For many digestive disorders, finding the problem is only the first part of treatment. An endoscope can now do considerably more than allow a doctor to look inside the digestive tract. Through the same flexible instrument, specialists can stop bleeding, remove certain lesions, open narrowed passages, clear blocked bile ducts and manage several other conditions.
This is the role of therapeutic endoscopy. At STAR Hospitals, Hyderabad, the Medical Gastroenterology Department provides a range of diagnostic and therapeutic endoscopic procedures, including ERCP, EUS, EMR, ESD, POEM, stenting and endoscopic treatment of gastrointestinal bleeding and performs more than 200 endoscopic procedures each month.
What Can Therapeutic Endoscopy Treat?
The procedure chosen depends on what is causing the digestive problem and where it is located. Some of the treatments available at STAR Hospitals include:
- Endoscopic haemostasis: Bleeding from ulcers, vascular lesions and varices can be treated using methods such as clips, thermal therapy, injection therapy, argon plasma coagulation (APC) and band ligation.
- ERCP: Endoscopic Retrograde Cholangiopancreatography can be used to manage conditions involving the bile and pancreatic ducts, including stone removal and stent placement.
- EMR and ESD: Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection can remove selected precancerous or early gastrointestinal lesions through the endoscope. ESD can allow appropriate lesions to be removed in a single piece for further pathological assessment.
- Dilatation and stenting: Narrowed areas of the oesophagus, stomach, intestine or bile ducts may sometimes be widened or supported with a stent, depending on the cause. STAR lists oesophageal, pyloric, duodenal, colonic and biliary stenting among its therapeutic endoscopy services.
- POEM: Peroral Endoscopic Myotomy is an endoscopic treatment used for selected patients with achalasia, a disorder in which the lower oesophageal muscle does not relax properly during swallowing.
- EUS-guided procedures: Endoscopic ultrasound combines endoscopy with ultrasound imaging to examine structures around the digestive tract, particularly the pancreas and bile ducts, and can also guide tissue sampling and selected therapeutic procedures.
- Foreign-body removal: Objects accidentally swallowed can sometimes be retrieved endoscopically, avoiding the need for an operation when the clinical situation permits.
How Is It Different from a Conventional Operation?
Therapeutic endoscopy uses a flexible scope introduced through a natural opening, usually the mouth or anus, depending on the part of the digestive tract being treated. Specialised instruments can then be passed through the scope to perform the required intervention.
This can spare patients a large surgical incision and may mean a shorter recovery, depending on the procedure and the condition being treated. It does not, however, mean that every digestive disorder can be treated endoscopically. Large or advanced cancers, perforations, intestinal obstruction requiring surgery and several other complex conditions may still require an operation.
STAR Hospitals maintains a Surgical Gastroenterology and Minimal Access Surgery service for conditions that require surgical treatment, including GI emergencies, gastrointestinal cancers, pancreatic disease and intestinal problems. This allows treatment to be planned according to the patient's actual condition rather than applying an endoscopic approach where it is unsuitable.
What Happens Before and After the Procedure?
- Before therapeutic endoscopy, the gastroenterologist reviews the patient's symptoms, previous investigations, medicines and medical history.
- Blood thinners and other medicines may need particular consideration, depending on the procedure.
- Some endoscopic interventions require sedation or anaesthesia, as sedation requirements vary according to the procedure and patient.
Afterwards, recovery depends on what was performed. A straightforward diagnostic procedure and a complex therapeutic intervention do not have the same recovery requirements. Patients are given instructions regarding food, medicines, activity and follow-up, and should seek medical attention if they develop significant bleeding, severe abdominal or chest pain, fever, persistent vomiting or other concerning symptoms.
Therapeutic Endoscopy at STAR Hospitals
STAR Hospitals' Medical Gastroenterology services at Banjara Hills and Nanakramguda cover a broad range of digestive and liver disorders, including GI bleeding, peptic ulcers, inflammatory bowel disease, pancreatitis, liver disease and gastrointestinal cancers. Our endoscopy services include upper GI endoscopy, colonoscopy, therapeutic ERCP, EUS, EMR, ESD, POEM, stenting, haemostasis and enteroscopy, with hepatology and surgical gastroenterology support available for more complex cases.
For a patient, the value of therapeutic endoscopy often lies in having diagnosis and treatment brought closer together. A problem discovered during an endoscopic examination may, when clinically appropriate, be treated through the same route, without automatically moving to major surgery. The gastroenterologist's assessment remains central to deciding whether an endoscopic procedure is safe and suitable for that particular condition
