• Title/Summary/Keyword: Advanced endoscopy

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Current status of image-enhanced endoscopy in inflammatory bowel disease

  • Young Joo Yang
    • Clinical Endoscopy
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    • v.56 no.5
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    • pp.563-577
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    • 2023
  • In inflammatory bowel disease (IBD), chronic inflammation leads to unfavorable clinical outcomes and increases the risk of developing colorectal neoplasm (CRN); thereby highlighting the importance of endoscopically evaluating disease activity as well as detecting and characterizing CRN in patients with IBD. With recent advances in image-enhanced endoscopic (IEE) technologies, especially virtual chromoendoscopy (VCE) platforms, this review discusses state-of-the-art IEE techniques and their applicability in assessing disease activity and surveillance colonoscopy in patients with IBD. Among various IEE, VCE demonstrated the capacity to identify quiescent disease activity. And endoscopic remission defined by the new scoring system using VCE platform better predicted clinical outcomes, which may benefit the tailoring of therapeutic strategies in patients with IBD. High-definition dye-chromoendoscopy (HD-DCE) is numerically superior to high-definition white light endoscopy (HD-WLE) in detecting CRN in IBD; however, discrepancy is observed in the statistical significance. VCE showed comparable performance in detecting dysplasia to HD-WLE or DCE and potential for optical diagnosis to differentiate neoplastic from nonneoplastic lesions during surveillance colonoscopy. Applying these novel advanced IEE technologies would provide opportunities for personalized medicine in IBD and optimal treatment of CRN in patients with IBD.

Vaginal Endoscopy for Detecting Estrual Cycles and developing Artificial Insemination Technique in the Bitch (개에서 내시경을 이용한 발정주기 검사 및 인공수정 기법의 실험조사)

  • 신남식;문유식;최윤주;정동희;김용준;권오경
    • Journal of Veterinary Clinics
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    • v.14 no.1
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    • pp.93-98
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    • 1997
  • The vaginal endoscopy was performed in two Labrador Retrievers from onset of vaginal bleeding until metestrus accompanying with vaginal smear and blood progesterone concentration to investigate estral changes, and the intrauterine infusion of radiopaque fluid using vaginal endoscope (rigid 25-degree endoscope, Karl Storz) was detected by radiogrphy to determine if theis technique is feasible for future artificial insemination in the dogs. During the proestrus vaginal mucous membrane folds were edematous and a large amount of clear red discharge was present. In the beginning of estrus, the mucous membrane folds was present and the amount of the red discharge was decreased. In the estrus there were obbvious shrinkage, angulation of the membrane folds and decreasing of the discharge. In metestrus the vaginal folds started to round out and the surface appeared moist and sticky. The endoscope used for endoscopic monitoring of the vaginal mucosa was advanced until the external os of the cervix could be visualized. A plastic catheter, 8Fr guage was manupulated into the cervical os and then advanced through into the uterus. The radiopaque fluid was injected into the uterus through the catheter and radiographs taken to detect the site of insemination using the endoscopic technique revealed the exact infusion of the fluid in the uterus, consequentlyto prove that this technique is usable for more successful artificial insemintion tn the bitch.

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Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy

  • Baldwin, Christina L.;Wilsey, Michael
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.19 no.4
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    • pp.276-280
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    • 2016
  • Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the stomach, which were treated with an epinephrine injection. The Dieulafoy lesion, although thought to be rare, should be considered when investigating an acute gastrointestinal bleed. These lesions have been successfully treated endoscopically. Appropriate anticipation and preparation for diagnosis and therapy can lead to optimal outcomes for the pediatric patient.

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

  • Do Han Kim;Somashekar G. Krishna;Emmanuel Coronel;Paul T. Kroner;Herbert C. Wolfsen;Michael B. Wallace;Juan E. Corral
    • Clinical Endoscopy
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    • v.55 no.2
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    • pp.197-207
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    • 2022
  • Background/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE). Methods: We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations. Results: Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needle-based CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization. Conclusions: CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

Development of Head Mounted Display Interface System for Controlling Wireless Capsule Endoscope (무선 캡슐내시경 조종을 위한 머리부착형 디스플레이 인터페이스 시스템의 개발)

  • Young-Eun, Hwang;Young-Don, Son
    • Journal of Biomedical Engineering Research
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    • v.43 no.6
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    • pp.417-423
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    • 2022
  • The present study proposed a new interface system for capsule endoscopy by using head mounted display (HMD) device, which can control the orientation of the capsule endoscope with electromagnetic actuator (EMA) system. The orientation information of the HMD user was detected by the gyroscope sensor built into the device and then calculated to as an angle increment using Unity Engine compiler. The measured angle changes from the HMD were converted to the current values of the corresponding coils to be changed in the EMA system. Two experiments were designed to measure the accuracy and the intuitiveness of the HMD interface system. In the angle accuracy measurement, the capsule endoscope driven by HMD interface system showed the averaged errors of 0.68 degrees horizontally and 1.001 degrees vertically for given test angles. In the intuitiveness measurement, HMD interface system showed 1.33 times faster manipulation speed rather than the joystick interface system. In this respect, the HMD interface system for capsule endoscopy was expected to improve the overall diagnostic environment while maintaining comfort of patients and clinicians.

