Interventional Endoscopy
What is Interventional Endoscopy?
Interventional endoscopy refers to a specialised field within gastroenterology and surgery that involves using endoscopic techniques to diagnose and treat various conditions. These techniques often involve minimally invasive procedures performed through an endoscope, a flexible tube with a camera and light attached to it.
Indications for Interventional Endoscopy
The indications for interventional endoscopy can vary depending on the specific medical condition, the organ system involved, and the goals of treatment. However, some common indications for interventional endoscopy include:
Diagnostic Purposes:
- Gastrointestinal Bleeding: To locate and assess the source of bleeding, such as ulcers, vascular malformations, or tumours.
- Abnormal Imaging Findings: Follow-up of abnormalities detected on imaging studies like CT scans or MRIs, such as suspicious lesions, masses, or strictures.
- Pancreatic and Biliary Disorders: Evaluation of pancreatic tumours, cysts, or biliary obstruction.
Therapeutic Purposes:
- Polyp Removal: Removal of polyps detected during screening or diagnostic endoscopy to prevent cancer or assess for malignancy.
- Stricture Dilation: Widening of narrowed areas in the digestive tract, such as strictures in the oesophagus, stomach, or intestines.
- Stent Placement: To relieve obstruction or strictures caused by tumours or other conditions in the digestive or respiratory systems.
- Hemostasis: Control of bleeding in the gastrointestinal tract due to ulcers, tumours, or other causes.
- Tissue Sampling/Biopsy: Collection of tissue samples for histological analysis to diagnose or stage cancers, assess inflammation, or identify infections.
- Ablation Therapy: Treatment of precancerous or early-stage cancers using techniques like radiofrequency ablation (RFA) or cryotherapy.
- Gastrointestinal Foreign Body Removal: Extraction of swallowed objects or foreign bodies stuck in the digestive tract.
Cancer Diagnosis and Staging:
- Endoscopic Ultrasound (EUS): Staging of gastrointestinal cancers, assessment of lymph nodes, evaluation of pancreatic and biliary tumours.
- Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnosis and management of pancreaticobiliary malignancies, assessment of ductal anatomy, and sampling of bile or pancreatic duct cells.
Palliative Care:
- Stent Placement: Palliation of symptoms caused by obstructive lesions, such as dysphagia (difficulty swallowing) in oesophagal cancer or jaundice in biliary obstruction.
- Hemostasis: Management of bleeding in advanced cancers or palliative care settings.
Chronic Disease Management:
- Inflammatory Bowel Disease (IBD): Monitoring disease activity, assessment of complications like strictures or fistulas, and surveillance for dysplasia or cancer.
- Barrett's Esophagus: Surveillance for dysplasia or early-stage cancer, and ablative therapy for dysplastic lesions.
- Chronic Pancreatitis: Evaluation of pancreatic duct strictures, drainage procedures, and pain management interventions.
These indications highlight the diverse range of conditions and situations where interventional endoscopy plays a crucial role in diagnosis, treatment, staging, surveillance, and palliative care across various medical specialities.
Preparation for Interventional Endoscopy
Preoperative preparation for Interventional Endoscopy may involve the following steps:
- A comprehensive medical evaluation including physical examination, review of your medical history, medications, allergies, and tests/imaging required for the procedure being performed
- Your physician may adjust your medications or ask you to stop taking certain medications such as blood thinners, which may affect blood clotting
- You will need to stop eating and drinking at least 8 hours prior to the procedure
- You will be asked to sign an informed consent form after the pros and cons of the procedure has been explained
What Happens During Interventional Endoscopy?
In general, interventional endoscopy may involve the following steps:
- You will be positioned comfortably on an examination table, often on your side or face-up position for procedures involving the gastrointestinal tract.
- Depending on the complexity of the procedure, local anaesthesia, conscious sedation, or general anaesthesia may be used to keep you comfortable and pain-free during the procedure.
- The endoscope - a flexible, lighted tube with a camera and working channels to pass miniature instruments through it - is inserted through a natural opening, such as the mouth (for upper gastrointestinal procedures) or anus (for lower gastrointestinal procedures). The endoscope is carefully advanced through the relevant organ system, allowing visualisation of internal structures on a monitor.
- Depending on the purpose of the endoscopy, various diagnostic or therapeutic interventions may be performed:
- Diagnostic Procedures: Visualisation of the area of interest, examination for abnormalities, biopsy sampling (using small forceps or brushes to collect tissue samples), and imaging techniques like endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) may be used for detailed imaging.
- Therapeutic Procedures: Treatment interventions such as polyp removal, stricture dilation (using balloons or other devices to widen narrowed areas), stent placement (insertion of stents to open up blocked passages), hemostasis (stopping bleeding), ablation therapy (destroying abnormal tissue), or foreign body removal may be performed.
- After the objective of the procedure has been obtained, the scope and the instruments are withdrawn.
Postoperative Care and Recovery
After the procedure, patients are usually monitored in a recovery area until they are fully awake and stable. Depending on the complexity of the procedure and the patient's condition, they may be discharged home the same day or kept for observation in a hospital setting. Patients typically receive instructions for post-procedure care, such as dietary restrictions, medication management, activity restrictions, and follow-up appointments for monitoring or further treatment.
Risks and Complications
Risks and complications associated with interventional endoscopy include:
- Post-procedure pain or discomfort
- Bleeding
- Infection
- Perforation (tear or hole)
- Allergic reactions
- Adverse effects of anesthesia
- Inflammation
Benefits
Interventional endoscopy is often preferred for its minimally invasive nature, which typically results in shorter recovery times, reduced risk of complications, shorter hospital stays, and less pain for patients compared to traditional surgical methods.
If you wish to be advised on the most appropriate treatment, please call to schedule an appointment or click here to request an appointment online.