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Each year, nearly 300,000 people in the United States are diagnosed with a type of gastrointestinal cancer. Many of these cancers are too complex or difficult to be treated with just one type of treatment. The Center for Gastrointestinal Cancers at Smilow Cancer Hospital and Yale Cancer Center provides patients with gastrointestinal cancers a comprehensive, multidisciplinary approach to the treatment of complex disease. As experts in the treatment of cancers of the esophagus, stomach, liver, pancreas, colon, bile ducts, rectum, and anus, we collaborate with diagnostic and interventional radiologists, gastroenterologists, and pathologists to provide the most up-to-date and effective treatments available. Our advanced diagnostic imaging services, including Endoscopic Retrograde Cholangiopancreatography (ERCP), MRI/MRCP (ERCP in conjunction with MRI), high-resolution CT scans, Endoscopic ultrasound (EUS), and EUS-guided fine needle aspiration, allow for patients to be comprehensively evaluated at the onset of their diagnosis. Surgical Oncology Surgery is commonly used to effectively manage certain types of gastrointestinal cancers, including malignant and premalignant tumors in the stomach, liver, bile ducts, pancreas, small intestine, and colorectum. Our team of surgeons incorporate a variety of state-of-the-art surgical techniques into procedures when necessary. These include: Laparoscopic and robotic surgery for stomach, small bowel, and colorectal tumors, as well as for primary and metastatic liver tumors and biliary tumors Cytoreduction and heated intraperitoneal chemotherapy Pancreatectomy (Whipple procedure, distal pancreatectomy, total pancreatectomy, central pancreatectomy, pancreas preserving enucleation) Medical Oncology In addition to chemotherapy, our medical oncology experts provide innovative nonsurgical treatment options including: Targeted Therapy, in which a special type of chemotherapy targets the changes in cancer cells that help them grow, divide, and spread Immunotherapy, which uses a patient’s own immune system to find and destroy cancer cells Yale Cancer Center emphasizes the importance of clinical trials for all stages of disease. Many of these drugs are exploring new types of therapy and new combinations of therapies, and many of our studies are available as part of our network of Care Centers. We perform state-of-the-art genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies for patients. Radiation Oncology Patients who need radiation oncology to treat their gastrointestinal cancers can feel confident that they are receiving the highest quality care from the most experienced team of radiation oncologists in Connecticut. We offer innovative therapies including: Three-dimensional Conformal Radiation: This technique may be used to target radiation to tumors by matching their particular shapes. Four-dimensional (4-D) CT simulation makes CT scans f

At Yale Medicine, we specialize in a full range of digestive health care, from advanced endoscopy and colon cancer genetics to managing such conditions as inflammatory bowel disease and liver cancer. We treat complex gastrointestinal motility disorders, provide care for rare diseases, and support patients through liver transplants. Our dedicated team is committed to offering personalized and effective treatments for all aspects of gastrointestinal health. Specialized care is offered in the following areas: Advanced endoscopy: Specialized procedure using an endoscope to diagnose or treat complex issues in the digestive system. Colon cancer genetics: Study of genes that affect the risk of developing colon cancer. Gastrointestinal motility: The movement of food through the digestive tract. Inflammatory Bowel Disease (IBD): Chronic inflammation of the digestive tract. Liver cancer Liver transplant Lysosomal disease: A group of rare inherited metabolic disorders that result when lysosomes in cells cannot breakdown waste properly. Viral hepatitis: Liver inflammation caused by a virus, such as hepatitis A, B, or C, which can lead to liver damage.

