Problems that traditionally required a surgical operation are now solved without the need to ‘open’ the patient.
Therapeutic endoscopy as a treatment
Digestive endoscopy was born as a diagnostic procedure of the digestive system whose objective is to “see inside” those organs accessible through natural orifices such as the mouth, nose or anus. What began with fiber optics, is now video; and what began as a diagnostic method, now offers multiple therapeutic applications.
These can be as varied and important as cutting off bleeding from a duodenal ulcer or unblocking an intestine blocked by a tumor with a stent. Emergency endoscopy makes it possible to diagnose the cause of bleeding and control it with various techniques (sclerosis, clipping, thermal coagulation, argon gas, etc.), avoiding urgent operations that are fraught with risk.
In short, endoscopy, in addition to being a method for the diagnosis of diseases such as ulcers or cancer, allows the treatment and resolution of very frequent pathologies. Advances in the field of endoscopy have forced some gastroenterologists to ‘super-specialize’ in what is now called advanced therapeutic endoscopy.
What does endoscopy look like?
The most frequent current therapy is the removal of polyps (small tumors of the intestinal mucosa that can evolve into cancer), which is the basis of colon cancer prevention. We can effectively treat diseases such as achalasia, alteration of the cardia that prevents the passage of food from the esophagus to the stomach; varicose veins that appear in the esophagus, or any narrowing of the digestive tract that hinders the passage of food or intestinal contents. But we not only access the digestive tract, either through the mouth or anus, we can also enter the bile ducts and remove stones or permeabilize tumors that cause jaundice by obstructing the outflow of bile.
The most frequent pathology to be treated are polyps and their removal or polypectomy. When an endoscopy of the colon (colonoscopy) is performed and the endoscopist identifies a polyp, he removes it by introducing through the working channel of the endoscope the specific instruments that allow the polyp to be embraced and cut with an electric current that coagulates at the same time to avoid bleeding, like an electric scalpel. The polyp is removed and sent to the laboratory for analysis. This procedure can be repeated as many times as polyps are found in the exploration.
I am going to have an endoscopy, what should I know?
The preparation depends on what is to be treated. As a general principle, interventions performed through the mouth (gastric polypectomy, esophageal dilatation, ulcer closure, etc.) require the patient to fast for at least 6 hours so that there are no food debris to obstruct vision or create a risk of bronchoaspiration. When the approach is through the anus, cleansing of the colon is fundamental and for this purpose there are preparations that are taken beforehand and which wash the intestine so that there are no fecal remains. Some of these operations require premedication with antibiotics as when a prosthesis is placed in the bile ducts, or the suspension of any medication that the patient may be taking so that the blood does not clot.
Endoscopy is an invasive technique in any of its versions and is therefore uncomfortable and unpleasant. Therefore it is performed under sedation or anesthesia so that the patient is comfortable and the endoscopist can solve effectively and safely.
Endoscopy and its risks
The objective of the medical team that performs the intervention (endoscopist, nurse/anesthetist, etc.) is to solve the patient’s problem effectively, minimizing the risk of complications and when they occur, treating them adequately and immediately.
In the treatment of polyps, the most frequent complication is the bleeding that occurs despite the use of instruments that cut and coagulate. This bleeding can be stopped immediately without the need to suspend the colonoscopy or allow the patient to lose a significant amount of blood.
Another complication of any endoscopic surgery within the digestive tract is perforation. It is a complication that requires an urgent operation to close the perforation but, currently, we already have suturing techniques through the same endoscope which allows in situ repair avoiding interventions and facilitating the patient’s recovery.