COLON: Innovations 3 steps, 3 parts..
|
|
- Kellie Allison Sparks
- 5 years ago
- Views:
Transcription
1 COLON: Innovations 3 steps, 3 parts.. Detection: I see an abnormality (usually a polyp) Characterization: Is this abnormality neoplastic? (for example: an adenoma) Treatment: it is neoplastic. Can I treat it using endoscopy?
2 COLON: Innovations Detection Characterization Treatment
3 COLON: Innovations Detection Characterization Treatment
4 Detection: : innovations..2 different approaches IMAGE QUALITY TOLERANCE to improve the pt compliance to screening (mass screening or individual screening)
5 Detection: : innovations..2 different approaches IMAGE QUALITY TOLERANCE to improve the pt compliance to screening (mass screening or individual screening)
6 How to improve patient tolerance?
7 New colonoscopes = mechanical part of the endoscope has been modified to facilitate insertion (and visualization) 1- Aer-O-scope 2- Colonosight 3- Invendo 4- Ethicon 5- Neoguide 6- Shapelock 7- Spiral overtube 8- Videocapsule
8 Is it possible to classify them? We must take into account the mass screening process: How is mass screening organized?
9 Mass screening of CRC = 2 tests first test: FOBT, second test: colonoscopy if first test positive
10 Some could replace the first test Ethicon Aer-O-scope Capsule because they have no therapeutic capabilities (no operating channel) Some could replace the second test: Invendo Neoguide Colonosight Overtube: Shapelock Spiral overtube
11 Abandoned
12 Some could replace the first test Ethicon Aer-O-scope Capsule because they have no therapeutic capabilities (no operating channel) Some could replace the second test: Invendo Neoguide Colonosight Overtube: Shapelock Spiral overtube
13 Vucelic Gastroenterology 2006: 10 caecal intubations /12
14 Almost abandoned
15 Some could replace the first test Ethicon Aer-O-scope Capsule because they have no therapeutic capabilities (no operating channel) Some could replace the second test: Invendo Neoguide Colonosight Overtube: Shapelock Spiral overtube
16
17 European study 320 pts All polyps >6mm >10mm Sensitivity 73% 64% 60% Specificity 77% 84% 98% PPV 86% 60% 83% NPV 59% 86% 93%
18 Bowel cleansing: grade good and above Capsule Colo Total 72% 87% Sigmoid 70% 87% Descending 77% 86% Transverse 74% 86% Ascending 69% 83% Caecum 61% 81%
19 Some could replace the first test Ethicon Aer-O-scope Capsule because they have no therapeutic capabilities (no operating channel) Some could replace the second test: Invendo Neoguide Colonosight Overtube: Shapelock Spiral overtube
20 Pneumatic bending Remote control LED Operating channel Rösch GIE patients 82% caecal intubation Single-use colonoscope
21 Pneumatic bending Remote control Uncertain future LED Operating channel Single-use colonoscope
22 Some could replace the first test Ethicon Aer-O-scope Capsule because they have no therapeutic capabilities (no operating channel) Some could replace the second test: Invendo Neoguide Colonosight Overtube: Shapelock Spiral overtube
23 NeoGuide Endoscopy System Eickhoff Am J Gastro caecal intubations / 11 Abandoned Development for «NOTES»
24 Some could replace the first test Ethicon Aer-O-scope Capsule because they have no therapeutic capabilities (no operating channel) Some could replace the second test: Invendo Neoguide Colonosight - STRYKER Overtube: Shapelock Spiral overtube
25 Pneumatic propeller LED Single use sheath
26 Almost Abandoned Only focused on single use sheath
27 Improving pt tolerance new colonoscopes: Conclusion Very disappointing Capsule: almost the last product Main problem with capsule = bowel cleansing
28 Detection: : innovations..2 different approaches IMAGE QUALITY TOLERANCE to improve the pt compliance to screening (mass screening or individual screening)
29 IMAGE QUALITY : innovations Virtual chromoscopy Autofluorescence Image enlargement
30 IMAGE QUALITY : innovations Virtual chromoscopy Autofluorescence Image enlargement
31 Narrow band imaging Spectrum White light NBI
32
33
34
35 Adenoma Detection Adenoma detection - Randomised % with 1+ adenomas NBI White Light Rex Adler East Kaltenbach Rex D et al GIE 2006 Adler A et al. Gut 08 East JE et al. DDW 07 Kaltenbach TR et al. DDW 07 Inoue T J Gastro 2008: 243 pts, No effect
36 HNPCC Adenoma detection - proximal colon At least one adenoma 45% 40% 35% 30% 25% 20% 15% 10% 5% 27% WL 42% NBI P=.004 White light WL + NBI 0% Proportion flat adenomas Proportion flat adenomas 50% 40% 30% 20% 10% 3/25 12% 45% 9/21 NBI White light NBI P=.03 East JE et al. Gut 08 0%
37 Detection DALMs in Colitis NBI can detect and characterise DALMs Not better than white light East et al. Gut 2006;55: Dekker et al. Endoscopy 2007;39:
38 NBI: detection Average risk population Is virtual chromoendoscopy recommended as the standard for CCR screening? No. High risk population: HNPCC Can NBI replace chromoendoscopy? Possibly Yes High risk population: UC surveillance Can NBI replace chromoendoscopy? No
39 Fujinon Intelligent Colour Enhancement (FICE)? Patients presenting for routine colonoscopy were randomly assigned to FICE or white light with targeted chromoscopy (indigo carmine). 871 pts Adenomas: 236 FICE vs 271 white light Pohl et al. DDW 2008
40 IMAGE QUALITY : innovations Virtual chromoscopy Autofluorescence Image enlargement
41 Autofluorescence Colon AFI Juntendo University AFI
42 Matsuda Am J Gastroenterol 167 pts, random AFI vs WL + 34% adenomas However Some disappointements
43 IMAGE QUALITY : innovations Virtual chromoscopy Autofluorescence Image enlargement = To better see behind the folds
44 Wide angle colonoscope 210 standard 140 Rex Am J Gastro 2003 Deenadayalu Am J Gastro 2004 Pb = No effect on miss rates
45 Third eye
46
47 Third eye: pilot study 100 pts % polyps % adenomas Waye GIE 2008 AB101
48 Image quality: Conclusion NBI and FICE: limited role Autofluorescence: uncertain Image enlargement: interesting field but japanese companies not so interested Why?
