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ADVANCES IN MANAGEMENT OF DIGESTIVE DISEASES, ACID REFLUX DISEASE TREATMENT & DIAGNOSIS
Anil Minocha M.D.; FACP
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About the author "Dr. A. Minocha"
| The year 2000 saw the advent of several new and exciting devices and
procedures for the management of digestive diseases.
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 traveling 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
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 anti-reflux surgery.
Another new procedure approved by the FDA for acid reflux is the Stretta‘ procedure. Similar to the Bard system, it is a non-surgical 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. Re-treatment every few years may be required.
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.
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.
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