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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

Endoscopy 2008

Grant F. Hutchins M.D.

Assistant Professor Gastroenterology/Hepatology

Advanced Endoscopy

upper lower gi tract
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
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
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*
halo photoablation
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
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

endoscopy the future
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!!!!!