Littérature scientifique sur le sujet « Endoscopic spraying »

Endoscopic assessment of inflammation and mucosal healing is crucial for appropriate management in IBD. Current definition of endoscopic mucosal healing has been derived using previous generation of standard white light endoscopes. New endoscopy technologies widely available provide much more detailed images of mucosal and vascular patterns. Novel endoscopic techniques with high definition image, optical and digital enhancement have enhanced the quality and fine details of vascular and mucosal pattern so that endoscopic images have started to reflect histological changes for lesions and inflammation/healing. These technologies can now define subtle inflammatory changes and increase detection and characterisation of colonic lesions in patients with IBD. The best endoscopic technique to detect dysplasia in IBD is still debated. Dye chromoendoscopy with targeted biopsies is considered by Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC consensus the standard of care and recommended for adoption by gastroenterologists in practice. In future, it is possible that well-trained colonoscopists using high definition equipment with image enhancements may be able to obtain equivalent yield without pan-colonic dye spraying and characterise lesions. Finally, SCENIC introduced endoscopic resectability of some dysplastic colonic lesions—new techniques may now better characterise endoscopic resectability and limit the number of colectomies. In this review, we will provide a state-of-the-art opinion on the direction of technological advances in the assessment of IBD and how new concepts will refine clinical practice.

Primary esophageal Paget’s disease is rare. Only a few case reports have described the intraepithelial papillary capillary loop (IPCL) pattern obtained by magnified Narrow Band Imaging (M-NBI) endoscopy in this rare pathology. This report highlights the usefulness of M-NBI and the successful diagnosis using a large bloc specimen obtained by endoscopic mucosal resection with the cap method (EMR−c). A 53-year-old man was referred to endoscopic examination for dysphagia. The endoscopic image revealed a ring-shaped scarring of the esophagus suggestive for eosinophilic esophagitis. The IPCL pattern by M-NBI endoscopy showed an inflammatory pattern, and the entire epithelium of the esophagus was not stained by Lugol iodine spraying. Based on six biopsies randomly performed, a poorly differentiated adenocarcinoma was diagnosed. Since the M-NBI pattern and the histology were completely different, EMR−c was performed to obtain large bloc specimens for a more detailed diagnosis. The pathological findings revealed extensive Paget’s cells infiltration into the epithelium and multifocal invasion from the mucosa to the submucosal layer with adenocarcinoma. In conclusion, a large bloc specimen by EMR-c might be more useful than a small biopsy for an accurate diagnosis of the rare esophageal Paget’s disease.Key words: – – .Abbreviations: EMR−c: endoscopic mucosal resection with cap method; IPCL: intraepithelial papillary capillary loop; LVLs: Lugol-voiding lesions; M-NBI: magnified Narrow Band Imaging; PET-CT: Positron-Emission Tomography and Computed Tomography.

The risk for developing dysplasia and colorectal cancer in patients with longstanding inflammatory bowel disease (IBD) involving the colon is well documented. Random biopsies during white-light, standard-definition colonoscopy (33 to 50 biopsies) with or without dye spraying chromoendoscopy has been the recommended strategy in North America to detect dysplastic lesions in IBD. However, there are several limitations to this approach including poor physician adherence, poor sensitivity, increased procedure time and considerable cost. The new generation of high-definition endoscopes with electronic filter technology provide an opportunity to visualize colonic mucosal and vascular patterns in minute detail, and to identify subtle flat, multifocal, polypoid and pseudopolypoid neoplastic and non-neoplastic lesions. The application of these new technologies in IBD is slowly being adopted in clinical practice. In addition, the advent of confocal laser endomicroscopy provides an opportunity to explore real-time histology, thus redefining the understanding and characterization of the lesions in IBD. There is emerging evidence that serrated adenomas are also associated with longstanding IBD colitis and may be recognized as another important contributing factor to colorectal cancer development. The circumscribed neoplastic lesions can be treated using endoscopic therapeutic management such as mucosal resection or, especially, endoscopic submucosal dissection. This may replace panproctocolectomy in selected patients. The authors review the potential of these techniques to transform endoscopic diagnosis and therapeutic management of dysplasia in IBD.

