Post on 19-Jun-2015
Endoscopy 2008
Grant F. Hutchins M.D.
Assistant Professor Gastroenterology/Hepatology
Advanced Endoscopy
The Beginnings – Not Torture Today
=
Modern Torture
Upper / Lower GI Tract
• From the eyepiece to HD and computer chips
• Better endoscopes, better colonoscopes, less diameter
• White light vs. narrow band imaging (NBI)
• Chromoendoscopy
• Improved therapeutics:
ERBE / APC
Gold Probes
Hemocliping
Improved Banding
Endoscopic Ultrasound (EUS)
• Basically and upper endoscope with an ultrasound transducer
• “Intimate images” of the upper GI tract in particular (rectum too)
• Loco regional cancer staging and tissue sampling using fine needle aspirate (FNA)
• Therapeutics include improved pancreaticobiliary access, cyst ablation with ethanol, direct chemotherapy into tumors
• A “Gatekeeper” for other procedures such as EMR/ESD
Cholangioscopy / Pancreatoscopy
• Performed during ERCP for select indications*
• Allows direct visualization into the bile and/or pancreatic ducts
• Spyglass system made by Boston Scientific, very progressive
• Rapidly emerging technology now with second generation Spyware
• Therapeutic as well as diagnostic uses
• UNMC involved in multicenter Spy trial currently*
Spyglass Images
HALO Photoablation
• The newest of therapies for Barrett’s esophagus and dysplasia/ early malignancy
• Basically burning the esophagus
• Important to remember SURGERY is still “standard of care” but…
• Exciting technology with great promise, patient friendly unlike prior treatments
• UNMC is involved in multi-institutional data base*
• Screening study using NBI and potentially HALO submitted to IRB
Small Bowel Imaging
• The last unmapped territory?
• Traditionally PUSH enteroscopy
• Today:
Capsule Endoscopy (2 types)
Single Balloon Enteroscopy
Double Balloon Enteroscopy
Endoscopy allows therapeutic performance, access to places (esp. biliary) previously unreachable*
Often used in combination
Enteroscopy Today
Endoscopy – The Future
• Technology/Equipment changing rapidly
• Emergence of therapeutic fellowships
• The place of NOTES (natural orifice transluminal endoscopic surgery)
• Improved therapy of malignancy/cystic lesions
• Many Thanks!!!!!