Gastroenterology and Hepatology

Recent medical advancements mean advanced endoscopy can now treat several conditions that formerly required surgery. At Mayo Clinic's Advanced Endoscopy Center in Florida, endoscopists use this minimally invasive approach — without incisions — to diagnose and treat many esophagus, stomach, small bowel, gallbladder, liver, pancreas and colon disorders.

Your Mayo care team can now treat these conditions on an outpatient basis, with minimal risk and discomfort for you.

We provide accessible, comprehensive and multidisciplinary care that combines procedural skills with close collaboration from oncologists, surgeons, radiologists and other specialists as needed. Together we deliver not only technically successful procedures, but also better long-term outcomes.

Why contact the Advanced Endoscopy Center?

Mayo Clinic doctors in the Advanced Endoscopy Center are widely published, recognized leaders. They offer advanced experience and expertise across a broad range of endoscopic care, including bariatric endoscopy; endoscopic bariatric therapy; resection; submucosal endoscopy; hepatopancreatobiliary diseases; luminal disease including stenosis, Barrett's esophagus and others; and deep enteroscopy.

People are frequently referred to the Advanced Endoscopy Center for focused, specialized endoscopic care from across the U.S. and internationally as well.

A team approach to care for the whole person

The Advanced Endoscopy Center on the Jacksonville, Florida, campus leverages an integrated practice model that coordinates care across many specialties and subspecialties for those with complex gastrointestinal issues. This team approach provides a thorough evaluation with well-rounded treatment recommendations to enhance function and restore quality of life.

During your comprehensive consultation, you'll receive a thorough evaluation by multiple specialists and likely undergo a series of procedures and tests. Your team will use those findings to recommend a treatment plan that's specific to your individual needs and goals.

Highly specialized expertise in therapeutic and oncologic endoscopic therapies including:

• Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA)
• Endoscopic ultrasound-guided biliary drainage, gallbladder drainage, pancreatic drainage, coil and glue injection of gastric varices, drainage of pancreatic fluid collections; and gastroenterostomy
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Esophagogastroduodenoscopy (EGD) /colonoscopy with full thickness resection
• Large polyp endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in polypectomies
• Peroral endoscopic myotomy (POEM) (esophageal, gastric, Zenker's)
• Deep enteroscopy (balloon enteroscopy)
• Barrett's ablation (cryoablation and radiofrequency ablation (RFA))
• Barrett's EMR and ESD
• EGD with dilation and stenting
• Antireflux therapies such as using a transoral incisionless fundoplication (TIF) device
• Endoluminal functional lumen imaging probe (EndoFLIP) and esophageal dilators such as the EsoFLIP
• Endoscopic suturing for various indications

Minimally invasive endoscopic weight-loss procedures

The Bariatric Center in Florida also offers endoscopic bariatric therapies (EBTs), non-surgical weight-loss procedures for certain people who do not qualify for bariatric surgery or who may not be able or willing to undergo a weight-loss operation. Currently, three procedures are being offered. It should be emphasized that any of these EBTs must be implemented under the care of a multidisciplinary team in the Bariatric Center in order to help one effectively lose weight, sustain the weight loss and be monitored for any issues.

• Intragastric balloon therapy (IGB):

  IGB therapy is a weight-loss procedure performed completely through the mouth using an endoscope. This physician-supervised procedure may be a good option for those with a body mass index (BMI) between 30 and 40 or an even higher BMI. The intragastric balloon placement procedure involves an upper endoscopy and placement of a silicone balloon inside the stomach. The balloon is inflated with sterile fluid and left in the stomach for up to six months. Another upper endoscopy is then performed to remove the balloon. The balloon limits the amount of food you can eat and has also been shown to slow down the emptying of food from the stomach into the intestine, further enhancing the sensation of early satiety. IGB therapy ultimately helps with portion control, leading to weight loss. Intragastric balloon placement is performed in the endoscopy lab.

• Endoscopic sleeve gastroplasty (ESG):

  ESG is another weight-loss procedure also performed completely through the mouth with an endoscope. This procedure involves the use of a suturing device attached to the endoscope to place full-thickness sutures inside the stomach. In doing so, the size of the stomach is significantly reduced, limiting the amount of food one can eat, leading to earlier satiety and portion control. In other words, the stomach becomes shorter and narrower, like an accordion. The ESG is performed in the endoscopy lab. The sutures placed are nonabsorbable and stay there permanently unless they need to be removed.

Transoral outlet reduction (TORe)

The TORe procedure, also known as the gastric outlet reduction procedure, is an EBT specifically for people who have had successful Roux-en-Y gastric bypass surgery but start to regain weight several years later. Gastric outlet reduction reduces the size of the opening between the stomach and small intestine. This reduces the amount of food that can be eaten, promotes early satiety and portion control, and results in weight loss. Mayo Clinic researchers have demonstrated that in some cases, over-dilation of this opening is responsible for weight regain after gastric bypass surgery. This procedure is nonsurgical and is performed in the endoscopy lab. TORe is also indicated for management of dumping syndrome or issues with hypoglycemia (low blood sugar) after gastric bypass surgery.

Evaluations for these endoscopic weight-loss procedures usually take one to three months from initial appointment to procedure. Before you decide to go through with surgery or an endoscopic weight-loss procedure, it's important to understand that these successful procedures require a lifelong commitment to changing diet and exercise habits. In large part, you determine the success of the treatment.

Advanced Endoscopy Center physicians

• Ernest P. Bouras, M.D.
• Bhaumik Brahmbhatt, M.B.B.S.
• Victoria Gomez, M.D.
• Vivek Kumbhari, M.B.Ch.B., Ph.D.
• Frank J. Lukens, M.D.S
• Massimo Raimondo, M.D.
• Mihir S. Wagh, M.B.B.S., M.D.
• Herbert C. Wolfsen, M.D.
• Timothy A. Woodward, M.D.

Advanced Endoscopy Center Advanced Practice Providers

• Jane A. Diamond, APRN

Contact

Mayo Clinic Advanced Endoscopy Center

4500 San Pablo Road
Jacksonville, FL 32224
Phone: 904-953-0891