Gastroenterology

GASTROENTEROLOGY DEPARTMENT

The Gastroenterology Department is a medical specialty that examines the organs, functions, and diseases of the digestive system. In the Gastroenterology Department, the diagnosis and treatment of diseases of the stomach, intestines, liver, pancreas, and bile ducts are carried out in line with current medical approaches.

Daviva Health Group Gastroenterology Department provides services in the diagnosis and treatment of digestive system diseases with an experienced team of specialists and modern medical equipment equipped with advanced technology.

What Is Gastroenterology?

The Gastroenterology Department deals with the diagnosis, diagnosis, and treatment of diseases of the digestive system. The digestive system consists of different organs that start from the mouth and extend to the intestines. For this reason, various problems and diseases can affect the digestive system.

A gastroenterology specialist carries out the diagnosis and treatment of digestive system diseases such as reflux disease (GERD), gastritis and stomach ulcer, irritable bowel syndrome (IBS), Crohn's disease and ulcerative colitis, celiac disease, liver diseases, pancreatic diseases, colon and stomach cancer.

What Diseases Does the Gastroenterology Department Treat?

Digestive system diseases are various disorders that occur in the organs that make up the digestive system. In the Gastroenterology Department, the diagnosis and treatment of diseases affecting the organs of the digestive system (esophagus, stomach, small intestine, large intestine, rectum and anus), digestive glands (liver and pancreas), and bile ducts are performed.

Stomach and Esophageal Diseases

• Gastroesophageal reflux disease (GERD): Reflux disease occurs when stomach contents flow back into the esophagus. Frequent and recurrent reflux complaints are defined as GERD (reflux disease).
• Barrett's esophagus
• Difficulty swallowing (dysphagia)
• Achalasia
• Esophageal varices
• Esophageal cancer
• Gastritis: Gastritis is inflammation of the stomach lining. It can be acute or chronic.
• Peptic ulcer
• Helicobacter pylori infection
• Stomach cancer

Intestinal Diseases

• Irritable bowel syndrome (IBS): IBS is a benign but chronic functional digestive system disorder, also commonly known as spastic colon.
• Crohn's disease
• Ulcerative colitis: A chronic inflammation of the lining of the rectum and colon.
• Celiac disease: Celiac disease is an autoimmune small intestine disease associated with gluten intolerance. Gluten consumption damages the intestinal villi, leading to malabsorption.
• Diverticulitis
• Colon cancer
• Rectal cancer

Liver, Bile Duct, and Pancreatic Diseases

• Hepatitis (A, B, C): Hepatitis is inflammation of the liver. It may be caused by infections, toxins, alcohol, medications, or autoimmune diseases.
• Fatty liver (hepatic steatosis): Fatty liver (NAFLD) develops as a result of excessive fat accumulation in the liver. In advanced stages, it can lead to severe liver damage.
• Cirrhosis
• Liver failure
• Gallstones
• Cholecystitis
• Bile duct obstructions
• Acute and chronic pancreatitis: Various factors can cause pancreatic fluid to accumulate in the pancreas and leak into surrounding tissues. This leads to painful inflammation.
• Pancreatic cancer

Diagnostic and Imaging Methods Used in the Gastroenterology Department

What Is Gastroscopy?

Gastroscopy uses an endoscope, a long and thin tube with a small camera at its tip, to examine the upper digestive system organs and their cavities. Gastroscopy is a diagnostic advanced endoscopic procedure that allows examination of the esophagus, stomach, and duodenum. It is used in the diagnosis of reflux, gastritis, ulcers, and stomach cancer.

What Is Colonoscopy?

Colonoscopy is an advanced endoscopic diagnosis and treatment method for lower digestive system diseases used for colon cancer, polyp detection, biopsy collection, and polypectomy (polyp removal). During colonoscopy, the inner surface of the large intestine is examined using a fiber-optic endoscope. Colonoscopy aims to detect the presence of diverticula, polyps, infection, inflammation, or cancer. Colonoscopy is considered the gold standard for colon examination because it allows biopsy sampling from suspicious lesions.

What Is EUS (Endoscopic Ultrasound)?

Endoscopic ultrasound (EUS) is an advanced diagnostic method performed by combining endoscopy (imaging the inner surface of the digestive system) with ultrasound technology.

With this method, both the digestive system wall and the organs beyond the wall (such as the pancreas, bile ducts, and lymph nodes) are evaluated in high resolution.

