Extensive expertise in therapeutic endoscopy a multidisciplinary team approach, technological advances and innovative research allow Ochsner’s therapeutic endoscopy program to provide a wide range of services to our patients—services that are available in few centers nationwide.

Ochsner offers more than just traditional endoscopy. Our advanced technology for diagnostic screenings provides faster recovery times for patients and clearer imaging capabilities so doctors can make proper diagnoses.

Endoscopic ultrasound (EUS) or echo-endoscopy is an endoscopy combined with ultrasound that obtains images of organs. EUS is a minimally invasive procedure that can be used to visualize the walls of organs. The procedure feels no different than a regular endoscopic procedure but delivers more information than a traditional endoscopy. Ochsner is one of very few hospitals in the United States that uses the latest enhancement in ultrasound technology—the ALOKA Alpha 10 system processor. This new technology offers unmatched image quality and provides the most accurate medical images currently available of the gastrointestinal tract wall. These images help the surgeon, radiologist, oncologist and internist to diagnose and treat many gastrointestinal cancers and other gastrointestinal problems.

An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. This procedure allows for better diagnosis of pains in the abdomen.

Ochsner has the newest technology to offer the Firefly procedure that uses infrared imaging to illuminate exactly where the kidney and its blood supply are. Firefly does not cause the blood loss and disruption of blood supply problems that older procedures did. With the more precise Firefly, doctors can see and accurately control blood flow to keep the body functioning as normally as possible. To read more about this procedure, click here.

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the doctor can see the inside of the stomach and duodenum and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.

Ochsner doctors and staff use a new medical fiberoptic technology called SpyGlass™ Direct Visualization System to make more accurate diagnoses about some of the smallest channels in the human body—the bile ducts leading to the liver and pancreas. A miniature 6,000-pixel fiberoptic camera probe fits easily into the endoscope and provides real-time images of these small bodily channels. SpyGlass™ can lead to earlier detection and effective treatment of suspected malignancies, gallstones, blockages or cystic lesions.

All of Ochsner’s gastrointestinal doctors are involved in the diagnosis and treatment of gastrointestinal cancers—esophageal, gastric, colon and pancreatic.

For your first appointment, bring your insurance card, co-payment (you may pay by check or credit card), an identification card, a list of the medications you take and your medical record if you were not referred by your doctor. If your doctor referred you, your records have probably already been faxed to us.

For follow-up appointments, bring a list of the medications you take, information about any new medical encounters that have occurred since your last visit and CDs of any imaging studies.

Dr. Ricardo V. Romero is board certified in internal medicine and gastroenterology.

Second opinions are available for any type of abnormal gastrointestinal mass, including cancers of the pancreas, bile duct, esophagus, stomach, colon and rectum. When you come to Ochsner for a second opinion, you will have the opportunity to discuss your condition and the appropriate course of treatment, recommended procedures, risk factors, prognosis and alternative treatment options with a highly trained specialist. You will see one of our three advanced endoscopists—Dr. Ramon Rivera, Dr. Ricardo Romero or Dr. Mainor Antillon.

The number for Ochsner’s gastroenterology clinic is 504-842-4015. The endoscopy lab phone number is 504-842-3085. Calls are answered Monday through Friday from 8:00 a.m. to 5:00 p.m.

Call 504-842-4015 to schedule an appointment. If you need to cancel or reschedule an appointment, please call 48 hours before your scheduled appointment.

Ochsner's colorectal surgeons specialize in the surgical removal of malignancies of the colon, rectum and anus. They offer a full range of surgical options and are nationally recognized authorities on anal and perianal tumors. When possible, our colorectal surgeons can perform sphincter-saving surgery for low rectal cancer. In some other cases, chemotherapy and radiotherapy are given before surgery to reduce the size of the tumor. Using a multi-disciplinary team approach, Ochsner's colorectal surgeons participate in chemotherapy protocols with our medical oncology team. They also participate in other research studies, such as ongoing clinical trials for colon cancer to investigate the use of ultrasound-guided surgery for colorectal malignancies.

The Ochsner Cancer Institute is at the forefront of colon cancer and rectal cancer prevention through patient screening, education, detection and treatment. Colorectal cancer, in particular, can be prevented through regular examinations to detect and remove premalignant polyps. This is good news for patients; if colon cancer is diagnosed in its early stages, the latest medical and surgical treatments offer a good chance for a cure. In fact, colon polyps and cancer prevention are one of our major research interests. We have several randomized clinical trials on chemo-prevention for colorectal polyps and cancer-in progress.

