Endoscopic techniques and treatments have helped change the way we diagnose and treat many issues within the body. With the continued advancement of technologies and procedures associated with endoscopy, the frontiers of what can be achieved continue to expand. One of these areas is how endoscopic procedures can be used as a bridge and, sometimes, as an alternative to surgery.
The typical treatment for any obstruction within the colon or rectum is to perform an emergency resection, where a small section of the colon or rectum containing the obstruction is surgically removed. More recently, doctors have been experimenting with using endoscopic stenting and delayed surgery as an alternative approach. Endoscopic stenting involves using an endoscope to place self-expanding metallic stents (SEMS) within the colon or rectum to open a pathway and negate the need for an unplanned surgery. One 2017 study identified endoscopic stenting as a safe approach in the management of malignant large bowel obstruction. A separate 2020 study also found endoscopic stenting with SEMS as a promising treatment option to avoid emergency surgery.
Most adults in the US who see a gastroenterologist for gastroesophageal reflux disease (GERD) are given proton pump inhibitors (PPIs) to control their symptoms. More recently, however, medical opinions are divided on if PPIs are the best way to manage reflux for many patients. This has led to an increase in surgical laparoscopic fundoplication techniques. These involve the fundus at the base of the esophagus being wrapped around it, tightening the sphincter, and preventing any burping or vomiting that may worsen your GERD symptoms.
Endoscopic fundoplication allows your gastroenterologist to bridge the gap between PPIs and laparoscopic techniques. There are currently three FDA-approved endoscopic fundoplication approaches.
- Stretta: Stretta involves using thermal energy via an endoscope to create a type of heat-induced fibrosis that tightens tissues in the sphincter.
- TIF: Transoral incisionless fundoplication (TIF) also involves wrapping the fundus around the base of the esophagus and fastening it with small polypropylene fasteners. According to one study conducted in 2017, TIF procedures were found to be an effective form of treatment for patients with GERD for at least two years following the procedure.
- MUSE: Medigus Ultrasonic Surgical Endostapler (MUSE) uses the same technique as TIF. However, instead of fasteners, it uses standard surgical staples to attach the fundus to the esophagus.
Endoscopic Bariatric Procedures
Traditional endoscopic procedures have enabled many doctors to diagnose and treat diseases in and around the large intestine, stomach, and esophagus. However, they have been less effective at diagnosing and treating diseases found in the small intestine. The development of balloon endoscopy, also known as enteroscopy, offers an alternative approach to this issue.
Balloon endoscopy is made up of two different procedures.
- Single Balloon Endoscopy: Single balloon endoscopy attaches an overtube over the endoscope, with a tip that can be inflated and deflated. The tip is then inflated like a balloon to anchor the overtube inside the small intestine. Once it is in place, the endoscope can be moved further into the small intestine. Also, by gently withdrawing the overtube, your doctor can straighten and shorten the small intestine so the endoscope can move forward more easily. If the endoscope needs to move even further into the small intestine, the tip can be deflated and reinflated again. All this allows your doctor to use the endoscope to perform several standard procedures within the small intestine, including taking a biopsy.
- Double Balloon Endoscopy: Balloon endoscopy also offers a double-balloon alternative. This technique is identical to single balloon endoscopy. However, in this method, both the endoscope and the overtube have inflatable tips. The benefit of the double-balloon option is to help both the endoscope and overtube move more effectively through the small intestine by offering additional anchoring.
Many more procedures are being administered by doctors as innovations are made in endoscopic treatment methods. The future frontiers of endoscopy as a bridge or alternative to surgery will continue to expand as long as technology advances. This will give patients more options for alternative, non-surgical treatment procedures.
- Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis
- Stenting as a bridge to surgery for extra-colonic malignancy induced colorectal obstruction: preliminary experience
- Efficacy of transoral incisionless fundoplication for refractory gastroesophageal reflux disease: a systematic review and meta-analysis
- Endoscopic Fundoplication: Effectiveness for Controlling Symptoms of Gastroesophageal Reflux Disease