49 COLON: Innovations Detection Characterization Treatment
50 Can we replace biopsies? Can we let in place a polyp? Can we orientate the management (IBD?)
51 CHARACTERIZATION : innovations Virtual chromoscopy Endocystoscopy Confocal microscopy
52 NBI: pit pattern (such as for chromoscopy) Hyperplastic Adenoma Carcinoma Hirata, GIE 2007
53 NBI can also permit to analyze the vascular pattern... (not possible with chromo)
54
55 NBI: vascular pattern Hyperplastic Weak vascular pattern Adenoma: strong vascular pattern
56 NBI: Adenoma vs hyperplastic polyp? Polyp number Sensitivity Specificity Chiu Gut 2007* % % Su Am J Gastro 2006* Hirata GIE Machida Endoscopy East GIE Tischendorf Endosc
57 From all these data concerning NBI, If we say type II = hyperplastic polyp, we have 6% of risk that the polyp is adenomatous If we say type III = adenomatous polyp, we have 16% of risk that the polyp is hyperplastic
58 chromoendo NBI Risk to miss adenoma 13% 6% Risk to miss hyperplastic. 25% 16%
59 CHARACTERIZATION : innovations Virtual chromoscopy Endocystoscopy Confocal microscopy
60
61
62
63 CHARACTERIZATION : innovations Virtual chromoscopy Endocystoscopy Confocal microscopy
64 Confocal microscopy Light Guide Light Guide CCD Confocal Imaging Window Air/Water Nozzles Biopsy Channel Auxiliary Water Jet Channel
65 Ileum Kiesslich
66 Hyperplasia Kiesslich
67 Adenoma Kiesslich
68 Colonic cancer Kiesslich
69 Cancer in-situ Kiesslich
70 Mild UC Kiesslich
71 Severe UC Kiesslich
72 Kiesslich Gastroenterol 2007 Diagnosis of neoplastic changes on IBD Accuracy = 97.8% 10 fold reduction of the number of biopsies Hurstone Clin Gastroenterol Hepatol 07, Gut 08 Kappa coefficient of agreement between endomicroscopy and histopathology: 0.91 Accuracy: 97% 2.5 fold increase of the dg yield / chromoscopy
73 Characterization: Conclusion NBI : promising to characterize polyps but is it helpful? (ex: serrated adenomas) Endomicroscopy: to be evaluated Confocal microscopy: Very effective in IBD in expert hands But needs confirmation in routine
74 COLON: Innovations Detection Characterization Treatment
75 Last advance = Endoscopic submucosal dissection (ESD)
76 IT knife Needle knife Flex knife Hook knife
77
78 Results of Colorectal ESD En bloc resection 97.7% (209/214) Curative resection 89.7% (192/214) Perforation 7.0% (15/214) Delayed Perforation 0.9% (2/214): surg Delayed bleeding 3.7% (8/214) Local recurrence 0% (0/214) Apr Jan.2008, Toranomon Hospital
79 RESULTS OF ESD Nbr en-bloc R0 Perf CR TANAKA 70 80% 10% 100% GIE 07 FUJISHIRO 35 88% 63% 6% 100% GIE 06 TAMAGAI % 1% UEGW07 Lyon 16 75% 44% 12%
80
81
82
83
84 Do we all need to learn and perform ESD for colorectal adenomas?
85 Main advantage of ESD = resection is aiming R0
86 Adenoma Aiming R0 Not aiming R0
87 Adenoma Aiming R0 Fragments = piece-meal Not aiming R0
88 piece-meal
89
90
91
92 Which are the 2 consequences to do not get a R0 resection? 1- Risk of «recurrence» = 30% Rate increased with diameter with piece-meal in comparison to one piece Kaltenbach GIE 07, Hurlstone Gut 04, Tamura Endosc 04, Tanaka GIE01, Su AJG 05, Sano Dig Endosc 04 FOLLOW-UP to be organized
93 Balance Perforation risk Procedure duration Need for follow-up Looking for perfection is maybe not the more cost-effective approach
94 Which are the 2 consequences to let in place adenomatous tissue? 2- Risk to let in place or to have destroyed carcinoma