We provide expert, compassionate inpatient and outpatient care for children with a variety of gastrointestinal, liver, and metabolic disorders including inflammatory bowel disease, esophageal disorders, diarrheal disease, acute and chronic liver disease, and metabolic liver diseases, including lysosomal diseases. Our care team harnesses the expertise of gastrointestinal nursing, nutrition, radiology, surgery and genetics experts, as well as Yale’s programs in inflammatory bowel disease and liver transplantation. Our multidisciplinary approach for our patients with nonalcoholic fatty liver disease also includes a clinical psychologist, a dietician, and an endocrinologist.The program also offers selective shunts for patients with noncirrhotic portal hypertension. Gastrointestinal conditions we often manage include: Abdominal Pain Celiac disease Constipation/Encopresis Eosinophilic esophagitis/allergic bowel disease Failure to thrive Feeding problems/swallowing problems Helicobacter pylori infection Hirschsprung’s disease Lactose intolerance Malabsorption Pancreatitis Peptic ulcer disease Vomiting Our pediatric hepatologists treat a range of liver diseases. Some can be managed with medication, while others require surgery. For example,acute liver failure(ALF) occurs when many of the cells in the liver die or become very damaged in a short period of time. ALF has many causes, such as metabolic conditions or toxicity from incorrect dosages of acetaminophen.ALF can sometimes be treated with medication, if it is identified early, but about half of all children who develop ALF require a liver transplant. Biliary atresiais a disease of the liver and bile ducts that occurs in infants. In children with biliary atresia, bile—a liquid that helps the body digest fat—cannot properly drain from the liver. This damages liver cells and can lead to liver failure. Surgical procedures can correct bile flow problems, but the liver disease progresses and requires specialized care to improve growth, development, nutrition, and long-term outcome.A multidisciplinary team consisting of pediatric liver specialists, surgeons, and a dietician provides comprehensive care for patients with biliary atresia. Other hepatology conditions we treat include: Alagille syndrome Alpha-1-antitrypsin deficiency Autoimmune hepatitis Neonatal cholestasis Progressive Familial Intrahepatic Cholestasis (PFIC) Urea cycle defects Wilson's disease Primary Sclerosing Cholangitis Glycogen Storage Disease Viral hepatitis Hepatoblastoma Nonalcoholic fatty liver disease

Our team works closely with colleagues in the departments of surgery, diagnostic radiology, laboratory medicine, and pathology to provide state-of-the-art diagnosis and treatment of digestive diseases in a coordinated and comprehensive manner. Our diagnostic clinics offer both routine and specialized endoscopic and nonendoscopic procedures. Our highly skilled and highly trained gastroenterologists offer several specialized programs: Our Advanced Endoscopy Program focuses on diseases of the pancreas, biliary tract, and gastrointestinal tract. We evaluate patients with a variety of symptoms and diseases, many of whom require complex endoscopic procedures using specialized techniques and equipment. Our Inflammatory Bowel Disease Program focuses on helping patients who suffer from Crohn’s disease and ulcerative colitis. Our specialists can treat these complex, lifelong inflammatory diseases through our dedicated program focused on clinical care, patient education, and research. Our Gastrointestinal Motility Program brings together a team of gastroenterologists, surgeons, pathologists, and radiologists to provide the latest diagnostic and treatment services to patients with hard-to-diagnose gastrointestinal disorders. Services offered by Yale Medicine Gastroenterology include: Cancer screening, including colonoscopy and upper endoscopy Diagnosis and management of Irritable bowel syndrome Nutrition evaluation and treatment Diagnosis and management of GI bleeding, including reflux disease, gastritis, ulcers, and portal hypertension Treatment of chronic diarrhea and disorders of malabsorption Evaluations for women's gastroenterological issues Video capsule endoscopy

The Yale Medicine Gastrointestinal Motility Program is led by a team of gastroenterologists who subspecialize in motility disorders. We work in collaboration with radiologists, colorectal, surgeons, GI surgeons, thoracic surgeons, urologists, urogynecologists, and physical therapists to care for patients with complex motility disorders. As part of our multidisciplinary approach, our team meets monthly to discuss complex cases to ensure that each patient receives an individualized treatment plan. We strive to provide excellent care in a compassionate way. Our state-of-the-art services include: The Bravo pH Monitoring System, a catheter-free instrument that measures acidity levels in patients suspected of having gastroesophageal reflux disease (GERD). A small capsule is attached to the wall of the esophagus, which transmits data to a pager-sized receiver, which is worn for 48 hours. During this time, patients push a button whenever they experience symptoms, so we can determine if the symptoms correlate with incidents of acid reflux. When the test is over, data from the receiver is downloaded to pH analysis software, where it is analyzed. The SmartPill Capsule, a new technology available at only about a dozen medical centers around the country. The ingestible, wireless capsule measures pressure, pH, and temperature as it moves through the GI tract, allowing physicians to identify where abnormalities in intestinal transit are located. The SmartPill transmits information to a data receiver worn by patients. After the capsule has passed from the body, patients return the receiver to the physician, who is able to display and analyze the data within minutes. Impedance monitoring is a catheter-based system that enables doctors to diagnose nonacid reflux. Patients wear the monitoring system for 24 hours, and push a button whenever they experience symptoms. Physicians then download and analyze the data to determine whether the reflux is acidic or nonacidic, and whether the symptoms correlate with incidents of reflux.