Furthermore, newer procedures, such as CT colongraphy, also known as virtual colonoscopy, are under evaluation by physicians in the in the endoscopy center and the Radiology Department. In addition, innovative multi-disciplinary therapies allow many patients to be cured of their rectal cancer while preserving anal muscles and avoiding a permanent colostomy. Collaboration with radiation and medical oncologists has allowed most rectal cancer patients to receive sphincter-saving procedures such as ultra-low anterior resections or colanal pull-throughs. To improve postoperative function, colonic pouches or coloplasty techniques are routinely performed.

Additional information about colon cancer or an appointment with one of our surgeons is available at:

Department of Colon and Rectal Surgery - 504-842-4060

While esophageal and gastric cancers have been historically difficult, treatment options and outcomes are better now than ever. At Ochsner, we have cutting-edge care, expertise and experience on our side – not to mention both the compassion and passion you’re looking for.

Ochsner’s award-winning surgeons perform more esophagectomies than anyone else in Louisiana – hands down. And robotic minimally invasive surgical resection is available to 90% of our patients. What’s more, Ochsner surgeons implement the newest approaches to esophageal preservation. We focus on maximizing long-term outcomes while optimizing your functional and digestive recovery.

• Ranked Nationally in Gastroenterology & GI Surgery by U.S. News & World Report 2020-21

Learn more about Ochsner’s outcomes.

We don’t just talk about the multi-disciplinary approach, we live it. At Ochsner, you’ll have a dedicated nurse navigator and a dedicated team of experts beside you every step of the way. Learn more about our team approach.

There are two main types of esophageal cancer. Each was named for the type of cells that become malignant.

• Squamous cell carcinoma – This cancer forms in the flat, thin cells lining the surface of the esophagus. It is most often found in the upper and middle part of the esophagus.
• Adenocarcinoma – This type of cancer begins in the mucus-secreting glands in the esophagus. Typically, they form in the lower part of the esophagus, near the stomach.

Our expert team of general surgeons leads the Gulf Coast in the surgical treatment of esophageal cancer and stricture. We take special measures to ensure the comfort and education of our patients and their family members - knowing they all play an important role in the recovery process. Ochsner is a national leader in minimizing complications and carrying out successful multimodality treatment. The medical staff is also experienced in the evaluation of high-risk Barrett's syndrome and laparoscopic-assisted, minimally-invasive esophagectomy.

Esophageal cancer surgeries available at Ochsner include:

• Open esophagectomy
• Minimally invasive esophagectomy
• Endoscopic mucosal resection

Patients may stay at Ochsner’s Brent House Hotel, a full-service hotel with guest rooms and suites adjacent to Ochsner Medical Center. Call toll free 1-800-535-3986 or go to brenthouse.com for more information.

Patients and a caregiver may also stay at the American Cancer Society’s Patrick F. Taylor Hope Lodge. This program helps patients cope with the cancer treatment process and provides a supportive environment for patients. Ochsner can help coordinate housing arrangements if needed and additional information is available by calling 504-219-2200.

Qualified patients and family members can obtain free lodging at the American Cancer Society Hope Lodge.

At Ochsner patients receive personalized treatment from a team who does more minimally-invasive, robotically-assisted surgery for stomach cancer than anywhere else in region.

Ochsner’s unique team approach to treat symptoms of stomach cancer ensures that all possible treatment strategies are discussed, including surgery, chemotherapy and radiation. Our team includes rehabilitation specialists and dietitians equipped to address quality of life issues – problems relating to eating, adjusting to a new diet or managing fatigue and nausea.

At Ochsner, we don’t just talk about the multi-disciplinary approach, we live it. You’ll have a dedicated nurse navigator and a dedicated team of experts beside you every step of the way. Learn more about our team approach.

Adenocarcinoma
About 90% to 95% of cancers of the stomach are adenocarcinomas, cancers that develop from the cells that form the innermost lining of the stomach.

Lymphoma
About 4% of stomach cancers are lymphomas, cancers of the immune system tissue that are sometimes found in the wall of the stomach.

Gastrointestinal stromal tumor (GIST)
This is a rare tumor that starts in the very early forms of cells in the wall of the stomach.

Carcinoid Tumor
Approximately 3% of cancers of the stomach are carcinoid tumors that begin in the hormone-making cells of the stomach.

Very rarely other types of cancer can start in the stomach, including squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma.

