Program at Emek Medical Center

​The Institute of Gastroenterology, Hepatology, and Endoscopy at Emek Medical Center, Afula, Israel

Chairman, Professor Ian M. Gralnek, MD, MSHS, FASGE

Rappaport Family Faculty of Medicine Technion-Israel Institute of Technology

Emek Medical Center in Afula, Israel serves a large and very diverse patient population (Jews, Muslims, Christians, and Druze) living in Israel's northern periphery.  As compared to Israel's' geographical center (e.g., Tel Aviv and Jerusalem), the northern periphery patient population is less educated, has a significantly lower socio-economic status, are less knowledgeable of available medical and preventive health care services, and thus often present with diseases already at an advanced stage (e.g, colorectal cancer, gastric cancer, esophageal cancer, pancreatic cancer, inflammatory bowel diseases such as Crohn's disease and Ulcerative Colitis, and Celiac disease).  At the Institute of Gastroenterology, Hepatology and Endoscopy at Emek Medical Center, we provide digestive disease care for up to 1 million Israeli's living in Israel's northern periphery.  The northern periphery of Israel is significantly underserved in their digestive disease healthcare, including access to basic and advanced gastrointestinal endoscopy procedures including gastroscopy, colonoscopy, ERCP, and EUS for both adults and pediatric patients. 

Due to our current lack of gastroenterology / endoscopy infrastructure, physical clinical space, and advanced endoscopy equipment at Emek Medical Center, waiting times for endoscopy procedures are long (many months), some endoscopy procedures are not available, and thus patients have to be referred to medical centers in the country's center, several hours away.  This is both a financial and social burden on the patient and their family.  This is simply not right nor good quality healthcare practice in 2021!

We must change this practice and we strongly believe it is possible, and it can be done immediately with an enormous impact on all of Israel's northern periphery.  But we need financial assistance to achieve this dream.  This proposed capital project would revolutionize gastroenterology, hepatology and endoscopy care for up to 1 million Israelis residing in Israel's northern periphery who are sent often times hours away for their gastroenterology care.

The space in the current GI Institute is woefully inadequate (only 560 square meters). Currently we only have 3 endoscopy rooms, with only 1 room able to perform advanced endoscopy procedures (e.g., ERCP, EUS, large polyp removals, treatment of Barrett's esophagus / early esophageal cancer, bariatric endoscopy, pediatric endoscopy). At our current maximum productivity, we currently are only able to perform approximately 4,700 endoscopy procedures per year (2,200 gastroscopies, 1,800 colonoscopies, 150-200 ERCPs, 200 EUSs, and 350 pediatric endoscopies).  Fortunately, there is an additional 250 sq meters of available space that directly abuts either side of the current physical location of the GI Institute, thus physical expansion will be greatly facilitated.  We could therefore increase our available space to over 800 sq meters!

The addition of 3 more endoscopy procedure suites (including an additional advanced endoscopy procedure suite and a dedicated pediatric endoscopy suite) will allow us to double our annual endoscopy procedure productivity to approximately 10,000 endoscopy procedures.  Moreover, the addition of 3 more endoscopy procedure suites would allow us to perform pediatric endoscopy sessions every day of the week instead of only 1 day/week and add GI motility testing procedures (e.g, esophageal manometry, esophageal impedance testing, ano-rectal manometry, 24-hour esophageal pH testing). Currently, GI motility testing does not exist at Emek Medical Center and thus we must send those patients requiring such testing away to distant medical facilities.

In addition to the needed endoscopy procedure room space, we urgently need more clinic room space to accommodate our growing ambulatory clinic visits.  This includes our general GI clinics as well as our subspecialty GI clinics including liver diseases, inflammatory bowel disease (IBD), pancreas / biliary diseases, and neuro-gastroenterology (e.g., Irritable Bowel Syndrome, GI dysmotility disorders).  Due to clinic space limitations, at the present time we are only able to have 3 liver clinics, 2 IBD clinics, and 5 general GI clinics per week. With additional clinic room space we would be able to see patients in general GI as well as in the GI subspecialty clinics every day of the week.  Moreover, this will also allow us to expand and open clinics in neurogastroenterology and in the future, GI oncology.

