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이매지나 제품의 특장점 IMAGINA CLINICAL CASES 회사 소개

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IMAGINA LEADERS COLON Prof. Kang-Moon LEE CASE 1

COLON

Prof. Kang-Moon LEE

Prof. Seong Woo JEON

image
  • Prof. Kang-Moon LEE
  • Division of Gastroenterology
  • Department of Internal Medicine
  • The Catholic University School of Medicine
  • St. Vincent’s Hospital
  • Area of Interest
  • Inflammatory bowel disease
  • Therapeutic endoscopy

CASE 1

CASE 2

CASE 3

How do I use PENTAX IMAGINA in my clinical endoscopy cases :

“ I use PENTAX IMAGINA for colorectal cancer surveillance in patients with long-standing ulcerative colitis (UC).
Previously, I had performed surveillance using traditional random biopsies or pan-chromoendoscopy with targeted biopsies,
which required a lot of effort and time. Recently, however, I’m using image-enhanced endoscopy (virtual chromoendoscopy)
like NBI or i-scan which is more convenient.
Although still controversial, high definition-virtual chromoendoscopy is known to be comparable to dye-spraying chromoendoscopy in detecting neoplasia in UC.
I assume that combination of high-definition endoscopy with i-scan of PENTAX IMAGINA system can be useful for colorectal cancer surveillance in UC.“

Neoplasia Surveillance in Ulcerative Colitis with i-scan

Patient History

A 51-year-old male patient with long-standing ulcerative colitis underwent surveillance colonoscopy for detection of dysplasia.

Endoscopic Findings

With HD-WLE, old cicatricial changes with whitish scars and numerous inflammatory polyps were observed throughout the entire colon distal to A-colon. There showed no active lesions. (image 1)

With HD + i-scan, an ovoid flat elevated lesion (6 mm) was detected in mid T-colon. The lesion showed brown and irregular. Surface. (image 2)

Another ovoid flat lesion (4 mm) was detected in proximal T-colon. (image 3)

i-scan helped to find dysplasia and demarcate the borders of the lesions.

Endoscopic Treatment and Pathology Results

Two lesions were removed by endoscopic mucosal resection.
he final pathology was ‘tubular adenoma with low grade dysplasia’ in both lesions.

Patient Outcome and Follow-ups

Two colitic neoplasia were detected and removed successfully by surveillance colonoscopy.
The patient recommended to have regular surveillance colonoscopy.

Image 1

image

Image 2

Image 3

Summary

  • Patients with long-standing ulcerative colitis (UC) are at increased risk for colorectal cancer, Thus, surveillance colonoscopy is recommended in all
  • UC patients 8-10 years after onset of symptoms.
  • With advances in optical and digital technologies, chromoendoscopy with targeted biopsies or virtual chromoendoscopy has become the preferred screening method over traditional random biopsies.
  • Virtual chromoendoscopy with i-scan showed similar diagnostic yield to conventional dye-spraying colonoscopy and shorter procedure time
  • (López-Serrano A. et al. Scand J Gastroenterol 2021;56:820).
  • In this case, HD colonoscopy with i-scan was helpful to identify colitic neoplasia.
qrcode

How do I use PENTAX IMAGINA in my clinical endoscopy cases :

“ I use PENTAX IMAGINA in my endoscopic procedures.
When an endoscopist performs a procedure, securing clean vision and smooth operation of endoscopy are essential factors. In this aspect, clear resolution and good maneuverability of PENTAX IMAGINA can be of great help to my successful procedure.”

Prophylactic Clip Application for the Prevention of
Postpolypectomy Bleeding of Large Pedunculated Colonic Polyps

Patient History

A 46-year-old male patient was referred for a large pedunculated colon polyp.

Endoscopic Findings

With HD-WLE, a 15 mm sized pedunculated polyp was noted in the hepatic flexure. The length and width of stalk was 30 x 8 mm. (image 1)

The surface of the polyp head showed hyperemia and nodularity.
With HD + i-scan, vessels with variable caliber and irregular surface pattern were noted. (image 2)

i-scan helped to define the microvascular and surface patten of the lesion.

