Advanced Diagnostic & Therapeutic Endoscopy
Advanced Diagnostic & Therapeutic Endoscopy
Diagnostic and therapeutic endoscopy
Endoscopy is not a single examination but a group of techniques. Some are used to look and to take biopsies, others to treat through the endoscope itself, without incisions and with the organ left in place.
This second group, advanced therapeutic endoscopy, has changed practice over recent years. Lesions that once meant surgery with removal of part of an organ are now resected endoscopically in a single session.
Diagnostic examinations
Gastroscopy examines the oesophagus, stomach and duodenum, while colonoscopy covers the colon and, where needed, the terminal ileum. Both allow biopsies and, where required, treatment in the same session.
Therapeutic techniques
- EMR, mucosal resection, for polyps and lesions confined to the mucosa.
- ESD, submucosal dissection, removes extensive or flat lesions in a single piece, which is decisive for histological assessment.
- POEM, peroral endoscopic myotomy, for achalasia and selected spastic disorders.
- Endoscopic ampullectomy for adenomas of the ampulla of Vater, as an alternative to the Whipple procedure.
Biliary and pancreatic endoscopy
ERCP with cholangioscopy treats stones, strictures and obstruction of the bile ducts. Endoscopic ultrasound assesses depth of invasion, examines regional lymph nodes and allows targeted fine needle biopsy, even of very small pancreatic lesions.
Individual procedures are described in more detail on their own pages, including gastroscopy and ERCP with cholangioscopy. Articles and updates are published on the blog.
Frequently asked questions
What is the difference between diagnostic and therapeutic endoscopy?
Diagnostic endoscopy examines the mucosa and takes biopsies in order to establish a diagnosis. Therapeutic endoscopy treats the lesion through the endoscope itself, for example by removing a polyp, dividing a muscle or placing a stent. In practice the two are often combined in one session, so the patient undergoes a single procedure.
When is ESD chosen over EMR?
Mucosal resection removes tissue in fragments and suits smaller, confined lesions. Submucosal dissection removes even extensive or flat lesions in a single piece. That matters because only en bloc removal allows the pathologist to assess margins and depth of invasion accurately.
Do these procedures replace surgery?
In selected cases yes. When the lesion is early and confined to the superficial layers of the wall, endoscopic removal is oncologically adequate and the organ is preserved. With deeper invasion or a risk of lymph node spread, surgery remains necessary. Staging, chiefly with endoscopic ultrasound, determines the choice.
Content last updated: September 2026 (15/09/2026).
