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GI Advanced Procedures

Archbold Memorial Hospital in Thomasville, Georgia, is home to the only Advanced Gastrointestinal (G.I.) Endoscopic Surgery program in the region. The program is led by Stavros Stavropoulos, MD, a world-renowned gastroenterologist and pioneer of endoscopic surgery.


To make a referral to Archbold’s new Advanced Gastrointestinal Endoscopy/Endoscopic Surgery program, call Archbold Gastroenterology at 229.584.7636 (POEM).

Please send the following information with your referral:

  • Patient Demographics
  • Insurance Information
  • Any pertinent radiology or endoscopy test (pictures in color preferred)
  • examples include: manometry, EGD, colonoscopy, biopsy/pathology reports
  • Office Notes (last two preferred)

About Dr. Stavros Stavropoulos

Stavros Stavropoulos, MD, FASGE, AGAF, FJGES, NYSGEF is an expert in endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) and a pioneer in the field of Endoscopic Surgery in the US as the first practitioner of POEM in 2009, the first practitioner of EFTR and STER in 2012 and one of the first two practitioners of ESD in 2005.

In addition to his role as a physician and educator, Dr. Stavropoulos is active in clinical research and has over 100 peer-reviewed publications. As a leading global expert in advanced gastrointestinal procedures, Dr. Stavropoulos often gives lectures, provides instruction, and performs live demonstrations across the world.

Dr. Stavropoulos is a fellow of the America Society for Gastrointestinal Endoscopy (ASGE) and the American Gastroenterological Association (AGA). He is also a member of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and one of a small number of international endoscopists honored with a fellowship to the Japanese Society of Gastrointestinal Endoscopy (FJGES). He has held academic appointments at Columbia University (Adjunct Professor of Clinical Medicine 2009-2019), Temple University (Adjunct Clinical Professor of Medicine 2015-2016), and NYU (Associate Professor of Medicine).

Dr. Stavropoulos will join the physicians at Archbold Gastroenterology in Thomasville as Chief of Endoscopy and Director of the Program in Advanced GI Endoscopy/Endoscopic Surgery (P.A.G.E.S). He is currently accepting new referrals.

Advanced GI Procedures and Surgery at Archbold

Archbold now offers the following cutting-edge hospital-based, advanced gastrointestinal procedures in Thomasville, Georgia:

Peroral Endoscopic Myotomy (POEM)

POEM is a minimally invasive endoscopic surgery procedure used to treat swallowing disorders caused by muscle spasms in the esophagus such as achalasia. During the POEM procedure, a narrow, flexible tube (an endoscope) is inserted through the patient’s mouth in order to perform a small cut in the muscle of the esophagus. The cutting of the muscle loosens it and prevents it from tightening and interfering with swallowing. POEM achieves the same effective and durable cut in the muscle as the prior standard therapy for achalasia, the surgical (laparoscopic or robotic) Heller myotomy, but it is performed through the mouth without any surgical incisions. Studies have shown POEM to be equally or slightly more effective than surgical Heller myotomy, with shorter procedure time, less blood loss, less pain, faster recovery/return to work and lower incidence of severe adverse events.

Dr. Stavropoulos gained international recognition for his work in peroral endoscopic myotomy (POEM), a minimally invasive procedure used to treat swallowing disorders caused by muscle spasms in the esophagus. In 2009, Dr. Stavropoulos was the second operator in the world to perform a POEM procedure (just months after the first operator, Japanese surgeon Haruhiro Inoue). Currently, Dr. Stavropoulos is the highest-volume POEM operator in the United States sought after by achalasia patients from across the US and abroad. He recently published the largest and most comprehensively analyzed single-center series of POEMs in the Western Hemisphere in the prestigious journal of the American Society of Gastrointestinal Endoscopy (ASGE).

His latest innovation is the Anti-Reflux POEM (AR-POEM), a POEM technique that minimizes the incidence of reflux (a common side-effect of all current effective treatments for achalasia).

POEM is commonly used to treat achalasia, the excessive tightening of the ring of muscle (sphincter) between the esophagus and the stomach. Symptoms commonly associated with achalasia include:

  • Inability to move swallowed food to the stomach
  • Constant choking after eating
  • Coughing and sore throat
  • Food becoming trapped in the esophagus
  • Weight loss and nutrient deficiencies

The diagnosis is usually confirmed by high-resolution manometry (HRM) a test that is available by our expert multidisciplinary esophageal disease team at Archbold.

Gastric POEM (G-POEM) and Zenker’s POEM (Z-POEM)

G-POEM and Z-POEM arose as “offshoots” of POEM. G-POEM makes a cut in the muscle of the stomach (the “pylorus”) that controls food passage from the stomach to the intestine. This facilitates stomach emptying in patients with gastroparesis (“paralysis of the stomach”). Previously, this type of cut (called a pyloromyotomy) required laparoscopic or robotic surgery with 4 or 5 abdominal incisions.

