Technological innovation has been a cornerstone of gastroenterology .Over the past few decades, exciting strides forward in GI/endoscopy technology are the biggest advancements in the field.
These advancements are the product of better technology, better equipment and innovative uses of the improved technology. One of the most important and widely embraced improvements is in endoscopic image clarity.
On the diagnostic side:
Florescence endoscopy, chromo endoscopy, confocal endoscopy ,narrow band imaging and the nearly 360 degree view fuse endoscope are now widely available giving us an image quality like watching an ultra-high definition TV.
The high resolution, high definition and high magnification endoscopy now allow us to examine the mucosa and even overlying capillaries in very fine details. By using narrow band imaging wherein, a light of very narrow wavelength is projected on the mucosa can help the endoscopist differentiate lesions as benign or malignant. The Special endoscopes now even allow endoscopists to see individual cells.
The capability also exists to do ultrasound from the inside of the gut lumen and sample tissues outside of our GI tract such as those found in the pancreas and the chest through endoscopy with guidance of EUS.
It is very exciting to practice gastroenterology in an era when we have the capability to investigate the gastrointestinal lumen with high definition cameras. Now, we can utilize video capsule endoscopy in which a capsule takes films as it travels through the GI tract and sends the images to a receiver outside of body.
In addition we can also implant a wireless capsule in the esophagus to measure the acid exposure over 48-72 hours .High resolution esophageal manometery , a procedure that helps determine how the muscle of the esophagus and the sphincter works by measuring the pressures they generate.
Enhanced visualization of colon adenomas has been made possible by several developments to improve detection rates including narrow band imaging (NBI) and high-definition colonoscopy.
An additional exciting technology is transient elastography which provides a reliable non-invasive way to assess the degree of liver fibrosis.
One of the most exciting advances in the gastroenterology field took place in August of this year when the FDA approved Cologuard, the first and only noninvasive stool DNA screening test for colorectal cancer. The test detects both DNA and blood biomarkers associated with colorectal cancer and pre-cancer in the stool and is highly accurate.
ERCP catheters and devices have also improved, providing a much smoother experience for both endoscopist and patient. Cannulation percentages will continue to improve with decreasing risks of complications such as pancreatitis as we continue to learn about the pancreaticobiliary tract. The ability to extract stones has never been easier than now as we have newer disposable baskets and the like which help us accomplish our goals
On the therapeutic side:
There have been significant treatment modalities developed, many of which continue to evolve, that broaden the possibilities of treatment with success that rival surgical therapies.
Radiofrequency ablation for high-grade dysplasia in Barrett’s esophagus is available for prevention of esophageal cancer; endoscopic mucosal resection and endoscopic submucosal dissection for treatment of Barrett’s esophagus and superficial cancers of the esophagus, stomach and colon.
Natural Orifice Transluminal Endoscopic Surgery (NOTES) offers the possibility of removing organs such as the gallbladder or appendix via natural orifices such as the mouth and results in scarless surgery. Peroral endoscopic myotomy provides a natural orifice approach to performing the Heller myotomy for the treatment of achalasia. Endoscopic full thickness resection is being evaluated to allow complete removal of tumors without any scars.
The other exciting innovation is improvement in our ability to close perforations or defects in the wall of the gut. This has been made possible due to special clips such as over the scope clips or endoscopic suturing devices. This has increased our confidence to attempt removing large polyps or superficial tumors through techniques such as endoscopic mucosal resection or dissection. These procedures have helped many patients avoid surgery.
During the past few years, there have been many advances in pharmacotherapy in the field of gastroenterology. Most notably, a new treatment for hepatitis C which can cure the patients and
Kill the virus in nearly 100 % of the cases. The availability of the Biological medications for patients with inflammatory bowel disease namely Crohn’s disease and Ulcerative colitis. Also the utilization of the Nanospray (Hemospray) to stop the bleeding from most of the GI bleeding pathologies.
We also look toward the future for even more new technologies like endoscopic drug delivery systems for pancreatic tumors and digital spyglass technology which will allow us to visualize the biliary tree and do biopsies.