Rotating action cuts patient risk in latest endoscopic advance
For a patient, having an endoscope inserted down the throat or up the anus to peer into the small bowel isn’t very comfortable, especially if one has to remain half awake. But such a procedure is necessary for doctors to have a clear view of the small intestine or nearby areas when diseases, like cancer, are suspected.
The conventional procedure to diagnose, repair or remove gastrointestinal abnormalities, which can sometimes be life-threatening, can take several hours. But a new medical technique – spiral enteroscopy – cuts the time taken for an endoscope to be guided through the body’s natural openings, so doctors can peer inside the digestive system, to under an hour, reducing the risks for a patient.
“The longer a patient is on the table, the greater the chance of a complication, so we try to keep our procedural time as short as possible,” said Dr Chris Kong San Choon, Consultant, Department of Gastroenterology and Hepatology, Singapore General Hospital (SGH), who pioneered the spiral enteroscopy technique at SGH.
Dr Kong has performed 10 of these procedures to date. His first patient was Mr Ong Hua Kok, 72, who suffers from anaemia. In early 2010, Mr Ong agreed to undergo the procedure in a bid to pin down the source of the anaemia. Anaemia is often due to intestinal bleeding. Dr Kong had explained to his patient what he wanted to try, the risks and advantages.
Dr Kong found nothing abnormal. But months later, Mr Ong’s anaemia recurred and his red blood count fell to dangerously low levels. He was urged to go for another investigation of his small intestine.
Cancerous tumour detected
In July 2011, he underwent his second spiral endoscopy. This time, a 4cm cancerous tumour was detected. A sample of the tissue was taken for examination and the site of the tumour marked. When it was found to be malignant, he was immediately operated on. Dr Kong’s early investigation and marking of the tumour site provided a clear map for surgeons.
Both times, Mr Ong underwent spiral endoscopy as it was faster than the alternative, conventional balloon enteroscopy.
Depending on whether a suspected bleeding or abnormal mass is near the beginning or end of the small intestine, the snake-like endoscope is guided through the patient’s mouth or anus to reach the affected site, which then allows the doctor to repair or remove the problem. The length of the small bowel can be around 6m in all, making insertion of the endoscope all the way through difficult.
In the balloon method, the long tube moves through the organ and a balloon is inflated via an external pump to hold the endoscope in one place. The balloon is deflated when the endoscope is pushed or pulled to a new location in the small bowel. The balloon method can take two to three hours to perform and a key problem is that there is a chance that the endoscope will slip backwards or lose its place in the small bowel, particularly when the balloon deflates, because the bowel wall is always moving.
Outside studies have shown spiral enteroscopy to be a faster procedure than its balloon counterpart and relatively safe.
Procedural time less than an hour
Dr Kong estimated the shortest procedural time he has encountered so far with using the spiral endoscope to be about 40 minutes.
Once the doctor locates the problem area, it may take another five minutes to prepare the minuscule tools needed to repair a bleeder or cut out a polyp. With the balloon method, the flexible telescope might slip back from the right location during this waiting time as it is not firmly anchored to the small bowel walls, thus lengthening the time of the procedure and increasing the risk to the patient if the doctor has to reprobe the area.
As with any scope procedure, perforation, bleeding and pancreatitis remain risks in spiral enteroscopy. But, skilfully done, spiral enteroscopy can be an outpatient procedure. Because it is relatively new at SGH, spiral enteroscopy is done under inpatient care. However, the patient is sedated and not put under anaesthesia during the procedure. Complications have been negligible.