The endoscope revolutionized the diagnosis and treatment of many kinds of gastrointestinal disease.
Ulcers
"Endoscopy provided the evidence for diagnosing and healing ulcers," says pioneering gastroenterologist Basil Hirschowitz, M.D., "leading to the great advances in medication for peptic ulcer, the first of which was Tagamet in 1974." Hirschowitz played a major role in the development and testing of the entire generation of ulcer drugs—both the histamine antagonists, which stop acid secretion into the stomach, and the proton pump inhibitors, which shut down the production of acid.
In addition to healing ulcers with peptic acid-reducing drugs, physicians can now absolutely cure most ulcers with antibiotics that kill the bacterium Helicobacter pylori. "What remains is to determine the best way to treat H. pylori," Hirschowitz says. "We are continuing to be involved in testing combinations of antibiotics and acid suppressants. Although there are several regimens now available, I think something better will be developed soon."
Polyps and Tumors
Endoscopists can now visualize and remove polyps (growths where cancer can form) throughout the length of the colon—and this is contributing to a decrease in colon cancer. Gastroenterologist Todd Baron, M.D., is also using self-expanding metal stents to relieve obstructions in the colon due to benign or malignant tumors. Baron, now five years out of specialized training at Duke University, is highly skilled in the complex procedures required to see into and treat problems in the pancreatic duct and biliary tree. He places stents through growths, uses sound waves to break up large stones (which are then captured and removed through the endoscope), and more recently, has begun draining pseudo-cysts, a complication of pancreatitis.
Baron is among the first generation of "therapeutic endoscopists," who were trained in the age of videoscopic endoscopy. These specialists push the limits of the endoscope, searching for new applications. Baron believes that marrying endoscopy to ultrasound could be the next major advance. Building on the use of transducers to provide images of the heart from inside the esophagus, Baron believes endoscopic ultrasound in the lungs could help diagnose more accurately how far a tumor has progressed. "Not too far off," he says, "is the advent of endoscopic surgery, which will allow us to make a puncture through the wall of the GI tract to drain an adjacent structure, such as the gallbladder."
Another major advance in endoscopy is photodynamic therapy (PDT), which involves beaming laser light through the endoscope at a certain point in the esophagus to activate a drug the patient took 24 to 48 hours earlier. "PDT actually allows us to destroy the pre-malignant cells of a condition called Barrett's esophagus," Baron says.
Small Bowel Disease
Endoscopists can now access the last frontier of the gastrointestinal tract—the 20 or so feet of small bowel—in order to search for sites of unexplained bleeding. Small bowel endoscopes have thus enhanced the diagnosis of small bowel problems today, as has the computed tomography (CT) scan. "The advent of CT scans has been a tremendous boon to the areas of the GI tract that are not accessible by endoscopes," says Jerry Spenney, M.D., chief of staff of the VA Medical Center. "UAB's Division of Gastroenterology and Hepatology and others have been instrumental in developing new treatments for inflammatory bowel disease in recent years."