Endoscopy 2008

Grant F. Hutchins M.D.

Assistant Professor Gastroenterology/Hepatology

Advanced Endoscopy

The Beginnings – Not Torture Today

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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!!!!!