Gastroscopy is a medical procedure that allows doctors to examine the upper digestive tract, including the esophagus, stomach, and duodenum. Unlike a standard diagnostic gastroscopy, which primarily aims to detect abnormalities, a therapeutic gastroscopy goes further by enabling immediate treatment during the procedure. This combination of diagnosis and treatment makes gastroscopy an essential tool in modern gastroenterology.
During gastroscopy, a thin, flexible tube called an endoscope is inserted through the mouth and guided into the stomach. The endoscope has a light and camera, allowing the physician to visualize the digestive tract in real time. Additionally, the endoscope may have channels through which instruments can be passed to perform therapeutic interventions.
Common Indications for Therapeutic Gastroscopy
Therapeutic gastroscopy is often indicated when patients present with conditions that require immediate intervention. Some of the most common reasons include gastrointestinal bleeding, polyp removal, dilation of strictures, and removal of foreign objects.
For instance, patients with bleeding ulcers can benefit from gastroscopy because it allows the physician to locate the source of bleeding and apply treatment without delay. Similarly, polyps, which can be precancerous, can be removed during the same session, reducing the need for multiple procedures. Strictures, or narrowed sections of the esophagus or stomach, can be dilated to restore normal swallowing function.
Preparation for Therapeutic Gastroscopy
Proper preparation is crucial for a safe and effective therapeutic gastroscopy. Patients are usually instructed to fast for several hours before the procedure to ensure the stomach is empty. Fasting reduces the risk of aspiration and provides a clear view for the physician.
Medications may also be adjusted prior to gastroscopy. Blood-thinning drugs, for example, might need to be paused to minimize the risk of excessive bleeding during therapeutic interventions. Patients are encouraged to inform their physician about any medical conditions, allergies, or previous surgeries, as these can influence the approach taken during gastroscopy.
Sedation and Anesthesia During Gastroscopy
Therapeutic gastroscopy is typically performed under sedation or anesthesia to ensure patient comfort. The level of sedation can vary from mild, where the patient remains awake but relaxed, to deep sedation, where the patient is unconscious during the procedure.
Local anesthetics may also be applied to the throat to minimize discomfort as the endoscope is inserted. Sedation not only helps the patient remain calm but also allows the physician to perform intricate therapeutic interventions more safely and efficiently.
Hemostasis: Controlling Gastrointestinal Bleeding
One of the most critical therapeutic procedures performed during a gastroscopy procedure is hemostasis, or controlling gastrointestinal bleeding. Bleeding can result from ulcers, erosions, or varices in the esophagus or stomach.
During gastroscopy, several methods can be used to control bleeding. These include injecting medications directly into the bleeding site, applying thermal coagulation to cauterize the area, or using endoscopic clips to mechanically seal bleeding vessels. The ability to manage bleeding immediately during gastroscopy significantly reduces the risk of complications and the need for emergency surgery.
Polyp Removal and Biopsy
Polyps are abnormal tissue growths that may develop in the stomach or duodenum. While some polyps are benign, others can progress to cancer if left untreated. Therapeutic gastroscopy allows for the safe removal of polyps using a technique called polypectomy.
During polypectomy, specialized tools passed through the endoscope remove the polyp, which is then sent for pathological examination. In addition to polyp removal, gastroscopy can also be used to take biopsies of suspicious areas, helping to confirm or rule out malignancy without the need for invasive surgery.
Dilation of Strictures
Strictures are narrowings in the digestive tract that can cause difficulty swallowing or obstruct the passage of food. Gastroscopy provides a minimally invasive method to dilate these narrowed areas.
During the procedure, balloons or specialized dilators are guided through the endoscope and gradually expanded to stretch the stricture. This technique restores normal passage and improves the patient’s ability to eat and drink comfortably. Therapeutic gastroscopy for stricture dilation is especially beneficial for patients with conditions like peptic strictures or esophageal rings.
Removal of Foreign Objects
Accidental ingestion of foreign objects is a common reason for therapeutic gastroscopy. Coins, small toys, and other items can become lodged in the esophagus or stomach, posing serious health risks if not promptly removed.
Gastroscopy allows physicians to visualize and safely retrieve these objects using specialized tools, avoiding the need for open surgery. This intervention is particularly important in children and elderly patients, who are at higher risk for complications from ingested objects.
Management of Gastroesophageal Varices
Patients with liver disease or portal hypertension may develop gastroesophageal varices, which are swollen veins in the esophagus or stomach that can rupture and bleed. Therapeutic gastroscopy provides several options for managing varices.
Endoscopic band ligation, for example, involves placing small rubber bands around the varices to stop bleeding. Alternatively, sclerotherapy can be used, where a chemical solution is injected to shrink the varices. These procedures performed during gastroscopy can be life-saving for patients at risk of severe gastrointestinal bleeding.
Post-Procedure Care
After a therapeutic gastroscopy, patients are closely monitored until the effects of sedation wear off. Minor throat discomfort or bloating may occur, but these symptoms typically resolve within a few hours. Patients are advised to follow specific dietary guidelines immediately after the procedure, such as starting with soft foods and avoiding alcohol or irritants.
Any signs of complications, including persistent bleeding, severe abdominal pain, or fever, should prompt immediate medical attention. Follow-up appointments are often scheduled to ensure the effectiveness of the treatment and monitor recovery.
Advantages of Therapeutic Gastroscopy
Therapeutic gastroscopy offers several advantages over traditional surgical interventions. Because the procedure is minimally invasive, it reduces recovery time, hospital stays, and overall risk of complications. The ability to diagnose and treat conditions in a single session is particularly valuable in urgent situations, such as active gastrointestinal bleeding.
Furthermore, therapeutic gastroscopy allows physicians to take precise, targeted action, reducing the likelihood of unnecessary procedures. The visual guidance provided by the endoscope ensures that treatment is delivered directly to the affected area, increasing safety and effectiveness.
Risks and Considerations
While therapeutic gastroscopy is generally safe, it is not without risks. Potential complications include bleeding, perforation of the digestive tract, infection, and adverse reactions to sedation. The risk of complications is higher in patients with severe underlying conditions or when complex therapeutic interventions are performed.
Patients should discuss their medical history thoroughly with their physician and understand both the benefits and risks before undergoing gastroscopy. With careful preparation and skilled execution, the benefits of therapeutic gastroscopy often far outweigh the potential risks.
Conclusion
Therapeutic gastroscopy represents a significant advancement in the management of upper gastrointestinal conditions. By combining diagnosis and treatment in a single procedure, gastroscopy allows for immediate intervention in cases such as bleeding, polyp removal, stricture dilation, and foreign object retrieval.
Preparation, sedation, and post-procedure care are essential components to ensure the safety and effectiveness of therapeutic gastroscopy. The procedure’s minimally invasive nature, combined with its ability to address multiple gastrointestinal issues, makes it a cornerstone of modern gastroenterology. Patients benefit from faster recovery, reduced complications, and prompt relief of symptoms, highlighting the vital role of gastroscopy in contemporary medical practice.
