Update in Gastroenterology
Moderators : Dr. Mathew Philip , Dr. Sunil K. Mathai
Speakers : Dr. Roy Mukkada, Dr. Ismail, Dr. Benoy Sebastaian, Dr. Prakash Zacharia
Endosonography ( EUS)
This is the amalgamation of an endoscope an an ultrasonic probe. It enables the probe to be placed close to the organ of interest and scanning is done at various frequencies ranging from 3.5 to 20 MHz. This allows the gastroenterologist to examine these organs in a more critical manner not possible even with the best of the CT scanners. The strength of EUS lies in examination of biliopancreatic system and submucosal tissue. EUS guided therapeutic procedures are on the up; Pseudocyst drainage, celiac axis neuronolysis and brachytherapy to name a few.
Small intestine was an inaccessible area for long. Itís tortuously and difficulty in fixing the organ was overcome recently with the use of double balloon and single balloon enteroscopes. Capsule enteroscopes which after swallowing telemetrically transmitted images to a recorder makes diagnosis of small bowel lesions a more
simpler affair. Lap assisted enteroscopy still has a role to play.
Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Scarless operations are the dream of any surgeon. This has
come true through with NOTES. Special endoscopic platforms and accessories now enable the surgeons or the endoscopist to access the peritoneum though the natural orifices like mouth, anus, vagina or urethra and remove or repair organs. Cholecystectomy, appendectomy and tubal
ligation are now performed. Sepsis and wound closures are issues under debate.
The process of biopsy and histopathology examination is at present an in vitro procedure. By attaching a laser microscopic probe to an endoscope and using light filters neoplastic areas are pinpointed and histological examination is done in vivo. The endoscopist need training in histopathology for the same. Chromoendoscopy is altering the light so as to obtain variable tissue penetration. This enables the endoscopist to see areas of dysplasia or metaplasia in a well defined manner.
As technology advances and newer medical gadgets come, we need hybrid specialists who has a subject knowledge and biotechnological base.