Dr. ALEXANDROS
MRCP(UK), FEBGH, AGAF
SERVICES
Endoscopy
I perform all my endoscopies in the Geniki Kliniki Endoscopy Suite. The procedures are performed with the latest HD videoendoscopes, with CO2 insufflation in order to minimise post procedural bloating and with complete cardiorespiratory monitoring.
Sedation is readily available rendering the procedures painless. Should it be deemed necessary, general anaesthesia is administered by registered anaesthetists.
Upper GI
Endoscopies - Colonoscopies
Diagnostic procedures covering the entire of spectrum of esophageal, gastric, duodenal and colonic diseases.
Stent Placement
Esophageal, Duodenal, Colonic. Stent placement is indicated for malignant stricture when the patient’s overall condition or the disease extent precludes radical surgical resection.
They are placed to alleviate strictures when neoadjuvant chemotherapy is indicated.
Stents can also be placed for management of select benign conditions like post surgical strictures or fistulae.
ERCP
ERCP is the therapeutic endoscopic method for the biliary and pancreatic tree. Indications are stone removal, pertubation of benign and malignant strictures, post surgical bile leaks, infection - cholangitis etc.
According to the indication stone removal, lithotripsy, plastic or metal stent can be performed.
Also in case of bile duct malignancies, tumour ablation can be performed (Habib technique).
Endoscopic Haemostasis
Endoscopic management of bleeding ulcers, variceal band ligation, AVM cautery with Argon Plasma, BICAP, Endospray and Bioglue use depending on the bleeding lesion.
Endoscopic Polypectomies
EMR - ESD
Resection of pedunculated and flat lesions irrespective of their size.
Endoscopic fundoplication
Esophyx and GERDX techniques
Patients with refractory gastroesophageal reflux disease or with treatment related side effects
may opt for interventional repair of their condition.
This can be performed endoscopically with results equivalent to those achieved with surgical - laparoscopic means.
Wireless Capsule Endoscopy
Double Balloon Enteroscopy
Capsule endoscopy allows for the examination of the entire small intestine.
The procedure is indicated in patients with anaemia or gastrointestinal bleeding, where there is suspicion of celiac disease, Crohn’s disease, polyposis syndrome or small bowel tumors.
Gastroscopy and colonoscopy are always performed beforehand in order to rule out pathology in the respective areas which is far commoner.
Double balloon enteroscopy is a technique that allows for the deep intubation of the small intestine in order to confirm or treat disorders that have been diagnosed by capsule endoscopy.
Pending on the site of the lesion, the approach can be either oral or rectal.
GI Tract Stricture
Dilatation & Bougienage
GI tract stricture dilatation and bougienage for chronic ulcer, radiation induced, post surgical stenosis.
Bariatric endoscopy
The obesity epidemic has led to the development of endoscopic procedures for weight loss. Endogastric balloon placement is a well known procedure that can help patients with relative low BMIs. Post operative complications of bariatric surgery are also managed, namely fistulae (with clip or stent placement), strictures (with ballon dilatation) etc.
I have been working closely with some of the most experienced bariatric surgeons of our city providing both pre op work up as well as post op troubleshooting - endoscopic support.
Feeding Tube Placement
PEGs, PEGJ, PEJ and NJ tubes.
Endoscopically placed feeding gastrostomies / jejunostomies is the most accepted way of feeding patients with neurologic dysphagia caused by strokes, dementia, advanced Parkinson’s disease or pre cervical irradiation.
Thus the proper patient’s nutrition is maintained, the risk of aspiration pneumonia is minimised, all the prescribed medications are administered reliably limiting the carer’s effort and stress. PEGs, PEGJ, PEJ can provide long term solution to feeding problems but can easily be removed should the patient’s condition improves.
NG tubes are placed for a limited period in cases where gastric feeding should be avoided.
Barrett’s esophagus ablation
HALO technique
Barrett’s esophagus is a GERD related condition which bears an increased risk of cancer development.
Subsequently endoscopic surveillance or ablation is indicated. Ablation is performed using the HALO technique.
For Barrrett’s length up to 3 cm HALO 90 is selected , whereas for longer segments HALO 360 is performed.
The procedure is performed on out patients and the side effects are mild and lasting just a few days not precluding the patient from returning to his daily activities.
GI Oncology
Complete evaluation of patients with GI malignancies (oesophagus, stomach, duodenum, small and large intestine, liver, pancreas and biliary tree). The appropriate management of all these patients is discussed in the weekly-held Oncology Board which comprises of medical oncologists, gastroenterologists, surgeons, radiation oncologists, diagnostic and interventional radiologists and pathologists. During each session every case is presented and all the relative investigations are reviewed by the panel, followed by a recommendations report which is available to the patient. This way we ensure that our patients benefit from the best available care provided by a team of experts.
Implementing all the latest modalities of therapeutic endoscopy (stent placement, EMR, ESD, polypectomies, HALO and Habib techniques), we ensure that our patients are covered for all their needs that arise from their GI malignancy.
Screening procedures (colonoscopies and polypectomies, Helicobacter Pylori testing and eradication) are routinely performed in members of the general population as well as people in higher risk groups.
Inflammatory Bowel Diseases
IBDs comprise of ulcerative colitis, Crohn’s disease and indeterminate colitis.
Having trained for 7 years in the U.K. where the incidence of IBD is significantly higher than in Greece, I have gained valuable experience in the diagnosis and management of these diseases.
I have under my care many IBD patients from initial diagnosis and treatment to follow up of patients diagnosed by other colleagues.
All up-to-date investigations are implemented like chromoendoscopy, wireless capsule endoscopy, double balloon enteroscopy, MR enterography etc.
All currently available treatments including biologics are prescribed (after the necessary diagnostic work-up) and administered under medical supervision in a purpose-made suite in Euromedica Geniki Kliniki Thessalonikis.
Close collaboration with radiologists, pathologists and surgeons ensures the best possible care for IBD patients by a team of experts.