Selected Podcast
Therapeutic Endoscopic Ultrasound
Dr. Bhogal (Interventional and General Gastroenterology) talks about therapeutic endoscopic ultrasound. He explains what is an endoscopy, what conditions typically require one and what is a therapeutic endoscopic ultrasound procedure.
Featured Speaker:
Neil Bhogal, M.D
Dr. Neil Bhogal is a native of Bakersfield, CA. He attended Garces Memorial High School and received his Bachelor of Science at the University of California, Riverside. He obtained his Medical Degree from St. George’s University School of Medicine, graduating magna cum laude. He went on to complete his Internal Medicine Residency and Gastroenterology Fellowship at the University of Nebraska Medical Center, where he served as chief gastroenterology fellow. He acquired additional training in advanced therapeutic endoscopy at Geisinger Medical Center. He received numerous mentorship and teaching awards throughout his training. He also enjoys research and has published extensively. He has special interests in therapeutic endoscopy, pancreaticobiliary disorders, and evidence-based medicine. He is a member of the Gold Humanism Honor Society, the American College of Gastroenterology, the American Gastroenterology Association, and the American Society for Gastrointestinal Endoscopy. Dr. Bhogal is thrilled to return to his hometown and serve the community. Transcription:
Therapeutic Endoscopic Ultrasound
Amanda Wilde (Host): If you're one of millions of Americans who experienced digestive problems, your Dr. May recommend an endoscopy. We'll walk through endoscopic procedures and latest advancements in therapeutic endoscopic ultrasound with interventional gastroenterologist, Dr. Neil Bhogal, who speaks to us from Bakersfield, California. This is Hello Healthy a Dignity Health Podcast. I'm Amanda Wilde, Dr. Bhogal, welcome.
Dr Neil Bhogal: Hi. Thank you for having me. Good morning.
Amanda Wilde (Host): An endoscopy is a way to look at your body's digestive system. Can you please describe that procedure?
Dr Neil Bhogal: Sure. So we do endoscopic procedures for various reasons. The most common procedures that we do is, regular endoscopy or an upper endoscopy, and then also we very commonly perform a colonoscopy. So an upper endoscopy looks at the upper part of your GI tract. This includes your esophagus stomach in the first part of your small intestine. We commonly will do this for various reasons, to evaluate things like acid reflux, abdominal pain, look for things like inflammation or ulcers. And sometimes if people are having gastrointestinal bleeding, then we will also do an upper endoscopy to try to find out why and hopefully fix it.
And then more commonly, we actually perform colonoscopies. Colonoscopy is the top line test to screen for colon cancer. And we do this by performing a colonoscopy. We look for little groats in your colon called polyps. These are pre-cancerous growths that, percentage of them can turn into cancer, and if we find them, then we remove them. So those are the reasons we do them. And how they work is we use small, flexible scopes, called an endoscope or a colonoscope. And then we either go, through your mouth doing an upper endoscopy or we will go, rectally for a colonoscopy and slowly advance to try to where we need to go and evaluate what we need to do. And generally, patients are sedated for these procedures.
Amanda Wilde (Host): So it sounds like we should not expect to experience pain with these procedures.
Dr Neil Bhogal: For the most part, people, do not experience pain. depending on the types of sedation people do, there are are various levels of sedation you can have. if you're doing this in an outpatient setting, commonly something called conscious sedation is used, which is like a twilight sedation. Occasionally people will have a little bit of discomfort during this, but we can usually adjust our medications appropriately to try to take care of this quickly.
Amanda Wilde (Host): You talked a little bit about what kind of conditions require an endoscopy, and I have read that digestive problems are becoming more and more common. Is there a reason for that surge in digestive problems?
Dr Neil Bhogal: Yes, it is definitely becoming more common. I do feel that a lot of the changes in digestive, issues is likely related to the advent and increasing use of things like processed foods. So, hundred or more years ago, almost no food was processed. Everything was natural farm to table. But now many of us are unable to eat completely, clean and unprocessed food. So a lot of these preservatives, a lot of these things do impact our GI tract cause inflammation caused antibody formation. So I do feel as, the more and more that we eat these kind of foods, we do see things like inflammatory bowel conditions, etcetera.
Amanda Wilde (Host): What is interventional endoscopy? Does that help with those conditions?
