|
Anti-reflux mucosal ablation (ARMA) or Anti-reflux ablation therapy (ARAT)
Both are technically similar (latter with Hybrid APC) in that the
cardia mucosa of the stomach is ablated using argon plasma coagulation, resulting in a
controlled scarring that reduces gastric acid reflux up through the gastro-oesophageal
junction. This minimally invasive endoscopic procedure can be done as day surgery or with one
night stay.
Oesophago-gastro-duodenoscopy or Gastroscopy (OGD) (including removal of polyps)
This is a simple short procedure where a slim, fibreoptic tube is
inserted down the throat into the oesophagus, stomach and part of the small intestine. It can
diagnose diseases like, cancer of the oesophagus, stomach and duodenum, gastro-oesophageal
reflux disease gastritis, stomach and duodenal ulcers, polyps. Biopsies, polyp removal and
even tumour resection can be carried out using the same tube. Bleeding due to various causes
can also be halted via this scope, including ligation of oesophageal varices (swollen veins).
Colonoscopy (with or without polypectomy)
This also involves insertion of a long fibreoptic tube up the anus
to visualise the entire large intestine (colon). It can also frequently be pushed to the
terminal end of the small intestine. It can detect abnormal areas in the colon and biopsy can
be carried out then. It is a very useful tool to detect and remove polyps which otherwise may
grow into cancer later in life. It can also be used to resect tumour as well as to stop
bleeding in the colon.
Endoscopic Retrograde Cholangio-pancreatography (ERCP)
This procedure allows us to diagnose and treat disorders of the
bile ducts and pancreatic duct. It is a relatively non-invasive way to diagnose and remove
stones from the bile duct and pancreatic duct. ERCP can also be used to biopsy or insert
stents for drainage in patients with bile duct narrowing (benign or cancerous). An ultrathin
scope (spyglass cholangioscope) can also be used during ERCP to visualize/biopsy the lining of
the bile ducts directly or blast stones within it with laser.
Endoscopic sleeve gastroplasty (ESG)
This is a minimally invasive weight loss procedure, involving
using a gastroscope to sulture the stomach intraluminally so as to reduce its size. This will
usually result in reduced food intake and slower gastric emptying and patient will feel full
longer. This is indicated for patients with BMI of >30 or above, and who have not been
successful to reduce weight through conventional diet and exercise modifications or with
related weight loss medications. Those with BMI of 28 with comorbid conditions including
diabetes mellitus, hyperlipidaemia, hypertension can also consider this procedure.
Endoscopic ultrasound (EUS)
EUS scope is a special scope with ultrasound capability. It is
used to examine the walls and linings of the upper and lower digestive tract as well as organs
or lesions adjacent to the gut wall. Lungs, liver, stomach, gall bladder, bile duct, spleen,
pancreas, adrenal glands can be evaluated fairly accurately with this procedure. EUS staging
of gut cancer is established and useful in the management. Biopsies of suspicious lesions,
drainage of cysts/abscess and celiac plexus neurolysis (for intractable pain of chronic
pancreatitis and pancreatic cancers) can be performed via EUS.
Double Balloon Enteroscopy
This scope comes along with some special features (balloon and
overtube) that literally makes it possible to push the scope from the mouth to the last part
of the small intestines. As such, direct visualization, diagnosis and treatment of disorders
of the small intestine is made possible, which is beyond the reach of conventional OGD or
colonoscopy. Clinical indications for this procedure include small intestinal bleeding,
ulcers, polyps and cancers.
Video Capsule Endoscopy (VCE)
This is a truly a
non-invasive
procedure in which the patient swallows a small capsule containing a camera. About 60 000
photos will be taken in total, allowing a comprehensive visualisation of the entire small
bowel. The photos can be downloaded and viewed on a computer subsequently.
Insertion of Self Expandable Metal Stents (SEMS)
Patients with advanced cancer of the gut often suffer from
obstruction of the tumour, leading to difficulty in swallowing, persistent vomiting,
intestinal obstruction or jaundice (yellowing of the skin). Endoscopic insertion of SEMS is a
safe, easy and cost effective way to relieve the obstruction and hence achieve symptom relief.
The stent can be placed temporarily or permanently.
Endoscopic Mucosal Resection and Endoscopic Sub-mucosal Dissection (EMR and ESD)
These are highly specialised endoscopic techniques which allows
complete resection of early cancer of the oesophagus, stomach, duodenum or colon; obviating
the need for an open or laparoscopic surgery.
Oesophageal Dilation
This procedure involves
endoscopically
enlarging the lumen of a narrow oesophagus from benign or cancerous cause.
Percutaneous Endoscopic Gastrostomy (PEG)
PEG is an endoscopic procedure in which a flexible feeding tube is
inserted through the abdominal wall into the stomach, allowing direct feeding and bypassing
the mouth. This is recommended if long term naso-gastric feeding is anticipated.
Intragastric balloon placement for the management of morbid obesity
This procedure involves the endoscopic placement of a water-filled
balloon into the stomach. The presence of the balloon will make the patient feel full much
earlier, and the patient eats less with resulting weight loss. The deployed balloon can be
easily removed subsequently with a scope.
Stretta Endoscopic Radiofrequency Treatment of GERD
This is an alternative to the conventional surgical
fundoplication. It is a minimally invasive endoscopic way to treat gastro-oesophageal reflux
disease (GERD). It has been used to treat laryngo-pharyngeal reflux (LPR) too. It uses
radiofrequency energy to re-modify the lower oesophageal sphincter LES to reduce reflux.
Monitored conscious sedation is usually adequate for the procedure.
Halo Endoscopic Radiofrequency Ablation of Barrett’s oesophagus
The recommendation for a known Barrett’s oesophagus is regular careful
surveillance gastroscopy and to resect any dysplastic tissues if discovered. Halo RFA is a
minimally invasive endoscopic method to ablate the precancerous Barrett’s tissues using
radiofrequency energy.
OTSC Ovesco clipping
The OTSC (over the scope clip) Ovesco device has been established to be
very efficacious to treat and close up fistula or perforation of the gastro-intestinal tract.
It is a minimally invasive endoscopic procedure and, if successful, saves the patient from a
surgical intervention.
Full Thickness Resection Device (FTRD)
This is one of the latest endoscopic techniques to resect a
gastrointestinal tract submucosal lesion completely (including the entire wall thickness). It
involves deploying a special OTSC clip first before the complete resection to prevent
perforation or leaking.
|
