ENDOSCOPY 2006 - Springerextras.springer.com/2008/978-1-4020-9147-6/pdf/S1_P3.pdf · •...

ENDOSCOPY 2006ENDOSCOPY 2006152nd 152nd FalkFalk Symposium, Symposium, BerlinBerlin MayMay 44--5, 20065, 2006

NovelNovel Endoscopic Endoscopic Imaging Imaging TechniquesTechniques

Paul Fockens, MD PhDPaul Fockens, MD PhDAcademic Medical Center, University of AmsterdamAcademic Medical Center, University of Amsterdam

NovelNovel Endoscopic Imaging Endoscopic Imaging TechniquesTechniques•• CurrentCurrent optimaloptimal techniquestechniques

–– HighHigh--resolutionresolution and and magnificationmagnification endoscopyendoscopy

–– ChromoChromo--endoscopyendoscopy

•• New New techniquestechniques

–– NarrowNarrow Band ImagingBand Imaging

–– AutofluorescenceAutofluorescence ImagingImaging

–– EndoEndo--microscopymicroscopy








OpticalOptical MagnificationMagnification (1,5 (1,5 -- 150 x)150 x)

+ + (> 800.000 pixels) (> 800.000 pixels) High High resolutionresolution

ChromoChromo--endoscopyendoscopy•• ContrastContrast stainsstains

–– IndigoIndigo--carminecarmine (0,1 (0,1 –– 0,4%)0,4%)

•• AbsorAbsorpptivetive stainsstains–– CresylCresyl violet violet

–– Methylene blue (0,1%)Methylene blue (0,1%)

•• SSpprarayyiningg cathetercatheter useful, not crucialuseful, not crucial

GoalGoal–– DelineateDelineate exact bordersexact borders

–– SurfaceSurface analysisanalysis (zoom) (zoom)

ChromoChromo--endoscopyendoscopyDelineateDelineate bordersborders

•• CarefullCarefull nonnon--magnifiedmagnified endoscopyendoscopy

•• UseUse contrast contrast dyedye at at anyany discolorationdiscoloration etc.etc.

ChromoChromo--endoscopyendoscopySurfaceSurface analysisanalysis

Kudo Type I

Kudo Type II


Kudo Type IIIS

Kudo Type IIIL


Kudo Type IV

Kudo Type V

DetectionDetection of dysplasia in UCof dysplasia in UC

•• ChromoendoscopyChromoendoscopy vs. vs. standardstandard 4q 4q biopsiesbiopsies

Kiesslich et al, Gastro 2003








ConventionalFilter

B G R

NBIFilter

B

G R

NarrowNarrow Band Imaging Band Imaging (NBI)(NBI)

NarrowNarrow Band Imaging Band Imaging (NBI)(NBI)

• Band-pass ranges of RGB are narrowed

• Relatively more contribution of blue light

• Result: more superficial (=mucosal) imaging

B G R

ConventionalFilter

B G R

NBIFilter

B

G R

CCDCCD

MucosaMucosa

CVCV--180180

StandardModus

StandardModus

NBINBI--FilterFilter

CLVCLV--180180

Narrow Band ImagingNarrow Band Imaging

Narrow Band Imaging Narrow Band Imaging –– ColonColon



NBINBIFlat Flat AdenomaAdenoma in UCin UC

NarrowNarrow Band Imaging Band Imaging –– UC surveillanceUC surveillance

•• ComparativeComparative studystudy in in UCUC--surveillancesurveillance

•• 2 2 colonoscopiescolonoscopies 66--8 8 wkswks apart apart

–– NBI NBI withwith targettedtargetted biopsiesbiopsies

–– Standard Standard colonoscopycolonoscopy withwith 4 4 biopsiesbiopsies / 10cm/ 10cm

–– Different endoscopistDifferent endoscopist

•• 08/04: 44 08/04: 44 patientspatients includedincluded

Dekker et al, DDW New Orleans 2004

42424343FeasibleFeasible

21212323FirstFirst colocolo

4 4 (0(0--26)26)38 38 (20(20--68)68)# # biopsiesbiopsies

49 49 (20(20--90)90)47 47 (25(25--90)90)Time (min)Time (min)

NBI NBI (n=44)(n=44)

ConventionalConventional(n=44)(n=44)




9/159/14Dysplastic lesions

912Total number of patienswith dysplasia

n.a.3/43Random biopsies with dysplasia

1514Number of endoscopies with abnormalities

NBIConventional


FuFujjinoninon Intelligent Chromo EndoscopyIntelligent Chromo Endoscopy

•• FICE = FICE = postpost--processingprocessing techniquetechnique

•• No No scientificscientific data data availableavailable–– PubMedPubMed negativenegative

–– DDW2006 abstracts DDW2006 abstracts negativenegative

••……………………

……………………








FluorescenceFluorescence ImagingImaging

Tissue fluorophores

Excitation light(short wavelength)

Fluorescent light(longer wavelength)

Xenon lamp

Rotary Filter

Barrier Filter

Mucosa

Monochromatic CCD

AFI Image

14 pts: abnormalities with WLE & AFI

7 pts: lesions detected with AFI but not

with WLE

21 pts had detectable lesions with HGIN

6 pts: 11 additional lesions with AFI

AFI feasibility study in 60 ptsAFI feasibility study in 60 pts

Kara et al, GIEndoscopy 2005

2828

NDBENDBE

55

ININDD

8181

TotaTotall

884040

LGDLGDHGD/HGD/ECEC

PositivePositive

AFIAFI

False positive rate: ~ 50% False positive rate: ~ 50%

False positive rate of AFI

Kara et al, GIEndoscopy 2005

Endoscopic Endoscopic TriTri--ModalModal Imaging Imaging –– ETMIETMI((WLEWLE, AFI en , AFI en NBINBI))








Confocal Laser Endoscopy Confocal Laser Endoscopy (Pentax)(Pentax)

Joint venture: Pentax, Japan & Optiscan, Australia

Images provided by Dr Kiesslich, Mainz

Normal RectumNormal Rectum

Images provided by Dr Kiesslich, Mainz – DDW 2004

Adenoma; HGDAdenoma; HGD

Images provided by Dr Kiesslich, Mainz - Gastro 2004

EndoEndo--CytoscopyCytoscopy System System (Olympus)(Olympus)

•• ProbeProbe--type videoscope system

with ultra high magnification

• Compatible to 3.7mm working channel

• Very high resolution: 1.7 or 4.2 µm

• Working depth: less than 30 µm

• Absorptive stain necessary

EndoEndo--CytoscopyCytoscopy System System (Olympus)(Olympus)

NovelNovel Endoscopic Imaging Endoscopic Imaging TechniquesTechniques•• New New techniquestechniques are are necessarynecessary

–– We miss flat + We miss flat + depresseddepressed lesionslesions andand dysplasia in UCdysplasia in UC

•• ChromoChromo--endoscopyendoscopy is is good & easy but underusedgood & easy but underused–– IndigoIndigo--carminecarmine shouldshould alwaysalways bebe availableavailable

•• NBINBI is is now commercially availablenow commercially available–– OlympusOlympus 180 series: High 180 series: High resolutionresolution (HDTV) + (HDTV) + NBINBI

•• AFI is very attractive as a AFI is very attractive as a ““redred--flagflag”” techniquetechnique

•• AllAll newnew technitechniqquesues needneed scientificscientific evaluationevaluation

Date post:	08-Jul-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

ENDOSCOPY 2006 - Springerextras.springer.com/2008/978-1-4020-9147-6/pdf/S1_P3.pdf · •...

Documents