Combining techniques advances endoscopic diagnosis and treatment

Endoscopy has advanced dramatically in the past 10 years with innovative technologies introduced by industry and novel procedures pioneers by physicians. Given a choice among the broad range of new tools and techniques, endoscopic surgeons have decided they want it all. And they are asking for more.

 The key word in evolving endoscopy practices is “combinations,” according to the surgeons presenting at the Medica Congress session on Wednesday entitled “Innovations in Endoscopy.”
In his presentation on diagnosis of early tumors of the digestive tract, Alexander Meining, MD, with the Klinikum rechts der Isar in Munich, showed how each new imaging technique developed by different manufacturers has been integrated into the hunt for neoplasia.
The traditional view using white light has been enhanced with magnification, then autofluorescence, and more various forms of computed virtual chromoendoscopy (CVC) to enhance mucosal surface contrast, “much like using Photoshop on photographs.
Using a blue light to illuminate tissue, Olympus introduced narrow band imaging (NBI), “which aids detection by the human eye and significantly improves the learning curve in endoscopy but is not necessarily better for detecting tumors,” he said.
High powered magnification to over 400-fold endocystoscopy system, also from Olympus further enhances examination of stained cells, but remains a surface examination.
More recently in vivo microscopy became possible using confocal laser scanning, a technology Dr. Meining said has proved effective in the early detection of tumors, adding that “virtual histology still has a lot of work to do before it can be adopted for routine clinical practice.”
“Again, it is combination of these techniques that allow us to go from a macro view to microscopic view, and then ideally, they will give us the confidence to perform a treatment for the condition we see in the same endoscopy session,” he said.
“More importantly, these tools are teaching us what to look for and to look more closely,” he said.
“Progress in therapeutic endoscopy,” was presented by Pierre Deprez, MD, Head of the Department of Gastroenterology at the Catholic University of Louvain in Belgium.
Beyond the improved imaging, endoscopy has benefitted greatly in recent years from the robust development of new tools for minimally invasive surgical interventions, he said.
Combining techniques, such as endoscopic ultrasound with Endoscopic retrograde cholangiopancreatography (ERCP) enables the diagnosis and treatment of conditions in the liver, gallbladder.
Crossing frontiers between endoscopy and surgery, innovations in natural orifice transluminal endoscopic surgery (NOTES) have introduced a toolbox of new instruments, including clips, stents, cutting tools and closure devices.
“We used to be afraid of perforations during surgery and now we routinely cut through lining to reach other organs,” he said.
And endoscopy has benefitted from combining experiences by crossing borders, he said.
Techniques advanced by surgeons in Asia have shown that tumors can be fully removed in one piece rather than cut into pieces, which was the dominant Western technique, he said.
The clinical uses of capsule endoscopy, the detection of tumors using pill cameras, was presented by Jean Pierre Charton, MD, with the gastroenterology clinic of the Evangelisches Krankenhaus Düsseldorf.
From the pioneering pill cameras that first opened the ‘black box’ of the small bowel the technology has advanced to specialized capsules used for examinations of the colon and esophagus, he said.
Accepted for routine practice for certain indications, the pill camera presents an opportunity to encourage greater compliance to screenings for a significant patient population reluctant, or unwilling to undergo endoscopic exams.


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