Dr Neil Bhogal: So interventional endoscopy is my specialty. Interventional endoscopy is essentially, requires extra training to perform a more complex and, a little bit more, high risk procedures for patients, depending on the conditions. Now, they are usually, for certain purposes, the procedures there's a whole host of them. A few of the procedures that will fall under interventional endoscopy are things like endoscopic ultrasound, something called an ERCP. Which is endoscopic retrograde, cholangio, pancreatography. And these essentially are procedures where we commonly are looking at the pancreas, at the bile ducts, at the liver, and at the gallbladder.
And if people have, problems with these organs such as stones, such as cancers, then we can identify these things. We can take samples to them, and often we can treat these conditions as well.
Amanda Wilde (Host): So are you saying that interventional endoscopy prevents more invasive procedures later on?
Dr Neil Bhogal: That is exactly right. So it's still considered minimally invasive as we're not doing surgery cutting from the outside. So, as interventional endoscopy has picked up over the last 10 or 20 years, definitely will limit the number of major operations that patients have. If you have a bile duct stone Then we can remove that endoscopically, as opposed to someone needing like a common bile duct exploration, which is quite a big procedure. We also, can do various techniques with endoscopic ultrasound to drain cysts. To drain collections, to drain abscesses that in the past needed, extensive and morbid procedures. So that is the goal of interventional endoscopy is to hopefully limit the amount of large operations, patients may need.
Amanda Wilde (Host): You mentioned therapeutic endoscopic ultrasound procedure. I know that's one of the most advanced forms of GI endoscopy. Can you describe what that is?
Dr Neil Bhogal: Sure this is a passion of mine is therapeutic or interventional endoscopic ultrasound. And endoscopic ultrasound is we use a scope that has, an ultrasound probe on it. And this lets us look at outside of the luminal GI tract, so we can be within the stomach, but look at things like the pancreas, or we can be in the small intestine, look at things like the bile ducts, look at things like the gallbladder, and using this technology then we can, intervene. So if someone has a gallbladder that needs to be drained, but they're not a candidate for surgery because they might have a lot of medical comorbidities, then we can actually drain the gallbladder.
Where as someone has a big pancreatic cyst that's causing a lot of symptom which commonly will happen after pancreatitis, then we can actually drain those cyst with the ultrasound to try to help that and prevent surgery. And there's a whole other host of applications that are much more complex, like, draining bile duct obstructions, things like that with this technique. So it's really, a really field that is in its infancy, I would say, and is rapidly expanding in the applications of therapeutic endoscopic ultrasound, the future is extremely bright for it.
Amanda Wilde (Host): With all these advancements happening so rapidly, what new gastroenterology procedures are you planning to bring to Bakersfield?
Dr Neil Bhogal: Well, that is the main reason I came back to Bakersfield. I'm a Bakersfield native and I lived away for many years and then I recently moved back after, training for interventional endoscopy. and the reason I came back is for. Many years, a lot of these procedures have not been offered here, and so many of our local patients have been referred to four hours away, separated from their families and not able to stay in their hometown. So hopefully I can bring some of these procedures here. Procedures that I have already started doing here are things like endoscopic ultrasound, guided liver biopsy.
I am doing other endoscopic ultrasound procedures. If people have a rux, why gastric bypass, but they end up getting bi duct problems. In that situation, you don't have access to the bi duct in our normal way. So I can actually create a conduit, to get back to the bile duct and do this all endoscopically. that's a procedure I've been doing here. And then also more complex, ERCP, so more bile duct exploration, endoscopically removal of large stones, etcetera. So quite a few new procedures that we've been fortunate to do here in Bakersfield and also we've been draining pancreatic cysts and things like that. And hopefully this is just the beginning. Hopefully we can continue to build.
Amanda Wilde (Host): How has that improved the quality of life for patients in Bakersfield to not have to travel for some of these procedure?
Dr Neil Bhogal: Well, it's been really rewarding. I see the patients sometimes in the hospital for the first time or sometime in my clinic for the first time. But we'll do these procedures just a couple miles away, and they're in their comfort zone. They're in their hometown, their families are near them. Families don't have to expend a ton of money to travel. And also, Find housing, things like that. And we're keeping them in the community, which, this is a great community. We have great medical, facilities here. We have great, medical staff here. And now hopefully, with some of the training I have, we can just continue to perform these procedures here so they don't have to leave their home community.
