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Mo2014 A Novel Volumetric Laser Endomicroscopy Computer Algorithm for Landmark Identification and Delineation of Barrett's Esophagus Dysplasia
Abstracts SB group (SB: 7.3 2.6 vs Dual: 34.3 7.0, pZ0.016). En bloc resection rates in SB group and dual group were 100% and 100% and curative resection rates were 100% and 90.0%, retrospectively, with no statistical significance. No delayed hemorrhage or perforation occurred in both groups. In protruding tumor, SB knife group showed significant shorter MST than dual group (SB: 53.8 29.9, Dual: 90.9 73.3, pZ0.015). Conclusions: Our results suggest that colorectal ESD using the SB knife might be a convenient and technically efficient method and not inferior to conventional dual knife. Furthermore, SB knife could be a useful device for fast and effective procedure in colorectal ESD of protruding colorectal tumor.
Mo2013 Novel Disposable Endoscopic Scissors: A Comparative Study With Traditional Reusable Scissors Matthew J. Skinner*, Andrew C. Storm, Christopher C. Thompson Brigham & Women’s Hospital, Boston, MA Background: Foreign material including staples and sutures are placed within the gastrointestinal tract during bariatric surgery and may result in an inflammatory response which can lead to extruded suture material within the gastrointestinal lumen. This may cause pain, ulceration, and bezoar formation at the site of visible suture. If symptoms are present, endoscopic removal of suture material is recommended. Immediate improvement in symptoms has been reported in at least 71% of patients after suture material removal. The availability of tools to address suture removal limits mainstream adoption and comfort performing the technique. Traditionally, reusable endoscopic scissors have been employed but require cleaning, sterilization and a large upfront cost. A novel disposable endoscopic scissor is now available for use in the US (Figure 1). Aim: To assess the efficacy of a novel disposable scissor compared to traditional reusable scissors. Methods: This was a retrospective analysis of prospectively collected data. Patients post Roux-en-Y gastric bypass surgery with abdominal pain and disrupted suture material were included who underwent suture removal with either traditional reusable scissors or novel endoscopic scissor. If the initial device failed, use of a second device, including biopsy forceps or APC was captured. We report technical success, whether a second device was required, type of suture material, and adverse events. Results: 20 patients were included. Patients who underwent suture material removal with traditional reusable scissors had 50% technical success with the initial device increasing to 90% success with the employment of a second device. 10 of 10 patients who underwent suture removal with the novel disposable system had technical success without use of a second device (100% technical success). Both prolene and silk sutures were able to be removed with the disposable system. Conclusions: Novel disposable endoscopic scissors demonstrate superior technical success compared to traditional reusable scissors in removing retained suture material. The scissors performed well across all types of suture material encountered and alleviate any concerns regarding sterility of reusable equipment.
Mo2014 A Novel Volumetric Laser Endomicroscopy Computer Algorithm for Landmark Identification and Delineation of Barrett’s Esophagus Dysplasia Amrit K. Kamboj*2, Liam Zakko1, Kavel Visrodia1, Daniel K. Chan1, Lori S. Lutzke1, Kenneth K. Wang1, Cadman L. Leggett1 1 Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; 2 Internal Medicine, Mayo Clinic, Rochester, MN Background: Volumetric laser endomicroscopy (VLE) is an emerging technology used for detection of Barrett’s esophagus (BE) dysplasia. Thorough review of VLE data can be challenging due to the subtle image characteristics and the large volume of data to interpret (1200 cross-sectional frames). We hypothesized that a whole scan en-face VLE view, where the segmentation of clinically relevant tissue structures is conveniently visualized, would aid in recognition of anatomical landmarks. The aim of this study was to generate an automated computer algorithm that provides an en-face VLE view with superimposed features of interest. Methods: The first step in the proposed computer algorithm is to generate an enface image of a full VLE scan. This is achieved by digitally ‘unwrapping’ the circumferential scan (tubular esophagus) and presenting the data from the top down (filleted and flattened esophagus), i.e. enabling visualization of the entire esophageal surface in one image (Figure 1). The second step is to overlay automatically segmented VLE features onto the en-face view. A feature that distinguishes normal squamous epithelium from BE is the presence of a layered architecture. Two other features of interest include the identification of high scattering tissue and glands, as these have some association with BE dysplasia. The algorithm first segments