Abstract Background and study aims Ulcerative colitis (UC) and Crohn’s disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD. Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time). Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [–0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE – including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86). Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.

Background: Esophagogastroduodenoscopy (EGD) is useful in the diagnosis and evaluation of dyspepsia. We investigated factors that might be associated with self-reported patient tolerance of EGD and therefore might serve as objective, reliable and useful surrogates for self-reported patient tolerance. We also investigated factors that might influence EGD tolerance.Study: We prospectively evaluated 300 cases prior, during and after an EGD procedure. None received sedation.Results: Seventy-nine percent of patients reported “good” tolerance of their EGD procedure. Other variables including (1) ease of intubation, (2) number and severity of retching episodes and (3) patient's cooperation during the endoscopic procedure, associated positively and robustly with patient self-reports of EGD tolerance. Evaluating the parameters that might predict EGD tolerance, only (4) age and (5) patient's gagging during Lidocaine throat spraying correlated closely with patient perception of EGD intolerance. Self-reported EGD tolerance did not correlate with gender, education level, body habitus (obesity), prior EGD experience, fear or anxiety about the procedure, procedure type or procedure duration.Conclusions: Several parameters might be used instead of or in addition to patient perception of EGD tolerance. Age and patient gagging during Lidocaine throat spraying, but not patient fear and anxiety about the procedure can be used to predict EGD intolerance and used for selection of patients for sedation.

