Advances in endoscopy

Dr Tarun Gupta MRCP [UK], DNB [Med], DNB [GI]

Consultant Gastroenterologist P.D. Hinduja Hospital [Mahim, Mumbai]

Hinduja Healthcare Surgical [Khar, Mumbai]

Advances in endoscopy

• Gastroenterology has advanced in leaps and bounds

• Exciting progress has been made especially in the branch of endoscopy over the last decade– Technological advances – Better understanding of interventional techniques

Small bowel capsule endoscopy[SBCE]

• Traditional endoscopes only reach the first three feet of the small bowel

• With this technology, doctors can view the entire length of the small and now the large intestine

• A small capsule containing a camera and a CMOS chip is swallowed by the patient

• As it flows through the digestive system, it takes 3 pictures per second

Performance1. Overnight 12 hour fast 2. Sensors placed on patient3. Patient wears a belt that contains a battery pack

and data recorder. 4. Patient ingests capsule around 8am5. Patient may have clear liquids two hours after

ingestion6. A light lunch is allowed4 hours after ingestion7. Patient returns 7-8 hours later8. Capsule is excreted in stools

Indications

• Intestinal bleeding– Overt obscure or occult

• Detection of polyps, intestinal cancers• Inflammatory pathology– Crohn’s disease

• Evaluation of intractable abdominal pain• Colon capsule – Instead of screening colonoscopy

Endoscopic ultrasound [EUS]

• Combination of endoscopy with ultrasound technology– Ultrasound transducer is at the tip of the

endoscope– Combination of technology allows us to see the

layers of the wall of the digestive tract and the surrounding organs very clearly

– Requires a high level of expertise

EUS

• Radial EUS

– Diagnostic instrument

– Staging and detecting early cancers of the

digestive tract, and the surrounding organs

– Gall bladder and bile duct stones

EUS

• Linear EUS– Diagnostic • Tissue acquisition for pathology

– Therapeutic• Drainage of intra-abdominal collections

– Pancreatic collections, abscesses

• Bile duct drainage • Pancreatic duct drainage• Pain management

Advanced therapeutic endoscopy

Intra-gastric balloon

Ampullectomy

Mega-stent

Palliative endotherapy for locally advanced carcinoma of pancreas

Conclusions

• Organs surrounding the digestive tract can now be visualized better than a CT scan or MRI

• Procedures which would have required prolonged and complex surgery are now within the realms of therapeutic endoscopy– Lesser costs– Lesser duration of in-patient stay

THANK YOU