Endoscopic Treatment and Pathology Results

To prevent post-polypectomy bleeding, hemoclip was applied to the base of stalk before resection.
Then, hot snare polypectomy was performed. (image 3)

The final pathology was early colon cancer.
Adenocarcinoma, moderately differentiated, arising in sessile serrated adenoma with cytologic dysplasia

a) Size: adenoma 1.5 x 1.5 cm, carcinoma 0.7 x 0.7 cm
b) sm invasion = 300 ㎛ (Haggit level 1)
c) Tumor budding: absent
d) Resection margin involvement: absent

Image 1

image
image

Image 2

image
image

Image 3

image image
image image

Summary

  • Since the rate of post-polypectomy bleeding (PBB) is high (~15%), preventive measures are recommended after resection of large pedunculated polyps.
  • Prophylactic clip application is a very simple and effective method to prevent PPB.
  • Prophylactic clip is as effective and safe as an endoloop in preventing PPB in large pedunculated polyps, and may reduce PPB compared to no prior treatment.
  • In clinical practice, prophylactic clip is more useful than endoloop because it is easier to apply and the procedure time is shorter.
  • In this case, a large pedunculated polyp was successfully removed after applying a clip on the base of stalk.
qrcode

How do I use PENTAX IMAGINA in my clinical endoscopy cases :

“ I use PETAX IMAGINA for colorectal cancer (CRC) screening. Higher quality colonoscopic withdrawal techniques, such as
(1)examining the proximal sides of flexures, folds and valves, (2) cleaning and suctioning, (3) adequacy of distention, and
(4) adequacy of time spent viewing, are associated with lower adenoma missing rate.
I think that clean resolution and good maneuverability of PENTAX IMAGINA may help to improve the yield of CRC screening.”

Detection of Sessile Serrated Adenoma in the Ascending Colon

Patient History

A 60-year-old female patient underwent colonoscopy for bloating and constipation.

Endoscopic Findings

With HD-WLE, a subtle flat lesion was suspected in the distal A-colon.

After adjusting for air inflation, an ovoid flat elevated lesion was clearly observed. (image 1)
With HD + i-scan, the surface of lesion showed slightly lighter color than background mucosa and some dark dots, suggesting a hyperplastic or
sessile serrated polyp. (image 2)

i-scan helped to define the microvascular and surface pattern of the lesion.

Endoscopic Treatment and Pathology Results

Endoscopic mucosal resection was done. (image 3)

The final pathology was sessile serrated adenoma.

Sessile serrated adenoma without cytologic dysplasia.

1) size: 0.8x0.8cm
2) resected margin involvement: absent

Patient Outcome and Follow-ups

The procedure performed successfully without any event.

Image 1

Image 2

image
image

Image 3

image
image

Summary

  • Colonoscopic removal of adenomatous polyps can prevent colorectal cancer (CRC) and death from CRC. However, colonoscopy is known to be less
  • effective in preventing death from right-sided CRC. One of the possible explanation is that right-sided colonic adenomas are more often flat, which makes them harder to identify and remove.
  • Therefore, endoscopists should make the best efforts to detect adenoma of the right colon, and in particular, be familiar with the endoscopic features of sessile serrated adenoma/polyp (SSA/P), which are common in the right colon.
  • In this case, a flat lesion in the distal A-colon showed JNET type 1 findings (invisible vessel pattern, regular dark spots on the surface, and similar to surrounding normal mucosa), suggesting hyperplastic or SSA/P and histologically confirmed as SSA after resection.
qrcode
IMAGINA LEADERS COLON Prof. Seong Woo JEON

COLON

Prof. Kang-Moon LEE

Prof. Seong Woo JEON

image
  • Prof. Seong Woo JEON
  • Division of Gastroenterology & Hepatology
  • Department of Medicine
  • Kyungpook National University Hospital
  • Area of Interest
  • Therapeutic endoscopy in esophageal, gastric and colon cancer
  • Prevention and screening of early gastric cancer
  • Development of novel endoscopic devices
  • Helicobacter pylori diagnosis and treatment

