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.
Referrals
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)
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
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).
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.
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
Advanced Endoscopy & Endoscopic Surgery, GastroenterologyView Profile
