Surgery News - May 2008 - (Page 14)

14 ACROSS SPECIALTIES SURGERY NEWS • M AY 2 0 0 8 Image-Enhanced Endoscopy Has ‘Come of Age’ BY DOUG BRUNK Else vier Global Medical Ne ws n the recent past, endoscopists always sought the input of pathologists when diagnosing gastrointestinal cancers. Now, thanks to the maturation of image-enhanced endoscopy, endoscopists are sometimes able to make a diagnosis on the spot. “The time for endoscopic diagnosis has come of age because now we have increased accuracy—sensitivity and specificity—in terms of diagnosing diseases, es- I pecially for the early tumors,” Dr. Roy Soetikno, chief of the gastroenterology section at Veterans Affairs Palo Alto (Calif.) Health Care System, said in an interview. “This technology is now hand in hand with the much-improved optics of the endoscopes. This allows more things to be done during endoscopic assessment, such as cutting tumors at time of assessment rather than going back in, so it’s increasing efficiency and reducing costs.” To assist clinicians in the appropriate use of such technology, Dr. Soetikno and his associates, Dr. Tonya Kaltenbach, Dr. Yasushi Sano, and Dr. Shai Friedland, created guidelines based on a Medline search (Gastroenterology 2008;134:327-40). They wanted to promote the use of image-enhanced endoscopy (IEE) outside of specialized academic centers, where it has been used almost exclusively. For many clinicians, using dye for image enhancement was a cumbersome process, requiring preparation of the solution, spraying it on, and interpretation. “Today, by changing the properties of American College of Surgeons 94th annual Clinical Congress October 12–16, 2008: San Francisco, CA Moscone Convention Center the lights that go through the endoscope, we can mimic what could have been achieved by the dye. Either the endoscopy lights have changed, or we’re using some kind of computer software to process the image, so in the end you highlight the gland or the abnormality, and you get a better diagnosis,” Dr. Soetikno explained. According to the guidelines, available data support the use of IEE in the detection and treatment of early squamous cell carcinoma of the esophagus, early gastric cancer, and superficial colorectal lesions. Diluted indigo carmine solution can be helpful in diagnosis and treatment of early gastric cancer because it “pools at the border of the lesion and thus enhances visualization of these lesions, which are most often nonpolypoid. By pooling into the depression or ulceration of the lesion, the solution aids classification of the morphology, which in turn is important in the medical decision making of treatment strategy.” Advances in endoscopic imaging continue to evolve and enhance visualization, including devices that use manipulations of the light source or captured light. Other approaches being studied include narrow-band imaging, which uses a narGASTROINTESTINAL Polypoid adenoma (sigmoid colon, 3 mm in diameter): Tumor is clearly visualized as brownish lesion by NBI. Join us in San Francisco for the 94th annual Clinical Congress. As always, it will be an educational opportunity you won’t want to miss! Please be sure to visit www.facs.org in the coming months for more details regarding the educational program, registration, housing, and transportation. row light source to enhance visualization of the surface microvessels; spectral estimation technologies, which use computerized processing to convert standard RGB (red, green, blue) signals from the endoscope’s charged-coupled device; and autofluorescence imaging, which uses changes in concentrations of endogenous fluorophores, such as collagen, nicotinamide adenine dinucleotide, and flavin adenine dinucleotide. The researchers also noted that high-resolution or high-definition endoscopes provide “a more detailed image of gastrointestinal mucosa, and high-magnification endoscopy enlarges the image up to 100x,” compared with 30x in standard endoscopy, which uses a 20-inch monitor. “At higher magnification with IEE, the visualized surface patterns of the gastrointestinal mucosa have been suggested to correlate well with the underlying histology. Potential barriers to the dissemination of IEE “include perceptions of its inefficiency and [exorbitant] cost, inadequate mechanism for reimbursement, lack of standardized training in techniques, and deficiency of high-quality comparison studies,” the authors wrote. Dr. Soetikno said that neither he nor his associates have any relevant financial relationships to disclose. ©AMERICAN SOCIETY ENDOSCOPY FOR Save the Date! http://www.facs.org http://www.facs.org

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Surgery News - May 2008 Contents New Lung Approach Speeds Extubation Innovative GI Procedures May Improve Diabetes Quality Programs Differ on Risk Data Crystal Ball Medical Modeling Ventricular Valve Taking Stock

Surgery News - May 2008

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