RECENT ADVANCES IN ENDOSCOPIC PROCEDURES:

Special Endoscopic Investigations

1. ERCP

ERCP (endoscopic retrograde cholangiopancreaticogram) uses a specialized gastroscope in order to view the pancreatic and biliary duct structures with the use of fluoroscopy. Through the same scope, procedures can be done to remove stones in the bile ducts, perform brushings of suspected tumour in the duct, delineate the anatomy with radio-opaque dye and even stent narrowing due to strictures or advanced malignancy. Finally a small surgery like sphincterotomy can be done on the papilla to continue release of trapped stones.

Intervention Endoscopic Procedures

Whilst the above procedures enable the specialist to view the respective organs, the use of cautery, biopsy forceps and specialized needles enable the specialist to perform minor surgery and remove tumours.

1. Endoscopy And Polypectomy.

Both OGD and Colonoscopy procedures allow the specialist to remove polyps including large tubulovillous adenomas. Polypectomy can be performed with a snare or hot biopsy forceps. Polypectomy prevents the tumour from growing bigger and becoming cancerous.

2. Endoscopy and EMR (endoscopic mucosal resection)

Endoscopy and EMR (endoscopic mucosal resection) is a special technique used to remove early tumours and cancers from the oesophagus, stomach and colon with a set of specialized instruments which include spray dye to identify the lesion, an injector to raise the tumour superficially enabling the specialist to safely surgically remove the tumour with cautery.

Endoscopy and Hemostasis

Bleeding lesions from the gastrointestinal tract is a common presention at the Emergency Department and some of the patients require immediate cessation of bleeding with endoscopes without having to go for major surgery.

1. Endoscopy And Injection Sclerotherapy.

With the endoscopes, we can stop bleeding from ulcers, diverticular disease, bleeding tumours and polyps by injecting various agents into the lesions. We can use histoacryl glue, adrenaline (1:1000), Thrombovar and normal saline. These are done in conjunction with applying a heated probe to the lesion and directly applying heat to bleeding spot thus securing a seal of the blood vessel. Other methods include application of a hemostatic clip directly under vision to the spurting blood vessel. Large bleeding areas like watermelon stomach, are effectively treated by the use of argon laser which will help the spots to seal and thus stopping further bleeding.

2. Endoscopy And Ligation Of Varices

Esophageal varices are complication of liver cirrhosis. Varices are thin walled dilated veins along the mucosa of the gastroesophageal junction and they can bleed torrentially. Hemostasis whether electively or in the emergency setting can be done with the help of an endoscope fitted with a special rubber band ligation device. The varix can be sucked into the scope and a rubber band applied to the base. The varices will slough off eventually in a few days time.

Endoscopic Treatment of Tumours

1. Endoscopy And Stenting

Advanced metastatic tumours of the colon, esophagus, duodenum, pancreas and biliary tree can be safely palliated with the help of endoscopes deploying specialized stents to overcome the obstruction. Patients with multiple medical problems as well as those too unstable for any surgery are suitable for such procedures so that surgery can be postponed to a later date when the patient’s medical condition is stabilized.

2. Endoscopy And Argon Laser

The use of argon laser for advanced rectal tumours for elderly or patients with medical conditions deemed too risky for surgery can also be used to enable the patient to pass motion and debulk the tumour. It will also slow the process of vascular tumours which bleed excessively should nothing be done to it.