95 Invasive car Adenoma Fragments
96 Invasive car Adenoma
97 In which cases do we need to aim to have a R0 resection?
98 2 CLASSIFICATIONS to be known Paris classification macroscopy, general pattern Kudo classification macroscopy, pitt pattern
99 Polypoïd 0-Ip pedunculated 0-Is sessile Flat 0-IIa 0-IIb 0-IIc surelevated flat depressed 0-III Ulcerated
100 Complex patterns IIc + IIa IIa + IIc LST = Is + IIc
101 II a + II c II c + II a
102 Submucosal invasion Oeso Stomach Colon I 0-II a 0-II b 0-II c III
103 2 CLASSIFICATIONS to be known Paris classification macroscopy, general pattern Kudo classification macroscopy, pitt pattern
104 Small tubular large tubular branched IIIS adenoma IIIL IV
105 irregular Non structured VI carcinoma VN
106 In which cases do we need to aim to have a R0 resection?
107 0-III Ulcerated Reference = surgery Endoscopy only if aiming R0
108 0-IIc If Kudo type V Reference = surgery Endoscopy only if aiming R0 IIc + IIa IIa + IIc LST = Is + IIc
109 II a + II c II c + II a
110
111 Treatment: conclusion on ESD Adenoma = cost-effectiveness analyzis is required Suspicion of invasive adenocar = ESD to be recommended (Kudo V, depressed or complex Paris) At least, excellent technique to improve material and skillfulness
112 GENERAL CONCLUSION Numerous innovations Different aims: needs to be classified (detection, characterization) Frequently disappointing Will not replace good practice (ex: adenoma detection rate, biopsies, EMR)
Chromoendoscopy and Endomicroscopy for detecting colonic dysplasia
Chromoendoscopy and Endomicroscopy for detecting colonic dysplasia Ralf Kiesslich I. Medical Department Johannes Gutenberg University Mainz, Germany Cumulative cancer risk in ulcerative colitis 0.5-1.0%
More informationHow to characterize dysplastic lesions in IBD?
How to characterize dysplastic lesions in IBD? Name: Institution: Helmut Neumann, MD, PhD, FASGE University Medical Center Mainz What do we know? Patients with IBD carry an increased risk of developing
More informationUpdate on EARLY GI-cancer. T Ponchon E.Herriot Hospital Lyon, France
Update on EARLY GI-cancer T Ponchon E.Herriot Hospital Lyon, France Rationale Epidemiology Diagnosis Treatment Rationale Epidemiology Diagnosis Treatment Why do we need, as GI endoscopists, to be concerned
More informationChromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis
Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis Bret A. Lashner, M.D. Professor of Medicine Director,
More informationManagement of pt1 polyps. Maria Pellise
Management of pt1 polyps Maria Pellise Early colorectal cancer Malignant polyp Screening programmes SM Invasive adenocar cinoma Advances in diagnostic & therapeutic endoscopy pt1 polyps 0.75 5.6% of large-bowel
More informationPage 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis
Screening for Colorectal Neoplasia in Inflammatory Bowel Disease Francis A. Farraye MD, MSc Clinical Director, Section of Gastroenterology Co-Director, Center for Digestive Disorders Boston Medical Center
More informationDysplasia 4/19/2017. How do I practice Chromoendoscopy for Surveillance of Colitis? SCENIC: Polypoid Dysplasia in UC. Background
SCENIC: Polypoid in UC Definition How do I practice for Surveillance of Colitis? Themos Dassopoulos, M.D. Director, BSW Center for IBD Themistocles.Dassopoulos@BSWHealth.org Tel: 469-800-7189 Cell: 314-686-2623
More informationColon Polyps: Detection, Inspection and Characteristics
Colon Polyps: Detection, Inspection and Characteristics Stephen Kim, M.D. Assistant Professor of Medicine Interventional Endoscopy Services UCLA Division of Digestive Diseases September 29, 2018 1 Disclosures
More informationFinding and Removing Difficult Polyps (safely)
Finding and Removing Difficult Polyps (safely) David Lieberman MD Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University Colonoscopy Clouds Interval Cancers Interval Cancer:
More informationEndoscopic Corner CASE 1. Kimtrakool S Aniwan S Linlawan S Muangpaisarn P Sallapant S Rerknimitr R
170 Endoscopic Corner Kimtrakool S Aniwan S Linlawan S Muangpaisarn P Sallapant S Rerknimitr R CASE 1 A 54-year-old woman underwent a colorectal cancer screening. Her fecal immunochemical test was positive.
