The therapeutic endoscopy has evolved in an impressive way in recent years, even in areas before under surgical domain. Endoscopic treatment of early cancer, for example, through the development of mucosectomy techniques (EMR – Endoscopic Mucosal Resection) and the most elaborate and effective submucosal dissection (ESD – Endoscopic submucosal resection) that can resect larger areas, are techniques used in the esophagus, stomach, duodenum and colon.
the colangiopancreatic endoscopy (ERCP) has long already become indispensable and is gold standard but it does not cease to evolve. The addition of therapeutic cholangioscopy with laser lithotripsy and access by endosonography is already able to drain and exploit decisively the gallbladder.
The treatment of obesity was restricted to behavioral changes, diets, physical exercise and medications for overweight patients in mild obesity. For severe obesity the option was restricted to the bariatric surgery. Currently, bariatric endoscopy emerges as an option for patients with overweight and obesity grade II with interventions on the stomach through equipment (devices) that occupy space such as the intragastric balloons and interventions that alter the anatomy, reducing the stomach volume through endosuture. In addition to these actions on the stomach, bariatric endoscopy advances with procedures in the small intestine intending to treat metabolic alterations such as type 2 Diabetes and NASH, with the possibility of proximal intestinal deviations, through an intestinal sleeve anchored in the duodenum or with distal intestinal deviations by means of endoscopic anastomosis through magnetic rings. There is also the possibility of remodeling the duodenal mucosa by means of endoscopic ablation. Also, in bariatric endoscopy, the endoluminal approach is practically the first option in the treatment of complications of bariatric surgeries such as stenosis and fistulas.
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