In addition to a complete medical history and physical examination, diagnostic procedures for stomach cancer may include the following:

Fecal Occult Blood Test
Checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the physician's office or sent to a laboratory.

Upper GI (gastrointestinal) Series (also called barium swallow)
A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
An EGD (upper endoscopy) is a procedure that allows the physician to examine the inside of the esophagus, stomach and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue forbiopsy (if necessary).

Endoscopic Ultrasound
This imaging technique uses sound waves to create a computer image of the wall of the esophagus and stomach, as well as nearby lymph nodes. A small transducer (which emits sound waves and receives their echoes) is placed on the tip of an endoscope. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).

Computed Tomography Scan (CT or CAT scan)
A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce horizontal or axial images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.

Surgery
Surgery may be necessary to remove cancerous tissue, as well as nearby noncancerous tissue. The most common operation is called gastrectomy. If part of the stomach is removed, it is called a subtotal or partial gastrectomy. If the entire stomach is removed, it is called a total gastrectomy. Nearby lymph nodes are usually removed as well.

External Radiation (external beam therapy)
External radiation precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. External radiation may be used after surgery to try to kill any remaining cancer cells or for more advanced stomach cancer to ease (palliate) symptoms such as pain or blockage.

Chemotherapy
Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.

Targeted Therapy
Some newer drugs work differently from standard chemotherapy drugs by targeting certain parts of certain cells that make them different from normal cells. For example, in some stomach cancers, the cells have too much of a protein called HER2 on their surfaces. A drug called trastuzumab (Herceptin) may be helpful against these cancers. It is usually given along with standard chemotherapy drugs to help treat advanced stomach cancers.

Sometimes, several treatments may be combined to treat stomach tumors. Please consult your physician with any questions or concerns you may have regarding this condition.

Patients may stay at Ochsner’s Brent House Hotel, a full-service hotel with guest rooms and suites adjacent to Ochsner Medical Center. Call toll free 1-800-535-3986 or go to brenthouse.com for more information.

Patients and a caregiver may also stay at the American Cancer Society’s Patrick F. Taylor Hope Lodge. This program helps patients cope with the cancer treatment process and provides a supportive environment for patients. Ochsner can help coordinate housing arrangements if needed and additional information is available by calling 504-219-2200.

Qualified patients and family members can obtain free lodging at the American Cancer Society Hope Lodge.

There was a time when cancer of the liver was considered an incurable state. That time is no more. Current treatments can extend survival and even offer the chance of a cure in select patients. At the Ochsner Cancer Institute Liver Tumor Treatment Center, the full spectrum of cutting-edge technologies for care of patients with liver cancer and other liver tumors is available close to home, in the Gulf South. Our patient-centered approach ensures the highest quality care while maintaining patient comfort and minimizing treatment-related stress and anxiety.

Each patient at the Liver Tumor Treatment Center is evaluated at a multidisciplinary conference where an individualized treatment plan is developed with the input of the entire liver tumor team. This team consists of surgical oncologists, transplant surgeons, medical oncologists, radiation oncologists, gastroenterologists and radiologists. This multidisciplinary approach ensures that all possible treatment strategies for liver cancer are discussed, including surgery, chemotherapy and radiation. The team also discusses clinical trial opportunities for patients who are interested in this option.

• Multidisciplinary care continues throughout the liver cancer treatment process. Anesthesia, nursing and psychology staff are trained specifically to care for patients with liver tumors and to help ensure that treatments, such as liver resection, are done in the safest possible manner.
• Same or next-day appointments are available. The physician support staff will coordinate with referring physicians to obtain a timely consultation and ensure all necessary studies are scheduled.
• Dedicated nurse navigators are available to help patients through the sometimes complex treatment process. Nurse navigator assistance begins with clinic access and continues through the entire course of therapy. For surgical patients, this assistance includes coordinating home care after hospital discharge and a routine postdischarge phone call to check in, to make sure everything is going OK at home and to schedule the follow-up appointment. Extensive patient and family education is vital to successful treatment and the nurse navigators are intimately involved with the patient education process.

Qualified patients and family members can obtain free lodging at the American Cancer Society Hope Lodge. Many of our patients travel many miles to obtain treatment at our Liver Tumor Treatment Center, making the Hope Lodge an incredibly valuable resource.