More informationPrevalence and Characteristics of Nonpolypoid Colorectal Neoplasm in an Asymptomatic and Average-Risk Chinese Population
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:463 470 Prevalence and Characteristics of Nonpolypoid Colorectal Neoplasm in an Asymptomatic and Average-Risk Chinese Population HAN MO CHIU,*,, JAW TOWN
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: April 15, 2018 Related Policies: 2.01.87 Confocal Laser Endomicroscopy 6.01.32 Virtual Colonoscopy/CT Colonography Chromoendoscopy as an Adjunct to Colonoscopy
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Aberrant crypt foci, chromocolonoscopy for, 539 540 Absorptive stains, for chromocolonoscopy, 522 524 Accessories, for colonoscopy, 680 684
More informationSupporting Information 2. ESGE QIC Lower GI Delphi voting process: Round 1 Working Group chair: Michal F. Kaminski, Poland
Supporting Information 2. ESGE QIC Lower GI Delphi voting process: Round 1 Working chair: Michal F. Kaminski, Poland Population Interventions Comparator Outcome Additional evidence 1.1 Rate of adequate
More informationDifficult Polypectomy 2015 Tool of the Trade
Difficult Polypectomy 2015 Tool of the Trade Jonathan Cohen, MD FACG FASGE Clinical Professor of Medicine NYU Langone School of Medicine Improving Therapeutics in the Colon Improved detection of polyp
More informationPhilip Chiu Associate Professor Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong
Application of Chromoendoscopy, NBI and AFI in Esophagus why, who, and how? Philip Chiu Associate Professor Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong Cancer of
More informationPredict, Resect and discard : Yes we can! (at least in some hands)
Diminutive polyps : Real time endoscopic histology Predict, Resect and discard : Yes we can! (at least in some hands) Robert Benamouzig Hôpital Avicenne AP-HP & Paris 13 University France Why it is important?
More informationDiagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases
Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases Parakkal Deepak, M.B.B.S., M.S. Assistant Professor of Medicine Division of Gastroenterology John T. Milliken Department
More informationEndoscopic Submucosal Dissection ESD
Endoscopic Submucosal Dissection ESD Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated
More informationWEO CRC SC Meeting. Barcelona, Spain October 23, 2015
WEO CRC SC Meeting Barcelona, Spain October 23, 2015 Identification of serrated polyposis syndrome in the context of population-based CRC screening programs Evelien Dekker Academic Medical Center Amsterdam,
More informationAdvances in Endoscopic Imaging
Advances in Endoscopic Imaging SGNA meeting February 20, 2010 Amar R. Deshpande, MD Asst Professor of Medicine Division of Gastroenterology University of Miami Miller School of Medicine Objectives To recognize
More informationTHE BIG, AWKWARD, FLAT POLYP THAT CAN T BE REMOVED WITH A (SINGLE) SNARE THE CASE FOR EMR AND ESD
THE BIG, AWKWARD, FLAT POLYP THAT CAN T BE REMOVED WITH A (SINGLE) SNARE THE CASE FOR EMR AND ESD Surgical Oncology Network meeting Dr. Eric Lam MD FRCPC October 14, 2017 DISCLOSURES None OBJECTIVES Appreciate
More informationDiagnostic accuracy of pit pattern and vascular pattern in colorectal lesions
Diagnostic accuracy of pit pattern and vascular pattern in colorectal lesions Digestive Disease Center, Showa University Northern Yokohama Hospital Department of Pathology Yoshiki Wada, Shin-ei Kudo, Hiroshi
More informationExperience and challenges of implementing optical diagnosis into clinical practice UK and European Perspective
Experience and challenges of implementing optical diagnosis into clinical practice UK and European Perspective WEO Image Enhanced Endoscopy San Diego, USA Dr James East Consultant Gastroenterologist Honorary
More informationSurveying the Colon; Polyps and Advances in Polypectomy
Surveying the Colon; Polyps and Advances in Polypectomy Educational Objectives Identify classifications of polyps Describe several types of polyps Verbalize rationale for polypectomy Identify risk factors
More informationEndoscopy in IBD. F.Hartmann K.Kasper-Kliniken (St.Marienkrankenhaus) Frankfurt/M.
F.Hartmann K.Kasper-Kliniken (St.Marienkrankenhaus) Frankfurt/M. F.Hartmann@em.uni-frankfurt.de Indications for endoscopy Diagnosis Management Surveillance Diagnosis Single most valuable tool: ileocolonoscopy
More informationAdvanced techniques for resection of large polyps. John G. Lee, MD February 2, 2018
Advanced techniques for resection of large polyps John G. Lee, MD February 2, 2018 Background 1cm - large polyp on screening 2cm - large for polypectomy 3cm giant polyp 10-15% of polyps can t be removed
More informationThe Importance of Complete Colonoscopy and Exploration of the Cecal Region
The Importance of Complete Colonoscopy and Exploration of the Cecal Region Kuangi Fu, Takahiro Fujii, Takahisa Matsuda, and Yutaka Saito 2 2.1 The Importance of a Complete Colonoscopy Ever since case-control
More informationThe Usefulness Of Narrow Band Imaging Endoscopy For The Real Time Characterization Of Colonic Lesions
Acta Medica Marisiensis 2016;62(2):182-186 DOI: 10.1515/amma-2016-0004 RESEARCH ARTICLE The Usefulness Of Narrow Band Imaging Endoscopy For The Real Time Characterization Of Colonic Lesions Boeriu Alina
More informationParis classification (2003) 삼성의료원내과이준행
Paris classification (2003) 삼성의료원내과이준행 JGCA classification - Japanese Gastric Cancer Association - Type 0 superficial polypoid, flat/depressed, or excavated tumors Type 1 polypoid carcinomas, usually attached
More informationBENEFIT APPLICATION BLUE CARD/NATIONAL ACCOUNT ISSUES
Medical Policy BCBSA Ref. Policy: 2.01.84 Last Review: 11/15/2018 Effective Date: 11/15/2018 Section: Medicine Related Policies 2.01.87 Confocal Laser Endomicroscopy 6.01.32 Virtual Colonoscopy/Computed
More informationUniversity Mainz. Early Gastric Cancer. Ralf Kiesslich. Johannes Gutenberg University Mainz, Germany. Early Gastric Cancer 15.6.
