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NEW TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY Edited by Oliviu Pascu and Andrada Seicean New Techniques in Gastrointestinal Endoscopy Edited by Oliviu Pascu and Andrada Seicean Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Masa Vidovic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright ekipaj, 2011. Used under license from Shutterstock.com First published September, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org New Techniques in Gastrointestinal Endoscopy, Edited by Oliviu Pascu and Andrada Seicean p. cm. ISBN 978-953-307-777-2 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Ultrasound Endoscopy 1 Chapter 1 EUS Staging of Luminal Cancers in the Upper GI Tract 3 Juan Carlos Bucobo and Jonathan M. Buscaglia Chapter 2 EMR and ESD for Gastrointestinal Neoplasms 19 Keiichiro Kume Chapter 3 Endoscopic Ultrasonography in Management of Cystic Disease of the Pancreas 41 Mohamed Othman, Mihir Patel and Massimo Raimondo Chapter 4 Endorectal Ultrasound Scan 53 Rani Kanthan and Selliah Kanthan Part 2 Capsule Endoscopy 59 Chapter 5 Capsule Endoscopy: Strategies and Pitfalls of Interpretation 61 ByungIk Jang, David Y. Graham, SiHyung Lee and KyeongOk Kim Chapter 6 Capsule Endoscopy: A Comprehensive Review 85 Rajendra Kumar Jain and Saransh Jain Chapter 7 Capsule Endoscopy - State of the Technology and Computer Vision Tools After the First Decade 103 Michał Mackiewicz Chapter 8 Videocapsule Endoscopy of the Small Bowel 125 Cristin Constantin Vere, Costin Teodor Streba, Ion Rogoveanu and Alin Gabriel Ionescu Chapter 9 Small Bowel Stromal Tumors: Approach by Capsule Endoscopy 149 Anca Trifan, Ana Maria Singeap and Carol Stanciu VI Contents Chapter 10 Wireless Capsule Endoscopy in Pediatric Gastrointestinal Diseases 165 Daisuke Tokuhara Chapter 11 Capsule Endoscopy - 2011 183 Zvi Fireman and Oren Atia Part 3 Other New Techniques 195 Chapter 12 Endoscopic Molecular Imaging in Gastrointestinal Oncology 197 Naoki Muguruma and Tetsuji Takayama Chapter 13 New Techniques in Endoscopy: Confocal Laser Endomicroscopy 213 Helga Bertani, Rita Conigliaro and Flavia Pigò Chapter 14 Light-Induced Fluorescence Techniques for Gastrointestinal Tumour Detection 231 Ekaterina Borisova, Borislav Vladimirov, Radina Ivanova and Latchezar Avramov Chapter 15 Magnifying Endoscopy and Chromoendoscopy in Upper Gastrointestinal Tract - Clinical Applications 253 Alina Boeriu, Daniela Dobru, Ofelia Pascarenco, Mircea Stoian and Simona Mocan Chapter 16 Highly Fluorescent Macrophages in Colonic Mucosa Under Autofluorescence Imaging Endoscopy: A Brief Case Report 281 Tetsuro Takamatsu, Yoshinori Harada, Naoki Wakabayashi, Katsuichi Imaizumi, Kiichiro Miyawaki, Keimei Nakano, Yoshihisa Yamaoka, Akio Yanagisawa and Toshikazu Yoshikawa Chapter 17 Effectiveness of Daikenchuto, a Traditional Japanese Herbal Medicine, in Accelerating Capsule Endoscopy Transit Time- A Prospective Pilot Study 289 Konosuke Nakaji, Shigeo Suzumura, Atsuyo Fujita, Mitsutaka Kumamoto and Yukinori Nakae Chapter 18 Non-Invasive Endoscopy Technique - Virtual Colonoscopy 297 Baki Ekçi, Bengi Gürses and Düzgün Yıldırım Preface Several decades have passed since endoscopy was introduced as a diagnostic method. Based on continuous cooperation between engineers and endoscopists, the standardization of endoscopic procedures in both diagnostic and therapeutic methods has been achieved. Furthermore, we assisted the uniting of academic and industrial research for obtaining further advances in GI endoscopy. As result of this progress, endoscopy has became more complex, using more sophisticated devices and it has claimed a special form. At this moment, the gastroenterologist performing endoscopy has to be an expert in the macrosopic view of lesions in the gut, with good skills for using standard endoscopes, good experience in ultrasound (for performing endoscopic ultrasound), pathology experience for confocal examination. It is compulsory to get experience and to have patience and attention for the follow-up of thousands of images transmitted during capsule endoscopy as well as to have knowledge in physics necessary for autofluorescence imaging endoscopy. Therefore, the idea of the endoscopist has changed. Examinations mentioned need a special formation, a superior level of instruction, accessible to those who have already gained enough experience in basic, diagnostic endoscopy. This is the reason for what these new issues of endoscopy are presented in this book New techniques in Gastrointestinal Endoscopy. The real benefit brought by this book is the presentation of latest developments in this field, as capsule endoscopy, confocal laser endomicroscopy, autofluorescence imaging endoscopy, endoscopic ultrasonography, advanced techniques for resection or stenting. Different issues are not presented only as general information, harvesting knowledge in literature, but highlight personal experiences of authors from all over the world. We are convinced that this book will be very useful to doctors who are performing these techniques, because there are many chapters written by impressive gastroenterologists with large experience in their area, but also to young fellows in formation who want to perform them in the future. Reasons for utility of the book are the didactic, complete and detailed presentation, with indications, contraindications, risks and complications for every method described. X Preface We would like to thank all of the authors for their excellent papers which facilitated the editing work for this book. We really appreciate the Editorial board members of Intech Open Access Publisher for their great effort to collect and publish all these works. Oliviu Pascu, MD, PhD 3rd Medical Department University of Medicine and Pharmacy 'luliu Hatieganu' Cluj-Napoca Romania Andrada Seicean, MD, PhD University of Medicine and Pharmacy ”Iuliu Hatieganu” Cluj-Napoca, Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania [...]