Thus, what are our specific needs and how can you make this important dream come true?

We must add 3 endoscopy procedure suites:

1.      1 combined regular endoscopy suite/ pediatric endoscopy suite similar in size, design and equipment to existing endoscopy suites 1 and 2.  Can do both adult and pediatric endoscopy procedures

  • 3 Olympus 190 series gastroscopes
  • 2 Olympus 190 series pediatric gastroscopes
  • 3 Olympus 190 series colonoscopes
  • 1 Olympus 190 series processor, light source, equipment storage carts, booms
  • 1 Large 40" HD screen
  • 1 ERBE 300D surgical generator with APC capability
  • 1 Water jet
  • 1 Orpheus endoscopy photo system
  • 1 CO2 insufflator

2.      Endoscopy / GI motility procedure suite" – this suite can be the same size as existing Endoscopy rooms #1 and #2

  • 3 Olympus 190 series diagnostic gastroscopes
  • 3 Olympus 190 series pediatric colonoscopes
  • 1 dedicated Olympus 190 series pediatric gastroscope
  • Olympus 190 series processor, light source, endoscopy equipment procedure carts elevated and on booms
  • 1 Large 40" HD screen
  • 1 ERBE surgical generator with APC capability
  • 1 Water jet unit
  • Orpheus endoscopy photo system
  • CO2 insufflator
  • GI motility equipment – pH testing, impedance testing, manometry equipment for both upper and lower GI tracts


3.  1 advanced endoscopy procedure suite (lead lined suite and equipped for radiology) even larger in size to current existing endoscopy suite #3

  • ERCP table that is C-arm / radiology ready
  • Overhead x-ray (like angiography room)
  • 1 Olympus 190 series processor, light source
  • 2 Olympus 190 series duodenoscopes
  • 3 Olympus 190 series gastroscopes
  • 3 Olympus 190 series adult colonoscopes
  • 1 therapeutic large single channel gastroscope
  • 1 Large 40" HD screen
  • 1 ERBE 300D surgical generator (including ability to have POEM / ESD capability) and APC capability
  • 1 Water jet unit
  • Orpheus endoscopy photo system
  • CO2 insufflator
  • Anesthesiology cart
  • EUS system with 2 linear EUS scopes
    1. Esophageal EUS probe
    2. Rectal EUS probe


4.      Additional endoscopy-related equipment needed

  • Replace C-arm with overhead x-ray in existing Endo Room #3
  • Need total of 6 scope washers, each with 2 scope capacity
  • Storage closets for all endoscopes

5. Expand patient recovery area to 12-15 beds (currently 7 recovery beds)

    • New / up to date bedside vital sign monitors for each recovery bed

6. Clinic / office space

  • Shared MD office space, 2-3 MDs per room
  • "Hot" clinic rooms

7. Office space for research coordinators

8. Office space for GI Institute nursing director

9. Nursing station in recovery room

10. Nursing intake room / patient check-in area / patient check-out area

11. Patient sitting area after leaving post-endoscopy recovery but before final discharge

12. Office space for GI Fellows / trainees

13. Enlarged kitchen / break room for medical and nursing staff

14. Conference room/ library

15. Changing rooms (M/F) for nurses / technicians

Estimated Costs

  1. Construction of additional endoscopy rooms, patient recovery areas, patient clinic rooms, physician offices / admin space = $2M

  2. Equipment costs = $1.9M


We are happy to provide you with formal blueprints of a proposed renovated gastroenterology / endoscopy department upon request.  We are happy to speak with you by video conference or in person. 

Naming of the Digestive Diseases and Endoscopy Institute is available.

Thank you for your interest and we hope together we can make this dream come true for the gastroenterology patients of northern Israel!