Ralf Kiesslich Johannes Gutenberg University Mainz, Germany DIAGNOSIS Unmask lesions - Chromoendoscopy -NBI Red flag technology - Autofluorescence Surface and detail analysis - Magnifying endoscopy - High
More informationAlberta Colorectal Cancer Screening Program (ACRCSP) Post Polypectomy Surveillance Guidelines
Alberta Colorectal Cancer Screening Program (ACRCSP) Post Polypectomy Surveillance Guidelines June 2013 ACRCSP Post Polypectomy Surveillance Guidelines - 2 TABLE OF CONTENTS Background... 3 Terms, Definitions
More informationChromoendoscopy as an Adjunct to Colonoscopy
Chromoendoscopy as an Adjunct to Colonoscopy Policy Number: 2.01.84 Last Review: 1/2018 Origination: 7/2017 Next Review: 7/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Colorectal cancer: colonoscopic surveillance for prevention of colorectal cancer in patients with ulcerative colitis, Crohn
More informationInterval Cancers: What is Next?
Interval Cancers: What is Next? Douglas Corley, MD, PhD Kaiser Permanente, Northern California Gastroenterologist, TPMG Director of Delivery Science & Applied Research Defining the mission Mercury project:
More informationEMR, ESD and Beyond. Peter Draganov MD. Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida
EMR, ESD and Beyond Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated by Endoscopy
More informationMissed Lesions at Endoscopy. Dr Russell Walmsley, MD, FRCP, FRACP Gastroenterologist WDHB Chair Endoscopy Guidance Group for New Zealand
Missed Lesions at Endoscopy Dr Russell Walmsley, MD, FRCP, FRACP Gastroenterologist WDHB Chair Endoscopy Guidance Group for New Zealand Missed Lesions at Endoscopy Is there a problem? With Gastroscopy
More informationTwo-stage optical system for colorectal polyp assessments
Surg Endosc (2016) 30:204 214 DOI 10.1007/s00464-015-4186-x and Other Interventional Techniques Two-stage optical system for colorectal polyp assessments Mirosław Szura 1 Artur Pasternak 1,2 Krzysztof
More informationQuality in Endoscopy: Can We Do Better?
Quality in Endoscopy: Can We Do Better? Erik Rahimi, MD Assistant Professor Division of Gastroenterology, Hepatology, and Nutrition UT Health Science Center at Houston McGovern Medical School Ertan Digestive
More informationProf Rupert Leong, Director of Endoscopy, Head of IBD Professor of Medicine UNSW, University of Sydney, Concord Hospital Australia IBDSydney
10:30-10:50 25 Sept 2017 Monday A-PSDE / WEO Colorectal Cancer Screening Committee (CRCSC) Meeting Room S228 (2/F) Prof Rupert Leong, Director of Endoscopy, Head of IBD Professor of Medicine UNSW, University
More informationWhen is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool
When is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool Adenomas/Carcinoma Sequence Providing Time for Screening Normal 5-20 yrs 5-15 yrs
More informationDescription. Section: Medicine Effective Date: July 15, Subsection: Original Policy Date: September 13, 2012 Subject: Page: 1 of 17
Page: 1 of 17 Last Review Status/Date: June 2016 Description Chromoendoscopy refers to the application of dyes or stains during endoscopy to enhance tissue differentiation or characterization. When used
More informationAdvanced Imaging and the Colon- Which Technology Should I Adopt?