At Yale Medicine, our colorectal surgery team specializes in surgical care for conditions affecting the lower gastrointestinal tract which includes your colon, rectum, and anus. We treat a complete array of conditions that range from non-cancerous (benign) disorders to cancerous (malignant) diseases, and they can involve surgical and non-surgical treatments. Expert physicians may also perform routine screening procedures, such as colonoscopies, to detect colon and rectal abnormalities, including cancer at an early stage. They work closely with gastroenterologists, oncologists, and other specialists to provide comprehensive care for patients with diseases affecting the lower digestive tract. About Us Specialized care is offered in the following areas: Colon and Rectal Cancer: Surgical removal of tumors in the colon and rectum. Inflammatory Bowel Disease (IBD): Including ulcerative colitis and Crohn's disease, which may require surgery to remove diseased portions of the intestinal tract. Diverticulitis: Inflammation or infection of small pouches that can form in the intestinal wall, sometimes requiring surgical intervention. Hemorrhoids: Swollen blood vessels in and around the anus and lower rectum that can cause discomfort and bleeding. Anal Fissures: Small tears in the lining of the anus that can cause pain and bleeding. Anal Fistulas and Abscesses: Infections in the anal gland that can form an abscess and may lead to an abnormal channel (fistula) between the inside of the anus and the skin. Rectal Prolapse: When part of the rectum protrudes from the anus. Fecal Incontinence: Inability to control bowel movements, which may be improved with surgery. Bowel Obstruction: Blockages in the colon or rectum that may require surgery to remove the obstruction. Polyps: Abnormal growths in the colon or rectum that can be benign or precancerous and are often removed to prevent cancer. Ostomy Surgery: Procedures that create an opening (stoma) for the body to eliminate waste, such as a colostomy or ileostomy, which may be temporary or permanent. Pelvic Floor Dysfunction: Disorders affecting the coordination of pelvic floor muscles and rectum, which may involve surgical repair. Colon and Rectal Trauma: Injury to the colon or rectum that requires surgical intervention to repair. Pilonidal Disease: A chronic skin infection in the crease of the buttocks near the coccyx.

We specialize in helping children with constipation who do not respond to commonly used treatments. Known as refractory constipation, this can be due to congenital anal malformations or problems with the muscles or nerves of the GI tract.

Yale Medicine Gastroenterology (GI) hospitalists are board-certified gastroenterologists who care for patients admitted to the hospital. By focusing solely on hospitalized patients, Yale’s GI hospitalists are a consistent presence in the hospital to provide safe, timely endoscopic procedures, improved interdisciplinary care coordination, and in-depth subspecialty expertise in the management of GI emergencies and complex GI illnesses. They provide efficient, high-quality inpatient care, reducing delays and barriers to endoscopy. The role of hospitalists has expanded since the concept was originally introduced to include subspecialty hospitalists. GI hospitalists improve the quality of care at Yale New Haven Hospital. As emerging leaders in this field, Yale School of Medicine’s GI Hospitalists led the first national conference on inpatient gastroenterology in December 2021. “The GI Hospitalist Model: Addressing the Needs of Hospital-Based Care,” which was organized under three themes: the state of inpatient GI care and the role of GI hospitalists; the benefits of GI hospitalists in clinical and non-clinical fields (education and research); and developing a GI hospitalist program. In March 2022, the team outlined the advantages and challenges of utilizing a hospitalist model in gastroenterology in The American Journal of Gastroenterology. In “Adapting to the Challenge of Hospital-Based Care: The Evolving Role of Gastroenterology Hospitalists,” the authors discuss how having a designated GI hospitalist permits more timely care for acute issues that may arise in the inpatient setting. Adding this role also helps to eliminate disruptions to outpatient and/or endoscopy clinics. Yale School of Medicine’s GI hospitalists are at the forefront of delivering high-quality, effective GI care for hospitalized patients at Yale New Haven Health system.

