Advances in Gastrointestinal Endoscopy

Endoscopy is a procedure where a flexible instrument is passed through mouth or anus (known as upper endoscopy and colonoscopy respectively), to examine the internal lining of the gastrointestinal tract. In Upper GI endoscopy the food pipe (esophagus), stomach and initial part of small intestine (duodenum) are examined while in colonoscopy the entire large intestine and also a part of most distal small intestine (Ileum) is examined. This procedure is done under conscious sedation and is usually an office procedure.

As endoscopy has evolved its role and emphasis has changed from being a diagnostic tool to a therapeutic mean. One of the earliest applications of therapeutic endoscopy was in controlling bleeding from various sources in the GI tract. Peptic ulcer is the commonest cause of gastrointestinal bleeding and surgery was the standard therapy for this condition till about two decades ago. But the success of endoscopic treatment has marginalized the role of surgery to one of rescue therapy. An endoscopist has various means in his armamentarium to control bleeding , starting from injection to application of clips and to direct coagulation of bleeding vessel there are many means to effectively and quickly stop bleeding. The biggest advantage of endoscopy is that it requires much less time and no general anesthesia in critically sick patients. Endoscopic banding and glue injection has proven to be very effective in control of bleeding in patients with cirrhosis of liver. These patients are very high risk for any kind of surgical procedures and the surgeons would not like to operate upon these patients unless pushed to the wall.

Endoscopic dilatation is a procedure where a narrowing in the GI tract can be opened up by the help of certain accessories. The commonest cause of such narrowing is ingestion of corrosive agents. In addition to simple dilatation stents, which are like spring coils made of metal, can be placed in the GI tract. This restores the patency of the GI tract and avoids surgery in such patients. These patients are usually moribund patients with terminal malignancy and stenting provides adequate palliation for them. Patients who are unable to take food due to cancers of esophagus and stomach can start food intake very rapidly after this procedure.

Foreign bodies accidentally ingested by children can be easily retrieved by endoscopy. Polyps are commonly found benign tumors of GI tract which can cause bleeding or even be a precursor of malignancy. These can be removed by cutting through cautery and thus obviating surgery.

Heart burn is one of the most commonly encountered GI symptom which requires a long term medical therapy in substantial percentage of patients. Endoscopic suturing of the junction of food pipe and stomach is now done endoscopically to prevent acid reflux in patients with heartburn. This is undertaken only in patients not responding to drugs and when the only option is surgery.

Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure where one can enter bile duct and pancreatic duct at the site where these ducts open in the gastrointestinal lumen. This procedure, which was started, nearly three decades back has made giant strides. The most common applications are to remove stone in the bile duct and pancreatic duct. Apart from this any obstruction in these ducts can be by-passed by placing stents. All these procedures hitherto were done by surgical procedures, which are fairly complicated. By doing these procedures endoscopically the hospital stay and costs has been shortened to a great extent.

Efforts are on to do surgeries of internal organs like gall bladder and uterus through a small hole made into the stomach. This would even make the button-holes of laparoscopic surgery a thing of past. 

Apart from the strides in therapeutic endoscopy great strides have been made in imaging characteristics of endoscopes. Narrow band imaging and optical coherence tomography are now available and in near future will play a vital role in early diagnosis of malignancy..

Endoscopic ultrasound (EUS) is fusion of endoscope with ultrasound probe. This allows much better imaging of walls on internal organ and their adjacent organs. This adds tremendously to the diagnostic capabilities and in addition is very useful as therapeutic tool.

Thus endoscopy has come a long way in last two or three decades. In the near future the advances are likely to make it more useful and the role of endoscopist is likely to expand in providing non-surgical treatment of various condition of gastrointestinal tract.