How do I use PENTAX IMAGINA in my clinical endoscopy cases :

“I use PENTAX IMAGINA in daily clinical endoscopy practice. One of our endoscopy purpose is surveillance after surgery or endoscopic resection of colorectal dysplasia or cancer. I frequently encounter metachronous polyps during this surveillance and the pathology provide exact diagnosis after resection of the polyp.
However, it is important to select exact candidates for colonoscopic resection to avoid unnecessary procedure.
I assume that PENTAX IMAGINA TE mode is useful in this aspect. JNET classification is useful tool in clinical decision.
Type 1 indicates a hyperplastic polyp or a sessile serrated adenoma/polyp.
Type 2A indicates low-grade dysplasia and includes tubular adenoma and tubulovillous adenoma.
Type 2B indicates high-grade dysplasia, intramucosal cancer, and superficial submucosal invasive cancer.
Type 3 indicates deep submucosal invasive cancer.
The PENTAX IMAGINA system have clear resolution and it can let me help to clear diagnosis. “

Endoscopic Differentiation of Colon Polyps

Patient History

The patient is a 61-year-old male who underwent sigmoid colon cancer surgery 2 years ago.
He is on adjuvant chemotherapy and colonoscopy surveillance was recently performed.

Endoscopic Findings

The colonoscopy revealed 8mm sized sessile polyp at transverse colon.

Endoscopic Treatment and Pathology Results

Endoscopic mucosal resection was done after submucosal injection and snaring.
No bleeding or perforation was noted after procedure. The final pathology was tubular adenoma, measuring 8mm in size.

Patient Outcome and Follow-ups

The patient will have another surveillance colonoscopy 2 or 3 year later.

Image 1,2 & 3

image image

Video clip available

The i-scan SE shows sessile polyp with whitish surface mimicking sessile serrated polyp. However, the vascular and surface pattern was regular without white spots on i-scan TE image.
So, I can expect the pathology as a low-grade dysplasia based on JNET classification.

Summary

  • The i-scan has comparable diagnostic accuracies for the histologic prediction of intermediate-to-large colorectal polyps.
  • Furthermore, the inter-observer agreement and intra-observer agreement were acceptable for i-scan when the JNET classification was applied.
  • JNET type 1 is characterized by changes in normal vessels and mucosal patterns, as well as the presence of dark and white spots.
  • Type 2A is characterized by vessels of a regular caliber and a normal distribution pattern.
  • Type 2B is characterized by vessels of a variable caliber with an irregular distribution pattern and an obscure mucosal pattern.
  • Type 3 is defined as a vessel pattern that is typified by areas of interrupted thick vessels and a mucosal pattern involving amorphous areas.
qrcode
COLON Prof. Kang-Moon LEE

COLON

< image >
  • Prof. Kang-Moon LEE
  • Division of Gastroenterology
  • Department of Internal Medicine
  • The Catholic University School of Medicine
  • St. Vincent’s Hospital
  • Area of Interest
  • Inflammatory bowel disease
  • Therapeutic endoscopy

CASE 1

CASE 2

CASE 3

How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :

“ I use PENTAX IMAGINA for colorectal cancer surveillance in patients with long-standing ulcerative colitis (UC).
Previously, I had performed surveillance using traditional random biopsies or pan-chromoendoscopy with targeted biopsies,
which required a lot of effort and time. Recently, however, I’m using image-enhanced endoscopy (virtual chromoendoscopy)
like NBI or i-scan which is more convenient.
Although still controversial, high definition-virtual chromoendoscopy is known to be comparable to dye-spraying chromoendoscopy in detecting neoplasia in UC.
I assume that combination of high-definition endoscopy with i-scan of PENTAX IMAGINA system can be useful for colorectal cancer surveillance in UC.“

Cascade Stomach

Patient History

A 51-year-old male patient with long-standing ulcerative colitis underwent surveillance colonoscopy for detection of dysplasia.

