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ADVANCES IN DIGESTIVE DISEASES

Anil Minocha M.D.; FACP

 

About the author

Dr. Minocha (http://www.diagnosishealth.com/minocha.htm) is the Chief of Gastroenterology at the Southern Illinois University School of Medicine in Springfield, IL, and is the author of How to Stop Heartburn; Simple Ways to Heal Heartburn and Acid Reflux.

 The year 2000 saw the advent of several new and exciting devices and procedures for the management of digestive diseases.

WIRELESS ENDOSCOPY

The future of endoscopy may be wireless endoscopy. A tiny capsule/camera has been developed, which can be swallowed by an awake patient. This high-tech capsule is like the Hubble Telescope, except that it is meant to look inside the gut. Inside it is a computer-chip as well as an antenna. This device, while travelling down the digestive tract transmits intestinal images outside the patientís body.

The patient wears a receiver set around his waist like a holter monitor for the heart. The images are beamed to this receiver and stored. These stored images are downloaded on to a computer and then be examined by a physician. The device will eliminate the need for an endoscopy in the not too distant future.

What happens to the swallowed camera/capsule? Think of it as the pill that never got digested. The camera travels down the entire digestive system and passed through feces. And no, you donít have to look out for it and retrieve it for later use. Itís disposable.

As of this writing, only a handful of people have had this device tested on them, and it has only been used for the small intestine.

Bard Endoscopic Suturing System

Bard Endoscopic Suturing System (Endocinch) was released by the Food and Drug Administration (FDA) in March 2000. This procedure provides long-term definitive treatment for chronic acid reflux disease. Simply put, it does what the surgeons do without requiring any incision in your body. In addition, the recovery period is much faster than with even the mini-surgery also known as Laproscopic Nissen's fundoplication used for antireflux surgery.

Endocinch procedure is performed using traditional endoscopic methods. A suturing device is attached to the end of an endoscope. In a sewing machine manner, the doctor applies multiple sutures at the lower esophageal sphincter between the esophagus and stomach in a pleat-like fashion to make it tighter and prevent reflux of stomach contents. Just as in any other endoscopy, patients can return to work the next day. The procedure is expected to be less costly than antireflux surgery.

 

Stretta Procedure

Another new procedure approved by the FDA for acid reflux is the Stretta procedure. Similar to the Bard system, it is a nonsurgical procedure. Instead of using a suturing system, it uses thermal energy generated by radiofrequency waves.

The position of the lower esophageal sphincter is determined using an endoscope. A catheter with electrodes is passed through the mouth, into the esophagus and positioned at the level of the sphincter. Tiny needles stick out from the catheter. Electrodes transmit powerful radiofrequency waves aimed at the sphincter. This produces thermal injury and damages the sphincter.

The injured sphincter heals by scarring resulting in a shrunken, tightened sphincter. The taut sphincter becomes more efficient in decreasing acid reflux. This procedure is done in one sitting and patient resumes normal activities the next day. Retreatment every few years may be required.

In my opinion, you should not rush to get the Endocinch or the Stretta procedure for the treatment of your reflux until physicians are more experienced in performing the procedures. As with any procedure, usually there is a learning curve- the more experienced the physician is in doing the procedure, usually the more optimal the outcome.

Although many centers have purchased these devices, there are very few physicians who have actually performed the procedure more than a couple of dozen times. Additionally, since these procedures are new, studies on their long term safety and efficacy are lacking.

Endoscopic surgery

Current abdominal surgery requires accessing the internal organs through a big incision or laprascopically made multiple small incisions through abdominal skin and muscles. In the future, access to internal abdominal organs would be obtained by inserting an endoscope through the mouth into the stomach and making an incision in the stomach to gain access to the neighboring internal organs and fixing the problems. Since no abdominal wall is cut, there is no pain involved. Experiments in animals have been successful.

Enterra Therapy

Just like pacemakers implanted in the heart, this is a gastric pacemaker available on limited basis for patients with severe gastroparesis (slowing of stomach emptying). This device is implanted in the stomach, and it improves gastric emptying by artificially pacing the stomach to empty.

Stay tuned!

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