Gastroenterology and Hepatology

There are many medical service items in Digestive Division, and our medical features include as follows:

Interventional endoscopy (EMR, ESD, POEM, MBM, OTSC, Suture machine)

Screening endoscopy is the main tool to detect early gastrointestinal tract neoplasm. To improve the diagnosis of early gastrointestinal tract neoplasm, we introduced the new generation of high definition endoscopy system (CV 290) and various kinds of image-enhanced endoscopy, including chromoendoscopy, narrow-band imaging, and magnifying endoscopy, to differentiate normal and abnormal structure. We also had a CO2 insufflator to reduce abdominal distension and discomfort during and after the endoscopic procedure.
In addition to various examination tools, we can also perform endoscopic submucosal dissection to resect early gastrointestinal tract neoplasm. Endoscopic submucosal dissection is an advanced endoscopic technique to provide curative resection, accurate pathological assessment, and organ preservation. For the management of procedure-related perforation, we had introduced an OTSC system to close the defect. Novel OverStitch endoscopic suturing device (Apollo endosurgery) can provide full-thickness sutures through a flexible endoscope and will be introduced in the future.
Recently, interventional endoscopy is evolving into the era of third space endoscopy. With the advancement of endoscopic instruments, we can not only resect mucosal neoplasm but also can treat subepithelial disease. For example, we can remove the subepithelial tumor by creating a submucosal tunnel, or perform peroral endoscopic myotomy for achalasia patients.

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for the diagnosis and treatment of biliary-pancreatic diseases like bile duct stones, bile duct cancer, or obstructive jaundice. Nowadays, ERCP is one of our special medicine. The ERCP team in our hospital is composed of specialized and fixed members, including endoscopists, nurses, and technicians. It’s rare that among those tertiary medical centers, we have our ERCP room belonging to our endoscopic center. There were more than one thousand ERCP cases in our hospital annually.
For these ordinary ERCP procedures, we have one new high-quality, high-resolution fluoroscope of single plane C arm for better treatment. Otherwise, we also have modern treatment modalities: direct per-oral cholangioscope system, for difficult bile duct stricture and bile duct cancer; Electrohydraulic lithotripsy (EHL) for large stone crushing; all series of metal stents for benign or malignant stricture of biliary, pancreatic, or gastrointestinal tracts of any locations; Balloon assisted enteroscopy ERCP (BAE-ERCP) for many difficult biliopancreatic diseases of surgically altered anatomy. In conclusions, we had abundant experiences for many difficult diseases like many intra- or extra-hepatic duct stones, many benign or malignant biliary or luminal strictures of pancreatic cancer, gastric cancer, bile duct cancer, or metastatic cancer, and even those anastomotic or non-anastomotic strictures after the surgical operation (Whipple operation, PPPD, Roux-en-y bypass surgery).

Endoscopic ultrasonography

Endoscopic ultrasonography was introduced to NCKUH gastrointestinal department in 2009. After that, we applied this examination in differentiating subepithelial mass lesions and staging esophageal squamous cell carcinoma tremendously that made NCKUH a pioneer in this field in southern Taiwan. By accumulating abundant experience and enthusiastic young staff, we expanded its indication into diagnostic and therapeutic pancreatobiliary disorder since 2016. Endoscopic ultrasound image was real-time and continuous which provide safer and more precise diagnostic choice to patients. We further advanced exam quality and quantity through involving in international conferences and overseas training. We had finished more than 200 cases of EUS tissue acquisition and more than 30 cases of interventional EUS since 2016. We were not only a high-volume center in EUS but also a certified facility. Our performance kept improving after introducing contrast endosonography and finishing several ongoing clinical studies in our department recently. Through all the efforts, NCKUH is the top center in endoscopic ultrasound in southern Taiwan.

Small bowel enteroscopy and cross-section enterography

The small intestine, which is 4-6 meters long, is the blind area of ​​the digestive system. Generally, esophagogastroduodenoscopy and colonoscopy cannot be fully inspected and examine the whole intestinal tract. Therefore, it is difficult to diagnose and treat small bowel diseases in general clinical practice. Small bowel endoscopy includes capsule endoscopy and balloon-assisted enteroscopy. Capsule endoscopy can provide non-invasive whole small bowel examination, diagnose and locate small bowel disease, which cannot be inspected by traditional endoscopy. Balloon-assisted enteroscopy can locate and treat small bowel lesions, including tumor biopsy, endoscopic tattooing, treatment of small bowel bleeding, polypectomy of small bowel polyps, and endoscopic dilation of bowel stricture.
Our endoscopy team is composed of experienced physicians and specialized technicians who specialize in performing the endoscopy and is one of the few medical centers in Taiwan that also has capsule endoscopy, single- and double-balloon-assisted enteroscopy equipment, providing comprehensive disease diagnosis and treatment.
Small bowel enterography includes computed tomography enterography (CTE) and Magnetic resonance enterography (MRE), which can provide a non-invasive whole small bowel examination, and offer a complete and detailed assessment of tumors, enteral fistula, abdominal abscess, or related complications. Among them, MRE has evolved as a non-invasive, radiation-free imaging modality for high-risk groups unsuitable for receiving endoscopic procedures or radiological exposure. Our medical center can provide the CTE or MRE for the evaluation of small bowel diseases. In our center, the images of CTE or MRE are interpreted by experienced radiologists, providing clinicians an important reference for diagnosis and follow-up in clinical practice.

Multidisciplinary Team of Esophageal Cancer

The National Cheng Kung University's esophageal cancer team is composed of medical experts in gastroenterology, diagnostic radiology, nuclear medicine, pathology, oncology, radiation oncology, chest surgery, and nutrition. We provide services for the diagnosis and treatment of esophageal cancer from early to late stages.
The in charging gastroenterologist includes Dr. Chang Wei-Lun, Lin Meng-Ying, Kang Rui-Wen, and Lee Jun-De. We provide diagnosis and staging of esophageal cancer before treatment. And further coordinate various specialties to tailor the most suitable treatment strategy for patients.
We have image-enhanced endoscopy technologies including Lugol chromoendoscopy, narrowband image, which can diagnose esophageal cancer as early as. We also have an endoscopic ultrasound, which can make accurate tumor staging before treatment. In combination with computer tomography, positron photography, and bronchoscopy, we comprehensively determine the extent and spread of the tumor. And help patients decide their optimal first-line therapy. After the first-line therapy, we offer treatment response assessment, which helps in the next-step decision.
In the early stage of esophageal cancer, we also provide minimally invasive therapy such as endoscopic tumor ablation or resection. Patients can maintain the best quality of life after these treatments.