26/06/2025
Flexible endoscopy is a fundamental tool in multiple medical specialties, allowing for minimally invasive diagnosis and treatment. Its scope is supported by scientific evidence and clinical guidelines:
Upper Gastrointestinal Endoscopy (UGE):
- Diagnosis: Detection of ulcers, Barrett's esophagus, gastric cancer, and H. pylori.
- Therapy:
- Esophageal variceal ligation (50% reduction in the risk of rebleeding).
- Polyp resection (polypectomy) and endoscopic mucosectomy (EMR) for early neoplasia.
- Stent placement in malignant strictures.
- Evidence: ASGE (American Society for Gastrointestinal Endoscopy) guidelines support its effectiveness in managing gastrointestinal bleeding. - Colonoscopy:
- Colorectal cancer (CRC) screening: Reduces mortality by 30-50% (NEJM, 2012).
- Resection of adenomatous polyps: Prevents progression to CRC.
- Therapeutic: Control of diverticular bleeding, dilation of strictures.
- ERCP (Endoscopic Retrograde Cholangiopancreatography):
- Management of choledocholithiasis, biliary strictures, and chronic pancreatitis.
- Evidence: ESGE (European Society of Gastrointestinal Endoscopy) guidelines highlight its success in >85% of cases.
- Enteroscopy:
- Evaluation of bleeding of obscure origin or Crohn's disease in the small intestine (with the aid of capsule endoscopy and balloon-assisted enteroscopy).
- Flexible Bronchoscopy:
- Diagnosis: Lung tumor biopsy, evaluation of infections (tuberculosis), and tracheobronchial strictures.
- Advanced Techniques:
- EBUS (Endobronchial Ultrasound): Staging of lung cancer (sensitivity >90%, Chest).
- Cryobiopsy: Higher diagnostic yield for interstitial diseases.
- Flexible Cystoscopy:
- Monitoring of bladder tumors (less invasive than rigid cystoscopy).
- Evidence: EAU (European Association of Urology) guidelines recommend it for post-resection surveillance of bladder cancer.
2. Key Advantages
- Superior anatomical access:
- Curved structures (colon, distal bronchi, intestinal loops).
- Outpatient procedures:
- Conscious sedation (general anesthesia not always required).
- Integrated Technologies:
- Chromoendoscopy and NBI (Narrow Band Imaging): Improve detection of dysplasia in Barrett's esophagus and colon (ASGE guidelines).
- Laser and argon plasma: For coagulation of bleeding lesions.
3. Limitations
- Management of serious complications:
- Massive hemorrhage or perforation may require surgery or rigid endoscopy.
- Dependence on operator skill:
- Steep learning curve (e.g., ERCP).
- Limited access in certain cases:
- Very narrow strictures or complex anatomy (requiring complementary techniques).
4. Recent Innovations (Emerging Evidence)
- Capsule endoscopy:
- Small bowel evaluation and CRC screening in high-risk patients.
- Confocal endomicroscopy:
- Real-time diagnosis of dysplasia (Gastroenterology studies).
- Robotics:
- Systems such as ENDOBRAVO for complex procedures (in clinical research).
In summary, flexible endoscopy is the gold standard in the diagnosis and treatment of digestive, respiratory, and urological pathologies, with solid support in international guidelines. Its technological evolution continues to expand its scope, although it requires combination with other techniques (e.g., surgery or rigid endoscopy) in complex scenarios.
