endotherapy

Endotherapy, also called endoscopic therapy, is the set of therapeutic interventions delivered through an endoscope to diagnose or treat diseases of the gastrointestinal tract and related ducts. It is a core component of therapeutic endoscopy and is practiced by gastroenterologists and interventional endoscopists. Endotherapy uses flexible endoscopes and specialized accessories to perform procedures that traditionally required open or laparoscopic surgery, with the aim of reducing morbidity and hospitalization.

Indications and examples: Management of nonvariceal and variceal GI bleeding using injection, clips, thermal coagulation, and band ligation; treatment of peptic ulcers or post-polypectomy bleeding. Dilation of strictures in the esophagus, stomach, or pylorus and stent placement for obstructive lesions. Mucosal resection to remove polyps or early cancers, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Ablation therapies for intestinal metaplasia or dysplasia, such as radiofrequency ablation for Barrett's esophagus. Pancreatobiliary applications include biliary and pancreatic duct drainage, stone extraction, and endoscopic necrosectomy in selected pancreatic collections, often under EUS guidance.

Safety, limitations, and training: Procedures require anesthesia or conscious sedation and carry risks such as perforation, bleeding, and infection. Not all conditions are amenable to endoscopic therapy, and outcomes depend on lesion characteristics and operator expertise. Training for these procedures is part of advanced endoscopy fellowships and multidisciplinary collaboration with surgical and radiologic teams.

Endotherapy continues to evolve with new devices and techniques, expanding the scope of minimally invasive management for GI diseases.