Early oesophageal neoplasia arising in a patient with Barrett`s oesophagus

This is a recording of a patient with early Barrett’s cancer. They were referred for radiofrequency ablation. With enhanced imaging and i-scan 1 there is a very subtle nodule with an area of irregularity at the centre. When we combine i-scan imaging with acetic acid chromoendoscopy the lesion becomes very apparent. The lesion does not whiten with acetic acid like the surrounding normal Barrett’s epithelium. With i-scan 2 and acetic acid, one can clearly see the abnormal irregular mucosal architecture which at times is featureless. This was removed by endoscopic resection and was shown to be a mucosal adenocarcinoma.


Courtesy of Dr. Rehan Haidry, UCLH, UK




Intramucosal adenocarcinoma in Barrett`s oesophagus

This short video shows the exciting new magniview gastroscope in use. This is a patient with a previous Barrett’s Cancer that was resected. At first inspection there appears to be residual flat Barrett’s oeosphagus. However a combination of i-scan and acetic acid shows an area at the right wall with featureless mucosa and abnormal irregular micro-vasculature with zoom endoscopy. One can appreciate the normal adjacent villous mucosa next to the featureless area of intramucosal cancer that was resected by EMR.


Courtesy of Dr. Rehan Haidry, UCLH, UK




A rare case of malignant melanoma of the oesophagus

The clip shows a very interesting appearance of the oesophagus. With the various enhancement settings and i-scan, one can see multiple pigmented plaques throughout the tubular oesophagus with areas of hyper-vascularity and dilated tortuous micro-vasculature on i-scan 2. This patient has malignant melanoma of the oesophagus and went on to have an oesophagectomy.

 


Courtesy of Dr. Rehan Haidry, UCLH, UK




Early squamous neoplasia of the oesophagus

Early squamous neoplasia of the oesophagus is often very difficult to appreciate with white light endoscopy alone. This patient was referred for assessment of acid reflux symptoms and the referring centre had taken random oesophageal biopsies which reported features consistent with atypia. With enhanced imaging and i-scan, there is an extensive circumferential lesion with abnormal vasculature and mucosal irregularity. With lugol’s chromoendoscopy the extent of the lesion is further appreciated with extensive areas of oesophageal unstaining.


Courtesy of Dr. Rehan Haidry, UCLH, UK




Squamous cell cancer of the oesophagus

Early squamous cell cancer of the oesophagus is easily missed. In these flat lesions, it is also difficult to identify the margins of the tumor. In this patient i-scan was used to assess the extension of the mucosal cancer before performing endoscopic submucosal dissection.


Courtesy of Dr. Michael Häfner St. Elisabeth Krakenhaus, Austria




Squamous dysplasia of the oesophagus

Early squamous neoplasia is a very aggressive pathology and the decision when to choose oesophageal sparing local endoscopic resective therapy, over invasive interventions such as surgery, depends on accurate staging. Micro-vasculature in squamous dysplasia is key to informing the endoscopist on the potential depth of invasion. Intrapapillary capillary loops arise from the submucosal veins. This short video clip shows an abnormal area with squamous dysplasia that with the magniview scope and i-scan 2 has type II IPCSLs. The normal vasculature is shown before the abnormal vessels come in to view with zoom imaging. This area was resected by EMR and show M3 invasion alone.


Courtesy of Dr. Rehan Haidry, UCLH, UK




Crohn`s disease ileum

Aphthoid ulcers of the terminal ileum are a typical finding in Crohn’s disease. As seen in this video, contrast and tone enhancement makes even subtle changes easier to spot.


Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria




Gastric high grade dysplasia

This patient was followed up for a gastric ulcer that had caused a large upper GI bleed. At endoscopy there is a dysplastic antral lesion seen on Pentax enhanced imaging. This lesion was removed by Endoscopic Submucosal Resection. 


Courtesy of Dr. Rehan Haidry, UCLH, UK




Hyperplastic gastric polyp

This patient presented with anaemia.

 

At endoscopy the patient was found to have a large hyperplastic polyp in the stomach. This video sequence demonstrates the characteristic PIT pattern of the hyperplastic lesion using PENTAX HD+ and i-scan enhancement.

 

This image enhancement was used to direct YAG laser therapy to this area to prevent further blood loss.


Courtesy of Dr. Rehan Haidry, UCLH, UK




Early gastric cancer

In this video clip i-scan is used to both detect a lesion and to get a clear idea of its margins. Based on i-scan and additional staining with indigo carmine the lesion`s margins were marked and an endoscopic submucosal dissection performed.


Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria




Laterally spreading tumour

In this patient with a laterally spreading tumour granular type i-scan was used to get a clear idea about the polyps pit pattern. As a pit pattern type IV was found, indicating a benign lesion, we proceeded to resect the lesion by means of endoscopic mucosal resection.


Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria




Serrated adenoma

Serrated adenoma are frequently missed as they are flat lesions with very subtle changes to the normal mucosa pattern. i-scan allows for enhanced vision of the vascular pattern and changes like the rim of debris and the mucus cap.


Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria




Ulcerative colitis

In ulcerative colitis i-scan clearly shows inflammatory changes of the mucosa. We also use it in conjunction with chromoendoscopy for the surveillance of patients with longstanding chronic inflammatory bowel disease to increase detection of flat lesions.


Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria




Radiation Proctopathy (RP)

RP is a chronic condition that has a significant burden on patients quality of life and healthcare. This clip shows how i-scan 2 helps to highlight the vascular lesions in detail in a patient with symptomatic bleeding and allows targeted YAG laser treatment to the lesions. The vascular areas are not prominent on HD WLE or even i-scan 1 but by switching to i-scan 2 thermal therapy can be directed to the abnormal areas.


Courtesy of Dr. Rehan Haidry, UCLH, UK




i-scan welcome video


Courtesy of Dr. Rehan Haidry, UCLH, UK




Gastric cancer

This video sequence demonstrates to observe characteristic of surface pattern with i-scan SE then switch to i-scan OE to observe vessel pattern and demarcation line of lesion without help of magnified scopes. Following pathological result concluded gastric cancer invaded slightly the submucosa.


Courtesy of Prof.Tomoki Michida, Teikyo University, Japan




Gastric cancer

This video sequence demonstrates to observe characteristic of surface pattern with i-scan SE then switch to i-scan OE to observe vessel pattern. i-scan OE brought up better assessment of vessel as compared with chromo endoscopy. Following pathological result concluded mucosal cancer 8mm in size.


Courtesy of Prof.Tomoki Michida, Teikyo University, Japan




Crohn`s disease duodenum

Crohn’s disease of the upper GI tract is rare and lesions can easily be missed as they are small. i-scan highlights inflammatory changes of the duodenal mucosa and enhances contrast thus making detection of small aphthoid lesions easier.


Courtesy of Dr. Michael Häfner, St. Elisabeth Krakenhaus, Austria




Normal duodenal architecture

This sequence demonstrates the normal villous architecture of the second part of the duodenum in detail using PENTAX HD+ with i-scan enhancement.


Courtesy of Dr. Rehan Haidry, UCLH, UK




Testimonial 1 - Dr Rogier de Ridder


Courtesy of Dr. Rogier de Ridder, Maastricht UMC+, The Netherlands




Testimonial 2 - Dr Rehan Haidry


Courtesy of Dr Rehan Haidry, UCLH, UK




Testimonial 3 - Dr. Arthur Hoffman


Courtesy of Dr. Arthur Hoffman, HSK Wiesbaden, Germany




Testimonial 4 - Dr. Silvia Sanduleanu


Courtesy of Dr. Silvia Sanduleanu, UMC+, The Netherlands




Testimonial 5 - Professor Helmut Neumann


Courtesy of Professor Helmut Neumann, UK Erlangen, Germany




“About i-scan OE” by Prof. Raf Bisschops


Prof. Raf Bisschops




“About i-scan OE” by Prof. Pradeep Bhandari


Prof. Pradeep Bhandari




Testimonial 1 - Dr. Erik van der Heijden


Courtesy of Dr. Erik van der Heijden, Radboud University Mediacl Centre Nijmegen, The Netherlands




Testimonial 2 - Dr. Piero Candoli, Ravenna Hospital, Italy


Courtesy of Dr. Piero Candoli




Testimonial 3 - Dr. Alessandro Messi


Courtesy of Dr. Alessandro Messi, Ravenna Hospital, Italy




Advanced imaging supporting quality in colonoscopy and improving ADR.

32nd GEEW, June 24th 2014


Courtesy of Professor R. Bisschops, UZ Leuven, Belgium




Imaging Guided Endoscopic Therapy for Early Oesophageal Neoplasia

PENTAX Medical’s UEGW Expert dinner, Camp Nou, Barcelona


Courtesy of Dr. Rehan Haidry, University College Hospital London, UK




Brief history of i-scan…and i-scan OE

Lisbon, May 10th 2016


Courtesy of Prof. Dr. Ralf Kiesslich, Wiesbaden, Germany




In vivo diagnosis of upper GI neoplasia with Optical Imaging (i-scan OE)

Lisbon, May 10th 2016


Courtesy of Dr. Rehan Haidry, University College Hospital London, UK




Optical Imaging (i-scan OE), the newest imaging technology for driving endoscopic therapy in the lower GI tract

Lisbon, May 10th 2016


Courtesy of Prof. Helmut Neumann, University Hospital Erlangen, Germany




Mucosal inflammation, healing and dysplasia in IBD: “A new era of enhanced endoscopic imaging”

Lisbon, May 10th 2016


Courtesy of Prof. Marietta Laccuci, University of Calgary, Canada




1st i-scan webinar

20th July 2016


Courtesy of Dr. Rehan Haidry, University College Hospital London, UK




Select which i-scan experience that you wish to view.

 

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