Operative endoscopy for benign gastro-intestinal lesions

Operative endoscopy has proven to be a discipline that continually renews itself. Referrals for treatment using flexible endoscopes in the gastroenteric tract are in fact on the rise. Diagnoses made at earlier phases of the disease uncover pre cancerous lesions that can be treated locally. The technological development of endoscopic instruments, on the other, make it possible to enter into the abdominal cavity and to go beyond the intestinal lumen and to carry out mini-invasive surgical procedures. Operative endoscopy must, of course, confront and collaborate with other traditional disciplines such as pharmacological therapy, interventistic radiology, and, above all, traditional surgery. It must, in particular, join hands with the latter placing itself at its service in the treatment of anastomic complications and imitating it in the development of miniinvasive endoluminal surgery. Some fields of application of operative endoscopy used in the treatment of benign lesions of the gastroenteric tract have been considered here. These include: endoscopic therapy of telangiectasia which represents its principal therapy once the disease has been staged and controlled; prophylactic ligation of esophageal varices in trasplant candidates who, due to their limited follow up, present more disadvantages than advantages with regards to propranolol therapy, laser therapy of Barrett's esophagus which aims to reduce the risk of adenomacarcinoma of the esophagus by ablating metaplasic tissue - further studies are warranted here to quantify its effect; laser therapy of large colorectal adenomas found to be an efficacious alternative to surgery in inoperable patients or those who reject surgery, avoiding the risk of degeneration; treatment of anastomic complications in esophageal surgery and in liver transplant patients in whom endoscopic therapy is the first choice therapy, and finally drainage of abdominal abscesses and necrosectomy carried out endoscopically with the aid of ecoendoscopy, which has taken operative endoscopy beyond the intestinal lumen. The latter field of application is a first step, already in fact utilized in clinical practice, towards the development of NOTES, the new miniinvasvie surgical discipline, still in an experimental stage but already being watched with great interest by the endoscopic and surgical worlds.