EUS is especially preferred in the following situations:

• Pancreatic diseases
• Bile duct diseases
• Digestive system tumors
• Stomach and intestinal wall lesions

In some cases, a thin needle can be passed through the endoscope during the procedure to obtain a sample from suspicious tissue. This procedure is called biopsy under EUS guidance (EUS-FNA).

With this method, a tissue sample can be obtained without surgery and the diagnosis can be clarified.

Ultrasonography

The main ultrasound examinations performed in the Gastroenterology Department are as follows:

Upper abdominal ultrasound: The liver, gallbladder, bile ducts, pancreas, and spleen are evaluated.

Intestinal ultrasound: Used to examine bowel wall thickening, inflammatory diseases, and masses.

Color Doppler ultrasound of the liver vessels: The vascular structure and blood flow of the liver are evaluated.

Contrast-enhanced ultrasound (CEUS): Allows more detailed analysis of liver lesions.

FibroScan (Transient Elastography): Assesses the risk of fibrosis and cirrhosis by measuring liver stiffness.

Thanks to the advanced imaging methods used in the gastroenterology department, liver, bile duct, and intestinal diseases can be diagnosed at an early stage.

MRI and CT Imaging

MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) are advanced diagnostic methods that provide detailed imaging of the organs in the abdominal region.

These imaging techniques are used to evaluate abnormalities detected in digestive system organs such as the small intestine, stomach, liver, pancreas, kidneys, and spleen.

In which situations are abdominal MRI and CT performed?

• Acute abdominal pain
• Suspected intra-abdominal abscess
• Cancer and lymphoma follow-up or screening
• Evaluation of lymph nodes
• Investigation of intestinal damage in Crohn's disease
• Examination of bowel pathologies while investigating the cause of anemia
• Suspected infection
• Pancreatitis and other pancreatic diseases

Capsule Endoscopy

It is a painless method used in the diagnosis of small intestine disorders using a swallowable camera.

Liver Biopsy

A liver biopsy is a medical procedure that involves taking a small sample of liver tissue using a thin needle under ultrasound guidance. Ultrasound ensures that the needle is precisely directed while avoiding blood vessels and risky areas. This sample is then examined under a microscope to make a definitive diagnosis of liver diseases.

A liver biopsy is necessary in many cases:

• Diagnosis or evaluation of liver cancer (hepatocellular carcinoma, metastasis)
• Suspected chronic hepatitis (viral, drug-induced, autoimmune)
• Screening for hemochromatosis, hepatic steatosis, or cirrhosis
• Follow-up of liver transplantation
• Evaluation of an unexplained biological disorder (elevated transaminase levels)

Liver biopsy helps confirm the diagnosis, guide treatment decisions, or assess the effectiveness of an ongoing treatment.

Polypectomy (Polyp Removal)

Polypectomy is a medical procedure aimed at removing intestinal polyps (protrusions in the intestinal wall) that can occur anywhere in the intestines. Polypectomy is usually performed endoscopically during colonoscopy. During colonoscopy, tissues can also be taken for biopsy from areas that appear suspicious on the inner lining of the intestine.

Advanced Endoscopic Procedures in the Gastroenterology Department

What Is ESD (Endoscopic Submucosal Dissection)?

ESD is a technique developed based on EMR that allows large lesions in the digestive system to be removed en bloc under endoscopy. ESD is mainly used for early-stage digestive system cancer and precancerous lesions.

What Is EMR (Endoscopic Mucosal Resection)?

EMR (endoscopic mucosal resection) is a procedure performed under endoscopy for the removal of flat or raised lesions such as early-stage digestive system cancers or flat adenomas. It is a minimally invasive surgical procedure performed using an endoscope. For lesions smaller than 2 cm in diameter, this technique ensures complete, safe, and single-piece removal of the lesions.

What Is POEM (Per-Oral Endoscopic Myotomy)?

It is an advanced endoscopic method used especially in the treatment of swallowing disorders such as achalasia.

In these diseases, the ring-shaped muscle (sphincter) between the esophagus and the stomach, or between the stomach and the intestines, does not relax sufficiently. Inability of the muscle to relax makes it difficult for food to pass and causes complaints such as difficulty swallowing, chest pain, or vomiting.