In 2001, the Yale Inflammatory Bowel Disease Program was formed to address the challenges faced by patients with complex, lifelong, gastrointestinal, inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Our team-based approach employs a gastroenterologist, physician assistant, and a team of nurses and medical assistants to share the responsibilities of our patients’ medical care. Following evidence-based guidelines, the IBD team will work closely together to plan and coordinate a comprehensive plan of care personalized to each patient, who will have the opportunity to meet the IBD team members during a visit. The key to effective management of the disease is coordinated care among specially trained, internationally recognized physicians with expertise in inflammatory bowel disease. Our experienced team also includes nutritionists, surgeons, radiologists, and pathologists. Our medical and surgical specialists are available at the same visit to provide comprehensive care. Our enterostomal nurses work with families to manage ostomy care and provide support. Treatment for ulcerative colitis or Crohn’s disease usually begins with medical therapy. While surgery can be a primary therapy for certain symptoms of IBD, it is usually reserved as a supplement to medical therapy. The goal of GI surgery is to restore function, using bowel-conserving surgery, including minimally invasive surgery where appropriate. In order to properly diagnose and treat patients with IBD, doctors must perform visual examinations of the gastrointestinal tract through procedures known as endoscopies. The three most common procedures are as follows: colonoscopy, upper endoscopy, and capsule endoscopy. Each procedure visualizes a different section of the gastrointestinal tract. Colonoscopy—Sigmoidoscopy: These procedures allow doctors to evaluate the entire large intestine and the end of the small intestine called the ileum. In patients with inflammatory bowel disease, a colonoscopy is required for evaluation of the disease activity and for colon cancer screening. Some patients may undergo a sigmoidoscopy, which only views the first third of the large intestine. Upper Endoscopy (EGD): This procedure allows evaluation of the esophagus, stomach, and duodenum. In patients with inflammatory bowel disease, an upper endoscopy evaluates disease involvement in the upper region of the digestive tract. Capsule Endoscopy: The newest diagnostic procedure, it allows evaluation of the small intestine not accessible by upper endoscopy and colonoscopy. A tiny camera contained in a capsule passes naturally through the digestive tract while transmitting video images to a data recorder. Images of the small bowel are downloaded to a computer and reviewed by a physician. Chromoendoscopy: Chromoendoscopy is a technique performed during colonoscopy to enhance the detection of pre-cancerous areas in the colon. It uses a blue dye that temporarily stains the colon wall du

The team of gastrointestinal & liver pathologists at Yale is dedicated to providing state-of-the-art diagnostic services for the following disorders: Barrett’s esophagus Chronic hepatitis Cirrhosis Colorectal polyps and cancer Gastroesophageal reflux, Helicobacter pylori gastritis Hepatocellular carcinoma Inflammatory bowel disease Stomach cancer Diseases of the gastrointestinal (GI) tract are some of the most common human disorders. Almost everyone experiences some form of a GI ailment at least once during their lifetime. The common disorders include gastroesophageal reflux and Barrett’s esophagus; gastroenteritides including inflammatory bowel disease; gastritides including helicobacter gastritis; hepatitides including viral hepatitis B and C; fatty liver disease; pancreatitis; and cancers of the large bowel, pancreas, and liver. The team consists of gastrointestinal pathologists who are fellowship-trained and who are experts in the field, with national and international recognition. Our faculty is committed to providing the best possible clinical care in a timely fashion, and being at the forefront of academic medicine. All our pathologists are engaged in clinical and translational research related to gastrointestinal disorders. We see about 15,000 cases each year pertaining to the gastrointestinal tract, which include diagnostic biopsies, explants, and resections. Being a tertiary care medical center, we see a high proportion of complex and rare cases, and frequently receive cases from other institutions within and outside the country for our expert opinion. The service strives for clinical and academic excellence. We are committed to provide outstanding and timely clinical care— more than 90% of all diagnostic biopsies are signed out within 24 hours after arriving in the laboratory. We frequently interact with the clinical care providers to discuss complex clinical cases and believe in a team-based approach. The division is well-supported by an excellent histopathology laboratory and technical staff, and has a state-of-the-art electron microscopy lab, molecular diagnostic lab, immunohistochemistry lab, and medical informatics. We offer all advanced ancillary tests required for the management of GI disorders, including molecular profiling of tumors and genomics.