Tu1662 Use of I-SCAN™ Endoscopic Image Enhancement Techonology in Clinical Practice to Assist in...
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Tu1661 “Passive-Vending Colonoscope” Significantly Improves Cecal Intubation and Reduces the Pain in Difficult Cases Takeshi Mizukami*, Haruhiko Ogata, Toshifumi Hibi Endoscopy Center, NHO Kuirhama Alcoholism Center, Yokosuka city, Kanagawa, Japan Colonoscopy sometimes causes pain during insertion. Over-insufflation of air causes elongation or acute angulations of the colon, making passage of the scope difficult and thereby causing pain. We previously reported a sedative-risk- free colonoscopy insertion technique, “WATER NAVIGATION COLONOSCOPY” (Dig Endosc 19(1), 2007). Complete air suction after water infusion not only improves the vision, but also makes water flow down to the descending and the sigmoid collapsed and shortened. While non-sedative colonoscopy can be carried out without pain in most cases, some patients do complain of pain. Most of these patients have abnormal colon morphology, and the pain is caused while negotiating the “hairpin” bends of the colon. The hairpin” bends of the colon should be negotiated by gently pushing the full-angled colonoscope. The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff with a wide turning radius, therefore, a conventional colonoscope cannot be negotiated through the “hairpin” bends of the colon without stretching them and causing pain. “PASSIVE-VENDING COLONOSCOPE” PCF-PQ260) have a flexible tip with a narrow turning radius, so that the scope can be negotiated through the “hairpin” bends of the colon with a minimum turning radius and minimal discomfort. Aims: Assess the intubation and pain-reducing performance of the “PASSIVE-VENDING COLONOSCOPE” in difficult cases. Methods: The subjects were 11 cases, including 2 cases of cecal intubation failure and 9 cases of difficult colonoscopy, who underwent colonoscopy twice: with PCF-240Z(1st) and PCF-PQ260(2nd). Colonoscopy was performed according to the method of “WATER NAVIGATION COLONOSCOPY”. The cecal intubation time was measured and the patients were asked to report their level of discomfort after the colonoscopy on a scale of 1 to 5, as follows: grade 1, no discomfort; grade 2, strange feeling; grade 3, distension of the abdomen; grade 4, tolerable pain; grade 5, intolerable pain. CT colonography (CTC) was performed for morphological evaluation. Results: Cecal intubation was accomplished successfully in all cases and the intubation time was significantly shortened with the use of PCF-PQ260 (10.13.2 vs. 5.12.8 min (n9, p0.05)). The average self-reported pain score was also significantly lower in PCF-PQ260 group (3.70.6 vs. 2.30.9 (p0.01)). CTC showed that every patient have the “hairpin” bends of the colon. [Discussion] PCF-PQ260 significantly shortened the cecal intubation time and reduced the pain score in difficult cases, and CTC showed every case had “hairpin” bends of the colon. This showed that the “PASSIVE-VENDING COLONOSCOPE” can be negotiated through the “hairpin” bends of the colon with minimum pain. Conclusion: Use of the “PASSIVE- VENDING COLONOSCOPE” shortens the cecal intubation time and reduces pain in difficult cases. Tu1662 Use of I-SCAN™ Endoscopic Image Enhancement Techonology in Clinical Practice to Assist in Diagnostic and Therapeutic Endoscopy Erik A. Bowman* 2 , Shawn M. Hancock 1,2 , Jyothiprashanth Prabakaran 1 , Mark Benson 1,2 , Rashmi Agni 3 , Jennifer M. Weiss 1,2 , Patrick Pfau 1,2 , Mark Reichelderfer 1,2 , Deepak V. Gopal 1,2 1 Gastroenterology & Hepatology, University of Wisconsin Hospitals & Clinics, Dept. of Gastro & Hepatology, Madison, WI; 2 Internal Medicine, University of Wisconsin-School of Medicine & Public Health, Madison, WI; 3 Pathology & Laboratory Medicine, University of Wisconsin-School of Medicine & Public Health, Madison, WI Introduction: Various methods to enhance gastrointestinal (GI) endoscopic mucosal imaging continue to be develop and applied. I-Scan™ is a software driven technology that allows for per pixel modifications of sharpness, hue and contrast to modify and enhance mucosal imaging. It uses post-image acquisition