Exploring the role of gastroscopy outside the endoscopic unit - an underappreciated entity Podcast

Endoscopy has long been associated with specialised units, but modern surgical practice demands flexibility and speed. Surgeons often face critical situations in operating rooms, ICUs, and emergency departments where waiting for equipment or staff can delay life-saving interventions. Professor Mayilone Arumugasamy, an upper GI surgeon and honorary professor at RCSI, shares how single-use GI scopes like the Ambu^® A-Scope Gastro are changing the game.

The Challenge with Traditional Endoscopy

Reusable scopes have been the gold standard for decades, but they come with limitations outside the endoscopy unit:

• Complex setup requiring specialised staff
• Workflow disruption when borrowing equipment
• Delays during emergencies, especially after hours
• Risk of infection due to reprocessing requirements

As Prof. Arumugasamy explains:

“Quite often, we’re relying on scopes in places that aren’t familiar for staff. That adds its own challenges—especially after hours when you need quick decisions.”

 

Why Single-Use Scopes Make a Difference

Single-use scopes offer portability, independence, and speed. Surgeons can set up and perform procedures without waiting for endoscopy staff or equipment. This is crucial in:

• Operating Rooms: For hybrid procedures like laparoscopic resections combined with intraoperative endoscopy.
• ICU: Rapid assessment of esophageal injuries or NG tube placement without disrupting emergency workflows.
• Emergency Department: Immediate evaluation of GI bleeds in critically ill patients.

Prof. Arumugasamy recalls a real-life scenario:

“Only recently, in the ED, a patient was critically unwell. We suspected a GI bleed alongside a heart attack. Instead of waiting for theater, we scoped in the resus room and confirmed no major bleed—allowing the team to proceed with cardiac treatment immediately.”
 

Clinical Impact and Patient Outcomes

The ability to perform endoscopy at the right time, in the right place improves patient care:

• Faster diagnosis in emergencies
• Reduced delays in treatment decisions
• Better resource allocation without pulling staff from other critical areas

“Portability makes a big difference—especially after hours in emergency settings.”

Hybrid Surgery and Advanced Applications

Single-use scopes aren’t just for emergencies. They play a vital role in complex surgeries:

• Esophageal cancer resections: Ensuring negative margins during minimally invasive procedures.
• Gastric tumor resections: Locating small lesions and protecting the esophagogastric junction.
• Benign procedures: Leak testing after Heller’s myotomy or anastomosis.

“We use scopes nearly on every upper GI list—sometimes for sole endoscopic procedures, sometimes for hybrid ones.”

Training and Teaching Benefits

The Ambu® system includes a large monitor with video recording, enabling:

• Real-time teaching for registrars and surgical trainees
• Data capture for documentation and review
• Portable setup for use in multiple environments
   

Reusable vs. Single-Use: Complementary Roles

Reusable scopes remain essential for major therapeutic interventions, but single-use scopes complement them effectively. Prof. Arumugasamy describes a case of severe variceal bleeding where both scopes were used together:

“We cleared clots with the Ambu scope while keeping the reusable scope ready for banding. It worked extremely well as an adjunct.”

 

The Future of Endoscopy

Looking ahead, Prof. Arumugasamy sees potential for:

• Outpatient endoscopy without sedation using transnasal scopes
• Ward-based procedures for quick checks and leak tests
• Reducing waiting lists by triaging patients in real time

“If you picture patients well, you could sift out a significant number who can be reassured immediately—helping reduce waiting times.”

Conclusion

Single-use GI scopes are more than a convenience—they’re a strategic solution for modern surgical practice, offering speed, flexibility, and improved patient outcomes. As healthcare evolves, these innovations will play a critical role in bringing endoscopy beyond the unit.