Colorectal cancer metastases: After the lymph nodes, the liver is the most common site of the spread of colon and rectal cancers. Nearly 50% of all patients with colorectal cancer will develop liver tumors. Significant progress has been made for treating this condition and patients now have the chance for long-term survival—even patients with extensive, bilateral liver involvement who were once considered poor candidates for liver treatments. Using advanced technologies, such as laparoscopic liver resection, portal vein embolization and two-stage resections, we can offer treatments to many patients with conditions that were once considered incurable.

• Hepatocellular carcinoma: Hepatocellular carcinoma most commonly develops in the presence of chronic liver disease such as viral hepatitis (hepatitis B, hepatitis C) or fatty infiltration that can lead to nonalcoholic steatohepatitis (NASH). Surgical treatment considerations are liver resection and liver transplantation. Patients who are not surgical candidates are often treated with chemotherapy delivered directly into the tumors using radiological techniques.
• Neuroendocrine tumor liver metastases: Neuroendocrine tumors often spread to the liver in a manner similar to the way colorectal tumors spread. Neuroendocrine tumors are rare cancers that develop in a neuoroendocrine cell rather than a cell lining a duct or bowel lumen. Neuroendocrine liver tumors are treated with liver resection and radiologic-directed chemotherapy or radiation. These tumors are rarely treated with liver transplantation.
• Biliary cancers: Our care team also treats bile duct and gallbladder cancers
• Benign liver lesions: Benign lesions include adenoma and focal nodular hyperplasia

The Liver Tumor Treatment Center surgeons have extensive experience with major liver resection, minimally invasive laparoscopic approaches and liver transplantation. Our liver transplant program is the busiest in the region and one of the top five busiest in the country. For patients previously considered poor surgical candidates, we routinely utilize portal vein embolization and two-stage resection techniques.

Other treatments include thermal ablation (RFA, microwave) and interventional approaches (drug-eluting beads, radioactive spheres).

Surgical and chemotherapy trials are available for patients who wish to get involved. There is no extra pressure to enroll in a trial, but they are available and our physicians are ready to discuss the options.

• John Bolton, MD – Surgical Oncology
• Suma Satti, MD – Medical Oncology
• Kim Drake, NP – Surgical Oncology

Our current three-year risk-adjusted mortality index (RAMI) is 0.49 for liver resection. This means our mortality rate is much less than expected for our patient population.

Ochsner is home to the only nationally ranked gastroenterology and GI surgery program in the area. Our team exists to help our patients not only survive but thrive.

Historically, cancer of the pancreas has been a challenging disease, but here at Ochsner there are reasons to be optimistic. Today, modern surgical techniques can safely remove early tumors, and there have been promising improvements in systemic therapies. In addition, a renewed emphasis on funding research nationwide is fostering progress.

The Ochsner pancreatic cancer treatment center team combines knowledge and talent with experience. Our team utilizes advanced minimally invasive laparoscopic and robotic surgical approaches to pancreatic cancer resection. And with more than 100 surgeries in 2014, we performed the highest volume of resections in Louisiana and Mississippi. All together, our surgeons performed more than 65 Whipple resections, and more than 30% of these procedures included vascular resection and reconstruction.

Is experience really that important? It’s everything. Our patients’ outcomes have been well above the national average.

We don’t just talk about the multi-disciplinary approach, we live it. At Ochsner, you’ll have a dedicated nurse navigator and a dedicated team of experts beside you every step of the way. Learn more about our team approach.

Cancerous tumors in the pancreas include:

• Adenocarcinoma of the Pancreas - The most common type of pancreatic cancer that occurs in the lining of the pancreatic duct
• Cystadenocarcinoma - A rare pancreatic cancer that develops from a fluid-filled noncancerous (benign) tumor called a cystadenoma
• Pancreatic Neuroendocrine tumors (NETs) – a rare tumors that arise from endocrine cells within or near the pancreas, NETs account for less than 5% of all pancreatic tumors.

Some noncancerous tumors in the pancreas include:

• Insulinoma - A rare pancreatic tumor that secretes insulin, which is the hormone that lowers glucose levels in the blood
• Gastrinoma - A tumor that secretes above average levels of gastrin, a hormone which stimulates the stomach to secrete acids and enzymes. Gastrinoma can also cause peptic ulcers.
• Glucagonoma - A tumor that secretes glucagon, a hormone which raises levels of glucose in the blood and leads to a rash
• Intraductal papillary mucinous neoplasm (IPMN) – A tumor that grows within the pancreatic ducts characterized by the production of mucinous.

