Looking into the stomach

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 oesophagus, 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.
Changing role

As endoscopy 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 marginalised 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 vessels. There are many means to effectively and quickly stop bleeding.

The biggest advantage is that endoscopy requires much less time and no general anaesthesia 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.

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 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. These patients are usually moribund patients with terminal malignancy and stenting provides adequate palliation. Patients who are unable to take food due to cancers of oesophagus 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 tumours of GI tract that can cause bleeding or even are a precursor of malignancy. These can be removed by cutting through cautery and thus obviating surgery.

Heart burn is one of the most common GI symptoms, which require a long term medical therapy in many patients. Suturing of the junction of the food pipe and stomach is now done endoscopically to prevent acid reflux in patients with heartburn. This is undertaken 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. The most common applications are to remove stone in the bile duct and pancreatic duct.

Also any obstruction in these ducts can be by-passed by placing stents. All these procedures so far required fairly complicated surgical procedures. Now endoscopy has reduced the hospital stay and costs 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 the past.
Great strides

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 of 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 the last two or three decades. 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 the gastrointestinal tract.