i-scan Atlas for Gastroenterology Courtesy of Dr Federico Buffoli, Ospedale di Cremona, Italy Case studies from clinical practice with HD+, i-scan and i-scan OE

PEWTAXMEDICAL Index Visible excellence. Gastrointestinal endoscopy with HD+, i-scan and i-scan OE. Introduction: Visible excellence 3 A leap forward for in vivo histology 4 Proven i-scan settings 4 i-scan and i-scan OE, a unique combination of digital and optical enhancements to support the clinical pathway 5 Case Reports - Diagnosis of early squamous cell carcinoma with i-scan, i-scan OE - Diagnosis of a Barrett's oesophagus with i-scan, i-scan OE and MagniView 10 - Diagnosis of an oesophageal squamous cell cancer with i-scan, i-scan OE - Detection and resection of an early neoplastic lesion...

i-scan is an established digital enhancement technology supporting detection, characterization and demarcation. i-scan 1 Surface Enhancement (SE) highlights surface tissue architecture which may be used for the detection of circumscribed lesions or to highlight diffuse alteration (e.g. inflammation, atrophy). i-scan 2 or Tone Enhancement (TE) focuses on vascular and tissue architecture, supporting characterization. The introduction of the new i-scan Optical Enhancement (OE) in addition to the existing i-scan family, will bring additional information on mucosal and especially vascularization patterns...

The i-scan Leaders The i-scan task force is a community of highly experienced doctors who have used i-scan in their clinical practice for many years. PENTAX Medical has been working closely with this group so that their best practices and scientific evidence in i-scan can be shared in a peer environment. Its members participate in training and case discussion forums and ultimately contribute to the highest quality of care to patients. Professor Dr. Ralf Kiesslich HSK Wiesbaden, Germany Professor Dr. Pradeep Bhandari Queen Alexandra Hospital, UK Dr. Silvia Sanduleanu Maastricht UMC+, The Netherlands...

How do you use i-scan and i-scan OE in your clinical practice? “In my own practice I rely on i-scan 1 (SE) as my default initial mode for interrogat- Diagnosis of early squamous cell carcinoma with i-scan, i-scan OE and MagniView OESOPHAGUS STO M AC H DUODENUM COLON ing the upper GI tract. This has superseded the white light mode for me and helps me to assess and detect early cancers. The depth and image resolution is excellent at defining mucosal patterns that when disordered or irregular lead one to suspect neoplasia. My own preference is then to switch to i-scan 2 (TE) to better characterize...

Diagnosis of a Barrett´s oesophagus with i-scan, i-scan OE and MagniView OESOPHAGUS STO M AC H DUODENUM COLON How do you use i-scan and i-scan OE in your clinical practice? “I use systematically advanced imaging techniques such as i-scan and i-scan OE in the work-up of patients with suspicion of Barrett’s associated neoplasia to help in the detection of small subtle lesions.“ Patient history Patient outcome and follow-up A 57 year old male patient with history of reflux disease was referred after surveillance endoscopy with random biopsies detected high grade dysplasia. The patient was scheduled...

OESOPHAGUS STO M AC H DUODENUM COLON Diagnosis of an oesophageal squamous cell cancer with i-scan, i-scan OE and MagniView How do you use i-scan and i-scan OE in your clinical practice? “i-scan OE combines the versatility and flexibility of i-scan with even sharper and crisper pictures. While i-scan 1 (SE) is my standard setting during every procedure, because it gives you the extra bit of contrast and detail to detect even very subtle changes of the mucosa, i-scan 3 (OE) offers an extremely sharp view of the surface pattern, for example in Barrett’s oesophagus.. Patient history A 60 year old...

How do you use i-scan and i-scan OE in your clinical practice? “In my own practice I rely on i-scan 1 (SE) as my default initial mode for interrogat- Detection and resection of an early neoplastic lesion in a Barret’s oesophagus with i-scan, i-scan OE and MagniView OESOPHAGUS STO M AC H DUODENUM COLON ing the upper GI tract. This has superseded the white light mode for me and helps me to assess and detect early cancers. The depth and image resolution is excellent at defining mucosal patterns that when disordered or irregular lead one to suspect neoplasia. My own preference is then to switch to...

How do you use i-scan and i-scan OE in your clinical practice? Assessment of a gastric lesion using i-scan and i-scan OE O E S O P H AG U S STOMACH DUODENUM COLON ”The PENTAX Medical High-Definition White Light (HD WL) image is a major advance but when I switch i-scan 1 (SE) on then the image becomes sharper and crisper without losing any other attribute so I don’t see any reason why i-scan 1 (SE) should not be left on at all times. Once I find a subtle abnormality or any obvious lesion then I switch on i-scan 2 (TE) and that really highlights the lesion from the surrounding normal mucosa. Once...

O E S O P H AG U S STOMACH DUODENUM COLON Diagnosis of a Gastrointestinal Stromal Tumor (GIST) with i-scan and i-scan OE How do you use i-scan and i-scan OE in your clinical practice? “I usually use as default i-scan 1 (SE) as a detection mode and I usually turn on i-scan 3 (OE) when I want to better visualize the mucosal and vascular pattern. I find it particularly useful in Barrett’s oesophagus to diagnose high grade dysplasia area, for rectal and colonic polyp to decide between ESD or piece meal EMR when i-scan 3 (OE) shows aspect of carcinoma in situ or limited to sm1“ Patient outcome and...

How do you use i-scan and i-scan OE in your clinical practice? “I think that i-scan OE represents a further step forward in the diagnostic capabilities of endoscopy. With the i-scan system we can see the mucosa and the lesions with different visualizations that allows to collect different information, specific for each enhance. We can choose the most suitable i-scan function depending on: anatomical site, pathology or just according to the way the endoscopist feels more confident to be able to make the diagnosis. After my first experience with i-scan OE I feel that it allows to better study the...