Novel Endoscopic Imaging Techniques

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Jasmin Snow
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ENDOSCOPY 2006 152nd Falk Symposium, Berlin May 4-5, 2006 Novel Endoscopic

2 ENDOSCOPY nd Falk Symposium, Berlin May 4-5, 2006 Novel Endoscopic Imaging Techniques Paul Fockens, MD PhD Academic Medical Center, University of Amsterdam

3 Novel Endoscopic Imaging Techniques Current optimal techniques High-resolution and magnification endoscopy Chromo-endoscopy New techniques Narrow Band Imaging Autofluorescence Imaging Endo-microscopy

4 Novel Endoscopic Imaging Techniques Current optimal techniques High-resolution and magnification endoscopy Chromo-endoscopy New techniques Narrow Band Imaging Autofluorescence Imaging Endo-microscopy

5 Optical Magnification (1,5-150 x) + (> pixels) High resolution

6 Chromo-endoscopy Contrast stains Indigo-carmine (0,1 0,4%) Absorptive stains Cresyl violet Methylene blue (0,1%) Spraying catheter useful, not crucial Goal Delineate exact borders Surface analysis (zoom)

7 Chromo-endoscopy Delineate borders Carefull non-magnified endoscopy Use contrast dye at any discoloration etc.

8 Chromo-endoscopy Surface analysis Kudo Type I Kudo Type II

9 Chromo-endoscopy Surface analysis Kudo Type IIIL Kudo Type IIIS

10 Chromo-endoscopy Surface analysis Kudo Type IV Kudo Type V

11 Detection of dysplasia in UC Chromoendoscopy vs. standard 4q biopsies Kiesslich et al, Gastro 2003

12 Novel Endoscopic Imaging Techniques Current optimal techniques High-resolution and magnification endoscopy Chromo-endoscopy New techniques Narrow Band Imaging Autofluorescence Imaging Endo-microscopy

13 Narrow Band Imaging (NBI) Conventional Filter B G R NBI Filter B G R

14 Narrow Band Imaging (NBI) Conventional Filter B G R B B G R NBI Filter G R Band-pass ranges of RGB are narrowed Relatively more contribution of blue light Result: more superficial (=mucosal) imaging

15 Narrow Band Imaging Standard Modus CCD CV-180 NBI- Filter Standard Modus Mucosa CLV-180

16 Narrow Band Imaging Colon

17 Narrow Band Imaging Colon

18 Narrow Band Imaging Colon

19 NBI Flat Adenoma in UC

20 Narrow Band Imaging UC surveillance Comparative study in UC-surveillance 2 colonoscopies 6-8 wks apart NBI with targetted biopsies Standard colonoscopy with 4 biopsies / 10cm Different endoscopist 08/04: 44 patients included Dekker et al, DDW New Orleans 2004

21 Narrow Band Imaging UC surveillance First colo Feasible Time (min) # biopsies Conventional (n=44) (25-90) 38 (20-68) NBI (n=44) (20-90) 4 (0-26) Dekker et al, DDW New Orleans 2004

22 Narrow Band Imaging UC surveillance Number of endoscopies with abnormalities Dysplastic lesions Random biopsies with dysplasia Total number of patiens with dysplasia Conventional 14 9/14 3/43 12 NBI 15 9/15 n.a. 9 Dekker et al, DDW New Orleans 2004

23 Fujinon Intelligent Chromo Endoscopy FICE = post-processing processing technique No scientific data available PubMed negative DDW2006 abstracts negative

26 Novel Endoscopic Imaging Techniques Current optimal techniques High-resolution and magnification endoscopy Chromo-endoscopy New techniques Narrow Band Imaging Autofluorescence Imaging Endo-microscopy

27 Fluorescence Imaging Excitation light (short wavelength) Fluorescent light (longer wavelength) Tissue fluorophores

28 AFI Image Monochromatic CCD Barrier Filter Mucosa Xenon lamp Rotary Filter

31 AFI feasibility study in 60 pts 21 pts had detectable lesions with HGIN 14 pts: abnormalities with WLE & AFI 7 pts: lesions detected with AFI but not with WLE 6 pts: 11 additional lesions with AFI Kara et al, GIEndoscopy 2005

32 False positive rate of AFI AFI Positive HGD/ EC 40 LGD 8 IN D 5 NDBE 28 Tota l 81 False positive rate: ~ 50% Kara et al, GIEndoscopy 2005

33 Endoscopic Tri-Modal Imaging ETMI (WLE,, AFI en NBI)

34 Novel Endoscopic Imaging Techniques Current optimal techniques High-resolution and magnification endoscopy Chromo-endoscopy New techniques Narrow Band Imaging Autofluorescence Imaging Endo-microscopy

35 Confocal Laser Endoscopy (Pentax) Joint venture: Pentax, Japan & Optiscan, Australia Images provided by Dr Kiesslich, Mainz

36 Normal Rectum Images provided by Dr Kiesslich, Mainz DDW 2004

37 Adenoma; HGD Images provided by Dr Kiesslich, Mainz - Gastro 2004

7mm working channel Very high resolution: 1.7 or 4.

38 Endo-Cytoscopy System (Olympus) Probe-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

39 Endo-Cytoscopy System (Olympus)

40 Novel Endoscopic Imaging Techniques New techniques are necessary We miss flat + depressed lesions and dysplasia in UC Chromo-endoscopy is good & easy but underused Indigo-carmine should always be available NBI is now commercially available Olympus 180 series: High resolution (HDTV) + NBI AFI is very attractive as a red-flag technique All new techniques need scientific evaluation

Real-Time in vivo Observation of Cells and Nuclei Opens New Possibilities for Diagnostic Endoscopy

Real-Time in vivo Observation of Cells and Nuclei Opens New Possibilities for Diagnostic Endoscopy Beyond Imagination Introducing Endocyto, Olympus has broken a new ground in endoscopy. Ultra-high magnification with up to 520x magnification ratio enables observation on microscopic level and helps to