Novel Gastroenterological Procedures

What Are The Various Novel Procedures Performed Under Gastroenterology?

Some of the novel procedures performed under gastroenterology:

1. Per Oral Endoscopic Myotomy (POEM): Per Oral Endoscopic Myotomy (POEM): This is a novel, minimally invasive, endoscopically performed treatment for different gastrointestinal motility disorders. In the process, a myotomy—or, more precisely, cutting of the muscular layers—is performed to alleviate abnormal muscle contractions that hinder normal passage of food and liquids through all parts of the gastrointestinal tract. Specific conditions that POEM is tailored for include:
   • E-POEM is performed for Achalasia Cardia, when the esophagus might fail to relax properly and thereby creates problems in swallowing. Through the mouth, an endoscope is introduced and a small incision is made in the esophageal muscle for the easier passage of food.
   • Z-POEM treats Zenker's Diverticulum, which is a condition in which food traps in a pouch in the upper esophagus that arises through abnormal development and causes difficulty in swallowing. Z-POEM is used to cut the muscle separating the diverticulum from the esophagus; this will permit the emptying of the pouch.
   • G-POEM focuses on Gastroparesis, delayed stomach emptying due to nerve damage common among patients suffering from diabetes. Myotomy in G-POEM is the cutting of the pyloric sphincter muscle at the stomach exit, allowing food out into the small intestine for better emptying.
   • PREM is an acronym for Proximal Rectal Endoscopic Myotomy, which is the application of POEM in Hirschsprung's Disease. It is a congenital disorder characterized by the absence of certain nerve cells along parts of the intestine that leads to severe constipation. A myotomy is then created in the affected intestine segment, which will help to re-establish normal bowel function.
2. EUS-guided Gastrojejunostomy (EUS-GJ)

   EUS-guided gastrojejunostomy represents a new, minimally invasive technique for creating a bypass between the stomach and the jejunum, the middle portion of the small intestine. The intervention is particularly useful in patients suffering from gastric outlet obstruction that may occur as a result of malignancy, benign strictures, or other conditions that block the normal passage of food from the stomach to the small intestine.

   During EUS-GJ, an endoscope equipped with an ultrasound probe is passed through the mouth down to the stomach. The ultrasound visualizes the surrounding structures, thus enabling the physician to know precisely where in the stomach the stent is being introduced. Then, the target in the jejunum is identified, after which a needle opens a hole and a specially designed stent is deployed that forms a new passageway between the stomach and jejunum. This bypasses the obstructed or narrowed segment and allows food to pass from the stomach directly into the small intestine. This relieves symptoms such as nausea, vomiting, and pain.

3. Anti-reflux Mucosal Ablation (ARMA) for GERD

   ARMA stands for Anti-Reflux Mucosal Ablation, a novel endoscopic treatment for gastroesophageal reflux disease. In this condition, the stomach acid frequently rises into the esophagus and causes heartburn and regurgitation; in severe forms. It can damage the lining of the esophagus. Traditional treatments include lifestyle modifications, medications, and surgery.

   The ARMA procedure accesses the gastroesophageal junction—the area where the esophagus meets the stomach—through an endoscope and ablates the mucosal layer of the esophagus in this region with radiofrequency energy or other ablation techniques. Scar tissue will then form due to this controlled injury, tightening the junction and thus reducing acid backflow from the stomach up into the esophagus. This results in the improvement of GERD symptoms, reduction of dependency on medications, and avoidance of surgery.

4. GERDx for GERD

   Another minimally invasive endoscopic procedure is GERDx, intended to treat GERD through improvement in the function of the LES (valve between esophagus and stomach). In GERD, the LES usually does not shut appropriately, allowing acid reflux into the esophagus. Mechanically, GERDx enhances the barrier function of the LES.

   The GERDx procedure involves the use of an endoscope, which places sutures or implants where the stomach and esophagus meet. The sutures or implants tighten the LES so that stomach acid cannot flow up into the esophagus. Since it does not depend on ablation to cause scarring, unlike ARMA, GERDx provides support to the LES and thus presents a long-term solution against acid reflux but without surgical incision.

5. Endoscopic Sleeve Gastroplasty (ESG)

   Endoscopic sleeve gastroplasty is a non-surgical, minimally invasive treatment targeting weight loss in people with obesity. The difference between ESG and traditional bariatric surgery is that no part of the stomach is removed, nor are the intestines re-routed. It is an endoscopic approach that reduces the size of the stomach.