Z-POEM treats non-invasively the Zenker’s diverticulum, an abnormal outpouching of the upper esophagus in the patient’s neck associated with difficulty swallowing solid food, particularly pills, and entrapment of solid food in the outpouching with later regurgitation. Z-POEM is easier, faster and less invasive than traditional surgical treatments for Zenker’s diverticulum.

Dr. Stavropoulos has been a pioneer of these procedures in the US. He was co-operator at the first G-POEM procedure performed in the US in 2013 (alongside H. Inoue from Japan and M. Khashab from Hopkins-published in Gastrointestinal Endoscopy in 2013) and was the first operator worldwide to perform and demonstrate the ultra-short tunnel Z-POEM technique that is now used by most operators at his highly-regarded annual live endoscopy course (“Long Island Live”) in March of 2017.

Endoscopic Submucosal Dissection (ESD)

Endoscopic submucosal dissection (ESD) is a revolutionary procedure invented in Japan for the removal of precancerous polyps (tumors) and early gastrointestinal cancers (also called T1 cancers). As an endoscopic “scarless” procedure, it is an alternative option to surgery for such tumors (i.e., surgical esophagectomy, gastrectomy or colectomy).

ESD removes tumors completely in one piece with the tumor surrounded by normal tissue (also called “negative margin”), unlike the older technique of EMR (Endoscopic Mucosal Resection), which removes tumors in multiple pieces (“piecemeal”). Piecemeal removal has a higher risk of leaving tumor cells behind and, therefore, a higher risk of the tumor “growing back” (tumor recurrence).

Dr. Stavropoulos is a pioneer of ESD in the US having performed his first human cases in early 2005 (8 to 9 years prior to other centers that currently offer ESD in the US). He recently published the largest single-center ESD series in the United States in the clinical journal of the American Gastroenterology Association (Clinical Gastroenterology and Hepatology, 2020). There are few expert centers for ESD in the US because of the high degree of training, precision and expertise that is required.

ESD is commonly used to remove pre-cancerous polyps and early cancers such as the following:

  • Early Barrett’s Esophagus cancers (T1) and nodules with high-grade dysplasia
  • Early squamous cancers of the esophagus
  • Early (T1) cancers and pre-cancers (dysplastic lesions) of the stomach
  • Pre-cancerous polyps larger than 2 cm, especially “flat polyps” that are large, have a depressed appearance, abnormal “pit pattern” on their surface, or other signs that suggest the presence of occult cancer despite a negative biopsy
  • Early (T1) cancers of the colon and rectum

Endoscopic Full Thickness Resection (EFTR) & Submucosal Tunnel Endoscopic Resection (STER)

Dr. Stavropoulos performed the first EFTR and STER cases in the United States in 2012. EFTR and STER are innovative techniques that allow complete en-bloc (one piece) removal of deep-seated tumors (often called “subepithelial” or “submucosal” tumors) of the wall of the GI tract such as GI stromal tumors (GISTs) and leiomyomas. The pre-cancerous tumors and early GI cancers removed by ESD are superficial tumors involving only the top layers of the GI wall (the mucosa, that forms the red “lining” of the GI tract, and the submucosa, the layer of tissue between the mucosa and the muscle layer of the GI wall). In contrast, subepithelial tumors such as GISTs involve also the deeper muscle layer and often extend beyond the muscle on the other side of the GI tract wall into the thoracic or abdominal cavities.

EFTR and STER achieve complete removal of tumors such as esophageal and gastric GISTs and leiomyomas by removing the tumor along with the entire thickness of the GI wall in one piece without the invasiveness and scars of laparoscopic or robotic abdominal or thoracic surgery, (the traditional treatment for such tumors). EFTR and STER are ideal for tumors smaller than 5 cm (2 inches) whereas surgery is preferable for tumors larger than 5 cm. At Archbold, there is extensive experience available for both approaches. On the endoscopic surgery side, Dr. Stavropoulos offers world-class expertise in EFTR and STER and the Archbold Endoscopy Unit boasts the latest equipment for Endoscopic surgery and Advanced Endoscopy.

On the surgical side, the minimally invasive surgical (MIS) team led by Dr. Ed Hall offers the latest in robotic minimally invasive surgery with exceptional resources including 3 latest-generation DaVinci robots.

Transoral Incisionless Fundoplication (TIF)

The standard therapies for gastroesophageal reflux disease (GERD) are acid suppression medications (most commonly proton pump inhibitors, “PPIs”) or a surgical fundoplication (or “wrap”) (e.g., Nissen or Toupet fundoplication).

The surgical approach is particularly useful in patients with a large “hiatal hernia” (sliding of the stomach upwards into the chest, one of the most important causes of GERD). The surgeon can correct the hernia and perform a fundoplication (i.e., a “wrap” of the fundus, the uppermost part of the stomach, around the esophagus to tighten the esophageal sphincter, the “valve” at the junction of the esophagus and stomach). The fundoplication strengthens this “valve” and prevents reflux of acid from the stomach.

