Therapeutic endoscopy is a developing field of study. Its usage for treatments like polypectomy, papillotomy, and the removal of foreign bodies is universally established, while more recent techniques like endoscopic hemostasis and injectable sclerotherapy for esophageal varices are still debatable.
What is Endoscopic Therapy?
Treatments carried out with an endoscope are collectively referred to as endoscopic therapy. A tiny incision or other body openings, such as the mouth, is used to put an endoscope, thin, tube-like equipment, into the body. An endoscope comprises a lit camera that sends images of your body inside to a video screen the doctor can see. Many diseases are examined and treated by doctors using endoscopes. Minimally invasive procedures are guided by the endoscope and involve the use of tiny tools or drugs. Peptic ulcers, gallbladder diseases, appendicitis, colon polyps, and endometriosis are among the common disorders managed using endoscopes.
Types of Endoscopic Therapy
The following procedures include the use of endoscopic therapy:
- Arthroscopy. An endoscope is inserted through a tiny incision close to a joint during arthroscopy to treat joints.
- Bronchoscopy. To treat lungs and airways an endoscope is inserted into the throat and lungs through the mouth or nose to perform the procedure. In addition to removing inhaled foreign bodies from the lungs, your doctor can obtain tissue or fluid samples for diagnostic purposes.
- The large intestine is treated using colonoscopy and sigmoidoscopy. During these procedures, the large intestine is accessed through the anus with an endoscope.
- The urethra, bladder, and ureters of the urinary system are treated via cystoscopy and ureteroscopy. Endoscopes are inserted via the urethra into the bladder and possibly the ureters during these procedures.
- Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopy that is done through the mouth. The esophagus, stomach, and duodenum are all entered by the endoscope. It treats pancreatitis and gallstones.
- Laparoscopy is used to treat the pelvis or abdomen. It entails making a tiny incision in the abdomen or pelvis and placing an endoscope through it.
- Treatment for the esophagus, stomach, and duodenum (the first portion of the small intestine) is provided through upper gastrointestinal endoscopic therapy. It is known as an esophagoscopy if only the esophagus is affected. Esophagogastroduodenoscopy (EGD) is the term used when all of these organs are examined. An endoscope is inserted through the mouth into the esophagus, as well as the stomach and duodenum, during the surgery.
Other Procedures Performed
Endoscopic therapy involves inspecting the affected part of the body and taking digital photos that are recorded in your health record. A biopsy, which involves removing a sample of tissue to check for disease or cancer, may also be conducted by your doctor.
Endoscopic Therapy Indications
The following conditions and diseases may benefit from endoscopic therapy, as recommended by your doctor:
- Abdomen, pelvic tumors, or cancer, as well as diseases affecting the gynecological and pelvic organs, such as the repair of hernias and removal of the appendix, gallbladder, spleen, uterine fibroids, endometrial tissue, ovarian cysts, and abdominal or pelvic tumors.
- Joint and orthopedic diseases including rotator cuff repair, carpal tunnel syndrome, loose bones or cartilage, and torn or injured tendons, ligaments, or cartilage are all examples of these.
- Lower gastrointestinal problems, such as the management of colonic bleeding and the resection of colon polyps.
- Conditions of the lungs and airways, such as opening a restricted airway, draining a lung abscess, placing a stent to keep an airway open due to obstruction from a malignant tumor, removing a foreign body from the airway, or removing too much fluid or mucus
- Upper gastrointestinal diseases that can be treated include extraction of polyps and foreign objects, widening of a narrowed esophagus, therapy of Barrett's esophagus, esophageal cancer, stopping bleeding from esophageal varices and peptic ulcers, and gallstone removal.
- Diseases affecting the urinary system, include the treatment of kidney stones.
Who Performs Endoscopic Therapy?
- Endoscopists are specialists in a particular branch of medicine and a particular endoscopic technique. They consist of:
- Critical care medicine doctors are experts in the diagnosis and treatment of potentially fatal disorders.
- Gastroenterologists are internists or pediatricians who specialize in digestive illnesses.
- General and pediatric surgeons who are involved in the surgical treatment of conditions, wounds, and abnormalities affecting the stomach, breasts, digestive system, endocrine system, and skin.
- Obstetricians and gynecologists are medical professionals who specialize in problems with the female reproductive system.
- Orthopedic Doctors who deal with bone and joint disorders.
- Pediatricians or internists who specialize in lung illnesses are referred to as pulmonologists.
- Thoracic surgeons operate on the chest.
- Urologists and pediatric urologists are doctors who deal with urinary and reproductive systems.
