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Diagnostic Evaluations

Endoscopic procedures

We use a number of endoscopic procedures to diagnose cancer. They include those listed below.

Endoscopic ultrasound

Doctors use endoscopic ultrasound (EUS) to diagnose and stage esophageal, pancreatic, gastric, rectal and bile duct cancers. In some cases, they may also use EUS for therapeutic purposes.

Learn more about EUS in the ultrasound section

Endoscopic retrograde cholangiopancreatography

This procedure is used to diagnose and treat bile duct cancer, as well as some cancers of the liver, gallbladder and pancreas.

In an endoscopic retrograde cholangiopancreatography (ERCP), a long, flexible, lighted tube called an endoscope is passed down the patient’s throat and into the first part of the small intestine. A catheter is then passed through the scope and a small amount of contrast dye is used to help outline the bile ducts as X-rays are taken.

This test allows for the removal of cell or fluid samples so they may be viewed under a microscope. It also may be used to relieve an obstruction of the bile duct, or to place a stent into a narrowed duct to help keep it open.


SpyGlass may be used during an ERCP to diagnose and treat bile duct cancer, as well as some cancers of the liver, gallbladder and pancreas.

During an ERCP, a scope is inserted into the bile duct, and a smaller scope—the SpyGlass or cholangioscope—is inserted into the bigger scope.

The SpyGlass endoscope has a digital probe attached to a camera, which allows a doctor to identify obstructions in the bile duct. He or she may also be able to differentiate between a tumor inside the bile duct and inflammation. If the doctor sees a tumor, it may be biopsied. If any stones are found inside the bile duct, they may be removed.

Video capsule endoscopy

Unlike a traditional endoscopy, which only reaches the upper digestive tract, video capsule endoscopy allows a doctor to examine the small bowel for abnormalities.

At the start of the procedure, the patient is asked to swallow a small capsule. The capsule contains a tiny camera that flows through the digestive system and takes two pictures per second.

Using wireless technology, these pictures are transmitted to a small recording device worn on a belt. After several hours, the images are downloaded to a computer and examined for potential tumors, as well as for sources of bleeding or pain.

This painless, non-invasive procedure allows a doctor to see up to 20 feet of the small intestine that cannot be reached with an upper endoscopy or colonoscopy. The capsule takes about eight hours to pass through the system. If a patient has concerns about swallowing the capsule, it may be placed in the stomach via endoscope.