For patients with significant GERD without a large hernia, there is an endoscopic fundoplication option (TIF), particularly for patients that want to avoid the invasiveness and side effects of a surgical fundoplication or for patients that are unsuitable for surgical fundoplication (e.g., patients with GERD after prior sleeve gastroplasty). TIF is a useful option for patients with small or no hiatal hernia, moderate or severe GERD on pH study (a test that quantifies the amount of acid reflux over a 48-hour period), significant symptoms (e.g. regurgitation) and inability or unwillingness to take PPIs or unresponsiveness to these medications.

Dr. Stavropoulos was among the first physicians to perform TIF procedures in the US in 2007-2008. After major technical upgrades to the original device and with encouraging outcomes in some long-term studies, TIF now offers a reasonable alternative to surgical fundoplication in carefully selected patients as outlined above. The multidisciplinary team at Archbold can perform a comprehensive evaluation of patients with pH studies, HRM (high-resolution manometry) studies, as well as endoscopy, barium studies and other tests to offer individualized GERD treatment according to each patient’s clinical characteristics and preferences. Our team at Archbold offers advanced surgical expertise for TIF (by Dr. Stavropoulos and his team) and robotic surgical fundoplication (by the MIS surgical team).

Endoscopic Ultrasound (EUS) & Endoscopic Retrograde Cholangio-Pancreatography (ECRP)

Dr. Stavropoulos is an expert in EUS and ERCP with a clinical experience in thousands of tertiary/quaternary level procedures for each of these modalities and multiple peer-reviewed publications. In particular, he specializes in novel cutting-edge techniques within these fields, such as EUS-guided access of the bile duct in patients with “failed ERCP” attempts, enteroscopy-assisted ERCP in patients with surgically-altered anatomy such as bariatric gastric bypass patients, minor papilla interventions in patients with pancreas divisum, cholangioscopy (examination of the inside of bile duct in patients with stones and tumors of the bile duct), endoscopic pancreatic necrosectomy (endoscopic clearing of dead tissue that sickens patients with severe pancreatitis), and EUS-guided gastroenterostomy (endoscopic bypass in patients with obstruction of the stomach by tumors) to name just a few.

Endoscopic Ultrasound (EUS)

Endoscopic ultrasound (EUS) allows in-depth examination of the wall of the GI tract to assess the extent of tumors within its wall. The upper GI tract consists of the esophagus, stomach, duodenum and small bowel; the lower tract includes the colon and rectum. EUS is also used to study other organs that are adjacent to the GI tract by imaging through the wall of the GI tract using the ultrasound beam. Such organs include the lungs, liver, gall bladder, pancreas, adrenal glands, kidneys and lymph nodes. Under EUS guidance a thin needle can be introduced through the GI wall into these organs to non-invasively take a biopsy of the liver, tumors, cysts, abnormal “suspicious” lymph nodes or other lesions.

  • EUS is often used to diagnose certain conditions that could be the cause of abdominal pain or abnormal weight loss.
  • EUS is also used to examine and/or take a biopsy of known abnormalities, including lumps or lesions, which were detected previously via endoscopy, computed tomography (CT) scan or MRI.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

ERCP is a procedure used to examine a patient’s pancreatic and bile ducts, the small tubes that carry pancreatic juice and bile from your pancreas and liver to the first portion of the small intestine (the duodenum) to aid digestion. During an ERCP procedure, a flexible, lighted tube called an endoscope is inserted through your mouth, into your stomach, and into the duodenum. The endoscope allows your physician to find the opening of the bile duct and pancreatic duct and insert a catheter in these ducts to inject a special dye that is opaque to X-rays and allows visualization of the ducts under X-ray (fluoroscopy). The physician can also insert a tiny endoscope (called a cholangioscope or pancreatoscope) through the larger endoscope and then up the bile duct or pancreatic duct to perform “cholangiscopy” or “pancreatoscopy” (i.e., visualize the inside of the ducts directly). This allows detection and removal of stones, placement of stents to facilitate drainage of bile or pancreatic juice in patients where there is obstruction by stones or tumors and other therapeutic interventions.

ERCP is commonly used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. Your doctor may recommend an ERCP if you are experiencing any of the following symptoms:

  • Unexplained abdominal pain
  • Yellowing of the eyes and skin (jaundice)
  • Blockage or stones in the bile duct or pancreatic duct
  • Fluid leakage from the bile ducts (“bile leak”), which can occur after gallbladder or liver surgery
  • Blockage or narrowing of the bile ducts
  • Tumors in the pancreas, liver, and/or bile ducts
  • Infection in the bile ducts

To make a referral to Archbold’s new Advanced Gastrointestinal Endoscopy/Endoscopic Surgery program, call Archbold Gastroenterology at 229.584.7636 (POEM).

Please send the following information with your referral:

  • Patient Demographics
  • Insurance Information
  • Any pertinent radiology or endoscopy test (pictures in color preferred) examples include: manometry, EGD, colonoscopy, biopsy/pathology reports
  • Office Notes (last two preferred)

Contact Us

Archbold Gastroenterology
112 Mimosa Drive
Thomasville, GA, 31792
229.584.7636 (POEM) referral line
229.584.5590 office

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