   In ESG, an endoscope equipped with a suturing device is passed through the mouth down to the stomach. The physician makes a series of stitches in the interior wall of the stomach, which creates the shape of a sleeve or tube. This reduces the volume of the stomach by about 70-80%, thereby limiting the quantity of food which a person can consume at any one time and making them feel fuller faster.

   ESG is much less invasive than traditional bariatric surgery, and the risk of complications is low, with a faster recovery time. In the majority of cases, it is performed as an outpatient procedure; therefore, the patient can return home the same day. The reduced capacity of the stomach entails great weight loss, which would help to improve or completely cure pathologies related to obesity, such as type 2 diabetes, hypertension, and obstructive sleep apnea.

What Are The Advantages Of Novel Gastroenterological Procedures?

Novel gastroenterological procedures provide several advantages over the more traditional surgical options, including:

1. Minimally Invasive: Since they are endoscopic procedures, they do not require big cuts; hence, they cause much less trauma to the human body, are much less painful, and provide a faster recovery rate compared to traditional surgery.
2. Reduced Complications: Since these procedures are minimally invasive, they generally have lower complication rates with respect to infections, bleeding, and adverse reactions to anesthesia.
3. Shorter Hospital Stay: Most of these procedures are done on an outpatient basis. Patients are allowed to return home the same day or after a short stay in the hospital, thus often reducing healthcare costs and the disruption to patients' lives.
4. Faster Recovery: Recovery is much faster, and patients can return to their daily activities much faster. This could be of special importance to those with other medical conditions that may make traditional surgery dangerous.
5. Targeted Treatment: All of these procedures are very specialized and focused, addressing specific problems like achalasia, GERD, or obesity with precision. This leads to more promising outcomes and enhanced symptom relief.

How to Prepare for These Novel Procedures?

Novel gastroenterological procedures typically involve the following steps to ensure the best possible outcome:

1. Medical Evaluation: Any procedure that a patient is to undergo is always preceded by a proper medical evaluation. Blood tests, imaging studies, endoscopy, among others—these are usually done to help assess the extent of the condition and that the patient is a suitable candidate for the procedure.
2. Medication Management: Another, and perhaps most common issue patients will probably encounter is the need to alter their medications. For instance, anticoagulants and some medications are usually suspended a few days before the procedure to minimize the risk of bleeding.
3. Fasting: Similar to most gastrointestinal procedures, the patient is required to fast for several hours prior to the procedure to ensure that the stomach and intestines are empty in order to decrease the risks associated with performing the procedure.
4. Pre-Procedure Instructions: The healthcare provider will give specific instructions to the patient to follow before the procedure. This probably includes dietary restriction, bowel preparation if the test requires, and also the time when they must stop eating and drinking prior to the test.
5. Arrange Transportation and Support: Many of these procedures are performed using sedation or anesthesia; therefore, the patient will need someone to drive them home and be with them for at least the first 24 hours after the test.
6. Mental Preparation: An awareness and understanding will contribute to a reduction in their anxiety for the prescribed procedure and its end benefits. Patients have to share their problems and questions to the health provider to get satisfaction and have confidence about this procedure, which is to be performed.

What are the Recovery Tips to Follow After These Novel Procedures?

Some of the guidelines to follow after novel gastroenterological procedures include:

1. Follow Post-Procedure Instructions: The post-operative instructions given by the healthcare team must be followed to the letter by the patients. These may include dietary restrictions, medications, and limitations in physical activity.
2. Dietary Adjustments: It depends on the procedure, but most often a liquid diet is initiated and progressed to solid foods. Soft, bland foods are usually given first to avoid irritating the gastrointestinal tract.
3. Stay Hydrated: The patient has to drink plenty of fluids in order to stay well-hydrated, particularly if the procedure involves the stomach or intestines. However, specific fluid intake guidelines that may be advised by a doctor need to be followed.
4. Pain Management: A little soreness or pain is normal after any of these treatments. Generally, over-the-counter pain relievers suffice, but the patient needs to get confirmation about taking them from the treating physician. If pain persists or worsens, a healthcare provider must be contacted.
5. Rest and Activity: Rest is a very important factor in early recovery. Patients are to avoid the strain of heavy lifting and strenuous activity for a few weeks, depending on the nature of the procedure. Light activity such as walking can and should be done, as it can circulate and lower the risk of blood clots.