Medizinische Klinik C, Klinikum Ludwigshafen gGmbH Gastroenterologie, Hepatologie, Diabetologie, Gastroenterologische Onkologie „KEY NOTE LECTURE“ FUTURE OF ENDOSCOPY IN GASTROENTEROLOGY J.F. Riemann L. Helmstädter Falk-Symposium Future Perspectives in Gastroenterology Dresden, 11 th -12 th October 2007 Medical Department C, Klinikum Ludwigshafen, Germany Gastroenterology, Hepatology, Diabetes Care, Gastrointestinal Oncology
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„KEY NOTE LECTURE“ FUTURE OF ENDOSCOPY IN GASTROENTEROLOGY · „KEY NOTE LECTURE“ FUTURE OF ENDOSCOPY IN GASTROENTEROLOGY J.F. Riemann L. Helmstädter Falk-Symposium Future
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Medical Department C, Klinikum Ludwigshafen, GermanyGastroenterology, Hepatology, Diabetes Care,
Gastrointestinal Oncology
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ENDOSCOPY
FUTURE PERSPECTIVES IN ENDOSCOPY
Quality Research
Technology
Prevention Interventions
Interdisciplinarity
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Diagnostics TherapyCombination1970
2007
HISTORY
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DIAGNOSTIC IMAGING
Structural Enhancement
High Definition Television (HDTV)
Chromoendoscopy (NBI, FICE, i-scan)
Adaptive IHb Color Enhancement
Autoflourescence-Imaging
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Structure EnhancementHDTV
(High Definition TV)
NBI(Narrow Band Imaging)
FICE(Fuji Intelligent Color
Enhancement)
DIAGNOSTIC IMAGING
Konventionell
NBI-Filter
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Adaptive IHb (Index of Hb)Color Enhancement
Colour Enhancement after calculation of hemoglobin concentration and comparison with
a reference index
Courtesy of R. Tamm, Olympus
DIAGNOSTIC IMAGING
AF CCD
Std CCDfor white light
endoscopy
LightGuide
LightGuide
biopsy
Autoflourescence-Imaging
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DIAGNOSTIC IMAGING
RED FLAG TECHNIQUESclear signal in the
presence of suspected lesions
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HISTORY OFSMALL BOWEL DIAGNOSTICS
push enteroscopyBenz et al., DMW 1997
In the 90s
use of transnasal sonde typeenteroscopesTada et al., Endoscopy 1986
intraoperative enteroscopyBosseckert et al., Endoscopy 1981
In the 80s
first use of endoscopes in small bowelClassen et al., DMW 1972
In the 70s
20th Century
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HISTORY OFSMALL BOWEL DIAGNOSTICS
21st Centurycapsule endoscopy (PillCam)Iddan et al., Nature 2000
2000
double balloon enteroscopyYamamoto et al., Gastrointest Endosc 2001May, Ell et al., Endoscopy 2003
2001
Olympus capsule (EndoCapsule)Hartmann et al., Endoscopy, accepted forpublication
2005
single balloon enteroscopyHartmann et al., Endoscopy, accepted forpublication
2007
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HISTORY OFSMALL BOWEL DIAGNOSTICS
notable simplification and improvement of proceduresexamination of the complete small bowelpossiblehigh diagnostic accuracytherapy in the hole small bowel possiblebecomes standard in all centers
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DIAGNOSTIC IMAGINGSmall Caliber Endoscopes
SpyGlass-SystemSingle-operator system
Four-way steering capability
Independent irrigationchannels
Diagnostic and therapeuticcapabilities
Disposable and multi-usecomponents
Courtesy of W. Weber, Boston Scientific
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FUTURE PERSPECTIVESPrevention
Incidence of CRC is increasingScreening-colonoscopy stagnates despitegood resultsShift in stages of CRCAcceptance is moderateImproved devices, new techniques
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Reasons for non-attendance of screening
no knowledge, no information 73%lack of interest, indecision 63%no time 62%fear of cancer 57%feeling healthy 43%no address / invitation 43%fear of examination procedure 39%mistrust in medicine 27%
flexible access to intraabdominal areas, which are laparoscopically not or just difficult reachable (right flank of liver, underside of liver, retroperitoneum …)