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New Technologies Improve the Diagnosis of Digestive Diseases

(Jan 27, 2009)

Doctors began looking into the cavities and canals of the human body using tubes outfitted with mirrors and lights almost 100 years ago. Over the century since, this approach, called endoscopy, has come a long way: the tubes they use are now flexible, not rigid. The light source has evolved – candles gave way to smaller electric bulbs, then in the 1960s to hair-thin, light-conducting glass fibers. Endoscopes are now equipped with video cameras and surgical instruments. These days, doctors routinely use endoscopy to examine the esophagus, stomach, small intestine, or colon to diagnose or treat diseases.

Endoscopic technologies continue to improve. Narrow-band imaging (NBI), a new approach that uses mainly blue wavelengths of light, is enabling doctors to see the lining of the gastrointestinal tract in amazing detail. The blue light penetrates only the superficial tissues, making the capillaries and veins that concentrate around precancerous areas more visible.

Physicians at NewYork-Presbyterian Hospital are using NBI to detect precancerous changes, called polyps or lesions, earlier, potentially reducing the number of deaths from esophageal and colorectal cancers. NBI has proved particularly valuable in patients with a condition called Barrett's esophagus, which can develop in those with gastroesophageal reflux disease (GERD). In GERD, continued exposure to stomach acid sometimes changes the lining of the esophagus to tissue more similar to that lining the intestine; this is Barrett's esophagus. People with this condition are at risk of developing a rare cancer of the esophagus.

Until now, doctors monitored patients with Barrett's esophagus by performing random biopsies every one to two centimeters along the esophagus, according to Charles Lightdale, MD, a gastroenterologist at NewYork-Presbyterian's Columbia University Medical Center campus. With NBI they can target biopsies to areas that appear irregular. "This means we can do fewer biopsies on normal tissue, and focus on only the areas that raise suspicion," he said. Under NBI's blue light, the areas with increased blood supply appear to be dark brown, so even flat polyps become visible as they are highlighted with a dark border, he said.

The use of NBI is now the standard of care at the Hospital not just for Barrett's esophagus but for all gastrointestinal procedures. For example, Brian Bosworth, MD, a gastroenterologist at NewYork-Presbyterian's Weill Cornell Medical Center campus, is using NBI to detect precancerous tissue in patients with ulcerative colitis and inflammatory bowel disease who are at risk for developing colorectal cancer. "NBI is a quantum leap above standard endoscopy," Dr. Bosworth said.

Narrow band imaging is just one of the advances in use at NewYork-Presbyterian Hospital. Gastroenterologists here are also researching a new technology called the "third eye" retroscope – a tiny camera that goes out the tip of the endoscope and turns back on itself in a shape of 'J'. Even the most astute gastrointestinal surgeons miss about six percent of all polyps because they are not visible in standard colonoscopy. Using the retroscope surgeons can spot more flat polyps or polyps located behind folds in the colon.

Physicians and surgeons at the Hospital have also begun using carbon dioxide (CO2) rather then whole air to inflate the bowel during endoscopy, allowing surgeons increased access without the abdominal pain often associated with this procedure.

Another new type of endoscope, a double-balloon endoscope, enables doctors to examine the small intestine, which, at 25 feet long, is one of the most inaccessible parts of the digestive tract. This new technique uses a specialized endoscope featuring two balloons, one attached to the front end of the scope, the second to a transparent tube that slides over the endoscope. When inflated with air, the balloons cling to sections of the small intestine and pleat it over the endoscope, effectively "shortening" it. Using this scope doctors can perform comprehensive exams of the entire small intestine, as well as biopsies and many surgical techniques, eliminating the need for external surgery in some cases.

Gastroenterologists at NewYork-Presbyterian Hospital are conducting several studies of these new endoscopic approaches to measure their benefits.

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