Keterangan
Endoscopy has been transformed by the quick advancements achieved in novel endoscopic technology to enhance mucosal visibility. Modern endoscopists can now offer visual diagnosis in real time due to improved lesion detection. High-definition endoscopy and optical contrast techniques including narrow-band imaging, flexible spectral imaging, color enhancement, and i-scan are now commercially available thanks to advancements in picture resolution, software processing, and optical filter technology. These methods have complimented and improved standard white light endoscopy, together with autofluorescence imaging and confocal laser endomicroscopy.
Ringkasan
- Advanced Endoscopic Imaging techniques, developed by scope companies, enhance visualization beyond conventional RGB light. These techniques primarily utilize the NBI (Narrow Band Imaging) filter, removing the red filter and focusing on green and blue wavelengths. The blue filter visualizes superficial structures, particularly blood vessels, which appear sharper due to blue light absorption. The green filter penetrates deeper into the submucosa, with sub-mucosal capillaries absorbing the green wavelength and reflecting it as cyan.
- Advanced Endoscopic Imaging has various applications throughout the GI tract, particularly in detecting pre-malignant conditions. In the esophagus, it helps in identifying specialized intestinal metaplasia in Barrett's esophagus and areas of high-grade dysplasia. The Inter-epithelial Papillary Capillary Loop (IPCL) is a key concept. The morphology of the superficial capillary networks, particularly their arrangement and shape, provides diagnostic information, classifying conditions from inflammation to malignancy.
- In gastroesophageal reflux disease (GERD), an increased number and dilation of IPCLs are reliable indicators, potentially eliminating the need for biopsies. In Barrett's esophagus, NBI aids in identifying irregular and distorted pits, which are highly sensitive indicators of dysplasia. Demarcation lines are critical for diagnosing malignancy on NBI, indicating a clear separation between normal and abnormal mucosa.
- In the stomach, NBI helps classify the mucosa as normal, exhibiting intestinal metaplasia, or malignant. The VS classification focuses on vessel and microsurface patterns, with the presence of a demarcation line being essential for diagnosing early gastric cancer. For H. pylori detection, NBI shows loss of the sub-epithelial capillary network in the body and the presence of connecting veins in the antrum, which are not usually visible.
- In the colon, NBI aids in differentiating between hypoplastic, adenomatous, and malignant polyps, using classifications like Nice and Gnet. The Nice classification focuses on polyp color, vessel arrangement, and surface pattern. The Gnet classification categorizes polyps into types 1, 2A/2B, and 3, reflecting their potential for malignancy and determining the need for therapy.
- Limitations include increased procedure time due to thorough cleaning and flushing, potential for observer variation, and interference from blood or bile. Future strategies should prioritize adequate training programs to promote the implementation of NBI in daily endoscopic practice, recognizing its value in early detection and targeted interventions.
Contoh Sertifikat
Tentang Pembicara
Dr.Siddharth Dhande
Advanced Endoscopy Fellow BIDS , Global Hospital , Mumbai
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