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Digestive Endoscopy has revolutionized the field of Gastroenterology and continues to evolve to provide us with even greater diagnostic and therapeutic capabilities.Image-guided radiotherapy is new technique that allows the delivery of precisely aimed radiation beams to tumors utilizing advanced imaging technology. Fiducials are inert radiologic markers that are implanted into the cancer to allow real time targeting of the lesion in order to compensate for patient's body movement and tumor displacement by respiration. EUS guided delivery of fiducials is very appealing in patients with pancreatic cancer and now for a first time a dedicated EUS needle preloaded with 4 fiducials is available.In Japan, ESD has become the preferred technique for removal of dysplastic lesions and early cancer throughout the GI tract. In the West dissemination has been slow because ESD is technically demanding with very flat learning curve. Preliminary evaluation of a new gel for submucosal injection with dissecting properties has been shown to greatly facilitate submucosal dissection without the use of electrosurgical ESD knifes. The small bowel has remains the final frontier of digestive endoscopy. Despite significant advances in the field of enteroscopy, in many cases total enteroscopy is not possible and the procedure remains technically demanding and time consuming. Early evaluation of a novel power spiral enteroscope comes with the promise of short procedure time and very high rate of one session total enteroscopy. Furthermore, this new platform may facilitate ERCP in patients with altered gastric anatomy. GI bleeding is the most common endoscopic emergency. There are many effective therapies but approximately 20% of patients will rebleed and 5% will require surgery. The early evaluation of a new easy to use hemostatic spray has sown very promising results. The most serious complication of endoscopy is perforation. Endoscopic closure with standard clips is possible in many cases but the procedure tends to be technically demanding and requires high level of endoscopic skills. Large perforations may be impossible to close and require surgery. New endoscopic devices provide surgical type of closure for even large perforations.The concept of cholangioscopy is more than 40 years old, yet all current cholangioscopy platforms have some significant drawbacks. Recent developments in cholangioscopes attempt to combine easy setup, high quality imaging and working channel that allows passage of various sampling and lithotripsy devices. |