software with real time mapping technology embedded in the endoscopic processor (EPKi). Analysis and modification of the real time image are performed using various combinations of three software algorithms: surface enhancement (SE), contrast enhancement (CE) and tone enhancement (TE). Aims: To review applications of i-Scan™ image enhancement technology in clinical endoscopic practice. Methods: This is a descriptive cases series of 20 consecutive patients over a 9 month period where i-Scan image enhancement technology was used in addition to standard white light endoscopy (WLE) to assist in diagnosis and/or guide therapy. Institutional IRB approval and informed consent was obtained from all patients. Described lesions and corresponding GI pathology were located in : 1) the Upper GI tract: esophagus, stomach, small intestine and 2) Lower GI tract: colo-rectal. Results: i-Scan image enhancement technology was used to diagnose and treat endoscopic findings and pathology in 13 cases involving the Upper GI tract and 7 cases of the Lower GI tract. Of the upper GI tract pathology, endoscopic image enhancement assisted in diagnosis and/or therapy of : 5 cases of Barrett’s Esophagus (BE) with dysplasia (DYS), 1 case of T1 Esophageal adenocarcinoma targeted for EMR (endoscopic mucosal resection) prior to radiofrequency ablation (RFA) therapy, 1 case of CMV ulcerative esophagitis, 1 case of gastric MALT lymphoma, 1 case of distal gastric antral intestinal metaplasia with dysplasia, 3 cases of duodenal follicular lymphoma and 1 case of duodenal flat adenoma with high grade dysplasia . Lower GI findings and pathology detected by i-Scan imaging included : 2 right sided serrated polyps 1cm, one flat tubular adenoma whose margins were defined and removed with polypectomy, 1 T1N0 rectal adenocarcinoma that was successfully resected with snare polypectomy, 1 T1N0 anal squamous cell CA diagnosed on routine screening colonoscopy in an asymptomatic patient, 1 case of solitary rectal ulcer in a patient presenting with persistent bleeding with prior negative colonoscopy, 1 case of radiation proctitis.(Table 1) Conclusions: 1)Compared to WLE (white light endoscopy), i-Scan™ imaging modes can provide more detailed topography of mucosal surface and potentially delineate lesion edges by enhancing vessel and minute mucosal structures. 2)This endoscopic technology can be clinically useful and directly impact the management of patients. Table 1. PATIENT DIAGNOSIS i-scan MODE MUCOSAL IMAGE IMPACT ON DX AND TX 1-4 BE with HGD 1,2,3 Nodule of HGD Targeted EMR 5 BE with LGD 1,2 Nodule of dysplasia Targeted EMR 6 Esophageal adeno CA 1,2,3 Accentuated abnormal tissue Targeted bx & EMR 7 CMV Esophagitis 1,2,3 Deep ulcerations Targeted bx after 2 neg EGD 8 Gastric MALT Lymphoma 1,3 Gastric folds mucosal abnormality Targeted bx 9 CAG with intestinal metaplasia & dysplasia 1,2,3 Highlighted gastric thickening & nodularity Sub-total gastrectomy 10 Duodenal adenoma w/ dysplasia 1,2,3 Highlighted flat polyp margins Complete EMR 11 Peri-ampullary Follicular Lymphoma 1,2 Identified extent of involvement Prevented performing unnecessary ampullectomy 12 Low grade follicular lymphoma 1,2 Highlighted nodular area Targeted bx 13 Grade 1-2 submucosal follicular lymphoma 1,2 Highlighted lymphoid appearance Targeted EMR & prevented surgical excision 14 Sessile serrated polyp 1,2 Margins of polyp Polyp detection & polypectomy 15 Serrated polyp 1,2 Identified the borders of a right-sided sessile polyp Complete polypectomy 16 Tubular adenoma 1,2 Accentuated borders of rectal polyp Complete endoscopic resection 17 Anal SCCa T1N0 1,2 Identified mucosal abnormality in anal canal Targeted bx 18 Rectal AdenoCA - T1N0 1,2 Identified the borders of flat “depressed” rectal polyp Targeted complete polypectomy 19 Radiation proctitis 1 Identified extent of involvement Allowed for more diffuse tx with APC 20 SRUS ulcer 1,2 Accentuated subtle ulcer Targeted bx Cases in which i-scan imaging highlighted mucosal abnormalities not as clearly seen with white light endoscopy (WLE). Abbreviations: WLE-white light endoscopy, BE-Barrett’s esophagus, LGD- low grade dysplasia, HGD-high grade dysplasia, RFA-radio