Endoscopic Therapy Preparation
You are a key player on your healthcare team. The preparation you do before surgery can enhance your comfort, improve the procedure's results, and help you get the most precise test results. To be ready for endoscopic therapy, do the following:
- Addressing all questions on your medical background and current medications. This covers prescription medications as well as over-the-counter medicines, herbal remedies, and vitamins. Carrying a current list of your medical issues, prescriptions, and allergies is a smart idea.
- Observing preoperative instructions, such as abstaining from food and liquids before a procedure or taking a laxative or enema as instructed.
- Using or discontinuing medication as advised. This may involve abstaining from the use of blood thinners, ibuprofen (Advil, Motrin), certain vitamins, aspirin, and other drugs. You'll receive instructions from your doctor on how to take your drugs and supplements.
Endoscopic Therapy Procedures
Your endoscopic therapy will be carried out in a hospital, outpatient surgery center, or doctor's office. Sedation or nerve block anesthesia is used during some forms of endoscopic therapy. Some operations are more complicated and need a hospital stay and general anesthesia.
Depending on the operation, your symptoms or diagnosis, and other circumstances, the endoscopic therapy technique differs. The endoscope is inserted into the body through a tiny incision or an opening, such as the mouth, to perform endoscopic therapies:
- In an arthroscopy, an endoscope is inserted through a small incision close to a joint. An orthopedic surgeon handles it. Depending on the procedure, a general, spinal, or local anesthetic is used.
- An endoscope is inserted into the throat and lungs during a bronchoscopy through the mouth or nose. A thoracic surgeon or a pulmonologist performs it. Depending on the treatment, either general anesthetic or sedation is used during the treatment.
- Endoscopes are inserted into the large intestine through the anus during colonoscopy and sigmoidoscopy procedures. They are often carried out by a surgeon or gastroenterologist. To reduce discomfort and anxiety, sedatives are frequently employed.
- An endoscope is inserted via the urethra into the bladder and perhaps the ureters during cystoscopy or ureteroscopy. A urologist typically performs these procedures. The urethra is numbed with a local anesthetic.
- Through the mouth, an endoscope is inserted during endoscopic retrograde cholangiopancreatography (ERCP) into the esophagus, stomach, and duodenum.
- Sedatives are frequently used to ease discomfort and anxiety. The throat may be numbed using a local anesthetic.
- An endoscope is inserted during a laparoscopy through a tiny abdominal or pelvic incision. Obstetrician-gynecologists, general surgeons, or abdominal surgeons typically perform it. To make sure you don't experience any discomfort during the surgery, general anesthetic or spinal anesthesia is administered.
- An endoscope is inserted through the mouth into the esophagus, stomach, and sometimes the duodenum, the first part of the small intestine, as part of upper gastrointestinal endoscopic therapy. The gastroenterologist typically performs it. Sedation is frequently used to alleviate discomfort and anxiety. The throat may be numbed using a local anesthetic.
Is Endoscopic Therapy Painful?
Both you and your care team value your relaxation and comfort. With some procedures, you can experience minor discomfort. Your pain or discomfort will be treated by your doctor. If you feel any type of discomfort, let your care staff know. For comfort during endoscopic therapy, you may take one or more of the following drugs:
- Gases and IV drugs (a combination of general anesthesia) send you into a deep sleep. You are not aware of the procedure and experience no discomfort. In addition to a general anesthetic, you might also get an infusion for a peripheral nerve block. A continuous drip of liquid anesthesia or injection can be used to perform a peripheral nerve block. To reduce discomfort during and after surgery, a small tube will be inserted close to your surgical site.
- Oral or intravenous administration of painkillers is available.
- Regional anesthesia (nerve block). It involves administering an anesthetic via injection near certain nerves to numb a large portion of the body. Your doctor injects the anesthesia into the skin and tissues surrounding the procedure site (local anesthesia) to numb a smaller area. To keep you at ease and comfortable, sedation with a regional anesthetic is likely to be used.
- Sedation is usually administered through an IV line. It relaxes and calms you to sleep. Deeper sedation, sometimes known as conscious sedation, may be used in particular circumstances. You feel calmer as a result. Conscious sedation patients typically aren't aware of the process and may not remember it afterward.
- A topical anesthetic is delivered to the skin or mucosa's surface. For example, you can rinse or spray an anesthetic down your throat to assist numb it and lessen your gag reflex.
Endoscopic Therapy Risks
Endoscopic therapy carries risks and potential consequences, much like all operations. Although complications are rare, they can occasionally be significant and life-threatening. During surgery or recovery, complications can arise. Endoscopic therapy side effects include:
- Negative reactions or issues caused by sedatives or drugs, such as an allergic reaction or breathing issues.
