New uses for endoscopy

Braquitherapy guided by ecoendoscopy has enabled a therapeutic approach to injuries, hitherto inaccessible by other means.

Braquitherapy involves the local administration of radiotherapy by means of the implantation of radioactive seeds. It involves a technique used in treatment for cancer of the prostate gland, uterus, bronchial tubes and other locations. The technique developed at the University of Navarra University Clinic enables access to tumorous lesions in the area along the digestive tract. Some of these damaged tissues are in areas difficult to access percutaneously or even through surgery. Thanks to the development of ecoendoscopy, we can gain access to many locations from the oesophagus, the stomach, the duodenum or the colon – without affecting the vital organs.

To date the University of Navarra University Clinic has dealt with two cases, both with good results. The treatment involves a low-invasive procedure that opens new therapeutic perspectives for many lesions that otherwise would not have effective treatment.

Reflux treatment

The second application involves the endoscopic fundoplication for the treatment of the gastroesophagael reflux. To date the endoscopic techniques have not enabled a transmural suture to be effected (i.e. one that completely penetrates the digestive wall), and so the sutures disappeared only after three or four years.

Recently, in the United States, this first transmural technique was about to be applied but with the limitation of a maximum of two sutures. However, with the advance in medical engineering, an endoscopic transmural suture has been developed that enables 10 or 12 sutures to be carried out. Unlike conventional procedures, known as fundoplication surgery, this technique has the advantage of gaining access to the lesion via the mouth, without the need for surgery.

To date the most effective gastroesophagael reflux treatment has been with surgery although, according to prestigious publications, after ten years up to 50-60% of the patients need medical treatment again. The endoscopic transmural suture can offer the same results as surgery but with less complications, cost and aggression that a surgical operation involves.

Treatment of obesity

Another novelty with the endoscopic approach is as an alternative to surgery for obesity. Surgical operation is the treatment of choice by patients suffering from morbid obesity. However, it has to be remembered that this is complex and aggressive, with a significant risk factor involved.

There are a number of endoscopic techniques: some aim to reduce the size of the stomach, thus provoking the sensation of satiation; others involve communicating part of the stomach with a distal zone of the small intestine, resulting in less absorption of nutrients.