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

  • Partha Pal;Sundeep Lakhtakia
    • Clinical Endoscopy
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    • v.56 no.2
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    • pp.143-154
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    • 2023
  • Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

Comparison of Endoscopic and Histological Findings between Typical and Atypical Celiac Disease in Children

  • Semwal, Pooja;Gupta, Raj Kumar;Sharma, Rahul;Garg, Kapil
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.21 no.2
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    • pp.86-92
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    • 2018
  • Purpose: Celiac disease is a common non-communicable disease with varied presentations. Purpose of this study was to find the duodeno-endoscopic features in celiac disease and to compare duodeno-endoscopic and histological findings between typical and atypical celiac disease in children. Methods: Hospital based observational study was conducted at Sir Padampat Mother and Child Health Institute, Jaipur from June 2015 to May 2016. Patients were selected and divided in two groups- typical and atypical celiac disease based upon the presenting symptoms. Upper gastrointestinal endoscopy and duodenal biopsy was performed for serology positive patients. Results were analysed using appropriate statistical test of significance. Results: Out of 101 enrolled patients, 47.5% were male. Age ranged from 1 to 18 years. Study showed that 54.5% were typical and 45.5% were atypical. Patients presenting with atypical symptoms were predominantly of older age group. On endoscopy, scalloping, mosaic pattern, reduced fold height and absent fold height; and in histology, advanced Marsh stage were significantly higher in the typical group. Conclusion: Awareness of atypical presentations as well as duodeno-endoscopic features may have considerable practical importance for the diagnosis of celiac disease in children. Scalloping, mosaic pattern, reduced fold height and nodularity are main endoscopic markers of celiac disease in children. Endoscopic markers of duodenal mucosa may be important in early diagnosis of celiac disease, in children subjected to endoscopy for atypical presentations or indication other than suspected celiac disease.

A performance Evaluation and Development of 3D Endoscopic Imaging system

  • Song, Chul-Gyo;Kim, Kyeong-Seop;Kim, Nam-Gyun;Lee, Myoung-Ho
    • Journal of KIEE
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    • v.10 no.1
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    • pp.1-6
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    • 2000
  • This paper represents the design of 3D endoscopic video system in order to improve visualization and enhance the ability of the surgeon to perform delicate endoscopic surgery. In comparison of the polarized and electric shutter-type stereo imaging system, The former is superior in terms of accuracy and performance speed for knot-tying and loop pass test. The result of experiments show that the proposed 3D endoscopy system has a wide viewing angle and zone which is necessary for multi-view and it has better image quality and stability of the optical performances than the electric shutter-type does.

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Colorectal carcinoma and chronic inflammatory demyelinating polyneuropathy: is there a possible paraneoplastic association?

  • Adnan Malik;Faisal Inayat;Muhammad Hassan Naeem Goraya;Gul Nawaz;Ahmad Mehran;Atif Aziz;Saad Saleem
    • Clinical Endoscopy
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    • v.56 no.2
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    • pp.245-251
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    • 2023
  • A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.

A Case of Pyloric Obstruction Developed after Upper GI Barium Study in Patients with Caustic Injury on Gastrointestinal Tract (부식제에 의한 위장관 손상 환자에서 상부 위장관 조영술 후 발생한 위유문부 폐쇄 1례)

  • Kim, Jeong-Goo;Cho, Hye-Jin;Lee, Seung-Hee;Kim, Pum-Soo;Roh, Hyung-Keun
    • Journal of The Korean Society of Clinical Toxicology
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    • v.1 no.1
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    • pp.51-55
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    • 2003
  • Caustic ingestion can produce a progressive and devastating injury to the esophagus and stomach, In the acute stage, perforation and necrosis may occur. Long-term complications include esophageal stricture, antral stenosis and the development of esophageal cancer. Endoscopy should be performed as soon as possible in all cases to evaluate the extent and severity of damage, unless there is evidence of perforation. Endoscopy is the diagnostic procedure of choice. However, when the endoscopy cannot be passed through due to esophageal stricture, upper GI barium studies may be useful as a follow-up measure and in the evaluation of complications. A 44-year-old man visited our hospital complaining frequent vomiting 1 hour after ingestion of unknown amount of hydrochloric acid. At the time of arrival, the patient's oral cavity was slightly swollen and erythematous. On the endoscopic examination fourteen hour after the caustic ingestion, marked swelling of the arytenoids and circumferential ulceration with brown and black pigmentation at the upper esophagus were observed. Four weeks after the caustic injury, upper esophageal narrowing was observed and then the scope could not be advanced to the stomach. Upper GI barium study performed at that time revealed diffuse luminal narrowing of the esophagus and concentric luminal narrowing from prepyloric antrum to pylorus with disturbance of barium passage. At a week after the Upper GI study, through endoscopic examination after bougie dilatation of the esophagus, barium impaction in the stomach and the pylorus was noticed.

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