- Tearing or perforation of the tissue
Depending on the endoscopic therapy, there could be potential complications:
- Blood clots, excruciating joint pain and swelling, and injury to blood vessels or nerves are all possible side effects of arthroscopy.
- A sore throat, a hoarse voice, a high temperature, pneumonia, and pneumothorax (collapsed lung due to air leak) may follow a bronchoscopy.
- The use of enemas and laxatives before colonoscopy or sigmoidoscopy might cause nausea, vomiting, rectal pain, perforation of the large intestine, bleeding, and dehydration.
- Urinary tract infection (UTIs) and bloody urine might be side effects of cystoscopy and ureteroscopy.
- Endoscopic retrograde cholangiopancreatography (ERCP) can cause bleeding due to local tissue trauma, sore throat, pancreatitis, penetration of the upper gastrointestinal system, and trouble swallowing.
- A further surgical procedure can be necessary to repair blood vessels or organ damage caused by laparoscopy.
- Due to local tissue trauma, upper gastrointestinal endoscopic therapy may cause bleeding, sore throat, trouble swallowing, and perforation of the upper gastrointestinal tract.
How to Lower Endoscopic Therapy Risks?
By adhering to your treatment plan, you can lower the risk of some complications, and you can also:
- Limits on exercise, nutrition, and lifestyle, as well as recommendations for these before surgery and throughout recovery.
- Notifying your physician as soon as you have any worries, such as bleeding, fever, or pain increasing.
- Take your prescriptions as prescribed.
- Notifying every member of your care team of any allergies you may have.
Endoscopic Therapy Recovery
It will be easier for you to return to normal life as quickly as possible if you are aware of what to anticipate after endoscopic therapy. Your post-endoscopic therapy symptoms will change depending on the procedure, your medical history, and other variables.
Following some treatments, you might experience discomfort or agony. Rest confident that current pain management techniques are highly effective. For you to feel comfortable and obtain the rest you require; your doctor will manage your pain. If your discomfort worsens or changes in any way, call your doctor right away since it could be an indication of a problem.
If you have narcotic painkillers, a sedative, or general anesthesia, you might experience sleepiness for around 24 hours. You might also feel a little queasy. If you feel queasy, let your medical team or doctor know so that it may be managed.
After receiving endoscopic therapy under regional or local anesthesia (nerve block), you can experience some temporary numbness. If the numbness lasts longer than it should after your specific procedure, let your doctor or the care team know.
After surgery, you'll remain in the recovery area until your vital signs are stable, you're breathing normally, and you're awake. If a tube was inserted into your windpipe during surgery, you can experience a sore throat. Tell your care team if you feel uncomfortable even though this is typically just temporary. An outpatient procedure means that you will return home the same day. For 24 hours, you won't be able to drive because of tiredness. You will need transportation home, and someone should accompany you on your first day. After long procedures including some types of arthroscopy, bronchoscopy, and laparoscopy, a hospital stay may be necessary.
When to Call The Doctor?
After receiving endoscopic therapy, it's critical to keep your follow-up sessions. If you have any queries or concerns in between visits, speak with your doctor. Call your doctor immediately away, or get immediate medical help if you have:
- Bleeding, including rectal bleeding, bloody or black feces, or bloody vomiting.
- Bloody urine or trouble urinating should be addressed, especially if it worsens once you arrive home or does not subside as expected.
- Breathing issues such as wheezing, labored breathing, shortness of breath, and difficulty breathing.
- A shift in alertness, such as fainting, being unresponsive, or becoming confused.
- Palpitations, tightness, pressure, or discomfort in the chest.
- Cough that didn't stop.
- Fever. After a short endoscopic treatment, you shouldn't have a high temperature, but after a long laparoscopic procedure, a low-grade fever is typical for a few days and isn't always an indication of postoperative infection. When to call for a fever, however, should be done according to your doctor's specific advice.
- Lacking the ability to urinate or defecate.
- Especially in the calf, leg pain, redness, or edema may be signs of a blood clot.
- Pain that your painkillers are unable to manage.
- Longer-than-expected sore throat or hoarseness.
- Unexpected bleeding, pus, edema, or redness around your incision.
Endoscopic therapy refers to an endoscopic procedure during which treatment is provided through the endoscope. In contrast, diagnostic endoscopy's sole purpose is to see a portion of the digestive, respiratory, or urinary tract to aid in diagnosis. According to the findings, a procedure that begins as a diagnostic endoscopy may change to a therapeutic endoscopy, as in situations of upper gastrointestinal hemorrhage or the detection of polyps during a colonoscopy.