endoscopy 2006 - springerextras.springer.com/2008/978-1-4020-9147-6/pdf/s1_p3.pdf · •...
TRANSCRIPT
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
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.
DetectionDetection of dysplasia in UCof dysplasia in UC
•• ChromoendoscopyChromoendoscopy vs. vs. standardstandard 4q 4q biopsiesbiopsies
Kiesslich et al, Gastro 2003
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
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
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)
NarrowNarrow Band Imaging Band Imaging –– UC surveillanceUC surveillance
Dekker et al, DDW New Orleans 2004
NarrowNarrow Band Imaging Band Imaging –– UC surveillanceUC surveillance
9/159/14Dysplastic lesions
912Total number of patienswith dysplasia
n.a.3/43Random biopsies with dysplasia
1514Number of endoscopies with abnormalities
NBIConventional
Dekker et al, DDW New Orleans 2004
FuFujjinoninon Intelligent Chromo EndoscopyIntelligent Chromo Endoscopy
•• FICE = FICE = postpost--processingprocessing techniquetechnique
•• No No scientificscientific data data availableavailable–– PubMedPubMed negativenegative
–– DDW2006 abstracts DDW2006 abstracts negativenegative
••……………………
……………………
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
FluorescenceFluorescence ImagingImaging
Tissue fluorophores
Excitation light(short wavelength)
Fluorescent light(longer wavelength)
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))
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
Confocal Laser Endoscopy Confocal Laser Endoscopy (Pentax)(Pentax)
Joint venture: Pentax, Japan & Optiscan, Australia
Images provided by Dr Kiesslich, Mainz
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
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