When Endoscopy Becomes Treatment – Why Surgical Expertise Matters

Upper gastrointestinal problems can often be treated in more than one way. Some conditions are best managed with endoscopy, others with surgery, and many could reasonably be approached either way. The right choice depends on your particular condition, your anatomy, and what you want from treatment.

Traditionally, endoscopy and surgery sit with different specialists who work together to plan your care. That model works well. There is also real value in having one specialist who is skilled in both and who can guide the whole picture, from diagnosis through to treatment.

That’s where therapeutic endoscopy, offered by an upper GI surgeon who also performs it, can make a difference.

In this article, we cover:

• What therapeutic endoscopy is, and how it differs from standard endoscopy
• How endoscopy and surgery usually work together
• The benefit of one specialist skilled in both
• Common conditions where this matters

What is therapeutic endoscopy?

Endoscopy is a procedure that uses a thin, flexible camera to look inside your upper digestive tract. A standard, or diagnostic, endoscopy is used to look and diagnose. Therapeutic endoscopy goes a step further: using specialised instruments passed through the same scope, the problem can be treated during the same procedure, with no external cuts.

That might mean removing a stone from the bile duct, opening a tight valve, relieving a blockage, or removing an early cancer from the lining of the oesophagus or stomach. Twenty years ago, many of these problems would have meant open surgery. You can read more about the specific procedures, including ERCP and POEM.

How endoscopy and surgery work together

Endoscopy and surgery are usually the focus of different specialists. A gastroenterologist concentrates on endoscopic diagnosis and treatment, while a surgeon concentrates on operating. In most cases, these specialists collaborate, sharing findings and planning treatment together, and that teamwork is an effective part of good care.

The main practical consideration is that care can move between clinicians. If an endoscopic finding might be better treated surgically, or the other way around, your plan may pass from one specialist to another before it’s finalised. For many patients, this is smooth. For some, it can mean a few more appointments along the way.

The benefit of one specialist skilled in both

A/Prof Michael Talbot is both a specialist upper GI surgeon and an interventional endoscopist. He performs therapeutic endoscopy, minimally invasive (keyhole) surgery, robotic surgery, and open surgery. Because he works across all of these, he can consider your situation as a whole and recommend the approach that fits best.

The main benefit for you is continuity. The specialist who assesses your problem is also the one who treats it, so the plan doesn’t need to be handed over. Diagnosis, decision and procedure sit together, which can mean fewer appointments and a clear path from the first consultation.

It can also make the choice between options more considered, because the same specialist understands both endoscopy and surgery first-hand and can weigh them side by side for your circumstances.

Common conditions where this matters

This joined-up approach is particularly useful for:

• Bile duct stones and blockages, often treated with ERCP
• Swallowing problems such as achalasia, zenker and other diverticulae, and gastroparesis where a POEM, Z-POEM, G-POEM and others offer an incisionless alternative to surgery
• Management of symptoms after anti-reflux, bariatric or cancer surgery.
• Barrett’s treatments, where endoscopic resection or Radiofrequency therapy (RFA) are standard of care
• Early upper GI cancers, where selected tumours can be removed endoscopically instead of via open surgery

In each case, the best option depends on your anatomy, your symptoms and your goals.

Considering therapeutic endoscopy?

If you’ve been told you might need endoscopy or surgery for an upper GI problem, it’s worth speaking with a specialist who can offer both. Learn about therapeutic endoscopy, or contact us to arrange an appointment and discuss the approach that best suits your condition.