Gastrointestinal System Advanced Endoscopic Diagnosis and Treatment

Assoc. Dr. Erdem Akbal gave information about digestive system diseases and effective gastrointestinal methods applied in these diseases.

What is achalasia?

Achalasia is a disease of unknown cause, caused by the destruction of nerve cells, which causes abnormal functioning of the muscles in the esophagus. As a result of the damage to the nerve cells, the esophagus normally does not have the regular muscle contractions necessary to push the food into the stomach. At the same time, there is thickening of the muscles of the esophagus, which is located at the junction of the esophagus and the stomach. Due to the non-contraction of the muscles in the esophagus, the ingested food has difficulty in being pushed down, and the passage of food into the stomach is impaired.

How does the disease develop? What are the symptoms?

Although the disease is a slowly progressing disease, it causes conditions such as lung infections as a result of patients getting stuck in the chest after eating, feeling of congestion, food coming back from the mouth, escaping into the lungs. In advanced disease, there is almost no passage of food from the esophagus to the stomach.

What tests should be done when diagnosing achalasia?

Investigations such as barium radiographs, high-resolution esophageal and lower sphincter pressure measurements (High Resolution Manometry-HRM), and computed tomography can be performed.

Which method is used in the treatment of Achalasia Disease?

Peroral endoscopic myotomy is an advanced endoscopic treatment method used in achalasia or some esophageal diseases. The muscles in the esophagus affected by achalasia are intervened endoscopically, allowing the patient to eat again.

Treatment methods

Digestive system polyps or cancers: Digestive system cancers are one of the most important public health problems in our country and in the world. The earlier the disease is caught, the higher the success rate of treatment. For this reason, endoscopic screening is recommended in national and international guidelines, even in people who do not have any complaints after the age of 45. According to certain risk factors and complaints of people, endoscopic screenings are performed at an earlier age. Endoscopic mucosal resection and endoscopic submucosal dissection methods can be removed without surgery in cancers and polyps detected at an early stage in endoscopic scans.

Gastroesophageal reflux disease and Barret’s Esophagus: Endoscopically applied Stretta method is used in reflux disease. In Barret’s Esophagus, radiofrequency ablation, endoscopic mucosal resection or endoscopic submucosal resection methods are applied mainly depending on the size of the lesion and the pathology results.

Unexplained bleeding and small bowel diseases: With standard endoscopes, only a part of the small intestine, which is approximately 4-6 meters long, can be seen. Diagnosis and treatment of small bowel diseases are performed with capsule endoscopy or balloon enteroscopy methods.

Can you talk about new development methods in endoscopy?

With the introduction of new generation endoscopes, great progress has been made in the identification and treatment of lesions. Many lesions that previously required surgery for removal can now be removed endoscopically.

How are early-stage cancers and lesions at risk of cancer diagnosed? Can you give information about the treatment?

Endoscopic mucosal resection (EMR) and Endoscopic Submucosal Dissection are advanced endoscopic methods used for the removal of early stage tumors or polyps in the esophagus, stomach, small intestine and large intestine. EMR and ESD procedures are performed with devices called endoscopes equipped with high resolution video cameras and other devices. Endoscopically, the endoscopic appearance, classification and determination of the area to be removed are determined, and the entire lesion is removed endoscopically as a single piece or piece by piece. In this way, early-stage cancers and lesions are treated endoscopically without the need for surgery.

In which diseases is EMR-ESD applied?

  • In esophageal polyps and early-stage cancers
  • Barret’s esophagus (in high grade dysplasia and intramucosal cancers)
  • Polyps in the stomach or early stage cancers
  • In small intestine polyps
  • Polyps in the large intestine, early stage cancers

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