The subject of Gastroenterology has advanced in leaps and bounds. The most exciting developments have occurred in the branch of endoscopy. Procedures which could only be performed by long and complex surgeries can now be safely done with an endoscope. Parts of our anatomy which were earlier thought to be in-accessible can now be clearly visualized after swallowing a capsule or with the help of an endoscopic ultrasound. To know more about some of these fascinating modalities, read on Advances in Endoscopy by our Consultant Gastroenterology, Dr. Tarun Gupta.

1. Advances in endoscopy
Dr Tarun Gupta MRCP [UK], DNB [Med], DNB [GI]
Consultant Gastroenterologist
P.D. Hinduja Hospital [Mahim, Mumbai]
Hinduja Healthcare Surgical [Khar, Mumbai]

2. Advances in endoscopy
• Gastroenterology has advanced in leaps and
bounds
• Exciting progress has been made especially in
the branch of endoscopy over the last decade
– Technological advances
– Better understanding of interventional techniques

3. Small bowel capsule endoscopy[SBCE]
• Traditional endoscopes only reach the first
three feet of the small bowel
• With this technology, doctors can view the
entire length of the small and now the large
intestine
• A small capsule containing a camera and a
CMOS chip is swallowed by the patient
• As it flows through the digestive system, it
takes 3 pictures per second

4. Performance
1. Overnight 12 hour fast
2. Sensors placed on patient
3. Patient wears a belt that contains a battery pack
and data recorder.
4. Patient ingests capsule around 8am
5. Patient may have clear liquids two hours after
ingestion
6. A light lunch is allowed4 hours after ingestion
7. Patient returns 7-8 hours later
8. Capsule is excreted in stools

7. Indications
• Intestinal bleeding
– Overt obscure or occult
• Detection of polyps, intestinal cancers
• Inflammatory pathology
– Crohn’s disease
• Evaluation of intractable abdominal pain
• Colon capsule
– Instead of screening colonoscopy

8. Endoscopic ultrasound [EUS]
• Combination of endoscopy with ultrasound
technology
– Ultrasound transducer is at the tip of the
endoscope
– Combination of technology allows us to see the
layers of the wall of the digestive tract and the
surrounding organs very clearly
– Requires a high level of expertise

9. EUS
• Radial EUS
– Diagnostic instrument
– Staging and detecting early cancers of the
digestive tract, and the surrounding organs
– Gall bladder and bile duct stones

10. EUS
• Linear EUS
– Diagnostic
• Tissue acquisition for pathology
– Therapeutic
• Drainage of intra-abdominal collections
– Pancreatic collections, abscesses
• Bile duct drainage
• Pancreatic duct drainage
• Pain management

14. Advanced therapeutic endoscopy

15. Intra-gastric balloon

16. Ampullectomy

19. Conclusions
• Organs surrounding the digestive tract can
now be visualized better than a CT scan or
MRI
• Procedures which would have required
prolonged and complex surgery are now
within the realms of therapeutic endoscopy
– Lesser costs
– Lesser duration of in-patient stay

20. THANK YOU