI bleeding, digestive tract narrowing, swallowing disorders and some early abnormal tissue changes.

Will I be asleep during ISE procedures?

Most ISE procedures use sedation or anesthesia to help you stay comfortable. Your care team will explain what type of sedation is recommended for your procedure.

How long does recovery take?

Recovery depends on the procedure. Most people go home on the same day, while some may need more monitoring. Your care team will give you instructions based on your specific procedure.

Do I need a referral to see ISE specialist?

Many patients are referred to by a primary care provider, gastroenterologist, surgeon or cancer specialist. Referral requirements may also depend on your insurance plan.