| セッション情報 | International Session7(消化器内視鏡学会・消化器病学会合同)Small bowel endoscopy-Where are we,and where to go? |
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| タイトル | IS7-基調講演1：Small bowel endoscopy - Where are we, and where to go |
| 演者 | M. Keuchel（Clinic for Internal Medicine Bethesda Hospital Bergedorf） |
| 共同演者 | |
| 抄録 | The advent of small bowel capsule endoscopy (SBCE) has enabled non-invasive exploration of the entire small bowel. Device assisted enteroscopy (DAE) provides advanced endoscopic diagnostic and therapy, leaving intraoperative enteroscopy only as ultima ratio. Capsule endoscopy is the primary endoscopic tool for diagnosis in mid GI bleeding; while device assisted enteroscopy is applied for biopsy or treatment of detected lesions. SBCE can direct insertion route of DAE. Enteroscopy is primarily preferred in ongoing active bleeding, suspected stenosis, postoperative anatomy and in case of high probability that biopsy or endoscopic treatment is required. SBCE can detect small bowel lesions not accessible to standard endoscopy in suspected Crohns disease; while DAE is helpful for biopsy or dilation of strictures in established Crohns. Other indications for small bowel endoscopy are complicated celiac disease, polyposis syndromes and pathologic imaging techniques. Single balloon, double balloon or spiral devices advance the endoscope deeply into the small bowel to take biopsies and to perform enhanced diagnostics including chromoendoscopy and probe based confocal laser microscopy or endoscopic ultrasound. Accessories also permit a wide range of treatment as coagulation, polypectomy, clipping, balloon dilatation, stent placement, ink marking, and foreign body retrieval including retained capsules. Improvements are directed towards increasing the rate of complete enteroscopy by optimized technique even when avoiding fluoroscopy. Advancement of the endoscope by motor-driven devices has been suggested. Retention, major complication of SBCE, can be reduced by preceding application of a self-dissolving Patency capsule in patients at risk. Endoscopic capsule placement avoids aspiration in swallowing disorders. Sedation related problems, perforation and pancreatitis may be caused by DAE. Careful patient selection and management, optimized techniques for insertion and therapy further reduce risk. Altogether, SBCE and DAE are safe with low complication rates. Resolution, illumination control, and battery life time of video capsules have been improved steadily. Motion adapted frame rate, 3D localization and spectral light selection has become available recently. Capsules able to measure pH, pressure and temperature might be helpful in motility studies. Future developments are directed towards self-propelling, steerable capsules that might even deliver therapy. Software features have been developed to skip redundant images and to detect suspected blood. Algorithms under investigation address automated detection of lesions like polyps, ulcers, tumors or villous atrophy to shorten time consuming reading of videos. |
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