05 May 2023 | Friday | News
"Advanced endoscopy" procedures are those which require additional training over and above general endoscopy procedures. These procedures provide a minimally invasive alternative to treating certain conditions that would have otherwise required conventional open surgery.
In this article, Dr Benjamin Yip, Consultant Gastroenterologist and Medical Director of Alpha Digestive & Liver Centre, tells us more about advanced endoscopic procedures and their potentially life-saving functions.
Endoscopic Ultrasound (EUS)
An endoscopic ultrasound (EUS) is a minimally invasive endoscopic procedure that involves the use of an ultrasound scanning probe attached to the tip of the endoscope. It allows the gastroenterologist to examine the lining of the upper (oesophagus, stomach and duodenum) and lower (sigmoid colon and rectum) gastrointestinal tract, as well as the structures next to the GI tract such as lymph nodes, tumours, collections, the pancreas, liver, gallbladder and bile duct.
EUS can be used to diagnose diseases, including:
EUS can be used to treat certain medical conditions without the need to make a cut on the body and perform surgery. These include:
In Dr Benjamin Yip's personal opinion, the EUS is a procedure tailor-made for the pancreas, which is a deep-seated abdominal organ often obstructed by other organs and structures.
For both diagnostic and therapeutic purposes, an EUS allows the gastroenterologist to access the pancreas (given the configuration of the stomach and duodenum) in a minimally invasive manner. Otherwise, access to the pancreas would generally be performed percutaneously (via the skin), which would often not be possible due to the inaccessibility of the pancreas.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure used to look at or treat the bile ducts, pancreatic ducts and gallbladder.
During the ERCP, a thin, flexible, and hollow tube with a camera attached at one end, called an endoscope, is inserted through the mouth and carefully moved into the digestive tract. The endoscope goes from the mouth to the oesophagus, stomach, and then lastly to the duodenum, the first part of the small intestine.
ERCPs may be used to evaluate certain conditions:
ERCPs may be used to treat certain conditions of the bile ducts and pancreatic ducts. It may also be used to treat complications after gallbladder or liver surgery.
Dr Benjamin Yip shares, "Although ERCP is one of the higher risk endoscopic procedures, it is usually well-tolerated. I had a patient in her 90's with incurable ampullary cancer, in which I did ERCP and inserted a biliary metal stent to prevent biliary blockage. I remember seeing her one year after the ERCP, and she remained well, and the stent was functioning well!"
Deep enteroscopy is an incisionless procedure whereby a long endoscope is inserted into the gastrointestinal tract. A common type is balloon-assisted enteroscopy, which makes use of small balloons to allow an endoscope to effectively travel through the small intestine, which is typically hard to reach. After the endoscope is inserted through the mouth (antegrade approach), the balloons are alternately inflated and deflated, allowing movement through the gastrointestinal tract. For the retrograde approach, the endoscope is inserted through the anus.
On average, the small intestine is six metres long, making it difficult to reach using more-traditional endoscopy procedures. Deep enteroscopy works by "pleating" the intestine as the endoscope is threaded through it, which can be likened to pushing a rod through a curtain.
Deep enteroscopy could be used as a diagnostic tool to:
Deep enteroscopy serves a therapeutic purpose, and various miniature tools can be attached to the end of the endoscope to:
The small bowel used to be a "no man's land" for Gastroenterologists as they are deep within the abdomen and were difficult to reach with the instruments of the past. Nowadays, however, modern endoscopes with various capabilities allow the Gastroenterologist to access these difficult-to-reach areas — sometimes saving the patient from having to undergo surgery.