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 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.
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