Gastroenterology

Gastroenterologic procedures progress over the years and find wider area of usage. Endoscope quality has improved as the basis of endoscopic diagnosis. Over 20 years have passed since the development of the videoscope. Compared to diagnostic procedures using other medical instruments, the great advantage of endoscopes lay in things like enabling more accurate diagnosis through the taking of biopsies, and minimally invasive therapy such as the use of endotherapy instruments to remove polyps. Nowadays, it is possible not only to diagnose whether lesions are benign or malignant, but also to make on the spot treatment decisions based on factors such as their size, depth, and how atypical they are.

Sedation is frequently used to minimize anxiety and discomfort, during the endosocopy procedure. Sedation is a state of sleepiness, and is commonly given before an endoscopic procedure.

Endoscopy allows examination of the esophagus, stomach, and duodenum. Diagnostic observations are made concerning focal benign or malignant lesions, gastritis ulcers and helicobacter pylori infection. Helicobacter pylori is a bacteria which lives in human stomach and can cause gastritis, ulcers and also gastric carcinoma. It may also cause upper abdominal pain, belching, nausea, vomiting and abdominal bloating. When we reveal the presence of the microbe we have to kill it.

Endoscopy absolute indications (Alarm symptoms):

1. New onset symptoms starting more than 50 years old
   
2. Family history of esophageal or gastric cancer
   
3. Unintended weight loss
   
4. Persistent vomiting or vomiting with blood
   
5. Bloody or black stools
   
6. Difficulty in swallowing
   
7. Iron deficiency anemia
   
8. Diarrhea in patients suspected of having small-bowel disease (eg, celiac disease)

Endoscopic procedures can be used for diagnostic and also therapeutic purposes. Common therapeutic endoscopic procedures include polypectomy, dilation of strictures, stent placement, removal of foreign bodies, gastrostomy (for patients cannot swallow), treatment of GI bleeding with injection, banding, coagulation, sclerotherapy, and removal of limited malignant lesions.

Colonoscopy allows examination of the entire colon and rectum and frequently the terminal ileum. Screening colonoscopy should be performed everyone older than 50 years old. With colonoscopic examination we can detect polyps and remove them. (Polyps can turn to cancer in 5-10 years. After removal of the polyps cancer risk approaches zero). Follow-up colonoscopies should be done in several years depending on the polyp type. The diagnosis of other disease of the colon (like ulcerative colitis) can be made by this method.

Colonoscopy is generally indicated in the following circumstances:

1. Evaluation of unexplained GI bleeding (after an upper GI source has been excluded)
   
2. Presence of fecal occult blood
   
3. Unexplained iron deficiency anemia
   
4. Screening and surveillance for colonic neoplasia (>50 years old, if family history of colon cancer or colonic polyps 10 years earlier than the index family member)
   
5. Clinically significant diarrhea of unexplained origin

Colonoscopic examination: Ulcerovegetan mass lesion

Endoscopic retrograde cholangiopancreatography, or ERCP, is a diagnostic procedure designed to examine diseases of the liver, bile ducts and pancreas. ERCP is performed under intravenous sedation, usually without general anesthesia. Frequently, therapeutic measures can be performed at the time of ERCP to remove stones in the bile ducts or to relieve obstruction of the bile ducts.

During ERCP, endoscope will pass through your mouth, esophagus and stomach into the small intestine. After finding of common bile duct at the second part of the duodenum, entrance of bile duct will be dilated and stones will be removed.

ERCP is generally indicated in:

1. Jaundice
2. Common bile duct stones
3. To drain the obstructed bile ducts due to tumor of strictures and to place the stents

ERCP, Stones in the common bile duct

ERCP, Stone removal

Endoscopic ultrasound (EUS) is a technique whereby an US transducer is incorporated into the tip of the endoscope. This provides high-resolution images of the GI wall and adjacent structures. Endoscopic ultrasound (EUS)-guided sampling, including EUS-guided fine needle aspiration (EUS-FNA) can be performed in submucosal tumors, pancreatic solid masses and cystic-appearing lesions, and other gastrointestinal tumors.

EUS is generally indicated for:

1. Staging tumors of the GI tract, pancreas, bile ducts.
   
2. Evaluating abnormalities of the GI tract wall or adjacent structures.
   
3. Tissue sampling of lesions within, or adjacent to, the wall of the GI tract.
   
4. Evaluation of abnormalities of the pancreas, including masses, pseudocysts, cysts, and chronic pancreatitis.
   
5. Evaluation of abnormalities of the biliary tree.

Endoscopic ultrasound staging of the colonic lesion

Small-bowel video capsule endoscopy is the first-line investigation in patients with obscure gastrointestinal bleeding. Other common usage areas are suspected small intestinal tumors and refractory malabsorptive syndromes.

Double balloon enteroscopy is an effective and safe technique for small-bowel examination. With this technique, we can diagnose suspected small bowel lesions, as well as, we obtain the biopsies. We sometimes make treatment depending on the lesion.