ENDOSCOPY AND OTHER PROCEDURES

Upper GI Endoscopy:

Upper GI(Gastro-intestinal) endoscopy is a test to look directly at the lining of the oesophagus , the stomach and around the first and second part of duodenum. An endoscope is passed through patient’s mouth into the stomach after local anaesthesia of oropharynx during the procedure. It is commonly done to look for ulcers, erosions, tumors, bleeding, obstruction, polyp etc. and sometimes for taking biopsies for histopathological analysis.

Colonoscopy:

Colonoscopy is a test to look directly at the lining of the large intestine (the cecum, colon,rectum and anal canal)and distal 10 cm of ileum(last part of small intestine).A colonoscope is carefully passed through the anus into the large intestine after proper bowel preparation and local anaesthesia. Colonoscopy is commonly done to look for ulcers,tumors,bleeding,obstruction,polyp etc and sometimes for taking biopsies for histopathological analysis.

Proctosigmoidoscopy:

Only lower part of large intestine(Descending colon and sigmoid colon) and rectum are examined with colonoscope usually to find the cause of bleeding per rectum(ex- polyp,ulcer,fissure,haemorrhoids etc).Hence also called “short colonoscopy”.

Endoscopic variceal ligation(EVL):

EVL is done as a management of esophageal varix(dilated submucosal veins at the lower third of esophagus ,mainly due to portal hypertension) to treat it and to prevent bleeding from it. The procedure is performed during an Upper GI Endoscopy after proper local anaesthesia where tiny elastic bands are placed around the dilated veins in the esophagus to tie them off so they can’t bleed.

Endoscopic Sclerotherapy(EST):

Alternative management of esophageal varix,where an irritant chemical called a sclerosant(usually absolute alcohol) is injected directly into an enlarged vein or into the wall of the esophagus next to the enlarged veins with sclerotherapy needle via endoscope. The substance causes inflammation of the inside lining of the vein, which over time causes the vein to close off and formation of scar.

Endoscopic Retrograde CholangioPancreatography(ERCP):

It a technique(done under sedation) that combines the use of endoscopy and fluoroscopy(X-ray) to diagnose and treat certain problems of the biliary or pancreatic ductal systems including CBD stones, inflammatory strictures (scars) of bile duct, leaks (from trauma and surgery), and cancer. ERCP is of two type-diagnostic and therapeutic. With the help of ERCP we can extract stones( in c/o CBD calculus), can dilate a strictureand insert a stent(in c/o CBD stricture) and thus can manage obstructive jaundice of different etiology(Therapeutic ERCP).Sometimes ERCP is used to take biopsy from CBD to rule out any malignancy(Diagnostic ERCP).

Double Balloon Enteroscopy(DBE):

It is a new endoscopic technique that allows complete examination of the small intestine. The technique involves the use of a balloon at the end of a special enteroscope camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon. The procedure is usually done under IV sedation.DBE can be done either per oral or per rectal approach.DBE is usually done to find the source of an obscure GI bleed or to take a biopsy from a small intestinal ulcer found in capsule endoscopy.

Capsule Endoscopy:

It is the least invasive and most direct way to see the inside of entire GI tract. During the procedure, a patient swallows a small pill with a camera inside which is transported smoothly and painlessly through the GI tract by the body’s own natural peristalsis. The pillcam video capsule measures 11 mm x 26 mm and weighs less than 4 grams, contains an imaging device and light-source on one-side and transmits images at a rate of 2 images per second generating more than 50,000 pictures over an 8-hour period and helps to diagnose disorders such as Crohn’s disease, Celiac disease, benign and cancerous tumors, ulcers, ulcerative colitis as well as others disorders.

Balloon Dilatation of Achalasia:

Achalasia cardia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES), characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus. Balloon dilatation is a management of achalasia where a small, inflatable balloon is passed into the lower end of esophagus or into the LES under fluoroscopic and endoscopic guidance and then the balloon is inflated for about a minute, which stretches and weakens the muscles.

Stricture dilatation:

Almost same as balloon dilatation of achalasia cardia, where we can dilate any stricture(due to various reasons) in the GI tract with the balloon dilatation process to release the obstruction due to stricture.