Advanced Imaging and the Colon- Which Technology Should I Adopt? Michael B Wallace MD, MPH, FACG Mayo Clinic Florida Learning Objectives Identify imaging and education methods to increased adenoma detection
More informationThe Paris classification of colonic lesions
The Paris classification of colonic lesions Training to improve the interobserver agreement among international experts Sascha van Doorn, MD, PhD-student in CRC-reserach group of Evelien Dekker Introduction
More informationRomanian Journal of Morphology and Embryology 2006, 47(3):
Romanian Journal of Morphology and Embryology 26, 7(3):239 23 ORIGINAL PAPER Predictive parameters for advanced neoplastic adenomas and colorectal cancer in patients with colonic polyps a study in a tertiary
More informationCorporate Medical Policy
Corporate Medical Policy Chromoendoscopy as an Adjunct to Colonoscopy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: chromoendoscopy_as_an_adjunct_to_colonoscopy 7/2012 11/2017
More informationAccuracy for optical diagnosis of colorectal polyps in clinical practice
1130-0108/2015/107/5/255-261 Revista Española de Enfermedades Digestivas Copyright 2015 Arán Ediciones, S. L. Rev Esp Enferm Dig (Madrid Vol. 107, N.º 5, pp. 255-261, 2015 ORIGINAL PAPERS Accuracy for
More informationIn Vivo Colorectal Polyp Analysis Archived Medical Policy
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationPost-colonoscopy colorectal cancers in Lynch syndrome
Post-colonoscopy colorectal cancers in Lynch syndrome Francesc Balaguer, MD PhD High Risk Colorectal Cancer Clinic Head of the Gastroenterology Department Hospital Clínic de Barcelona fprunes@clinic.cat
More informationIn Vivo Analysis of Colorectal Polyps
Medical Policy Manual Medicine, Policy No. 104 In Vivo Analysis of Colorectal Polyps Next Review: October 2018 Last Review: October 2017 Effective: December 1, 2017 IMPORTANT REMINDER Medical Policies
More informationEmerging Interventions in Endoscopy. Margaret Vance Nurse Consultant in Gastroenterology St Mark s Hospital
Emerging Interventions in Endoscopy Margaret Vance Nurse Consultant in Gastroenterology St Mark s Hospital Colon Cancer Colon cancer is common. 1 in 20 people in the UK will develop the disease 19 000
More informationImproving Your Adenoma Detection Rate
Improving Your Adenoma Detection Rate JILL TINMOUTH, ASSOCIATE PROFESSOR, UNIVERSITY OF TORONTO JERRY MCGRATH, ASSOCIATE PROFESSOR, MEMORIAL UNIVERSITY OF NEWFOUNDLAND FEB. 11 2017 X CanMEDS Roles Covered
More informationColorectal Cancer Screening
Recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer Colorectal Cancer Screening Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson
More informationBowel Screening Colonoscopy in Glasgow How well are we doing? How well should we be doing? How can we evidence and improve performance?
Bowel Screening Colonoscopy in Glasgow 2017 How well are we doing? How well should we be doing? How can we evidence and improve performance? Bowel Screening Standards - Scotland Definitions Completion
More information2015 Winter School 대장종양성병변의진단과치료. Dong Kyung Chang. Sungkyunkwan University, School of Medicine Samsung Medical Center
2017 gastroenterology Winter School 77 2015 Winter School 대장종양성병변의진단과치료 Dong Kyung Chang Sungkyunkwan University, School of Medicine Samsung Medical Center Colon Polyps (Epithelial origin) Neoplastic Premalignant
More informationDevices To Improve Colon Polyp Detection
Devices To Improve Colon Polyp Detection ACG/VGS Regional Postgraduate Course Sep 10-11, 2016 Williamsburg, VA VIVEK KAUL, MD, FACG Segal-Watson Professor of Medicine Chief, Division of Gastroenterology
More informationQuality indicators for colonoscopy and colonoscopist. Mirjana Kalauz Clinical Hospital Center Zagreb
Quality indicators for colonoscopy and colonoscopist Mirjana Kalauz Clinical Hospital Center Zagreb Why is quality monitoring important in CRC screening programme? Quality adjustment in all endoscopic
More informationHow to remove BE cancer: EMR or ESD? Expected outcome
How to remove BE cancer: EMR or ESD? Expected outcome Presented by Horst Neuhaus Institution Dpt. of Gastroenterology Evangelisches Krankenhaus Düsseldorf, Germany Indications for endoscopic resection
More informationThe addition of high magnifying endoscopy improves rates of high confidence optical diagnosis of colorectal polyps
E140 The addition of high magnifying endoscopy improves rates of high confidence optical diagnosis of colorectal polyps Authors Mineo Iwatate 1, Yasushi Sano 1, Santa Hattori 1, Wataru Sano 1, Noriaki
More informationVirtual Chromoendoscopy with I-Scan and its Application for Detection and Characterization of Colon Polyps
DOI: https://doi.org/10.22516/25007440.127 Virtual Chromoendoscopy with I-Scan and its Application for Detection and Characterization of Colon Polyps Henry Royero G., MD. 1 1 Internist and Gastroenterologist
More informationChromoendoscopy - Should It Be Standard of Care in IBD?
Chromoendoscopy - Should It Be Standard of Care in IBD? John F. Valentine, MD, FACG Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Utah What is the point of
More informationLocal recurrence after endoscopic resection of colorectal tumors
Int J Colorectal Dis (2009) 24:225 230 DOI 10.1007/s00384-008-0596-8 ORIGINAL ARTICLE Local recurrence after endoscopic resection of colorectal tumors Kinichi Hotta & Takahiro Fujii & Yutaka Saito & Takahisa
More informationColon Cancer Screening with Image-Enhanced Endoscopy
FOCUSED REVIEW SERIES: Endoscopic Screening and Surveillance for Gastrointestinal Cancer Clin Endosc 2014;47:504-508 Print ISSN 2234-2400 / On-line ISSN 2234-2443 http://dx.doi.org/10.5946/ce.2014.47.6.504
More informationRectal EMR: Techniques and Tips
Rectal EMR: Techniques and Tips Dr Paul Urquhart Epworth Eastern Eastern Health (Head of Endoscopy) The context of EMR Basic Technique Recurrence Perforation Bleeding Introduction 1 I don t treat rectal
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationT. Shono, 1 K. Ishikawa, 1 Y. Ochiai, 1 M. Nakao, 1 O. Togawa, 1 M. Nishimura, 1 S. Arai, 1 K. Nonaka, 2 Y. Sasaki, 2 and H. Kita 1. 1.