frequency ablation, EMR-endoscopic mucosal resection,CMV-cytomegalovirus,MALT-mucosal associated lymphoid tissue, CAG-chronic active gastritis, CA-cancer, Bx-biopsy, Dx-diagnosis, Tx-therapy, SCCa-squamous cell cancer, adenoCA-adenocarcinoma, SRUS-solitary rectal ulcer syndrome, APC-argon plasma coagulation. Tu1663 The Effect of the Third Eye® Retroscope® (TER) on Additional Adenoma Detection Rates (DR) During Colonoscopy in Above- Average Risk Patients for Colorectal Cancer in a Community Setting Daniel Mishkin* 1,2 1 Granite Medical Group, Quincy Medical Center, Quincy, MA; 2 Boston Medical Center, Boston, MA The TER is a proprietary device used in addition to standard colonoscopy techniques to improve visualization of the colonic mucosal surface. This IRB- approved prospective trial, with one physician endoscopist in a community hospital and ambulatory endoscopy center, includes consecutive above-risk Abstracts AB480 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012 www.giejournal.org
Transcript of Tu1662 Use of I-SCAN™ Endoscopic Image Enhancement Techonology in Clinical Practice to Assist in...
Tu1661“Passive-Vending Colonoscope” Significantly Improves CecalIntubation and Reduces the Pain in Difficult CasesTakeshi Mizukami*, Haruhiko Ogata, Toshifumi HibiEndoscopy Center, NHO Kuirhama Alcoholism Center, Yokosuka city,Kanagawa, JapanColonoscopy sometimes causes pain during insertion. Over-insufflation of aircauses elongation or acute angulations of the colon, making passage of thescope difficult and thereby causing pain. We previously reported a sedative-risk-free colonoscopy insertion technique, “WATER NAVIGATION COLONOSCOPY”(Dig Endosc 19(1), 2007). Complete air suction after water infusion not onlyimproves the vision, but also makes water flow down to the descending and thesigmoid collapsed and shortened. While non-sedative colonoscopy can becarried out without pain in most cases, some patients do complain of pain. Mostof these patients have abnormal colon morphology, and the pain is caused whilenegotiating the “hairpin” bends of the colon. The hairpin” bends of the colonshould be negotiated by gently pushing the full-angled colonoscope. Theproximal 10-20 cm from the angulated part of the conventional colonoscope isstiff with a wide turning radius, therefore, a conventional colonoscope cannot benegotiated through the “hairpin” bends of the colon without stretching them andcausing pain. “PASSIVE-VENDING COLONOSCOPE” PCF-PQ260) have a flexibletip with a narrow turning radius, so that the scope can be negotiated through the“hairpin” bends of the colon with a minimum turning radius and minimaldiscomfort. Aims: Assess the intubation and pain-reducing performance of the“PASSIVE-VENDING COLONOSCOPE” in difficult cases. Methods: The subjectswere 11 cases, including 2 cases of cecal intubation failure and 9 cases ofdifficult colonoscopy, who underwent colonoscopy twice: with PCF-240Z(1st)and PCF-PQ260(2nd). Colonoscopy was performed according to the method of“WATER NAVIGATION COLONOSCOPY”. The cecal intubation time wasmeasured and the patients were asked to report their level of discomfort afterthe colonoscopy on a scale of 1 to 5, as follows: grade 1, no discomfort; grade 2,strange feeling; grade 3, distension of the abdomen; grade 4, tolerable pain;grade 5, intolerable pain. CT colonography (CTC) was performed formorphological evaluation. Results: Cecal intubation was accomplishedsuccessfully in all cases and the intubation time was significantly shortened withthe use of PCF-PQ260 (10.1�3.2 vs. 5.1�2.8 min (n�9, p�0.05)). The averageself-reported pain score was also significantly lower in PCF-PQ260 group(3.7��0.6 vs. 2.3�0.9 (p�0.01)). CTC showed that every patient have the“hairpin” bends of the colon. [Discussion] PCF-PQ260 significantly shortened thececal intubation time and reduced the pain score in difficult cases, and CTCshowed every case had “hairpin” bends of the colon. This showed that the“PASSIVE-VENDING COLONOSCOPE” can be negotiated through the “hairpin”bends of the colon with minimum pain. Conclusion: Use of the “PASSIVE-VENDING COLONOSCOPE” shortens the cecal intubation time and reduces painin difficult cases.
