Track 5: Therapeutic Uses of Endoscopy

Therapeutic Uses of Endoscopy

In addition to its diagnostic applications, endoscopy is widely used for therapeutic purposes in managing various gastrointestinal (GI) and non-GI conditions. Therapeutic endoscopy involves using the endoscope as a tool to perform minimally invasive procedures, often eliminating the need for major surgery.

Common Therapeutic Applications of Endoscopy

1. Treatment of GI Bleeding

   • Hemostasis Techniques:
     • Injection Therapy: Injecting substances (e.g., adrenaline) into bleeding vessels to stop bleeding.
     • Thermal Coagulation: Using heat to cauterize bleeding vessels.
     • Mechanical Methods: Applying clips or bands to stop bleeding, such as in variceal bleeding.

2. Polyp Removal (Polypectomy)

   • Endoscopy is used to remove polyps in the colon or stomach, reducing the risk of developing colorectal or gastric cancer.

3. Stent Placement

   • Esophageal, Duodenal, or Colonic Stents: Inserted to keep narrowed or obstructed areas open, often due to tumors or strictures.
   • Biliary Stents: Placed to relieve blockages in the bile ducts caused by gallstones or tumors.

4. Treatment of Esophageal Varices

   • Band Ligation: Rubber bands are placed around varices to prevent or stop bleeding.
   • Sclerotherapy: Injection of a sclerosant into varices to induce clotting and shrinkage.

5. Foreign Body Removal

   • Used to safely extract objects that have been swallowed, such as coins, bones, or dentures, from the esophagus, stomach, or intestines.

6. Stricture Dilation

   • Balloon or mechanical dilators are used to widen narrowed areas in the esophagus, stomach, or intestines caused by conditions such as peptic strictures or achalasia.

7. Gallstone Removal

   • Performed during Endoscopic Retrograde Cholangiopancreatography (ERCP) to remove stones from the bile or pancreatic ducts.

8. Feeding Tube Placement

   • Percutaneous Endoscopic Gastrostomy (PEG): A feeding tube is inserted directly into the stomach for patients unable to eat orally.

9. Treatment of Barrett's Esophagus

   • Techniques like radiofrequency ablation (RFA) or cryotherapy are used to remove abnormal tissue and reduce cancer risk.

10. Drainage of Abscesses or Fluid Collections

    • Endoscopic Ultrasound (EUS)-Guided Drainage: Drains pancreatic pseudocysts or other fluid collections.

11. Tumor Resection

    • Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD): Techniques to remove early-stage tumors or large polyps from the GI tract.

12. Weight Loss Procedures

    • Endoscopic Sleeve Gastroplasty (ESG): A minimally invasive procedure for reducing stomach size to manage obesity.

13. Fistula or Leak Closure

    • Closing abnormal connections or leaks in the GI tract using clips, sutures, or stents.

14. Therapeutic Capsule Endoscopy

    • Rarely, therapeutic capsules may deliver targeted medications to specific areas in the GI tract.

      Advantages of Therapeutic Endoscopy

      • Minimally Invasive: Reduces the need for open surgery.
      • Lower Risk: Fewer complications, less pain, and quicker recovery compared to surgical alternatives.
      • Real-Time Visualization: Provides direct visualization and immediate treatment during the procedure.
      • Cost-Effective: Typically less expensive than traditional surgeries.

        Risks of Therapeutic Endoscopy

        While generally safe, therapeutic endoscopy may carry risks such as:

        • Perforation of the GI tract.
        • Bleeding, especially during polypectomy or tumor resection.
        • Infection.
        • Adverse reactions to sedation.

          Conclusion

          Therapeutic endoscopy is a cornerstone of modern gastroenterology, enabling doctors to treat a wide range of conditions efficiently and with minimal discomfort to patients. Its role in managing GI bleeding, removing polyps, placing stents, and performing other interventions has significantly improved outcomes and reduced the need for invasive surgery.

          Sub Topic: Polypectomy and Removal of Abnormal Growths, Endoscopic removal of benign and precancerous polyps, Techniques for safe and effective polypectomy, Management of GI Bleeding, Endoscopic control of lower GI bleeding, including diverticular and colonic hemorrhage, Colonic stents for bowel obstruction or stricture management, Balloon dilation for strictures in the esophagus, stomach, and intestines, Comparison between EMR and ESD for specific lesions, Management of GI Infections and Inflammatory Conditions.