Description

Gastroenterology

Gastroenterologic procedures progress over the years and
find wider area of usage. Endoscope quality has improved as the basis of
endoscopic diagnosis. Over 20 years have passed since the development of the
videoscope. Compared to diagnostic procedures using other medical instruments,
the great advantage of endoscopes lay in things like enabling more accurate
diagnosis through the taking of biopsies, and minimally invasive therapy such
as the use of endotherapy instruments to remove polyps. Nowadays, it is
possible not only to diagnose whether lesions are benign or malignant, but also
to make on the spot treatment decisions based on factors such as their size,
depth, and how atypical they are.

Sedation is frequently used to minimize anxiety and
discomfort, during the endosocopy procedure.  Sedation is a state of
sleepiness, and is commonly given before an endoscopic procedure.

Endoscopy

Endoscopy allows examination of the esophagus, stomach,
and duodenum. Diagnostic observations are made concerning focal benign or
malignant lesions, gastritis ulcers and helicobacter pylori infection.
Helicobacter pylori is a bacterium which lives in human stomach and can cause
gastritis, ulcers and also gastric carcinoma. It may also cause upper abdominal
pain, belching, nausea, vomiting and abdominal bloating. When we reveal the
presence of the microbe we have to kill it.

Endoscopy absolute indications (Alarm symptoms):

1-New onset symptoms starting more than 50 years old

2-Family history of esophageal or gastric cancer

3- Unintended weight loss

4-Persistent vomiting or vomiting with blood

5-Bloody or black stools

6-Difficulty in swallowing

7-Iron deficiency anemia

8- Diarrhea in patients suspected of having small-bowel
disease (eg, celiac disease)

Endoscopic procedures can be used for diagnostic and also
therapeutic purposes. Common therapeutic endoscopic procedures include
polypectomy, dilation of strictures, stent placement, removal of foreign
bodies, gastrostomy (for patients cannot swallow), treatment of GI bleeding
with injection, banding, coagulation, sclerotherapy, and removal of limited
malignant lesions.

Colonoscopy

Colonoscopy allows examination of the entire colon and
rectum and frequently the terminal ileum. Screening colonoscopy should be
performed everyone older than 50 years old. With colonoscopic examination we
can detect polyps and remove them. (Polyps can turn to cancer in 5-10 years.
After removal of the polyps cancer risk approaches zero). Follow-up
colonoscopies should be done in several years depending on the polyp type. The
diagnosis of other disease of the colon (like ulcerative colitis) can be made
by this method.

Colonoscopy is generally indicated in the following circumstances:

1-Evaluation of unexplained GI bleeding (after an upper GI source has been excluded)

2- Presence of fecal occult blood

3- Unexplained iron deficiency anemia

4- Screening and surveillance for colonic neoplasia (>50
years old, if family history of colon cancer or colonic polyps 10 years earlier
than the index family member)

5- Clinically significant diarrhea of unexplained origin

ERCP

Endoscopic retrograde cholangiopancreatography, or ERCP,
is a diagnostic procedure designed to examine diseases of the liver, bile ducts
and pancreas. ERCP is performed under intravenous sedation, usually without
general anesthesia. Frequently, therapeutic measures can be performed at the
time of ERCP to remove stones in the bile ducts or to relieve obstruction of
the bile ducts.

During ERCP, endoscope will pass through your mouth,
esophagus and stomach into the small intestine. After finding of common bile
duct at the second part of the duodenum, entrance of bile duct will be dilated
and stones will be removed.

ERCP is generally indicated in:

1-Jaundice

2-Common bile duct stones

3-To drain the obstructed bile ducts due to tumor of
strictures and to place the stents

ERCP, Stones in the common bile duct

ERCP, Stone removal

Endoscopic
ultrasound

Endoscopic ultrasound (EUS) is a technique whereby an US
transducer is incorporated into the tip of the endoscope. This provides
high-resolution images of the GI wall and

adjacent structures. Endoscopic ultrasound (EUS)-guided
sampling, including EUS-guided fine needle aspiration (EUS-FNA) can be
performed in submucosal tumors, pancreatic solid masses and cystic-appearing
lesions, and other gastrointestinal tumors.

EUS is generally indicated for:

1-Staging tumors of the GI tract, pancreas, bile ducts.

2- Evaluating abnormalities of the GI tract wall or adjacent structures.

3- Tissue sampling of lesions within, or adjacent to, the wall of the GI tract.

4- Evaluation of abnormalities of the pancreas, including
masses, pseudocysts, cysts, and chronic pancreatitis.

5- Evaluation of abnormalities of the biliary tree. Endoscopic ultrasound staging of the colonic lesion

Capsule endoscopy

Small-bowel video capsule endoscopy is the first-line
investigation in patients with obscure gastrointestinal bleeding.  Other
common usage areas are suspected small intestinal tumors and refractory
malabsorptive syndromes.

Double balloon enteroscopy

Double balloon enteroscopy is an effective and safe
technique for small-bowel examination. With this technique, we can diagnose
suspected small bowel lesions, as well as, we obtain the biopsies. We sometimes
make treatment depending on the lesion.