Often, during a diagnostic endoscopy procedure meant just to look for sources of signs or symptoms, sources are found and the endoscopy becomes a therapeutic endoscopy. An endoscope is a medical flexible tube with a light and camera inside that allows a specialist to look down the throat and view the esophagus, stomach and duodenum at the top of the small intestine, or into bronchial passages and upper lungs. If noncancerous polyps, gastrointestinal bleeding, strictures, or early stage malignant tumors are found, surgical instruments can be inserted through the endoscope to perform procedures to remedy the problems. The two most common treatments using an endoscope are to search for and stop any bleeding anywhere in the gastrointestinal (GI) tract, or to stretch and widen an esophagus partially blocked by strictures or growths that cause swallowing difficulties.
Preparations for having a therapeutic endoscopy include no food for eight hours before the procedure and no water up to two hours prior. Nail polish on hands or feet should be removed as nails offer a monitor of oxygen levels and a small medical device to be attached to one of the fingers cannot attach to polish. The procedure will be performed under heavy sedation or under a light general anesthetic; therefore, someone who can drive home and monitor the patient for at least 12 hours later should accompany the patient. Most important, any current medications, whether prescription or over the counter, including aspirin, should be disclosed beforehand to the endoscopic staff for instructions what can be taken before or after the procedure; particularly, any diabetes or blood-thinning medications must be disclosed.
Treatments, besides the ones already mentioned, can include injection therapy, mechanical or tamponade therapy, or ablative therapy. Injection therapy is usually epinephrine, which prepares the tissues surrounding any GI bleeding for a local tamponade, which will induce clotting. Care must be taken as epinephrine can cause angina or coronary artery vasospasming due to effects from the endoscopic procedure pressures, and a myocardium that has been stressed by bleeding can restrict more blood flow, leading to angina, tachycardia, arrhythmias and hypertension.
Endoscopic balloons can dilate a narrowed esophagus, and polyps are snared and snipped. For bleeds, ablative therapies can use intense thermocoagulation energies, electrocoagulations, or excited electrons in an argon plasma coagulation (APCs) to focus such energy to tissues that they cauterize the wound or seal a bleeding vessel. Mechanical therapies involve the use of metallic hemoclips or endoclips that pinch off bleeds as sutures or a tourniquet would.
There are new developments in techniques for therapeutic endoscopy for those suffering from Barrett’s Esophagus, a condition beyond gastroesophageal reflux disease (GERD), which is a precancerous condition that must be carefully monitored long-term. APCs have proved unproductive to treat the damaged tissues, as relapse is common. One idea in trial in 2011 is circumferential radiofrequency ablation, which allows large tissue areas to receive treatment uniformly for better results. Another therapeutic endoscopy treatment in early trial is called transoral gastroplasty. It involves the techniques of bariatric stapling to assist in restricting the diets of patients with morbid obesity.
Risks and possible complications from therapeutic endoscopy can include adverse reactions to sedatives or anesthetics used for the procedure or infections. Additionally, intestinal or GI perforations or tearing can occur. Reactions to sedatives can include severe nausea and vomiting, irregular heartbeats, breathing difficulties and more rarely, strokes. Bacterial infections such as endocarditis can travel to the heart; the symptoms of endocarditis include: high fever and associated chills, heart murmur, night sweats, muscle and joint aches, and extreme fatigue.
