Dr Rehan Haidry, University College Hospital London
I am based at UCLH in London – one of the largest units in the UK involved in the diagnosis and treatment of patients with Oesophago-Gastric cancer. The outcomes for these patients remain poor and so, with the advancements and innovations in minimally invasive endoscopic treatments, we must be able to improve early detection and allow early curative treatment to be offered.
For too long we have relied on random endoscopic sampling and white light endoscopy to aid diagnosis but now we are in the unique position that we have at our disposal, an array of optical enhancements and virtual chromoendscopic tools to direct us. We have been using the PENTAX EPK-i system with the i10 endoscopes for over 5 years in my center. It supports us in the diagnosis and management of patients with early Oesophago-gastric cancer with great results. In my own practice I rely on i-scan 1 (Surface enhancement) as my default initial mode for interrogating the upper GI tract. This has superseded the WLE mode and helps me to assess and detect early cancers. The depth and image resolution is so good at defining mucosal patterns that, when disordered or irregular, lead one to suspect neoplasia. My own preference is then to switch to i-scan 2 to better characterize the lesion in terms of borders. It also allows one to interpret vascularity in great detail. Coupled with the magnification range of endoscopes, I have used this mode with much success, for example in patients with early squamous cell cancer of the oesophagus. With the combination of conventional chromoendoscopy and agents such as acetic acid it can provide very accurate delineation of flat lesions.
Over the past six months, I have been using newer optical enhancements that PENTAX Medical has developed above and beyond the conventional i-scan modes described above. These are i-scan OE1 and i-scan OE2. I have particularly liked i-scan OE1, as the filtering technology provides a very distinct and lighter image of the vascularity and mucosal pit patterns that become disordered in early cancer. Coupled with i-scan 1, these have become the two most commonly used enhanced imaging modalities that I use. I-scan OE2 has promise in patients with ESCN and, as our experience grows, we will no doubt understand the disease process and applications where this mode will play a role in the future.
Finally, I would like to bring to peoples’ attention a unique online platform that has been developed for understanding the various image enhancements from i-scan to i-scan OE and magnification endoscopy – it can be found at www.i-scanimaging.com. This website has evolved into a fantastic platform for trainees and experienced endoscopists to learn and share their experiences of image enhancement using the PENTAX Medical system, with online access to videos and cases. I would encourage users of i-scan to explore this platform to inform themselves of some of the benefits that they can gain when diagnosing their own patients.
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