Advancements in Upper Gastrointestinal Endoscopic Therapy: A Comprehensive Review

Authors : Abul Hasan Shadali Abdul Khader; Rakshaya Venu; Sruthi Nandhaa Shanmugam; Diviya Bharathi Ravikumar; Husna Qadeer; Shrinidhi Senthil Kumar; Barath Prashanth Sivasubramanian

Volume/Issue : Volume 8 - 2023, Issue 9 - September

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This paper focuses on endoscopic therapeutic advances in gastrointestinal conditions. Over-The-Scope Clips (OTSC) are effective in non-variceal upper gastrointestinal bleeds (NVUGIB) and have promising results in large fibrotic ulcers. The Apollo endoscopic suturing system is effective for refractory peptic hemorrhage. Endoclip application +/- epinephrine is considered for large peptic ulcers. Persistent bleeding is controlled by Hemospray with a hemostatic endoscopic procedure. Stand-alone therapies like Endoclot and Polysaccharide hemostatic powder hold potential but require further research. Endoscopic ultrasound-guided cyanoacrylate and coil embolization are effective for gastric varices, while Endoscopic Band Ligation is preferred for esophageal varices. Endoscopic submucosal dissection can excise Barrett's lesions of any size but is challenging; hence, for multiband mucosectomy, an Endoscopic mucosal resection (EMR) is used. Argon plasma coagulation is effective for smaller lesions after EMR. Radiofrequency ablation (RFA) is preferred for Barrett's esophagus, and cryotherapy is used if RFA fails. When life expectancy is less than two months, Self- expanding metallic stent is preferred, and Endoscopic gastrojejunostomy is provided when it is more than three months. However, Brachytherapy is recommended for long-term relief. Laser modalities show promise for mid- esophageal tumors, while cryoablation compliments others for advanced conditions. In conclusion, many methods have a user-friendly interface and are easy to master. The problems with resource availability, funding, proper training, and the lack of larger studies still limit some of the above-described techniques.

Keywords : Endoscopy; Variceal ligation; Stenting; Cryoablation; Barrett’s.


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