Gastrointestinal Endoscopy

By: Shelly Cruz

The field of gastrointestinal endoscopy is undergoing a revolution the likes of which it has not witnessed since its inception in the early 1960's. Flexible endoscopy provides potentially a less invasive alternative to more invasive traditional surgical routes. Today may surgeons and gastroenterologists around the globe are working together to pioneer this exciting new field.

This new approach to surgery is being referred to as NOTES (Natural Orifice Translumenal Endoscopic Surgery) or NOS (Natural Orifice Surgery). Additionally, Natural Orifice Surgery is comprised of Translumenal surgery (procedures that breach the GI tract to access the peritoneal cavity), and Endolumenal Surgery (procedures performed within the lumen of the GI tract or other hollow organs which can be accessed through natural orifices). These new approaches are very promising and have the potential to greatly reduce post operative pain, infection, complications and have the ability to get back to their normal activities dramatically quicker than laparoscopic surgery.

Companies like Apollo Endosurgery, Inc. in Austin, TX are working closely with surgeons and therapeutic endoscopists from around the world to develop new flexible surgical tools to assist in the advancement of natural orifice surgical procedures. These devices will be compatible with existing endoscope platforms and allow surgeons and endoscopists to perform procedures previously only possible through laparoscopic or open surgical approaches.

There are greater than twenty commonly performed surgical procedures that are being researched and considered good candidates for NOTES procedures. Procedures such as cholecystectomy (gall bladder removal), appendectomy, oopherectomy, tubal ligation, ventral hernia repair, peritoneal exploration, gastrojejunostomy, early cancer resections and gastric reduction procedures for obesity are being investigated by leading medical centers around the world. These procedures represent over five million surgeries in the U.S. alone that could be performed as NOS procedures in the future. In 2002, Dr. Tony Kalloo from Johns Hopkins Medical Center published the first paper on NOTES and the potential patient benefits of Natural Orifice procedures. While the vast majority of the medical community was skeptical of Dr. Kalloo's claims, visionaries grasped onto his concepts and initial research began.

Today there have been over two hundred Natural Orifice surgical procedures performed around the world. The early results are very promising, but much more research will be needed before these procedures become readily available to the general public. Many experts believe that in the next two to three years surgery as we have known it the past two decades could be radically changed forever. The evolution of less invasive medicine has enormous potential impact on not only the quality of life of the surgical patient, but on our economy as well. Reducing pain and convalescence is not only good for the patient, but also good for the economy.

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