International Surgical Oncology Volume 2011, Article ID 948293, 6 pages doi:10.1155/2011/948293 Clinical Study Feasibility of Endoscopic Submucosal Dissection: A New Technique for En Bloc Resection of
More informationAdenoma to Carcinoma Pathway
It is widely accepted that more than 95% of colorectal cancers arise from adenomatous polyps, which are generally defined as benign lesions with dysplastic epithelium that have variable potential for malignancy.
More informationDr Conor Lahiff, Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
Title Endoscopic approach to polyp recognition Authors Dr Conor Lahiff, Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK Dr James E. East, Translational Gastroenterology Unit, John
More informationIncidence and Management of Hemorrhage after Endoscopic Removal of Colorectal Lesions
Showa Univ J Med Sci 12(3), 253-258, September 2000 Original Incidence and Management of Hemorrhage after Endoscopic Removal of Colorectal Lesions Masaaki MATSUKAWA, Mototsugu FUJIMORI, Takahiko KOUDA,
More informationBenchmarking For Colonoscopy. Technology and Technique to Improve Adenoma Detection
Benchmarking For Colonoscopy Technology and Technique to Improve Adenoma Detection Objectives 1. Review the latest data on performance characteristics and efficacy for colon cancer prevention 2. Highlight
More informationScreening & Surveillance Guidelines
Chapter 2 Screening & Surveillance Guidelines I. Eligibility Coloradans ages 50 and older (average risk) or under 50 at elevated risk for colon cancer (personal or family history) that meet the following
More informationmalignant polyp Daily Challenges in Digestive Endoscopy for Endoscopists and Endoscopy Nurses BSGIE Annual Meeting 18/09/2014 Mechelen
Plan Incidental finding of a malignant polyp 1. What is a polyp malignant? 2. Role of the pathologist and the endoscopist 3. Quantitative and qualitative risk assessment 4. How to decide what to do? Hubert
More informationClinical outcomes of the resect and discard strategy using magnifying narrow-band imaging for small (<10 mm) colorectal polyps
Original article Clinical outcomes of the resect and discard strategy using magnifying narrow-band imaging for small (
More informationAn Atlas of the Nonpolypoid Colorectal Neoplasms in Inflammatory Bowel Disease
An Atlas of the Nonpolypoid Colorectal Neoplasms in Inflammatory Bowel Disease Roy Soetikno, MD a, *, Silvia Sanduleanu, MD, PhD b, Tonya Kaltenbach, MD a KEYWORDS Inflammatory bowel disease Nonpolypoid
More informationQuality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right?
Quality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right? Hartery K 1, Sukha A 1, Thomas-Gibson S 1, Thomas H 1,2, Latchford A 1,2. 1 Wolfson Endoscopy Unit, St.
More informationChromoendoscopy is an image-enhanced endoscopic technique
The Role of Chromoendoscopy in Evaluating Colorectal Dysplasia Anna M. Buchner, MD, PhD Dr Buchner is an assistant professor of medicine in the Division of Gastroenterology at the University of Pennsylvania
More informationENDOSCOPY IN COMPETITION DIAGNOSTICS. Dr. med. Dirk Hartmann Klinikum Ludwigshafen
Falk Symposium 166 GI Endoscopy Standards and Innovations Mainz, 18. 19. September 2008 ENDOSCOPY IN COMPETITION DIAGNOSTICS Dr. med. Dirk Hartmann Klinikum Ludwigshafen ENDOSCOPY IN COMPETITION Competing
More informationSize of colorectal polyps determines time taken to remove them endoscopically
Original article Size of colorectal polyps determines time taken to remove them endoscopically Authors Heechan Kang 1, Mo Hameed Thoufeeq 2 Institutions 1 Department of Medicine, Peterborough Hospitals
More informationFactors for Endoscopic Submucosal Dissection in Early Colorectal Neoplasms: A Single Center Clinical Experience in China
ORIGINAL ARTICLE Clin Endosc 2015;48:405-410 http://dx.doi.org/10.5946/ce.2015.48.5.405 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Factors for Endoscopic Submucosal Dissection in Early Colorectal
More informationLinked color imaging improves the visibility of colorectal polyps: a video study
Original article Linked color imaging improves the visibility of colorectal polyps: a video study Authors Naohisa Yoshida 1,YujiNaito 1,TakaakiMurakami 1, Ryohei Hirose 1,KiyoshiOgiso 1,YutakaInada 1,
More information비확대협대역대장내시경을이용한대장용종의감별진단
Korean J Gastroenterol Vol. 63 No. 5, 276-282 http://dx.doi.org/10.4166/kjg.2014.63.5.276 pissn 1598-9992 eissn 2233-6869 ORIGINAL ARTICLE 비확대협대역대장내시경을이용한대장용종의감별진단 김봉진, 박무인, 박선자, 문 고신대학교의과대학내과학교실 원, 박은택,
More informationImproving the Adenoma Detection Rate. ADR is a (the) priority quality indicator
