Hybrid technology in flexible endoscopy

As endoscopy can be unpleasant and painful, you will first be given a sedative and painkiller. Removal of the polyp, a polypectomy, is in itself generally painless.

You should not eat for at least 6 hours nor drink for 2 hours before the procedure.

The intestines must be cleaned thoroughly. Therefore, please follow the instructions for eating, drinking and bowel cleansing given by your doctor exactly. Avoid foods rich in fibers and containing seeds for a few days before the procedure, such as wholemeal bread, grapes, etc., which have a longer dwell time in the intestines.

Despite the utmost care of the endoscopy team, complications may occasionally occur during these procedures. During your medical consultation, your physician will inform you about possible risks.

You will feel tired for some time after the procedure; during this time you will be cared for and monitored until all organ functions are stable. Gastric surgery can result in nausea, irritation of the throat and difficulty in swallowing, or a blocked nose. Air remaining in the stomach and duodenum can cause short-term pain. In a polypectomy, painful flatulence due to air remaining in the intestines is possible. After anesthesia of the throat, short anesthetics or sedation, you must not eat or drink for at least 1 hour. And you must not actively participate in road traffic for 24 hours, not even as a pedestrian. The best thing to do is have an adult pick you up and take care of you at home for the first 24 hours. Dangerous work is taboo during this time, as are alcohol and nicotine. You should inform your attending physician or family doctor immediately if blood leaks from the anus or in case of pain, dizziness, fever or vomiting of blood.

Polyps can be mushroom-shaped with a stalk, or moss-shaped flat. The former can be grasped with an electric snare, separated near the base and retrieved via the endoscope. As with a gastroscopy or colonoscopy, abdominal surgery is generally not required. Larger flat polyps that cannot be removed with a single snare size are somewhat more demanding to treat, but can also be treated endoscopically. Before being removed, a liquid, possibly with an added dye, should be injected under this type of polyp. This elevates the mucous membrane including the polyp and allows it to be separated as a whole with an electrosurgical snare or a knife electrode. Depending on the polyp or medical condition, the physician will choose the optimal treatment concept for you.

In cooperation with leading physicians, we have developed a new hybrid technology: The affected area is first marked with coagulation points, the polyp is injected and removed, bleeding is stopped at the end of the procedure, all with the same instrument. At an international level, many physicians are convinced of this technique and regard it as possible future method of choice.

As the distance to the outer organ layer is increased by the fluid cushion, it remains protected during the entire procedure - even against thermal injury*. The reason being that cutting is done with electricity, i.e. with heat.

Both drug therapy as well as Botox injection or balloon dilatation (pneumatic dilatation) are possible. However, the most effective therapy providing long-term treatment success is a separation of the lower esophageal muscles, called a myotomy. This procedure can be performed laparoscopically or endoscopically.

In laparoscopic Heller myotomy, the existing standard technique, small incisions are made to access the abdominal wall. This surgical procedure is therefore performed from the outside. The new endoscopic technique POEM (Peroral Endoscopic Myotomy) does not require incisions in the abdominal cavity. The cutting instrument is inserted inside the esophagus via an endoscope, making the technique less invasive.

The muscle tissue can be myotomized precisely and flexibly, theoretically even over the entire length of the esophagus. It does not need to be exposed or mobilized during the procedure and remains attached to the connective tissue - in its natural suspended condition.

The muscle fibers are split underneath the mucous membrane. To do this, a tunnel is prepared in the submucosa between the mucous membrane and the muscle layer. The myotomy is then "covered" by the mucous membrane, which covers the separated section of the esophagus after the procedure like a plaster.

The duration of the stay depends on the individual healing process and in the case of normal progress only a few days.

This is usually due to the frequent reflux of gastric juices (reflux) into the esophagus. Approximately 10% of patients with chronic heartburn develop a Barrett's Esophagus. Recurrent inflammations or acid burns can also be the cause.

The development risk from a Barrett's Esophagus without dysplasia to esophageal cancer is up to 0.5% per patient year, so treatment is indicated from this stage onwards. If a malignant tumor has developed over several stages, the predicted 5-year survival rate is only under 20%.

One of the therapeutic options is the ablation of the affected mucous membrane with heat. In argon plasma coagulation, electric current is transferred contact-free to the diseased tissue and kills it. The heat effect must be sufficiently large to achieve complete destruction. With this therapy, there is a risk that structures close to the wall may be thermally damaged, which can lead to a partial narrowing of the esophagus.

Before the application of heat, the mucous membrane is elevated by means of a waterjet. The thermal energy can now be applied sufficiently deep without damaging the external structures such as the muscle layer of the esophagus and causing constrictions, so-called strictures. This prevents constrictions and protects healthy adjacent tissue, while at the same time treating the affected mucous membrane even more effectively.