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New endoscopy techniques may save life, money
JP/Tertiani ZB SimanjuntakStomach pain is associated with various gastrointestinal diseases, from the less worrying indigestion to colon cancer
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JP/Tertiani ZB Simanjuntak
Stomach pain is associated with various gastrointestinal diseases, from the less worrying indigestion to colon cancer.
The latest technology in medicine allows doctors to use various methods to find the source of stomach pain without undergoing a surgical procedure.
Gastrointestinal endoscopy involves the insertion of an endoscope, a flexible fiber-optic tube with a tiny TV camera at the end, into the digestive tract from the mouth, nose or anus.
The camera is connected to either an eyepiece for direct viewing or a video screen to allow a doctor to see the inside lining of the digestive tract and to give treatment as well.
An endoscopy has several names, depending on which portion of the digestive tract a doctor inspects. Colonoscopy, for instance, is placed in the colon, or large bowel; while an enteroscopy allows a doctor to see your small bowel.
An endoscopy is the widely suggested method when other imaging tests fail to see any cause of disorder in the abdomen, but it too may miss the lesions on the intestines or the small stones stuck on the bowel duct.
Enter advanced endoscopic procedure with the use of narrow band imaging (NBI) and endoscopic ultrasound (EUS) for more accurate diagnosis and treatment.
NBI provides greater contrast in imaging test, hence allowing for easier identification of any disorder on the mucus layers as well as biopsies to identify early gastric cancers.
Meanwhile, EUS is a combination of an endoscopy and ultrasound imaging test, enabling detailed imaging of the pancreas and biliary system.
Singaporean gastroenterologist Chua Tju Siang is among few experts and the only one in the region skilled in the new techniques.
In meeting Indonesian press during his visit to Jakarta last week, the doctor gave a thorough explanation on his technique and procedures to accurately detect the source of stomach pain.
'If we can find the problem earlier, we can better solve the problem. If we cannot get rid of the problem, we can provide relief.
'We can also look into the small intestine, which not usually seen,' said the doctor, who runs the Gastrointestinal Endoscopy and Liver Clinic at Mount Elizabeth Medical Center, Mount Elizabeth Novena Specialist Center and Mount Alvernia Medical Center in Singapore.
A 27-year-old with severe stomach pain was referred to him as she refused to remove her entire stomach due to a malignant tumor. No previous test had been able to find the exact location of the tumor.
The accurate identification of the tumor using NBI analysis saved two-thirds of the stomach and after five years the woman no longer has gastric cancer.
A EUS-guided Fine Needle Aspiration (EUS-FNA) biopsy can also be performed on the pancreas and liver for tissue diagnosis to remove gastric bumps.
Chua has also performed Endoscopic Submucosal Dissection (ESD) to remove early gastric adenocarcinoma on a 61-year-old man.
'I'm an internist, not a surgeon. You can either carry out a procedure in which a minimally small incision is made or aggressive medicine can be used. It depends on how you look at it,' said the doctor, who was the first to ever perform an ESD for early gastric cancer in Singapore in 2009.
The advanced endoscopy could help provide relief for terminally ill patients through procedures such as an EUS-guided biliary stenting and celiac plexus blocking.
Capsule endoscopy and double-balloon enteroscopy techniques were used by Chua to stop intestinal bleeding on a 55-year-old patient with end-stage cardiac failure.
EUS procedure may take about 30 minutes to one hour, depending on the difficulty level of the procedure.
'The procedure is the second line of investigation when other tests show normal results but the pain continues. It's a 99.9 percent safe procedure and, yes, financially wise, you may save yourself an unnecessary operation.
'For some, it may be taken as an extra procedure at an extra cost. But the main concern is the medical sense of it.'