the tissue surface and measures the signal intensity decay at every imaging point (A-line) in a cross-section and displays a graded color map onto the en-face view. The algorithm then performs segmentation of areas that contain glandular structures. The final output is an en-face view of the entire VLE scan with superimposed color graded information on layered architecture, signal intensity and glandular structures. Results: The CAD algorithm was applied to 10 VLE scans obtained from a U.S. multicenter VLE registry. The gastroesophageal junction (GEJ) was identified by the en-face visualization of the top of the gastric folds. The squamocolumnar junction was identified by the transition of high signal intensity (associated with gastric epithelium) to lower signal intensity (associated with squamous epithelium). Both anatomical landmarks were easily identified on en-face imaging. BE showed lack of a layered architecture with glandular structures that extended beyond the GEJ. A VLE scan contained an area concerning for BE dysplasia delineated by VLE laser markings. Laser markings were clearly visible on en-face imaging and delineated a region with higher surface signal intensity compared to surrounding BE. Conclusion: The proposed computer algorithm can potentially simplify VLE image interpretation by providing a comprehensive en-face view with superimposed color graded imaging features. Further validation of this algorithm is needed to determine its diagnostic performance for detection of BE dysplasia.
Figure 1: The computer algorithm ‘unwraps’ a VLE scan of the (A) tubular esophagus and displays an (B) en-face view where anatomical landmarks including the gastroesophageal junction and squamocolumnar junction can be identified. The algorithm then displays color-graded information on layered architecture, signal intensity, and glandular structures. (C) An area of high signal intensity delineated by laser markings was found to contain BE dysplasia.
Figure 1 – Disposible endoscopic scissors (Slater NeoEndoscopy, USA)
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Mo2015 Safety and Effectiveness of Colorectal Endoscopic FullThickness Resection Using a New, Flat-Based Over-TheScope Clip: A Prospective Study Yara Backes*1, Wouter Kappelle1, Luuk Berk2, Arjun D. Koch3, John N. Groen4, Wouter de Vos tot Nederveen Cappel5, Matthijs P. Schwartz6, Marjon Kerkhof7, Roland Schröder8, Gie Tan9, Miangela M. Lacle10, Frank P. Vleggaar1, L. M. G. Moons1 1 Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; 2Gastroenterology & Hepatology, St. Franciscus
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB521
Mo2013 Novel Disposable Endoscopic Scissors: A Comparative Study With Traditional Reusable Scissors Matthew J. Skinner*, Andrew C. Storm, Christopher C. Thompson Brigham & Women’s Hospital, Boston, MA Background: Foreign material including staples and sutures are placed within the gastrointestinal tract during bariatric surgery and may result in an inflammatory response which can lead to extruded suture material within the gastrointestinal lumen. This may cause pain, ulceration, and bezoar formation at the site of visible suture. If symptoms are present, endoscopic removal of suture material is recommended. Immediate improvement in symptoms has been reported in at least 71% of patients after suture material removal. The availability of tools to address suture removal limits mainstream adoption and comfort performing the technique. Traditionally, reusable endoscopic scissors have been employed but require cleaning, sterilization and a large upfront cost. A novel disposable endoscopic scissor is now available for use in the US (Figure 1). Aim: To assess the efficacy of a novel disposable scissor compared to traditional reusable scissors. Methods: This was a retrospective analysis of prospectively collected data. Patients post Roux-en-Y gastric bypass surgery with abdominal pain and disrupted suture material were included who underwent suture removal with either traditional reusable scissors or novel endoscopic scissor. If the initial device failed, use of a second device, including biopsy forceps or APC was captured. We report technical success, whether a second device was required, type of suture material, and adverse events. Results: 20 patients were included. Patients who underwent suture material removal with traditional reusable scissors had 50% technical success with the initial device increasing to 90% success with the employment of a second device. 10 of 10 patients who underwent suture removal with the novel disposable system had technical success without use of a second device (100% technical success). Both prolene and silk sutures were able to be removed with the disposable system. Conclusions: Novel disposable endoscopic scissors demonstrate superior technical success compared to traditional reusable scissors in removing retained suture material. The scissors performed well across all types of suture material encountered and alleviate any concerns regarding sterility of reusable equipment.
