BGS Global Hospitals plans to set up a pancreatic and biliary stone centre soon. With this, the healthcare major will expand the horizons of endotherapy and endoscopic ultrasound to introduce Extracorporeal Shock Wave Lithotripsy (ESWL) and high-end endoscopy for complex bile duct and pancreatic stones.

Endoscopy is much-sought after for its short hospital stay, minimal blood loss, minimal invasiveness and no general anaesthesia. All these factors have attributed to the economies-of-scale making it popular among patients and specialists in the current surgical space, Dr Amit Maydeo, senior consultant, Endoscope, Global Hospitals Group, told Pharmabiz in an email interaction.

Until a decade ago, from stone and tumour removal to control of ulcer bleeding, a long drawn-out surgery was the only answer. Currently, stone clearance in the biliary- pancreatic ducts, pancreatic cyst drainage, pancreatic necrosectomy, palliation of malignant tumours through stents, treatment of pancreatitis, early diagnosis of oesophageal, stomach and pancreatic cancers and assessing the stage of the tumour are all done without surgery but using an endoscope which is an advanced a non-surgical day care procedure.

For instance bile duct stones are accurately targeted, pulverized and removed using 'Choloangioscope' which is a small endoscope.

"Science of endoscopy continues to evolve since the use of the first fibre optic endoscopy in the 50s. In the past, endoscopes were used only to view the oesophagus, stomach and duct but now with technology improvements, it has been a new treatment option," said Dr Maydeo.

Endoscopic procedures and laproscopy are complimentary to each other. While the bile duct stones are removed by laparoscopy through gall bladder removal, the large pancreatic stones are removed by endoscopic process because it is proven to be highly accurate, reliable and safe, he said.

However, endoscopy is known to require high levels of expertise. Not all medical centres have the facility. The complexity of the work handled in a centre varies depending on the expertise of the team. This has resulted in a serious shortfall of endoscopy specialists. The cost of setting up of a department of Endoscopy is high. It is both technology and specialist intensive involving radiologists, surgeons, blood bank other allied specialists, informed Dr S T Gopal, consultant hepatologist, BGS Global Hospitals.

The western countries offer a formal degree in advanced endoscopy which is a sub-speciality of gastroenterology opening up exciting possibilities with newer treatment options. Some of the future advances would be in Chromo endoscopy which would revolutionize the treatment of early gastrointestinal tumours and biliary endotherapy. In certain tertiary care centres in India, the procedure is on par with the West. However, the lacunae is the lack of an uniform availability and standardization in procedure across the centres here compared to the West. The biggest challenge for specialist would be to improve the accuracy of the diagnostic tools like endoscopic ultrasound than CT scan to treat gastrointestinal tumours endoscopically, added Dr Gopal.