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A Stomach for Hi-tech Change
Advancements in gastrointestinal technology
If the heart is the most important part of the body, the gastric system—from the mouth to the oesophagus, stomach and intestines—in a human being is a close competitor. The general well-being of a person depends on how well the gastric system functions as on it rests the ability to digest food, absorb nutrients and expel waste as faeces and urine.
Over the past decade, gastrointestinal surgery has seen more advances than most other medical fields. Moreover, India has emerged as one of the frontrunners in this field, in terms of both technique and equipment. It has now become a leading centre for gastrointestinal surgery. Among the several techniques pioneered by India, the most notable involves liver transplants using live donors.
Technical advancements in surgery come not only from better ways of carrying out surgery, but also in understanding the body better in order to circumvent diseases. According to specialists, it also means conducting procedures in ways that are more minimalistic, making it easier to access parts of the body without making long cuts and exploring each organ through a scope.
One of the biggest advancements in this field is the improvement in endoscopic techniques. Endoscopy involves looking inside a hollow organ or cavity in the body through a device inserted into the body to get a better understanding of the problem. In gastroenterology, endoscopy is used for diagnosis and exploration and was earlier carried out inside an organ cavity or outside it. A new kind of endoscopic technique called ‘third space endoscopy’ has evolved over the past few years. It enables surgeons to access the wall of the cavity to further improve the scope of exploration. “Earlier endoscopic techniques were either carried out outside or inside the lumen, which refers to the inside space in the intestines,” says Dr Ajay Bhalla, director and head of the gastroenterology department at Fortis Hospital in Noida. This is done by making a tunnel through the wall of the lumen and guiding an endoscope through it. Such techniques have helped in identifying and extracting tumours found deep inside the lining of the lumen’s wall, which required exploratory open surgery earlier.
Some endoscopes have been developed even further, to not only go within the lining of the lumen but beyond it as well. This has helped surgeons with several kinds of bypass surgeries that can now be carried out without making a single cut in the body. The probe is usually inserted from the mouth and guided through the oesophagus to other gastric organs within the body. Improvement in endoscopes has now made it possible for gastroenterologists to reach even the small intestines to find and fix any obstructions within the canal.
Several researchers have also developed laparoscopic and robotic surgeries, which are minimally invasive as well as require less manpower. Procedures that used to be performed earlier without the use of such machines required cutting open the patients from chest to abdomen. Now, all it takes are a few holes in the body.
Another advancement in endoscopic procedures is called NOTES (Normal Orifice Trans-luminal Endoscopic Surgery). The method, still in its development stage, involves putting a probe through the belly button and guiding it to the lumen and trans-lumen. It ensures minimal intervention, leaves no scar after surgery and ensures a faster recovery time for the patient.
Along with improvement in surgical procedures and devices, imaging methods to identify issues within the gastrointestinal track have also improved substantially over the past few years. Better machines with higher resolutions such as MRI machines and Barium X-rays have improved diagnostics. CT machines too have helped in the exact depiction of problems, so doctors are now able to take a more rounded approach.
Dr Subrat Raul, senior consultant in the department of gastroenterology at Paras Hospital in New Delhi, points out that surgeons can now take six to eight matches of the gut through different imaging techniques to pinpoint exactly where a problem may lie. “In addition, we now have endoscopes instead of only gastro scopes, enabling better diagnostics and surgical procedures,” says Raul, who believes that while the procedures for surgery remain more or less the same, what has brought about the advancement is a more complex understanding of anatomy. This understanding has been proved useful in diagnosing several diseases. Other major contributors to the advancements in gastrointestinal sciences are the developments in and better understanding of ancillary fields of medicine such as pathology and nutrition.
Nutrition has become a major part of gastrointestinal surgery in the recent years and has helped in both prevention and post-operative outcomes. Several advancements in nutrition have helped surgeons and doctors guide patients better on what to eat to prevent several diseases. In operative care as well, a better understanding of nutrition has helped surgeons circumvent the process of fasting that patients needed to undergo before any major surgery. Monitoring the diet of the patient post operation can also help in steadier recovery.
New advancements have also been made in gastric bypass surgery and gastric angioplasties. Just like cardiac angioplasty, gastric angioplasties too require the use of stents to unclog arteries and restore blood flow to integral organs. Recent advancements in enteroscopy techniques, which refer to procedures used to identify and treat gastric problems, have helped substantially. Doctors can now identify bleeding sites in the gastric track through simple, non-invasive angioplasties instead of proper surgery, says Dr Raul. “Bleeding sites in the gastric track can now be identified through the veins itself,” he says, adding that a complete roadmap of the veins and arteries in the gastric system can be created through such new techniques.
Along with this, there have also been advancements in regular surgical equipment and instruments. Surgeons have managed to tweak conventional instruments used for surgery to utilise them for more delicate procedures and reach spots within the organs that might have earlier been difficult to achieve. Devices such as the harmonic scalpel have reduced blood loss to a minimum during surgery, while a new device called Thunderbeat, which uses some kind of energy to heat up the tissue in order to reduce damage, has also become popular with gastroenterologists. Such devices have helped bring down mortality rates in patients to the extent of 25 per cent.
“India became a leading nation in gastroenterology only in the past decade, but has already established itself as a centre for cutting-edge research in the field,” says Raul, adding that only Japan and the United States are ahead of India.
In the past, the Indian gastroenterological industry used to depend on the West for technological advancements and new research. But now research centres, both private and public, have come up in India in a big way.
One of the biggest examples is India’s contribution to the field of liver surgery and transplantation, which has made the country the centre for gastrointestinal intervention in Asia. Over the past decade, India has pioneered research in live liver transplant—a relatively new field even in the West, where a majority of such transplants are made through cadavers.
Raul suggests India’s pioneering role in this field has a lot to do with its high population. “It ensures there are living donors for most transplants,” he says. This also means surgeons in India perform far more liver resections than in the West. There are more than 40 centres across the country where such surgeries are performed. “India is taking up more than 25 cases every year for live liver resections and transplants, which is more than anywhere else in the East.”
India has also made its mark in third space endoscopy. More than 12 centres are being run in various private and public hospitals, where students from other countries are also being trained. Bhalla runs such training programmes in Noida, where students from universities as well as doctors doing their residencies in Europe and America come for advance training through the year. Government institutions such as the All India Institutes of Medical Sciences (AIIMS) also run such programmes to train students from other countries.
India plays a big role in formulating the curriculum and contributing research papers for various programmes and conferences. Moreover, in February, Hyderabad hosted the first World Congress of Gastrointestinal Endoscopy organised by the World Endoscopy Organisation.
Advancements in gastroenterology have improved not only surgical interventions, but also patient health and aftercare. As India is fast evolving as a premier centre for gastro sciences, there is a lot of new research happening on how to innovate and use the existing technology more effectively.