Endoscopy headed for the surgical field

Endoscopia caminha para a área cirúrgica

For David Serra, director of the symposium on digestive endoscopy and Leaping Forward and coordinator of the Gastroenterology and Digestive Endoscopy Centre of Hospital da Luz, the meeting that marks the first day of work of the congress will show the state of the art of this specialty through innovative procedures, without neglecting the importance of endoscopy in the diagnosis of very common illnesses, such as colorectal cancer.

“Colorectal cancer, which affects both sexes, is one of the few oncological diseases in which an early diagnosis is effective,” says David Serra, who also cites breast cancer in women and prostate cancer in men as other diseases in which timely detection can prevent greater evils.

According to this doctor, early diagnostic colonoscopy should begin at the age of 50 in those persons without personal or family risk factors. Anyone who has a direct family member that suffered from an oncological disease of the colon or rectum should have a colonoscopy 10 years earlier (at the age of 40).

A third group that should undergo screening for colorectal cancer includes those people who, before the age of 50, show symptoms such as: loss of blood through the rectum (the most easily identifiable sign), or a sudden and prolonged change in intestinal habits – constipation that becomes a chronic diarrhoea or a regular functioning of the intestines that turns into constipation or chronic diarrhoea - which may lead to doing a colonoscopy at an earlier age.

David Serra points out that this exam is not only effective in prevention, as it detects pre-malignant lesions (polyps), but in treatment as well: “It is possible at the same time to remove more than 95% of the pre-malignant lesions. This prevents the development of malignant tumours, and the follow-up of the patients shows relapse rates and post-exam complications of 0%,” he adds.

In fact, today, given the possibility of doing a colonoscopy with general anaesthesia, this exam is no longer uncomfortable nor even painful, which has contributed to there being less reluctance on the part of the population, and has resulted in a greater success in the early detection of oncological diseases.

Joining gastroenterology and general surgery

Speaking about what will be demonstrated live at the digestive endoscopy symposium of Leaping Forward, David Serra refers to the endoscopic mucosectomy of polyps of the colon with the aid of laparoscopy, a hybrid procedure, in which a gastroenterologist and general surgeon work together, and which is done in the operating theatre with the support of the anaesthetist and nursing teams from gastroenterology and general surgery.

The procedure makes it possible to safely remove large-size polyps, without disturbing the integrity of the intestine: “This is a relatively recent procedure, which we have done since 2009 and has been tried in only five other centres in the world. On a world-wide level, Hospital da Luz is currently the number two centre for this treatment, with many dozens of patients who have been treated. A scientific article is to be released soon,” affirms David Serra.

Also related to new endoscopic techniques, this physician mentions the debut in Portugal of a procedure for the treatment of a disease called achalasia, which will be carried out by Professor Paul Fockens.

“Basically, it consists of an endoscopic surgery to treat achalasia, a motor disturbance of the oesophagus, in which the sphincter that separates the oesophagus from the stomach does not relax and function as a valve, preventing foods from reaching the stomach,” says David Serra.

For the patient, the major advantages begin with the fact that the procedure avoids the need for a major transthoracic operation, with hospitalisation of over a week and poorer results than those now achieved by the endoscopist, who is able to do the procedure with a much higher success rate, plus the patient is released from hospital 24 hours after the surgery.

Another topic that will be focused on during the symposium is the detection of pancreatic cancer, a disease for which a reliable method of early detection has not yet been found. But some solutions are beginning to appear, which will be brought up and debated during the symposium.

 

Special Report, Leaping Forward - Lisbon International Clinical Congress, Hospital da Luz, Lisbon, february 13-19.