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In vivo diagnosis of upper GI neoplasia with Optical Imaging (i-scan OE)
Lisbon, May 10th 2016
Courtesy of Dr. Rehan Haidry, University College Hospital London, UK
Brief history of i-scan…and i-scan OE
Lisbon, May 10th 2016
Courtesy of Prof. Dr. Ralf Kiesslich, Wiesbaden, Germany
Imaging Guided Endoscopic Therapy for Early Oesophageal Neoplasia
PENTAX Medical’s UEGW Expert dinner, Camp Nou, Barcelona
Courtesy of Dr. Rehan Haidry, University College Hospital London, UK
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
Gastric cancer
This video sequence demonstrates to observe characteristic of surface pattern with i-scan SE then switch to i-scan OE to observe vessel pattern. i-scan OE brought up better assessment of vessel as compared with chromo endoscopy. Following pathological result concluded mucosal cancer 8mm in size.
Courtesy of Prof.Tomoki Michida, Teikyo University, Japan
Gastric cancer
This video sequence demonstrates to observe characteristic of surface pattern with i-scan SE then switch to i-scan OE to observe vessel pattern and demarcation line of lesion without help of magnified scopes. Following pathological result concluded gastric cancer invaded slightly the submucosa.
Courtesy of Prof.Tomoki Michida, Teikyo University, Japan
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
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
