General Gastroenterology
The most common procedures performed by a gastroenterologist are Upper Endoscopy (aka EGD) and colonoscopy.
EGD: A procedure by which Dr. Simoni is able to look into the esophagus, stomach, and the upper portions of small intestine. During this process a thin and flexible tube (that has a high definition but tiny camera lens attached to its tip) is utilized under sedation to evaluate the upper digestive tract. The tube also has a small channel through which samples of lining of the digestive tract can be obtained. Although this procedure generally takes just a few minutes, it has a very high yield and many different disorders can be diagnosed or ruled out. Read more…
Colonoscopy: A procedure by which Dr. Simoni is able to look into the large intestine (aka colon) and often times the very last part of the small intestine (terminal ileum). During this process a thin and flexible tube (but longer than the EGD scope that also has a high definition but tiny camera lens attached to its tip) is utilized under sedation to evaluate the lower digestive tract. The tube also has a small channel through which samples of lining of the colon can be obtained and through which polyps can be removed. Generally colonoscopy takes less than 20 minutes and it also has a very high yield and not only many different disorders can be diagnosed or ruled out, it has been an essential tool in reduction of colon cancer. Read more…
Specialized Gastroenterology
The following procedures that Dr. Simoni offers, require special training and experience which not all gastroenterologists are able to perform:
TNE: Which stands for Transnasal Endoscopy is a specialized miniature scope with very thin (the size of a ink reservoir of a ballpoint pen) tube which can be passed through a nostril into the esophagus and the upper part of the stomach. This procedure is often performed in the office without sedation (although the nose and throat are locally anesthetized). The advantage of TNE over EGD is that it can easily be performed without sedation or anesthesia, patient does not need a ride, and therefore less expensive than an EGD. The shortfall of TNE is that it is short and is often used to evaluate the back of the throat and the esophagus only. Read more…
WCE: Or Wireless Capsule Endoscopy is a revolutionary disposable capsule with a minuscule camera and transmitter inside of it. It is the size of a large vitamin pill but with a very smooth outer shell that makes it slippery and easy to swallow. This procedure is used to visualize the inside of the small bowel (approximately 30 feet) which cannot be evaluated by conventional scopes such as EGD or colonoscopy. This is and office-based procedure that does not require any sedation in almost all cases. WCE is utilized in diagnosis of Crohn’s disease, Celiac disease, tumors of the small bowel, and to find sources of gastrointestinal bleeding. Read more…
BRAVO ph: This is a disposable plastic capsule (the size of a pencil eraser) with microchip, micropipette, and a transmitter that is placed in the esophagus to measure severity and frequency of acid reflux and transmit the data to a wireless recorder. It attaches to the lining of the esophagus by suction and a tiny pin which falls off after a few days. It is very helpful in subjective measurement of gastroesophageal reflux disease (GERD). Read more…
Impedance pH: This procedure is performed by using a thin plastic catheter that is fitted with multiple electrodes along its length that measures direction of material within the esophagus and an inner channel that measures the pH. It is utilized for subjective evaluation of those patients who suffer from GERD or Laryngopharyngeal Reflux (LPR) and either have had a negative BRAVO pH, are suspected of having non-acid reflux, or cannot be off their anti-reflux medications. Read more…
HALO (RFA ablation): This procedure is for treatment of Barrett’s esophagus (a pre-cancerous condition due to GERD). Radiofrequency energy (radio waves) is delivered via a catheter to the esophagus to remove diseased tissue while minimizing injury to healthy esophagus tissue. This is called ablation, which means the removal or destruction of abnormal tissue. While you are sedated, the catheter is inserted through the mouth into the esophagus and used to deliver a controlled level of energy and power to remove a thin layer of diseased tissue. Less than one second of energy removes tissue to a depth of about one millimeter. Read more…
EHL: Also known as Endoscopic Hemorrhoidal Ligation (or Band Ligation) is a procedure that can be performed in the office without a need for sedation, but can also be done during a colonoscopy under sedation. This procedure is performed for patients who have recurrent rectal bleeding that is due to internal hemorrhoids. It simply places a very small rubber band over the ano-rectal vessels that supply blood to the hemorrhoids, cutting off the blood supply to them. It is one of the least invasive but most effective treatments for hemorrhoidal bleeding. (EHL is not for treatment of external hemorrhoids or non-bleeding hemorrhoids) Read more…
Interventional Gastroenterology
TIF: Which stands for Transoral Incisionless Fundoplication, is a minimally invasive procedure for treatment of reflux and associated conditions such as chronic cough, clearing of throat, sinusitis, and post nasal drip (to name a few).
Dr. Simoni is one of the very first gastroenterologists in the country who started to perform TIF in 2009. Dr. Simoni has performed more successful TIFs than any other gastroenterologist west of the Mississippi. He also trains other surgeons and gastroenterologists who are interested and have the skill-set to perform this highly specialized procedure.
The TIF procedure can be performed safely and with relatively minimal patient downtime. TIF is completely incisionless because the EsophyX device is introduced into the body through the mouth, rather than through an abdominal incision. The advantages of incisionless surgery over conventional laparoscopic or open GERD surgery include shorter hospital stay, reduced discomfort, shortened recovery, and no visible scars. Performed with the patient under general anesthesia, the EsophyX device is introduced into the body transorally (through the patient’s mouth) and advanced into the esophagus under visualization of a small video camera inserted down the central shaft of the device. The EsophyX device is then used to form and fasten several tissue folds, or “plications,” to create a robust anti-reflux valve at the gastroesophageal junction.
