Endoscopy advances improve early diagnosis

State-of-the-art endoscopy technology which provides consultants with exceptionally high definition (HD) imaging has been helping key hospitals around the country to improve early cancer detection rates, leading to better patient treatment and reducing the cost to the NHS. A growing body of clinical studies show that a new generation of devices, incorporating megapixel, charge coupled device (CCD) technology, are having a significant impact on the way consultants are working. This is due to the fact that this advanced technology is enhancing clinicians’ abilities to view changes in tissue patterns much more clearly than was previously possible. According to a peer reviewed study1 published in the World Journal of Gastroenterology, the enhanced resolution and visualisation provided by the latest Pentax Medical HD+ endoscopes and video processors, leads to a significantly higher detection rate of polyps, specifically adenomas, when compared with alternative high resolution endoscopes. In the endoscopy suite, it is the availability of such high definition technology that is providing exceptional and superior visualisation of the mucosa, which in turn is improving detection and characterisation, while also helping reduce procedure and diagnosis times. This was highlighted by Dr Matthew Banks, University College London Hospital NHS Foundation Trust, at the Digestive Disorders Federation Conference, held in Liverpool, last year. In his presentation, he outlined how the on-going evolution of HD endoscopy, along with virtual chromoendoscopy, has helped to improve the detection of gastrointestinal pathology in recent years, and improved diagnostic accuracy.

The value of HD endoscopy

Dr Banks explained that the newer HD video endoscopes encompass CCD chips containing 700K to 1.4M pixels and resolution increases with the number of pixels available, which can subsequently increase the ability to define the finest architectural details, or patterns, of the mucosa. To demonstrate the advantages of using HD endoscopy for gastrointestinal visualisation, Dr Banks discussed best practice for surveillance of Barrett’s Oesophagus. Considering the questions: ‘Can we identify specialised intestinal metaplasia?’ and ‘Can we detect high grade intraepithelial neoplasia?’, Dr Banks illustrated the advantages presented by Pentax’s HD+ endoscopes, with 1.3 mega pixel CCD chips, and ‘i-scan’ (a computed virtual chromoendoscopy system). By using acetic acid spray to remove the mucosa film to leave a clear view of the tissue surface, in conjunction with HD endoscopy and i-scan, Dr Banks highlighted how it is easy to see changes in mucosal patterns and vasculature (Table 1). This is achieved through the excellent images provided by ‘i-scan’ SE (Surface Enhancement), CE (Contrast Enhancement) and TE (Tone Enhancement) features without the loss of light, ensuring improved in vivo detection, demarcation and characterisation of Barrett’s Oesophagus. Dr Banks then moved on to discuss whether simply taking targeted biopsies will suffice without the need for taking random biopsies. Here, he concluded that enhanced endoscopy techniques used together with acetic acid may well be improving detection of dysplasia in Barrett’s Oesophagus through better targeted biopsies. However, random biopsies are still required following the taking of targeted biopsies. This is due to the fact that the level of expertise in recognition and classification of pit patterns, as well as mucosal and vascular patterns, is still growing; random biopsies may therefore still detect any lesions missed. However, there is certainly evidence at UCLH that by using Pentax HD+ and i-scan endoscopy, numbers of biopsies being taken are reducing.