Amanda Wilde (Host): It's very inspiring that you come back as a native to help transform things, to make things better for people in your community. Thanks so much for giving us some great insight into the wonderful wide world of endoscopy.
Dr Neil Bhogal: Thank you. I really appreciate it. Thank you for having me.
Amanda Wilde (Host): For more information, please visit www.dignityhealth.org/bakersfield. If you found this podcast helpful, please share it on your social media and check out our full podcast library for topics of interest to you. Thanks again for listening to Hello Healthy a Dignity Health podcast. I'm Amanda Wilde. Be well.
Therapeutic Endoscopic Ultrasound
Amanda Wilde (Host): If you're one of millions of Americans who experienced digestive problems, your Dr. May recommend an endoscopy. We'll walk through endoscopic procedures and latest advancements in therapeutic endoscopic ultrasound with interventional gastroenterologist, Dr. Neil Bhogal, who speaks to us from Bakersfield, California. This is Hello Healthy a Dignity Health Podcast. I'm Amanda Wilde, Dr. Bhogal, welcome.
Dr Neil Bhogal: Hi. Thank you for having me. Good morning.
Amanda Wilde (Host): An endoscopy is a way to look at your body's digestive system. Can you please describe that procedure?
Dr Neil Bhogal: Sure. So we do endoscopic procedures for various reasons. The most common procedures that we do is, regular endoscopy or an upper endoscopy, and then also we very commonly perform a colonoscopy. So an upper endoscopy looks at the upper part of your GI tract. This includes your esophagus stomach in the first part of your small intestine. We commonly will do this for various reasons, to evaluate things like acid reflux, abdominal pain, look for things like inflammation or ulcers. And sometimes if people are having gastrointestinal bleeding, then we will also do an upper endoscopy to try to find out why and hopefully fix it.
And then more commonly, we actually perform colonoscopies. Colonoscopy is the top line test to screen for colon cancer. And we do this by performing a colonoscopy. We look for little groats in your colon called polyps. These are pre-cancerous growths that, percentage of them can turn into cancer, and if we find them, then we remove them. So those are the reasons we do them. And how they work is we use small, flexible scopes, called an endoscope or a colonoscope. And then we either go, through your mouth doing an upper endoscopy or we will go, rectally for a colonoscopy and slowly advance to try to where we need to go and evaluate what we need to do. And generally, patients are sedated for these procedures.
Amanda Wilde (Host): So it sounds like we should not expect to experience pain with these procedures.
Dr Neil Bhogal: For the most part, people, do not experience pain. depending on the types of sedation people do, there are are various levels of sedation you can have. if you're doing this in an outpatient setting, commonly something called conscious sedation is used, which is like a twilight sedation. Occasionally people will have a little bit of discomfort during this, but we can usually adjust our medications appropriately to try to take care of this quickly.
Amanda Wilde (Host): You talked a little bit about what kind of conditions require an endoscopy, and I have read that digestive problems are becoming more and more common. Is there a reason for that surge in digestive problems?
Dr Neil Bhogal: Yes, it is definitely becoming more common. I do feel that a lot of the changes in digestive, issues is likely related to the advent and increasing use of things like processed foods. So, hundred or more years ago, almost no food was processed. Everything was natural farm to table. But now many of us are unable to eat completely, clean and unprocessed food. So a lot of these preservatives, a lot of these things do impact our GI tract cause inflammation caused antibody formation. So I do feel as, the more and more that we eat these kind of foods, we do see things like inflammatory bowel conditions, etcetera.
Amanda Wilde (Host): What is interventional endoscopy? Does that help with those conditions?
Dr Neil Bhogal: So interventional endoscopy is my specialty. Interventional endoscopy is essentially, requires extra training to perform a more complex and, a little bit more, high risk procedures for patients, depending on the conditions. Now, they are usually, for certain purposes, the procedures there's a whole host of them. A few of the procedures that will fall under interventional endoscopy are things like endoscopic ultrasound, something called an ERCP. Which is endoscopic retrograde, cholangio, pancreatography. And these essentially are procedures where we commonly are looking at the pancreas, at the bile ducts, at the liver, and at the gallbladder.
And if people have, problems with these organs such as stones, such as cancers, then we can identify these things. We can take samples to them, and often we can treat these conditions as well.
Amanda Wilde (Host): So are you saying that interventional endoscopy prevents more invasive procedures later on?
Dr Neil Bhogal: That is exactly right. So it's still considered minimally invasive as we're not doing surgery cutting from the outside. So, as interventional endoscopy has picked up over the last 10 or 20 years, definitely will limit the number of major operations that patients have. If you have a bile duct stone Then we can remove that endoscopically, as opposed to someone needing like a common bile duct exploration, which is quite a big procedure. We also, can do various techniques with endoscopic ultrasound to drain cysts. To drain collections, to drain abscesses that in the past needed, extensive and morbid procedures. So that is the goal of interventional endoscopy is to hopefully limit the amount of large operations, patients may need.
Amanda Wilde (Host): You mentioned therapeutic endoscopic ultrasound procedure. I know that's one of the most advanced forms of GI endoscopy. Can you describe what that is?
Dr Neil Bhogal: Sure this is a passion of mine is therapeutic or interventional endoscopic ultrasound. And endoscopic ultrasound is we use a scope that has, an ultrasound probe on it. And this lets us look at outside of the luminal GI tract, so we can be within the stomach, but look at things like the pancreas, or we can be in the small intestine, look at things like the bile ducts, look at things like the gallbladder, and using this technology then we can, intervene. So if someone has a gallbladder that needs to be drained, but they're not a candidate for surgery because they might have a lot of medical comorbidities, then we can actually drain the gallbladder.
Where as someone has a big pancreatic cyst that's causing a lot of symptom which commonly will happen after pancreatitis, then we can actually drain those cyst with the ultrasound to try to help that and prevent surgery. And there's a whole other host of applications that are much more complex, like, draining bile duct obstructions, things like that with this technique. So it's really, a really field that is in its infancy, I would say, and is rapidly expanding in the applications of therapeutic endoscopic ultrasound, the future is extremely bright for it.
Amanda Wilde (Host): With all these advancements happening so rapidly, what new gastroenterology procedures are you planning to bring to Bakersfield?
Dr Neil Bhogal: Well, that is the main reason I came back to Bakersfield. I'm a Bakersfield native and I lived away for many years and then I recently moved back after, training for interventional endoscopy. and the reason I came back is for. Many years, a lot of these procedures have not been offered here, and so many of our local patients have been referred to four hours away, separated from their families and not able to stay in their hometown. So hopefully I can bring some of these procedures here. Procedures that I have already started doing here are things like endoscopic ultrasound, guided liver biopsy.
I am doing other endoscopic ultrasound procedures. If people have a rux, why gastric bypass, but they end up getting bi duct problems. In that situation, you don't have access to the bi duct in our normal way. So I can actually create a conduit, to get back to the bile duct and do this all endoscopically. that's a procedure I've been doing here. And then also more complex, ERCP, so more bile duct exploration, endoscopically removal of large stones, etcetera. So quite a few new procedures that we've been fortunate to do here in Bakersfield and also we've been draining pancreatic cysts and things like that. And hopefully this is just the beginning. Hopefully we can continue to build.
Amanda Wilde (Host): How has that improved the quality of life for patients in Bakersfield to not have to travel for some of these procedure?
Dr Neil Bhogal: Well, it's been really rewarding. I see the patients sometimes in the hospital for the first time or sometime in my clinic for the first time. But we'll do these procedures just a couple miles away, and they're in their comfort zone. They're in their hometown, their families are near them. Families don't have to expend a ton of money to travel. And also, Find housing, things like that. And we're keeping them in the community, which, this is a great community. We have great medical, facilities here. We have great, medical staff here. And now hopefully, with some of the training I have, we can just continue to perform these procedures here so they don't have to leave their home community.
Amanda Wilde (Host): It's very inspiring that you come back as a native to help transform things, to make things better for people in your community. Thanks so much for giving us some great insight into the wonderful wide world of endoscopy.
Dr Neil Bhogal: Thank you. I really appreciate it. Thank you for having me.
Amanda Wilde (Host): For more information, please visit www.dignityhealth.org/bakersfield. If you found this podcast helpful, please share it on your social media and check out our full podcast library for topics of interest to you. Thanks again for listening to Hello Healthy a Dignity Health podcast. I'm Amanda Wilde. Be well.