Glue Injection:

Bleeding from gastric varix(dilated veins) is an uncommon but serious complication of portal hypertension. Glue injection is a management of Gastric Variceal bleeding(GVB). The tissue glue, N-butyl-2-cyanoacrylate, is a watery solution which is diluted with the oily contrast agent lipiodol ultra fluid and injected into the gastric varix.The glue polymerizes and hardens instantaneously on contact with blood and obliterates the varix.

Endotherapy for ulcer:

Different types of endoscopic therapy are there for active management of Upper Gastrointestinal bleeding(most commonly bleeding peptic ulcer). Endoscopy with different hemostatic therapy are the mainstay of treatment. The procedures are: a.APC b.Injection therapy c.Hemostatic clipping

  • Argon Plasma Coagulation(APC): APC involves the use of a jet of ionized argon gas (plasma) that is directed through a probe passed through the endoscope towards the bleeding lesion.High-frequency electric current is then conducted through the jet of gas, resulting in coagulation of the bleeding lesion. The procedure is safe and can be used to treat bleeding in different parts of the GI tract. APC is used to treat the following conditions:angiodysplasiae, gastric antral vascular ectasia(GAVE), secure of bleeding points after polypectomy,bleeding esophageal varices(along with EVL) etc.
  • Injection Therapy: In this procedure solutions of diluted epinephrine (1:10,000) is injected with a sclerotherapy needle via endoscope. The diluted epinephrine makes a tamponade effect by the volume of solution injected.
  • Hemostatic clipping: Sometimes hemostatic clips are applied over the active bleeding points to secure the source of bleeing with the help of endoscope.

Polypectomy:

Polypectomy is the removal of polyps (antral,colorectal etc.) in order to prevent them from turning cancerous,bleeding, or for histopathological studies. Gastrointestinal polyps can be removed endoscopically with the help of polypectomy snare.

Endoscopic Mucosal Resection(EMR):

EMR is a technique used to remove cancerous or other abnormal lesions found in the GI tract and shown to be a less invasive, safe, and effective nonsurgical therapy for early stages of different GI cancers. The most commonly employed modalities of EMR include strip biopsy, double-snare polypectomy, resection with combined use of highly concentrated saline and epinephrine, and resection using a cap.

Foreign body removal:

Removal of ingested objects from the esophagus, stomach and duodenum by endoscopic techniques. It encompasses a variety of techniques and instruments(like forcep, snare, basket etc) , employed through the gastroscope for grasping foreign bodies, manipulating them, and removing them while protecting the esophagus and trachea. Commonly swallowed objects include coins, buttons, batteries, fish bones etc but can include more complex objects.

Endoscopic Ultrasound(EUS):

EUS is a medical procedure(done under sedation) , in which endoscopy is combined with ultrasound to obtain images of the internal organs of abdomen. Combined with Doppler imaging, nearby blood vessels can also be evaluated. It can be either diadnostic or therapeutic. It can be used for screening of pancreatic/esophageal/ gastric cancer, or benign tumors of the upper GI tract and for biopsy of any focal lesions found in the upper GI tract.

Fibroscan(Elastrography):

The fibroscan is a non-invasive device to stage the severity of liver disease. It assesses the ‘hardness’ (or stiffness) of the liver by measuring the velocity of a vibration wave (also called a ‘shear wave’) generated on the skin. Because fibrous tissue is harder than normal liver, the degree of hepatic fibrosis can be inferred from the liver hardness.

Liver Biopsy:

Liver biopsy is the biopsy (removal of a small sample of tissue) from the liver, done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment of liver disease. Liver biopsies most commonly done percutaneously via a needle through the skin under local anaesthesia. It also can be done transvenously (through the blood vessels) and directly during abdominal surgery. Liver biopsy usually done in following cases:

  • Determination of stage of fibrosis and grade of inflammation for chronic Hepatitis B and Hepatitis C
  • Evaluation of autoimmune hepatitis
  • Evaluation of a liver mass that does not exhibit typical imaging features of Hepato Cellular Carcinoma (HCC)
  • Quantitative estimation of iron in Hemochromatosis/ Copper in Wilson disease
  • Evaluation of the suitability of a donor liver for transplantation
  • Diagnosis and staging of Non Alcoholic Fatty Liver Disease (NAFLD)/Nonalcoholic Steatohepatitis (NASH) etc.
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