In the weeks following the procedure, a natural healing process causes the tissue folds to fuse to form a strong, reliable and robust anti-reflux valve during which time patients can stop taking anti-reflux medications. Read more…
EMR: Also known as Endoscopic Mucosal Resection, is another highly specialized technique with which large polyps or small tumors can be safely removed from lining of the digestive tract, without a need to have a surgical incision or removal of part of the intestine. During this process, a skillful endoscopist will inject a non-toxic solution underneath the polyp of tumor lifting away from the outer wall of the intestine in order for it to be removed without damaging the lining or cutting through the wall of the intestine. Read more…
ERCP: Is the acronym for Endoscopic Retrograde CholangioPancreatography. ERCP is another complex and delicate procedure that requires a high level of endoscopic skills and sophistication. This procedure uses a technique that combines endoscopic proficiency with competence in use of fluoroscopy (an imaging technique that uses x-rays to obtain real-time moving images of the interior of an object or organ) to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, Dr. Simoni is able to see the inside of the stomach and duodenum, and inject radiographic contrast into the ducts in the biliary tree and pancreas so they can be seen on X-rays.
ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. Read more…
GERD
Gastroesophageal Reflux Disease (GERD) is abnormally frequent or chronic reflux. It is the most common gastrointestinal-related diagnosis given by physicians during clinical visits in the U.S. Although GERD is not a life-threatening disease, serious complications such as esophageal stricture, Barrett’s esophagus or adenocarcinoma of the esophagus may occur.
GERD affects patients differently and involves symptoms which vary from mild or moderate to severe. Mild sufferers may experience occasional bouts of heartburn whereas more severe patients may experience heartburn daily. Other patients never experience heartburn but may have atypical symptoms such as asthma, chronic cough, hoarseness or chest pain due to reflux.
Treatment for GERD varies according to the severity of the disease and to the individual. Mild sufferers may experience relief by implementing simple lifestyle changes. Others achieve effective symptom control through medical therapy. Patients who experience more troublesome symptoms of GERD may require or opt for surgery. It is important to remember that GERD is a chronic disease that usually requires lifetime management to control symptoms.
Click below for our self-evaluation tool for GERD:
Cancer Prevention
One of the most important aspects of our field of medicine is to prevent cancers of the digestive tract. Most gastrointestinal cancers are what we call “silent killers” due to the fact that they do not have any sign or symptoms until it is too late. Our approach is a “proactive” approach and we strongly believe in preventative health as opposed to a “reactive” approach.
Below are just a few examples of some of the preventable silent killers and what they may cause if not diagnosed and/or treated appropriately:
| Silent killer | Most common symptom(s) | Other related symptoms | What kind of cancer does it cause? | What we can do to prevent cancer? | |||||
| Colon polyps | None | Constipation or rectal bleeding | Colon cancer | Colonoscopy | |||||
| Barrett’s esophagus | None | few may have reflux, cough, or voice changes | Esophageal cancer | EGD | |||||
| Celiac Disease | Non-specific | Range from none to abdominal pain, bloating, diarrhea, and at times constipation | Intestinal lymphoma | EGD, labs, and WCE | |||||
| H pylori infection | None | At times bloating, upper abdominal pain, history of gastric ulcers | Stomach cancer | EGD, labs | |||||
| Crohn’s disease | None (early stages) | Abdominal pain, nausea, diarrhea, mouth ulcers, low vitamin D3 | Digestive cancers (any, but most commonly colon cancer) | WCE, labs | |||||
| Ulcerative colitis | Bloody diarrhea | Abdominal pain, diarrhea, rectal bleeding | Colon cancer | Colonoscopy | |||||
| Hepatitis C | None | Yellowing of skin, abnormal liver enzymes on routine labs | Liver cancer | Labs, Ultrasound, and Fibroscan, but prevention is the key. | |||||
| Fatty liver | None | Obesity, abnormal liver enzymes on routine labs | Liver cancer | Labs, Ultrasound, but weight loss is the key |
In office procedures
Most digestive tract evaluations are easily performed in an outpatient (outside of the hospital) setting while others have to be performed in the hospital setting. Patient’s general medical condition, co-morbidity, and age of the patient may determine the safest location of the procedure(s) to be performed for that individual patient.
There are some procedures that may be performed in the office or at an Ambulatory Surgery Center (ASC), while others that can only be done in the office.
Examples of the procedures that have to be done at the hospital:
The procedures below are examples of the procedures that can be done at the hospital, ASC, or the office. To determine which location is the safest for you, it is best to discuss it with Dr. Simoni and our staff.
Here are some examples of the procedures that are mainly performed in the office:
TIF Procedure
The TIF procedure can be performed safely and with relatively minimal patient downtime. TIF is completely incisionless because the EsophyX device is introduced into the body through the mouth, rather than through an abdominal incision. The advantages of incisionless surgery over conventional laparoscopic or open GERD surgery include shorter hospital stay, reduced discomfort, shortened recovery, and no visible scars.
Performed with the patient under general anesthesia, the EsophyX device is introduced into the body transorally (through the patient’s mouth) and advanced into the esophagus under visualization of a small video camera inserted down the central shaft of the device. The EsophyX device is then used to form and fasten several tissue folds, or “plications,” to create a robust antireflux valve at the gastroesophageal junction.
In the weeks following the procedure, a natural healing process causes the tissue folds to fuse to form a strong, reliable and robust anti-reflux valve. Read more…
To find out if you are candidate for TIF, click below to make an appointment with Dr. Simoni:
Advanced Gastroenterology, Inc.
Phone: (805) 719-0244
555 Marin Street, Ste. 270
Thousand Oaks, CA 91360