The POEM procedure is performed under general anesthesia with an endoscope advanced through the mouth. During the procedure, the problematic muscle layer is cut and relaxed from the inside. In this way, the passage of food from the esophagus to the stomach or from the stomach to the small intestine is facilitated.

What Is ERCP (Endoscopic Retrograde Cholangiopancreatography)?

ERCP is a procedure used in the diagnosis and treatment of bile duct and pancreatic disorders, gallstones, and strictures.

This examination method also provides images of the internal structure of the body. Using a contrast agent applied beforehand, the glandular and biliary systems, in particular, can be visualized. If bile flow is reduced, this can be treated during the examination.

When Should You Consult the Gastroenterology Department?

The most common symptoms that require consulting a gastroenterology specialist include persistent stomach pain, difficulty swallowing, persistent bloating, indigestion, nausea, heartburn, long-term constipation or diarrhea, anemia, blood in the stool, and unexplained weight loss.

What Procedures and Applications Are Performed in the Endoscopy Unit?

In our endoscopy unit, interventional endoscopic procedures for diagnosis and treatment are performed using the latest technologies. Safe and comfortable care is provided to patients through modern endoscopic methods used in the diagnosis, evaluation, and treatment process of digestive system diseases.

All endoscopic procedures are performed under anesthesia and under the supervision of our anesthesiology and reanimation department. In this way, gastroscopy, colonoscopy, and other interventional endoscopy applications are performed with patient comfort as a priority.

The procedures performed in our endoscopy unit are as follows;

Diagnostic Endoscopic Procedures

• Esophagogastroduodenoscopy (Gastroscopy)
• Colonoscopy
• Flexible sigmoidoscopy
• Rectoscopy
• Capsule endoscopy
• Endoscopic ultrasonography (EUS)
• Mini-probe endoscopic ultrasonography
• Diagnostic imaging, staging, and biopsy procedures
• Esophageal and anal manometry – motility studies
• pH meter measurement (24-hour stomach acid measurement)
• Ultrasound-guided liver biopsy

Endoscopic Treatments for Esophageal and Stomach Diseases

• Bougie and balloon dilation in esophageal strictures
• Band ligation and sclerotherapy for esophageal varices
• Cyanoacrylate treatment for gastric varices
• Sclerotherapy for bleeding lesions
• Endoscopic sphincterotomy
• Anti-reflux mucosectomy (ARMS-Reflux, GERDx, TIF2)
• Per-oral endoscopic myotomy (POEM)
• Endoscopic Zenker diverticuloseptomyotomy

Endoscopic Procedures for Polyp, Tumor, and Cancer Treatment

• Polypectomy
• Endoscopic Mucosal Resection (EMR)
• Endoscopic Submucosal Dissection (ESD)
• Submucosal Endoscopic Tumor Resection (STER / POET)
• Endoscopic Full-Thickness Resection (EFTR)
• Stent placement in malignant strictures
• Electroincision, argon plasma coagulation, and laser applications
• Hemoclip application
• Endoscopic suture applications (OverStitch, OTSC, loop, etc.)

ERCP Procedures for Bile Duct and Pancreatic Diseases

• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Imaging of the bile and pancreatic ducts
• Removal of stones from the bile ducts
• Balloon dilation of bile duct strictures
• Stent placement in bile duct strictures
• Nasobiliary stent placement
• Stone removal or stent placement in pancreatic patients
• Drainage procedures from the bile ducts
• Cystogastrostomy in pancreatic cysts
• Celiac plexus block in chronic pancreatitis
• Celiac plexus block in pancreatic cancer

Nutrition and Interventional Endoscopy Applications

• Percutaneous Endoscopic Gastrostomy (PEG)
• Percutaneous Endoscopic Jejunostomy (PEJ)
• Nasojejunal tube placement

Procedures for Hemorrhoids and Intestinal Diseases

• Endoscopic hemorrhoid treatments (injection sclerotherapy / band ligation)
• Per-Anal Endoscopic Myotomy (PAEM)

Advanced Endoscopy and Obesity Treatments

• Chromoendoscopy – magnifying endoscopy
• Endoscopic sleeve gastroplasty (obesity treatment)
• Per-oral Endoscopic Pyloromyotomy (G-POEM / POP-Gastroparesis)
• Enteroscopy (PowerSpiral-Motorized Enteroscopy, Single-Balloon Enteroscopy, Double-Balloon Enteroscopy)
• Endoscopic-laparoscopic treatments (LECS)