Gastrointestinal bleeding is a medical emergency that requires immediate attention due to its potentially life-threatening nature. In such critical situations, therapeutic endoscopy plays a crucial role in diagnosis, localization, and treatment. This blog aims to explore the significance of therapeutic endoscopy in managing gastrointestinal bleeding, including advanced endoscopy therapy techniques.

 

Understanding Gastrointestinal Bleeding

 

In gastrointеstinal bleeding, blood appear іn thе dіgеstive systеm. Numеrous condіtіons, such as pеptic ulcеrs, gastrіtіs, varices, and cancer, can cause this blееding. Common symptoms of gastrointestinal bleeding include hematemesis (vomiting blood), melena (dark, tarry stools), and hematochezia (bright red blood in stools). 

 

Anaemia, hypovolemіa, and occasіonally haеmorrhagic shock can also be consеquеnces of blееding. And they can range in sеvеrіty from mild to severe. Thеrеforе, іt іs essential to gеt medical help right away and get a proper diagnosis to start thе rіght treatment.

 

Therapeutic Endoscopy: An Overview

 

Therapеutic endoscopy is a minimally invasive procedure that can be used to diagnose and treat a variety of gastroіntestinal conditions. Unlike diagnostic endoscopy, which primarily aims to visualise and evaluate the digestive tract, therapeutic endoscopy involves actively intervening to control bleeding or manage other abnormalities. Common therapeutic endoscopy procedures include esophagogastroduodenoscopy (EGD) and colonoscopy. These procedures enable direct visualisation of the gastrointestinal tract and the application of various therapeutic techniques.

 

Advanced imaging techniques, such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), are valuable adjuncts in therapeutic endoscopy. EUS provides detailed imaging of the gastrointestinal wall layers and nearby structures, aiding in targeted interventions. ERCP allows access to the bile ducts and pancreatic ducts, enabling the management of conditions like biliary or pancreatic strictures or stone removal.

 

Advanced Endoscopy Therapy Techniques

 

There are various advanced endoscopy therapy techniques to treat gastrointestinal bleeding effectively and manage other conditions. Some notable techniques include:

 

Haemostasis

Haemostasis refers to the control of bleeding, and therapeutic endoscopy offers several methods to achieve it. Thermal coagulation uses heat to coagulate bleeding vessels, while hemoclipping involves placing clips on actively bleeding vessels to stop the bleeding. Injection therapy involves the injection of substances like epinephrine or sclerosants into bleeding sites to achieve haemostasis.

 

Endoscopic Resection

Some of the methods used to rеmovе polyps, tumours, or abnormal tissue іnclude еndoscopic mucosal rеsеction (EMR) and endoscopіc submucosal dіssectіon (ESD). These techniques offer a less invasive alternative to surgery in selected cases, allowing for accurate diagnosis, staging, and potentially curative treatment.

 

Luminal Dilation

Endoscopic balloon dilation is used to treat strictures or narrowings of the gastrointestinal tract, such as esophageal strictures or colonic strictures in conditions like Crohn's disease. This technique involves inflating a balloon within the narrowed segment, stretching it to restore normal luminal diameter.

 

Stenting

Self-expandable metallic stents can be placed endoscopically to alleviate obstructions in the digestive tract. These stents are particularly useful in managing strictures caused by tumours or in relieving blockages in the oesophagus, stomach, or intestines.

 

Enteral Nutrition

In cases where patients are unable to consume food orally, endoscopic techniques like percutaneous endoscopic gastrostomy (PEG) can be used to place a feeding tube directly into the stomach or small intestine. This allows for enteral nutrition, ensuring adequate nourishment for patients with swallowing difficulties or gastrointestinal abnormalities.

 

Therapeutic Endoscopy for Gastrointestinal Bleeding

 

Therapeutic endoscopy, which provides a variety of diagnostic and therapeutic optіons, іs essential in the management of gastrointestinal bleeding. Prompt intervention can be life-saving in severe bleeding cases. For instance:

 

Peptic Ulcers

Endoscopic therapy is highly effective in managing bleeding peptic ulcers, the most common cause of upper gastrointestinal bleeding. Techniques like thermal coagulation, hemoclipping, or injection therapy can achieve haemostasis and prevent recurrent bleeding.

 

Esophageal Varices

Esophageal varices, commonly seen in patients with liver cirrhosis, pose a significant risk of life-threatening bleeding. Therapeutic endoscopy enables the identification and treatment of these varices through techniques such as band ligation or sclerotherapy, reducing the risk of haemorrhage and its associated complications.

 

Diverticular Bleeding

Diverticula are small pouches that can develop along the walls of the digestive tract, particularly in the colon. If these diverticula bleeds, therapeutic endoscopy allows for identification and haemostasis through various methods, ensuring effective control of bleeding.

 

Success Rates and Complications

 

Therapeutic endoscopy has demonstrated high success rates in managing gastrointestinal bleeding. Studies have shown that endoscopic haemostasis achieves successful control of bleeding in most cases, reducing the need for more invasive procedures or surgery.

 

While therapeutic endoscopy is generally safe and associated with low complication rates, it is essential to be aware of potential risks. Complications can arise due to various factors, including patient characteristics, the complexity of the procedure, and inherent risks associated with endoscopic interventions. Some possible complications include:

 

Perforation

Perforation, though rare, is a serious complication that can occur during therapeutic endoscopy. It involves the creation of a hole or tear in the digestive tract wall. Factors such as the presence of underlying pathology, advanced endoscopic procedures like endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or inadequate skills of the endoscopist can increase the risk of perforation.

 

Infection

Infection following therapeutic endoscopy is uncommon but can occur, particularly if there is a breach in the mucosal barrier or contamination during the procedure. Strict adherence to infection control measures, such as proper sterilisation of instruments and adherence to aseptic techniques, helps minimise this risk.

 

Adverse Reactions to Sedation

Therapeutic endoscopy procedures often involve the use of sedation or anaesthesia to ensure patient comfort and cooperation. While sedation is generally safe, there can be rare instances of adverse reactions, such as respiratory depression, cardiovascular complications, or allergic reactions to medications used for sedation. Proper monitoring and administration of sedatives by experienced personnel help mitigate these risks.

 

Conclusion

 

Therapeutic endoscopy is a life-saving intervention for gastrointestinal bleeding, allowing for precise diagnosis and targeted treatment. Through advanced endoscopy therapy techniques, such as haemostasis, endoscopic resection, endoscopists can effectively manage bleeding sources and other gastrointestinal conditions. 

 

With its minimally invasive nature and high success rates, therapeutic endoscopy offers significant advantages over traditional surgical interventions. As technology continues to advance, further improvements in therapeutic endoscopy are expected, leading to enhanced outcomes and improved patient care in the future.

 

If you’re considering getting an endoscopy done, visit a super speciality hospital for expert treatment and management!