Improving the Adenoma Detection Rate Douglas K. Rex, MD, MACG Indiana University School of Medicine Indianapolis, IN ADR is a (the) priority quality indicator Endorsed Adenoma Detection Rate Cecal intubation
More informationDetermining the adenoma detection rate and adenomas per colonoscopy by photography alone: proof-of-concept study
Original article 245 Determining the adenoma detection rate and adenomas per colonoscopy by photography alone: proof-of-concept study Authors Institution Douglas K. Rex, Kyle Hardacker, Margaret MacPhail,
More informationPolyps Adenomas Lipomas
30 Chapter 2 CT Colonography Chapter 2 Polyps Adenomas Lipomas Case 8 Case 9 Case 10 Case 11 Case 12 Case 13 Case 14 Case 15 Case 16 Case 17 Case 18 Pseudopolyp Polyp after intravenous administration of
More informationNeoplastic Colon Polyps. Joyce Au SUNY Downstate Grand Rounds, October 18, 2012
Neoplastic Colon Polyps Joyce Au SUNY Downstate Grand Rounds, October 18, 2012 CASE 55M with Hepatitis C, COPD (FEV1=45%), s/p vasectomy, knee surgery Meds: albuterol, flunisolide, mometasone, tiotropium
More informationImproving you ADR. Robert Enns Colonoscopy Education Day October 2018
Improving you ADR Robert Enns Colonoscopy Education Day October 2018 ADR Applying to CSP Assume 50% ADR in FIT positive patients Out of 40 patients only 20 will have polyps Out of 20 likely 15 will be
More informationDiagnostic techniques for surveillance of dysplasia
January 27th 2017, 8th Gastro Foundation Weekend for Fellows; Spier Hotel & Conference Centre, Stellenbosch Diagnostic techniques for surveillance of dysplasia Gerhard Rogler, Department of Gastroenterology
More informationHigh Resolution Colonoscopy With Chromoscopy Versus Standard Colonoscopy for the Detection of Colonic Neoplasia: A Randomized Study
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:349 354 High Resolution Colonoscopy With Chromoscopy Versus Standard Colonoscopy for the Detection of Colonic Neoplasia: A Randomized Study MARC LE RHUN,*
More informationCarol A. Burke, MD, FACG
Updated Guidelines for CRC C Screening and Surveillance Carol A. Burke MD, FACG, FASGE, FACP Cleveland Clinic, Cleveland, OH Gastroenterology t 2012;143:844 143 Gut 2010;59:666 1 Caveat for all Recommendations
More informationColorectal Cancer Screening: A Clinical Update
11:05 11:45am Colorectal Cancer Screening: A Clinical Update SPEAKER Kevin A. Ghassemi, MD Presenter Disclosure Information The following relationships exist related to this presentation: Kevin A. Ghassemi,
More informationHow to treat early gastric cancer? Endoscopy
How to treat early gastric cancer? Endoscopy Presented by Pierre H. Deprez Institution Cliniques universitaires Saint-Luc, Brussels Université catholique de Louvain 2 3 4 5 6 Background Diagnostic or therapeutic
More informationFeasibility of endoscopic mucosa-submucosa clip closure method (with video)
Feasibility of endoscopic mucosa-submucosa clip closure method (with video) Authors Toshihiro Nishizawa 1, Shigeo Banno 2, Satoshi Kinoshita 1,HidekiMori 2, Yoshihiro Nakazato 3,YuichiroHirai 2,Yoko Kubosawa
More informationIntroduction. Piecemeal EMR (EPMR) Symposium
Symposium Symposium II - Lower GI : Colonoscopy Issues in 2015 Resection of Large Polyps Using Techniques other than Endoscopic Submucosal Dissection: Piecemeal Resection, Underwater Endoscopic Mucosal
More informationi-scan Mini-Atlas Case studies from clinical practice with HD + and i-scan.
i-scan Mini-Atlas Case studies from clinical practice with and i-scan. Visible excellence. Gastrointestinal endoscopy with and i-scan. Index Introduction 3 and i-scan at a glance 4 5 PENTAX i-scan in characterization
More informationremoval of adenomatous polyps detects important effectively as follow-up colonoscopy after both constitute a low-risk Patients with 1 or 2
Supplementary Table 1. Study Characteristics Author, yr Design Winawer et al., 6 1993 National Polyp Study Jorgensen et al., 9 1995 Funen Adenoma Follow-up Study USA Multi-center, RCT for timing of surveillance
More informationCRC and Dysplasia in IBD: Objectives of Talk. Colorectal Cancer and Dysplasia in IBD: A Case-Based Approach. Page 1
Colorectal Cancer and in IBD: A Case-Based Approach Fernando Velayos MD MPH Associate Director of Translational Research University of California, San Francisco Center for Crohn s s and Colitis CRC and
More informationRetroflexion and prevention of right-sided colon cancer following colonoscopy: How I approach it
Retroflexion and prevention of right-sided colon cancer following colonoscopy: How I approach it Douglas K Rex 1 MD, MACG 1. Indiana University School of Medicine Division of Gastroenterology/Hepatology
More information