Cette thèse est dédiée à l’étude et au développement d’une méthode endoscopique d'impression additive par photo-polymérisation. Le principe de l'endoscopie permet d'imprimer des objets en 3D ou de réparer des pièces endommagées dans un assemblage mécanique dense sans le démonter. La thèse consiste, après étude de l’état de l’art, à proposer des solutions adaptées à la problématique endoscopique, puis modéliser, concevoir, réaliser et valider expérimentalement deux principaux sous-systèmes (photo-polymérisation UV par guide d’image, pulvérisation de résine par conduit tubulaire) qui, une fois synchronisés, permettent l’impression additive par voie endoscopique. Le principe d’impression additive proposé et étudié est inspiré de la méthode de photo-polymérisation en cuve. Une résine liquide est transmise par voie endoscopique et pulvérisée sur la surface d'impression. Suite à cette pulvérisation, un motif UV, structuré par une matrice de micro-miroir de type DMD (Digital Micromirror Device), est transmis par guide d'image et focalisé sur la surface d'impression pour polymériser certaines zones d’une couche de résine liquide. Ces deux étapes sont effectuées plusieurs fois de façon à imprimer des couches superposées pour l’obtention finale d’une pièce en trois dimensions. Un système d'actionnement de la sonde endoscopique (platine de translation non intégrée) permet de maintenir la sonde à une distance de la surface d'impression égale à la distance focale de l’objectif de l’instrument. Dans cette thèse, le système de projection UV endoscopique a été conçu, modélisé, réalisé et testé. La conception et les performances du système optique ont été publiés dans des actes de conférence. Des objets multicouches ont été fabriqués avec une épaisseur de couche de 50 μm, sur une surface d'impression circulaire de 9,54 mm de diamètre. Une méthode d'analyse optique basée sur l'utilisation des fonctions de transfert de modulation (MTF) est utilisée pour tester les performances de l'instrument optique endoscopique et pour caractériser la résolution des pièces imprimées. En exploitant la méthode MTF de façon expérimentale, une chute de la résolution optique due au guide d'image a été estimée à 16 μm par rapport à la valeur obtenue dans le montage expérimental contenant les mêmes composants optiques, à l'exception du guide d'image. La résolution latérale des pièces imprimées est finalement de 50 μm, la limite n’étant pas liée à la résolution latérale du système optique mais à la nature de la résine utilisée. Dans cette thèse, un système de pulvérisation par voie tubulaire a également été dimensionné, réalisé et testé. Un système d'atomisation endoscopique a été mis en place pour permettre un dépôt à distance de la résine sur la surface d'impression. Le choix d’une méthode d'atomisation par air a été adopté. La conception, le contrôle et la réalisation du système d'atomisation sont présentés. Le système de pulvérisation et le système de projection de motifs UV ont été finalement combinés. Des résultats préliminaires d'impression d'objets ont été obtenus et des pièces 3D d'une épaisseur de 0,65 mm ont été imprimées (9 couches). À cause d’un phénomène nommé « overspray » (durant le processus de pulvérisation, la résine atteint la surface d'impression et est poussée sur les côtés par la pression de l’air qui la pulvérise), l'épaisseur des couches n'est pas constante, mais diminue progressivement, le réglage des paramètres de pulvérisation devient alors critique. Différentes perspectives de ce travail de thèse ont été identifiées. Le système de pulvérisation doit encore être optimisé afin de résoudre le problème posé par le phénomène d’overspray. De plus, une pré-étude d’un système de visualisation intégré a été effectuée, qui demande à être approfondie, pour permettre un contrôle de la photo-polymérisation en cours d’impression
This thesis concerns the study and the development of a novel endoscopic 3D printing process based on photo-polymerization. The idea behind endoscopic 3D printing is to print 3D objects or to repair damaged parts in a dense mechanical assembly without disassembling it. The thesis aims, once the state of the art is studied, to propose solutions adapted to the endoscopic problem, then to model, design, realize and experimentally validate the two main subsystems (UV photo-polymerization through an image guide, resin spraying through a tubular pipe) which, once synchronized, provide the additive printing. Inspired by the vat polymerization method, the liquid resin is transmitted endoscopically and sprayed onto the printing surface (spraying system). Then, a UV pattern, structured by a DMD (Digital Micromirror Device), is transmitted through the image guide and focused onto the printing surface to polymerize a layer of liquid resin. These two steps are repeated several times in order to print layers on top of each other to obtain a 3D part. An endoscopic actuation system (non-integrated translation actuator) allows maintaining the probe at a distance from the printing surface equal to the focal length of the objective of the instrument. In this thesis, the endoscopic UV projection system was designed, modeled, implemented and tested. The design and performances of the optical system were presented in two international conferences. Multilayer objects were fabricated with a layer thickness of 50 μm on a circular printing area of 9.54 mm in diameter. An optical analysis method based on the use of the modulation transfer functions (MTF) was used to test the performance of the endoscopic optical system and to characterize the lateral resolution of the printed parts. Using the MTF method experimentally, a drop in optical resolution due to the image guide was estimated as high as 16 μm compared to the value obtained in the experimental setup containing the same optical components except for the image guide. The lateral resolution of the printed parts was finally limited by the resin (50 μm) and not by the resolution of the optical system. An endoscopic atomization system was also studied, implemented and tested. An endoscopic spraying system was implemented to allow a remote deposition of the resin onto the printing surface. The choice of an air atomization method was adopted. The design, control and realization of the atomization system are presented. Finally, the spraying system was combined with the UV pattern projection system. Preliminary results of printing objects were obtained and 3D parts with a thickness of 0.65 mm are printed (nine layers). Due to a phenomenon called "overspray" (during the spraying process, the resin reaches the printing area and is pushed to the sides by the air pressure that sprays it), the thickness of the layers is not constant between them, but gradually decreases, so the adjustment of the spraying parameters becomes critical. The spraying system still needs to be optimized in order to eliminate overspray and to be able to print uniform layers with a specific thickness. In addition, we have been working on a 2D visualization system but the lack of light on the printing surface prevents us from being able to visualize and control the system. In the future, we propose to spray a resin mixed with a fluorescent dye to make it possible to distinguish the polymerized zones from the uncured zones in each layer of the part