... procedure was 19 min 3.3.4 EMRC using IRS (internally retained snare) cap In EMRC, the crescent-shaped snare needs to be prelooped into the groove of the rim of the cap during the procedure itself As this prelooping can be initially difficult, the author has 24 New Techniques in Gastrointestinal Endoscopy avoided this step by developing a new type of prelooped cap, the “internally retained snare” (IRS)... classified as T3 In contrast to a T2 tumor, a T3 tumor will have irregular margins, often 10 New Techniques in Gastrointestinal Endoscopy appearing as finger-like projections, or pseudopodia, extending into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures T4 tumors are defined as those invading the serosa... malignancies and 25-50% of all small intestinal cancers Adenocarcinomas are the most common followed by carcinoid tumors [1, 63, 64] 14 New Techniques in Gastrointestinal Endoscopy Duodenal tumors are staged using the 7th edition of the AJCC for Small Intestine Cancer.[1] The role of EUS in staging these tumors is not well-defined and has not been widely studied Depending on the size of the tumor, a radial... high-resolution imaging of both intraluminal and extraluminal structures, allowing for the detection and staging of even the smallest tumors in a minimally invasive manner The accuracy of EUS in assessing depth of invasion of luminal tumors (T stage) is greater than other imaging modalities, including multi-detector CT and MRI The addition of fine needle aspiration (FNA) allows for assessment of nodal involvement... Ultrasound Endoscopy 1 EUS Staging of Luminal Cancers in the Upper GI Tract Juan Carlos Bucobo and Jonathan M Buscaglia Stony Brook University Medical Center State University of New York at Stony Brook Stony Brook, New York USA 1 Introduction Endoscopic ultrasound (EUS) has revolutionized the field of gastrointestinal endoscopy, and it plays a pivotal role in the staging of tumors of the upper gastrointestinal. .. (TNM) staging system as described by the American Joint Committee on Cancer (AJCC) [1] The basic technique for performing endoscopic ultrasound for staging is similar for tumors located in the esophagus, stomach, and duodenum We usually begin with standard upper endoscopy to visually assess the lesion, to determine whether the larger echoendoscope will 4 New Techniques in Gastrointestinal Endoscopy. .. reserved for intraepithelial tumors without invasion of the lamina propria [1] The T1 category is further subdivided into T1a for invasion of lamina propria or muscularis mucosa, and T1b for invasion of submucosa [41] The distinction between Tis, T1a and T1b is important in deciding whether endoscopic resection is feasible Contrary to staging in other parts of the GI tract, invasion of the lamina propria... accurate examination Experience in identifying local and regional lymph nodes, and precisely assessing the level of tumor invasion, is critical for directing patients into the appropriate treatment algorithm; as often the choice of surgical procedure relies upon this information There are several classification systems currently in use for defining GI cancers, predicting prognosis and determining treatment... Infiltrating gastric malignancies Infiltrating malignancies of the stomach include the diffuse type of gastric adenocarcinoma (linitis plastica) and primary gastric lymphomas (PGL) EUS is important in determining the depth of involvement of these lesions The normal gastric thickness is between 3 to 5 mm and appears thickened in infiltrating tumors Sonographic images in linitis plastica will either show... cautioned that overstaging of T2 tumors can lead to the inappropriate use of neoadjuvant therapy instead of immediate surgery [25] EUS has its highest accuracy in staging advanced tumors The distinction between a T3 (tumor invading adventitia, or going through the muscularis propria) and a T4 (tumor invading adjacent structures) is important in that it can determine resectability [1, 7, 14] In the latest revision . NEW TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY Edited by Oliviu Pascu and Andrada Seicean New Techniques in Gastrointestinal Endoscopy Edited. already gained enough experience in basic, diagnostic endoscopy. This is the reason for what these new issues of endoscopy are presented in this book New techniques in Gastrointestinal Endoscopy. . Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org New Techniques in Gastrointestinal