Tu1662Use of I-SCAN™ Endoscopic Image Enhancement Techonologyin Clinical Practice to Assist in Diagnostic and TherapeuticEndoscopyErik A. Bowman*2, Shawn M. Hancock1,2, Jyothiprashanth Prabakaran1,Mark Benson1,2, Rashmi Agni3, Jennifer M. Weiss1,2, Patrick Pfau1,2,Mark Reichelderfer1,2, Deepak V. Gopal1,2
1Gastroenterology & Hepatology, University of Wisconsin Hospitals &Clinics, Dept. of Gastro & Hepatology, Madison, WI; 2InternalMedicine, University of Wisconsin-School of Medicine & Public Health,Madison, WI; 3Pathology & Laboratory Medicine, University ofWisconsin-School of Medicine & Public Health, Madison, WIIntroduction: Various methods to enhance gastrointestinal (GI) endoscopicmucosal imaging continue to be develop and applied. I-Scan™ is a softwaredriven technology that allows for per pixel modifications of sharpness, hue andcontrast to modify and enhance mucosal imaging. It uses post-image acquisitionsoftware with real time mapping technology embedded in the endoscopicprocessor (EPKi). Analysis and modification of the real time image are performedusing various combinations of three software algorithms: surface enhancement(SE), contrast enhancement (CE) and tone enhancement (TE). Aims: To reviewapplications of i-Scan™ image enhancement technology in clinical endoscopicpractice. Methods: This is a descriptive cases series of 20 consecutive patientsover a 9 month period where i-Scan image enhancement technology was used inaddition to standard white light endoscopy (WLE) to assist in diagnosis and/orguide therapy. Institutional IRB approval and informed consent was obtainedfrom all patients. Described lesions and corresponding GI pathology werelocated in : 1) the Upper GI tract: esophagus, stomach, small intestine and 2)Lower GI tract: colo-rectal. Results: i-Scan image enhancement technology wasused to diagnose and treat endoscopic findings and pathology in 13 casesinvolving the Upper GI tract and 7 cases of the Lower GI tract. Of the upper GItract pathology, endoscopic image enhancement assisted in diagnosis and/ortherapy of : 5 cases of Barrett’s Esophagus (BE) with dysplasia (DYS), 1 case of
T1 Esophageal adenocarcinoma targeted for EMR (endoscopic mucosal resection)prior to radiofrequency ablation (RFA) therapy, 1 case of CMV ulcerativeesophagitis, 1 case of gastric MALT lymphoma, 1 case of distal gastric antralintestinal metaplasia with dysplasia, 3 cases of duodenal follicular lymphoma and1 case of duodenal flat adenoma with high grade dysplasia . Lower GI findingsand pathology detected by i-Scan imaging included : 2 right sided serratedpolyps �1cm, one flat tubular adenoma whose margins were defined andremoved with polypectomy, 1 T1N0 rectal adenocarcinoma that was successfullyresected with snare polypectomy, 1 T1N0 anal squamous cell CA diagnosed onroutine screening colonoscopy in an asymptomatic patient, 1 case of solitaryrectal ulcer in a patient presenting with persistent bleeding with prior negativecolonoscopy, 1 case of radiation proctitis.(Table 1) Conclusions: 1)Compared toWLE (white light endoscopy), i-Scan™ imaging modes can provide more detailedtopography of mucosal surface and potentially delineate lesion edges byenhancing vessel and minute mucosal structures. 2)This endoscopic technologycan be clinically useful and directly impact the management of patients.
