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Archive Surgery's Hottest Trends 2014

The View From Inside

For colonoscopy, good visualization is getting better.

Seth Gross

Seth Gross, MD, FACG, FASGE

BIO

endoscopic visualization WHAT'S AHEAD Innovations are significantly improving endoscopic visualization, says Seth A. Gross, MD, FACG, FASGE.

The latest advances in colonoscopy help physicians inspect the surface of the colon more effectively to identify and remove more polyps and adenomas. Scope manufacturers continue to push the innovation envelope, offering optical and mechanical advances to flexible endoscope designs that have drawn physicians' attention for their potential to improve patient care. Here's a look at a few buzz-worthy devices.

Expanded viewpoints
Traditional colonoscopy is based on a forward view, seeing only what's directly ahead as the scope is withdrawn. Two new endoscopes' optical enhancements are expanding this standard view, though, significantly improving visualization by shedding light on potentially challenging areas.

One of the scopes, the Fuse Full Spectrum Endoscopy colonoscope by EndoChoice, employs 3 CCD imaging chips and 7 LEDs (3 at the front and 2 on each side) to nearly double the field of view to 330 degrees. The panoramic video image it captures is displayed across 3 adjacent monitors, with 1 screen showing the straight-ahead view and the others, angled 45 degrees on the left and right sides, providing peripheral views, similar to the way a car's side-view mirrors would. The wider view enables a more thorough examination of the colon's lining.

In another scope, increased distal-end articulation offers an improvement on visualization. The narrower retroflex radius of the RetroView Video Colonoscope from Pentax allows 210 degrees of angulation. This maneuverability gives physicians easier access to the proximal side of folds and flexures in the colon lining, where polyps might be particularly challenging to spot.

Medivator's Endocuff Endoscopic Overtube SCOPE ASSISTANCE Medivator's Endocuff Endoscopic Overtube makes it easier for physicians to inspect both the front and the back sides of folds in the colon.

Additional assistance
Not every advance in colonoscopy visualization arrives through the camera lens. Some innovations lend an internal hand instead. A pair of mechanical innovations to the design of standard endoscopes can literally smooth the way to better screening colonoscopies.

During insertion, the flexible arms on Medivators' EndoCuff Endoscopic Overtube are folded down against the tip of the scope. As the scope is withdrawn, however, they umbrella out to flatten folds in the lining of the colon, making it easier for physicians to inspect both the front and the back sides of the folds. The single-use device also serves as a stabilizing handbrake, preventing the scope from slipping and keeping its view steady as instruments are inserted through the biopsy channel.

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