The Race for Mainstream Gastrointestinal Endoscopy: Frontrunners

H Seltenreich; J Van Den Bogaerde; D Sorrentino

Disclosures

Expert Rev Gastroenterol Hepatol. 2012;6(4):467-479. 

In This Article

Abstract and Introduction

Abstract

In recent years, gastrointestinal endoscopy has evolved and branched out from a primary naked-eye diagnostic technique to a multitude of sophisticated investigative and therapeutic procedures. While many of the new endoscopic techniques are currently too complex or expensive to make it to mainstream clinical practice, others are already bringing major progress to the management of digestive diseases. In this review we will discuss a selected group of the emerging techniques and technologies used to increase the diagnostic yield in the colon and small intestine, including Third Eye® Retroscopes®, colon capsule endoscopy, spiral enteroscopy and confocal laser endomicroscopy. We will also discuss over-the-scope clip devices, a relatively simple and inexpensive tool potentially capable of noninvasive closing intestinal perforations and allowing the removal of infiltrating tumors.

Introduction

Gastrointestinal endoscopy is a very fast moving field. Progress is continuously being made in diagnostic and therapeutic techniques ranging from early and more accurate detection of colon polyps/cancer, to real-time histology, to endoscopic treatment of mucosal lesions. The authors of this review will discuss a selected group of recent advances that hold great promise for the near future. The authors will not discuss the techniques that are either too distant from clinical practice (e.g., natural-orifice translumenal endoscopic surgery) or already too developed (e.g., endoultrasonography, narrow-band imaging) and deserving a separate article. Comprehensive reviews have already been published.[1] Here, the authors will first discuss some basic techniques and instruments used to increase the diagnostic yield of colonoscopy, with a focus on proximal colonic lesions. Noninvasive colonic evaluation with capsule endoscopy will be discussed next. This technology builds on experience with small bowel capsule – and may also assist in screening for colonic polyps, given the predictable higher patient acceptance and increased adherence rate in colonic screening programs. The small bowel remains an area that is difficult to evaluate, and although small bowel capsule is an excellent diagnostic procedure, interventions are difficult. Here the authors will describe – and compare with other techniques – spiral entero­scopy (SE); a procedure with great potential to explore the small intestine allowing therapeutic maneuvers as well. The authors will then outline the recent progress in imaging techniques such as confocal laser endomicroscopy (CLE) that may make precise definition and characterization of flat lesions with premalignant potential possible, with the final aim of their endoscopic removal. Finally, the authors will discuss new clipping devices (over-the-scope clipping devices [OTSC]), which may allow endoscopists to approximate large mucosal defects enabling closure of perforations and even removal of intramucosal neoplastic lesions. It is anticipated that many of these techniques will find a stable place in the modern endoscopist's armamentarium. However, only time and appropriate studies will tell whether they will become true 'must haves' or will fade away.

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