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Endoscopy 2008

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

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Endoscopy 2008

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  1. Endoscopy 2008 Grant F. Hutchins M.D. Assistant Professor Gastroenterology/Hepatology Advanced Endoscopy

  2. The Beginnings – Not Torture Today =

  3. Modern Torture

  4. 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

  5. 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

  6. 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*

  7. Spyglass Images

  8. 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

  9. 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

  10. Enteroscopy Today

  11. 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!!!!!

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