Most people are familiar with colonoscopy and upper endoscopy, procedures where a thin, flexible tube equipped with a tiny camera and light is used to examine the colon or the upper GI tract, the esophagus, stomach and first part of the small intestine. These procedures are done to find explanations for signs (e.g. bleeding) or symptoms (e.g. pain) and to detect and evaluate abnormal areas. Biopsies are commonly done, bleeding areas treated and polyps (pre-cancerous growths in the colon) removed. All gastroenterologists and some surgeons are skilled at these procedures.
The field of Advanced Therapeutic Endoscopy, or Interventional Endoscopy, goes well beyond these basic techniques, and it has become a specialty unto itself. Endoscopic ultrasound (EUS) allows the physician to use sound waves to look through the wall of the stomach or intestine to “see” structures on the other side; just like the images obtained using ultrasound to “look through” the mother’s abdominal wall and see the unborn baby with remarkable detail. The clarity of these images allows the physician to guide a needle for biopsies, or to drain an area that is infected. ERCP allows us to examine the bile ducts and pancreatic ducts (the “plumbing” of the liver and the pancreas) and to remove stones or to treat blockages. Other techniques of therapeutic endoscopy are used to treat early cancers of the esophagus, stomach and colon.
Advanced Therapeutic Endoscopy provides a safe minimally invasive alternative to manage a number of conditions that previously required much more invasive diagnostic techniques or even life altering surgery. Recovery is quicker, complications are few, and there is often little or no impact on the patient’s quality of life. In most instances, these are outpatient procedures.