In addition to a complete medical history and medical examination, diagnostic procedures for pancreatic cancer may include:

• Endoscopic Ultrasound - A specialized diagnostic technique that uses high-frequency sound waves delivered through an endoscope to create high-quality images of the upper GI tract, including the pancreas
• Computed Tomography (CT or CAT scan) - A non-invasive procedure that takes cross-sectional images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary x-ray
• Magnetic Resonance Imaging (MRI) - A non-invasive procedure that produces two-dimensional views of an internal organ or structure, especially the brain and spinal cord
• Endoscopic Retrograde Cholangiopancreatography (ERCP) - This procedure involves inserting an endoscope, which is an advanced viewing tube, through the stomach and into the small intestine. A special dye injected during this procedure shows the ducts in the biliary system.
• Biopsy of the pancreas
• Special blood tests

Patients may stay at Ochsner’s Brent House Hotel, a full-service hotel with guest rooms and suites adjacent to Ochsner Medical Center. Call toll free 1-800-535-3986 or go to brenthouse.com for more information.

Patients and a caregiver may also stay at the American Cancer Society’s Patrick F. Taylor Hope Lodge. This program helps patients cope with the cancer treatment process and provides a supportive environment for patients. Ochsner can help coordinate housing arrangements if needed and additional information is available by calling 504-219-2200.

Qualified patients and family members can obtain free lodging at the American Cancer Society Hope Lodge.

Ochsner is home to the only nationally ranked gastroenterology and GI surgery program in the area. Our team exists to help our patients not only survive but thrive.

Historically, cancer of the pancreas has been a challenging disease, but here at Ochsner there are reasons to be optimistic. Today, modern surgical techniques can safely remove early tumors, and there have been promising improvements in systemic therapies. In addition, a renewed emphasis on funding research nationwide is fostering progress.

The Ochsner pancreatic cancer treatment center team combines knowledge and talent with experience. Our team utilizes advanced minimally invasive laparoscopic and robotic surgical approaches to pancreatic cancer resection. And with more than 100 surgeries in 2014, we performed the highest volume of resections in Louisiana and Mississippi. All together, our surgeons performed more than 65 Whipple resections, and more than 30% of these procedures included vascular resection and reconstruction.

Is experience really that important? It’s everything. Our patients’ outcomes have been well above the national average.

We don’t just talk about the multi-disciplinary approach, we live it. At Ochsner, you’ll have a dedicated nurse navigator and a dedicated team of experts beside you every step of the way. Learn more about our team approach.

Cancerous tumors in the pancreas include:

• Adenocarcinoma of the Pancreas - The most common type of pancreatic cancer that occurs in the lining of the pancreatic duct
• Cystadenocarcinoma - A rare pancreatic cancer that develops from a fluid-filled noncancerous (benign) tumor called a cystadenoma
• Pancreatic Neuroendocrine tumors (NETs) – a rare tumors that arise from endocrine cells within or near the pancreas, NETs account for less than 5% of all pancreatic tumors.

Some noncancerous tumors in the pancreas include:

• Insulinoma - A rare pancreatic tumor that secretes insulin, which is the hormone that lowers glucose levels in the blood
• Gastrinoma - A tumor that secretes above average levels of gastrin, a hormone which stimulates the stomach to secrete acids and enzymes. Gastrinoma can also cause peptic ulcers.
• Glucagonoma - A tumor that secretes glucagon, a hormone which raises levels of glucose in the blood and leads to a rash
• Intraductal papillary mucinous neoplasm (IPMN) – A tumor that grows within the pancreatic ducts characterized by the production of mucinous.

Diagnostic Procedures For Pancreatic Cancer

In addition to a complete medical history and medical examination, diagnostic procedures for pancreatic cancer may include:

• Endoscopic Ultrasound - A specialized diagnostic technique that uses high-frequency sound waves delivered through an endoscope to create high-quality images of the upper GI tract, including the pancreas
• Computed Tomography (CT or CAT scan) - A non-invasive procedure that takes cross-sectional images of the brain or other internal organs to detect any abnormalities that may not show up on an ordinary x-ray
• Magnetic Resonance Imaging (MRI) - A non-invasive procedure that produces two-dimensional views of an internal organ or structure, especially the brain and spinal cord
• Endoscopic Retrograde Cholangiopancreatography (ERCP) - This procedure involves inserting an endoscope, which is an advanced viewing tube, through the stomach and into the small intestine. A special dye injected during this procedure shows the ducts in the biliary system.
• Biopsy of the pancreas
• Special blood tests