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Vital Signs

Fall 2011

Endoscopy Emerging as Major Nonsurgical Intervention

At major medical centers such as UCLA, an increasing number of gastrointestinal illnesses are being diagnosed and treated through the nonsurgical approach known as interventional endoscopy.

“Many procedures that were once the domain of the surgeon can now be done in a more minimally invasive way,” says V. Raman Muthusamy, M.D., associate clinical professor of medicine at the David Geffen School of Medicine at UCLA and director of interventional endoscopy, a newly created position within UCLA Health that reflects the field’s emergence.

An endoscope is a long fiber-optic tube with a camera and a light at its tip, along with a small channel through which gastroenterologists pass instruments into the gut to perform a variety of treatments while viewing images on a monitor. “Through the endoscope, we can now perform biopsies, cut things, cauterize and even seal up small holes,” explains Dr. Muthusamy.

Some early-stage cancers and polyps that would have previously required surgical removal can now be treated endoscopically, he notes. In some advanced cancers stents can relieve obstructions for patients with tumors blocking the gastrointestinal tract. Interventional endoscopists are accessing the bile duct and pancreas to remove gallstones or overcome obstructions that might otherwise require surgical exploration. For patients with Barrett’s esophagus with dysplasia — early changes in cells that can signal cancer — the first-line therapy now involves use of endoscopic techniques to burn away the affected cells and prevent the development of cancer and the need for surgery.

Endoscopy is also being used to treat other gastrointestinal disorders. With endoscopic ultrasound — a procedure that combines endoscopy with ultrasound imaging to create more detailed pictures — a patient suspected of having a pancreatic tumor, for example, can be diagnosed and biopsied, the tumor can be staged, and the nerves can be injected through the endoscope to relieve pain.

UCLA has also begun to use endoscopy to improve the results of bariatric weight-loss surgery. Many patients who have gastric bypass operations begin to regain weight over time, often because the pouch created to restrict food intake stretches. Interventional endoscopist Rabindra Watson, M.D., has been involved in the development of techniques that improve the surgical outcome by reducing the volume of the pouch endoscopically. Dr. VS-Fall11-EndoscopyWatson is also conducting research toward the goal of using endoscopy to perform the weight-loss surgery itself.

He is the first of several additional interventional endoscopists who will join the program. “Endoscopy represents the continuation of a natural progression from open surgery to minimally invasive laparoscopic techniques, to something even less invasive that has also been shown to be safe and effective, as well as reversible,” Dr. Watson says. “This is the future for many procedures, and it’s going to be an increasing focus at UCLA.”

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