Clinical Videos i-scan

Normal duodenal architecture

This sequence demonstrates the normal villous architecture of the second part of the duodenum in detail using PENTAX HD+ with i-scan enhancement.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Crohn`s disease duodenum

Crohn’s disease of the upper GI tract is rare and lesions can easily be missed as they are small. i-scan highlights inflammatory changes of the duodenal mucosa and enhances contrast thus making detection of small aphthoid lesions easier.

Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria

Radiation Proctopathy (RP)

RP is a chronic condition that has a significant burden on patients quality of life and healthcare. This clip shows how i-scan 2 helps to highlight the vascular lesions in detail in a patient with symptomatic bleeding and allows targeted YAG laser treatment to the lesions. The vascular areas are not prominent on HD WLE or even i-scan 1 but by switching to i-scan 2 thermal therapy can be directed to the abnormal areas.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Ulcerative colitis

In ulcerative colitis i-scan clearly shows inflammatory changes of the mucosa. We also use it in conjunction with chromoendoscopy for the surveillance of patients with longstanding chronic inflammatory bowel disease to increase detection of flat lesions.

Courtesy of Michael Häfner, St. Elisabeth Krakenhaus, Austria

Serrated adenoma

Serrated adenoma are frequently missed as they are flat lesions with very subtle changes to the normal mucosa pattern. i-scan allows for enhanced vision of the vascular pattern and changes like the rim of debris and the mucus cap.

Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria

Laterally spreading tumour

In this patient with a laterally spreading tumour granular type i-scan was used to get a clear idea about the polyps pit pattern. As a pit pattern type IV was found, indicating a benign lesion, we proceeded to resect the lesion by means of endoscopic mucosal resection.

Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria

Early gastric cancer

In this video clip i-scan is used to both detect a lesion and to get a clear idea of its margins. Based on i-scan and additional staining with indigo carmine the lesion`s margins were marked and an endoscopic submucosal dissection performed.

Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria

Hyperplastic gastric polyp

This patient presented with anaemia.

At endoscopy the patient was found to have a large hyperplastic polyp in the stomach. This video sequence demonstrates the characteristic PIT pattern of the hyperplastic lesion using PENTAX HD+ and i-scan enhancement.

This image enhancement was used to direct YAG laser therapy to this area to prevent further blood loss.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Gastric high grade dysplasia

This patient was followed up for a gastric ulcer that had caused a large upper GI bleed. At endoscopy there is a dysplastic antral lesion seen on Pentax enhanced imaging. This lesion was removed by Endoscopic Submucosal Resection.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Crohn`s disease ileum

Aphthoid ulcers of the terminal ileum are a typical finding in Crohn’s disease. As seen in this video, contrast and tone enhancement makes even subtle changes easier to spot.

Courtesy of  Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria

Squamous dysplasia of the oesophagus

Early squamous neoplasia is a very aggressive pathology and the decision when to choose oesophageal sparing local endoscopic resective therapy, over invasive interventions such as surgery, depends on accurate staging. Micro-vasculature in squamous dysplasia is key to informing the endoscopist on the potential depth of invasion. Intrapapillary capillary loops arise from the submucosal veins. This short video clip shows an abnormal area with squamous dysplasia that with the magniview scope and i-scan 2 has type II IPCSLs. The normal vasculature is shown before the abnormal vessels come in to view with zoom imaging. This area was resected by EMR and show M3 invasion alone.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Squamous cell cancer of the oesophagus

Early squamous cell cancer of the oesophagus is easily missed. In these flat lesions, it is also difficult to identify the margins of the tumor. In this patient i-scan was used to assess the extension of the mucosal cancer before performing endoscopic submucosal dissection.

Courtesy of Dr. Michael Häfner St. Elisabeth Krakenhaus, Austria

Early squamous neoplasia of the oesophagus (sq emr)

Early squamous neoplasia of the oesophagus is often very difficult to appreciate with white light endoscopy alone. This patient was referred for assessment of acid reflux symptoms and the referring centre had taken random oesophageal biopsies which reported features consistent with atypia. With enhanced imaging and i-scan, there is an extensive circumferential lesion with abnormal vasculature and mucosal irregularity. With lugol’s chromoendoscopy the extent of the lesion is further appreciated with extensive areas of oesophageal unstaining.

Courtesy of Dr. Rehan Haidry, UCLH, UK

A rare case of malignant melanoma of the oesophagus (Melanoma)

The clip shows a very interesting appearance of the oesophagus. With the various enhancement settings and i-scan, one can see multiple pigmented plaques throughout the tubular oesophagus with areas of hyper-vascularity and dilated tortuous micro-vasculature on i-scan 2. This patient has malignant melanoma of the oesophagus and went on to have an oesophagectomy.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Intramucosal cancer in Barrett`s Oesophagus (Zoom IMC)

This short video shows the exciting new magniview gastroscope in use. This is a patient with a previous Barrett’s Cancer that was resected. At first inspection there appears to be residual flat Barrett’s oeosphagus. However a combination of i-scan and acetic acid shows an area at the right wall with featureless mucosa and abnormal irregular micro-vasculature with zoom endoscopy. One can appreciate the normal adjacent villous mucosa next to the featureless area of intramucosal cancer that was resected by EMR.

Courtesy of Dr. Rehan Haidry, UCLH, UK

Early oesophageal neoplasia arising in a patient with Barrett`s oesophagus (ACA EMR)

This is a recording of a patient with early Barrett’s cancer. They were referred for radiofrequency ablation. With enhanced imaging and i-scan 1 there is a very subtle nodule with an area of irregularity at the centre.

Courtesy of Dr. Rehan Haidry, UCLH, UK