Outpatient Surgery Magazine

The Secret of Gritflowness - October 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 41 of 75

proximal bowel and place a guidewire beyond the narrow segment," explains Dr. Kaul. "They then remove the gastroscope and slide a colonoscope back over the guidewire to reach the tumor." Dr. Kaul adds that physicians can opt for ultra- thin scopes when evaluating fistula openings in the colorectal tract such as the connection between the colon and the urinary bladder. "The scopes provide physicians with the opportunity to better evaluate the fistula tract, obtain a better anatomical perspec- tive and localize cancerous growths," he explains. Ultrathin scopes are used to facilitate esophageal stenting in the upper GI tract for duodenal stent placement, according to Dr. Kaul. He says that application addresses gastroduodenal strictures caused by malignant or benign growths in the stom- ach, pancreas or duodenum. Dr. Kaul says physicians are also able to intro- duce super-slim scopes through a percutaneous bil- iary tract created by interventional radiology and into the liver to sample tumors, facilitate stent placement and break stones using laser or electro- hydraulic lithotripsy. Taking a closer look Upgrades to the imaging capabilities of ultrathin scopes continue to evolve. Camera chips at the tips are more sophisticated and offer high-definition res- olution, which has come online in the last three to four years. The latest models also feature electronic chromoendoscopy, a technology that provides con- trast enhancement of mucosal surfaces. "The enhanced imaging helps physicians identify lesions, better characterize the mucosal lining and facilitate mapping of abnormal anatomy," says Dr. Kaul. When examining growths in the duodenum, for example, advanced imaging helps physicians differ- entiate between a benign mucosal, hypoplastic polyp, and fundic and adenomatous polyps. Advanced imaging also helps physicians exam more subtle areas of abnormalities on the mucosa, which, according to Dr. Kaul, could prove useful when following the American Society for Gastrointestinal Endoscopy updated guideline for the screening and surveillance of Barrett's esopha- gus. The guideline, released in September 2019, calls for identifying this precancerous condition in its early stages and monitoring changes in the cell lining of the esophagus to provide the best chance of successful treatment and outcomes. "During screenings for Barrett's esophagus, physicians who are looking for precancerous lesions appreciate the extent of the Barrett's seg- ment much better with electronic chromoen- doscopy than with standard high-definition imag- ing," says Dr. Kaul. High-definition imaging allows for super-thin endoscopes to be used for non-traditional applica- 4 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 2 0 SIZE AND SCOPE The diameters of shafts on ultrathin endoscopes are typically 6 mm or less, which helps physicians maneuver in narrow areas of the upper GI tract. Vivek Kaul, MD, FACG, FASGE, AGAF

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