Table 1.
PATIENT DIAGNOSISi-scanMODE MUCOSAL IMAGE
IMPACT ON DX ANDTX
1-4 BE with HGD 1,2,3 Nodule of HGD Targeted EMR5 BE with LGD 1,2 Nodule of dysplasia Targeted EMR6 Esophageal adeno CA 1,2,3 Accentuated abnormal
tissueTargeted bx & EMR
7 CMV Esophagitis 1,2,3 Deep ulcerations Targeted bx after 2neg EGD
8 Gastric MALTLymphoma
1,3 Gastric folds mucosalabnormality
Targeted bx
9 CAG with intestinalmetaplasia &dysplasia
1,2,3 Highlighted gastricthickening &nodularity
Sub-total gastrectomy
10 Duodenal adenomaw/ dysplasia
1,2,3 Highlighted flat polypmargins
Complete EMR
11 Peri-ampullaryFollicularLymphoma
1,2 Identified extent ofinvolvement
Prevented performingunnecessaryampullectomy
12 Low grade follicularlymphoma
1,2 Highlighted nodulararea
Targeted bx
13 Grade 1-2submucosalfollicularlymphoma
1,2 Highlighted lymphoidappearance
Targeted EMR &prevented surgicalexcision
14 Sessile serrated polyp 1,2 Margins of polyp Polyp detection &polypectomy
15 Serrated polyp 1,2 Identified the bordersof a right-sidedsessile polyp
Completepolypectomy
16 Tubular adenoma 1,2 Accentuated bordersof rectal polyp
Complete endoscopicresection
17 Anal SCCa T1N0 1,2 Identified mucosalabnormality in analcanal
Targeted bx
18 Rectal AdenoCA -T1N0
1,2 Identified the bordersof flat “depressed”rectal polyp
Targeted completepolypectomy
19 Radiation proctitis 1 Identified extent ofinvolvement
Allowed for morediffuse tx with APC
20 SRUS ulcer 1,2 Accentuated subtleulcer
Targeted bx
Cases in which i-scan imaging highlighted mucosal abnormalities not as clearly seen with whitelight endoscopy (WLE). Abbreviations: WLE-white light endoscopy, BE-Barrett’s esophagus, LGD-low grade dysplasia, HGD-high grade dysplasia, RFA-radio frequency ablation, EMR-endoscopicmucosal resection,CMV-cytomegalovirus,MALT-mucosal associated lymphoid tissue, CAG-chronicactive gastritis, CA-cancer, Bx-biopsy, Dx-diagnosis, Tx-therapy, SCCa-squamous cell cancer,adenoCA-adenocarcinoma, SRUS-solitary rectal ulcer syndrome, APC-argon plasma coagulation.
Tu1663The Effect of the Third Eye® Retroscope® (TER) on AdditionalAdenoma Detection Rates (DR) During Colonoscopy in Above-Average Risk Patients for Colorectal Cancer in a CommunitySettingDaniel Mishkin*1,2
1Granite Medical Group, Quincy Medical Center, Quincy, MA; 2BostonMedical Center, Boston, MAThe TER is a proprietary device used in addition to standard colonoscopytechniques to improve visualization of the colonic mucosal surface. This IRB-approved prospective trial, with one physician endoscopist in a communityhospital and ambulatory endoscopy center, includes consecutive above-risk
Abstracts
AB480 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012 www.giejournal.org