Mo2014 A Novel Volumetric Laser Endomicroscopy Computer Algorithm for Landmark Identification and Delineation of Barrett’s Esophagus Dysplasia Amrit K. Kamboj*2, Liam Zakko1, Kavel Visrodia1, Daniel K. Chan1, Lori S. Lutzke1, Kenneth K. Wang1, Cadman L. Leggett1 1 Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; 2 Internal Medicine, Mayo Clinic, Rochester, MN Background: Volumetric laser endomicroscopy (VLE) is an emerging technology used for detection of Barrett’s esophagus (BE) dysplasia. Thorough review of VLE data can be challenging due to the subtle image characteristics and the large volume of data to interpret (1200 cross-sectional frames). We hypothesized that a whole scan en-face VLE view, where the segmentation of clinically relevant tissue structures is conveniently visualized, would aid in recognition of anatomical landmarks. The aim of this study was to generate an automated computer algorithm that provides an en-face VLE view with superimposed features of interest. Methods: The first step in the proposed computer algorithm is to generate an enface image of a full VLE scan. This is achieved by digitally ‘unwrapping’ the circumferential scan (tubular esophagus) and presenting the data from the top down (filleted and flattened esophagus), i.e. enabling visualization of the entire esophageal surface in one image (Figure 1). The second step is to overlay automatically segmented VLE features onto the en-face view. A feature that distinguishes normal squamous epithelium from BE is the presence of a layered architecture. Two other features of interest include the identification of high scattering tissue and glands, as these have some association with BE dysplasia. The algorithm first segments the tissue surface and measures the signal intensity decay at every imaging point (A-line) in a cross-section and displays a graded color map onto the en-face view. The algorithm then performs segmentation of areas that contain glandular structures. The final output is an en-face view of the entire VLE scan with superimposed color graded information on layered architecture, signal intensity and glandular structures. Results: The CAD algorithm was applied to 10 VLE scans obtained from a U.S. multicenter VLE registry. The gastroesophageal junction (GEJ) was identified by the en-face visualization of the top of the gastric folds. The squamocolumnar junction was identified by the transition of high signal intensity (associated with gastric epithelium) to lower signal intensity (associated with squamous epithelium). Both anatomical landmarks were easily identified on en-face imaging. BE showed lack of a layered architecture with glandular structures that extended beyond the GEJ. A VLE scan contained an area concerning for BE dysplasia delineated by VLE laser markings. Laser markings were clearly visible on en-face imaging and delineated a region with higher surface signal intensity compared to surrounding BE. Conclusion: The proposed computer algorithm can potentially simplify VLE image interpretation by providing a comprehensive en-face view with superimposed color graded imaging features. Further validation of this algorithm is needed to determine its diagnostic performance for detection of BE dysplasia.
Figure 1: The computer algorithm ‘unwraps’ a VLE scan of the (A) tubular esophagus and displays an (B) en-face view where anatomical landmarks including the gastroesophageal junction and squamocolumnar junction can be identified. The algorithm then displays color-graded information on layered architecture, signal intensity, and glandular structures. (C) An area of high signal intensity delineated by laser markings was found to contain BE dysplasia.
Figure 1 – Disposible endoscopic scissors (Slater NeoEndoscopy, USA)
www.giejournal.org
Mo2015 Safety and Effectiveness of Colorectal Endoscopic FullThickness Resection Using a New, Flat-Based Over-TheScope Clip: A Prospective Study Yara Backes*1, Wouter Kappelle1, Luuk Berk2, Arjun D. Koch3, John N. Groen4, Wouter de Vos tot Nederveen Cappel5, Matthijs P. Schwartz6, Marjon Kerkhof7, Roland Schröder8, Gie Tan9, Miangela M. Lacle10, Frank P. Vleggaar1, L. M. G. Moons1 1 Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; 2Gastroenterology & Hepatology, St. Franciscus
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB521