1. Small bowel endoscopy.

 After the development and revolution of capsule endoscopy in 2001 we could provide a simple and easy way of looking into the small intestine. Treating the abnormal areas seen by capsule endoscopy was the main problem. In 2004 we were the first group to trial a brand new small bowel endoscopy device known as double Balloon Endoscopy (DBE). Since then, we have been able to help hundreds of patients with bleeding, tumours and other small bowel diseases. We are continuing to publish key research papers to help define the best way to use this device.

 

2. Pancreatico-biliary endoscopy.

This consists of two main endoscopic types. ERCP (endoscopic retrograde cholangio-pancreatography) is a procedure where we enter the bile duct or pancreatic duct. This procedure is very useful for patients with jaundice and gall stones and provides therapy to unblock narrowings or remove stones. Pancreatic ERCP is very difficult and requires great care. My training in one of the leading pancreatic centres in the world with the highest volume of ERCP has helped provide a high level of skill and understanding in this area. EUS (endoscopic ultrasound) is a technique used to perform US from inside the abdomen. The endoscope places the US tip in the correct place (usually stomach and duodenum) and this provides the most accurate method to examine many illnesses including cancers. Stones and pancreatic examinations are also very useful. One key area of EUS is performing biopsies called FNA and this provides a safe and easy way for diseases such as cancers including lung cancer. Future directions will allow us to inject treatment directly into tumours and this is a great area of research interest.

 

3.Colonoscopy and colon polyps. 

Despite the widespread availability of colonoscopy polyp miss rates have been the biggest recent problem as shown in key medical journals. Some strategies have been proven to help decrease our “polyp miss rates”. We are currently studying several new devices and techniques to maximise our accuracy with 4 studies ongoing at RPAH. Also, large polyps can be difficult to remove and some patients undergo unnecessary surgery to remove these. New techniques and tools can make it safe to remove many of these large polyps.