Endoscopic Findings

With HD-WLE, old cicatricial changes with whitish scars and numerous inflammatory polyps were observed throughout the entire colon distal to A-colon. There showed no active lesions. (image 1)

With HD + i-scan, an ovoid flat elevated lesion (6 mm) was detected in mid T-colon. The lesion showed brown and irregular. Surface. (image 2)

Another ovoid flat lesion (4 mm) was detected in proximal T-colon. (image 3)

i-scan helped to find dysplasia and demarcate the borders of the lesions.

Endoscopic Treatment
and Pathology Results

Two lesions were removed by endoscopic mucosal resection.
he final pathology was ‘tubular adenoma with low grade dysplasia’ in both lesions.

Patient Outcome and
Follow-ups

Two colitic neoplasia were detected and removed successfully by surveillance colonoscopy.
The patient recommended to have regular surveillance colonoscopy.

Image 1

image

Image 2

Image 3

Summary

  • Patients with long-standing ulcerative colitis (UC) are at increased risk for colorectal cancer, Thus, surveillance colonoscopy is recommended in all
  • UC patients 8-10 years after onset of symptoms.
  • With advances in optical and digital technologies, chromoendoscopy with targeted biopsies or virtual chromoendoscopy has become the preferred screening method over traditional random biopsies.
  • Virtual chromoendoscopy with i-scan showed similar diagnostic yield to conventional dye-spraying colonoscopy and shorter procedure time
  • (López-Serrano A. et al. Scand J Gastroenterol 2021;56:820).
  • In this case, HD colonoscopy with i-scan was helpful to identify colitic neoplasia.
qrcode

How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :

“ I use PENTAX IMAGINA in my endoscopic procedures.
When an endoscopist performs a procedure, securing clean vision and smooth operation of endoscopy are essential factors. In this aspect, clear resolution and good maneuverability of PENTAX IMAGINA can be of great help to my successful procedure.”

Prophylactic Clip
Application for the
Prevention of
Postpolypectomy
Bleeding of Large
Pedunculated
Colonic Polyps

Patient History

A 46-year-old male patient was referred for a large pedunculated colon polyp.

Endoscopic Findings

With HD-WLE, a 15 mm sized pedunculated polyp was noted in the hepatic flexure. The length and width of stalk was 30 x 8 mm. (image 1)

The surface of the polyp head showed hyperemia and nodularity.
With HD + i-scan, vessels with variable caliber and irregular surface pattern were noted. (image 2)

i-scan helped to define the microvascular and surface patten of the lesion.

Endoscopic Treatment and Pathology Results

To prevent post-polypectomy bleeding, hemoclip was applied to the base of stalk before resection.
Then, hot snare polypectomy was performed. (image 3)

The final pathology was early colon cancer.
Adenocarcinoma, moderately differentiated, arising in sessile serrated adenoma with cytologic dysplasia

a) Size: adenoma 1.5 x 1.5 cm, carcinoma 0.7 x 0.7 cm
b) sm invasion = 300 ㎛ (Haggit level 1)
c) Tumor budding: absent
d) Resection margin involvement: absent

Image 1

image
image

Image 2

image
image

Image 3

image image
image image

Summary

  • Since the rate of post-polypectomy bleeding (PBB) is high (~15%), preventive measures are recommended after resection of large pedunculated polyps.
  • Prophylactic clip application is a very simple and effective method to prevent PPB.
  • Prophylactic clip is as effective and safe as an endoloop in preventing PPB in large pedunculated polyps, and may reduce PPB compared to no prior treatment.
  • In clinical practice, prophylactic clip is more useful than endoloop because it is easier to apply and the procedure time is shorter.
  • In this case, a large pedunculated polyp was successfully removed after applying a clip on the base of stalk.
qrcode

How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :

“ I use PETAX IMAGINA for colorectal cancer (CRC) screening. Higher quality colonoscopic withdrawal techniques, such as
(1)examining the proximal sides of flexures, folds and valves, (2) cleaning and suctioning, (3) adequacy of distention, and
(4) adequacy of time spent viewing, are associated with lower adenoma missing rate.
I think that clean resolution and good maneuverability of PENTAX IMAGINA may help to improve the yield of CRC screening.”

Prophylactic Clip
Application for the
Prevention of
Postpolypectomy
Bleeding of Large
Pedunculated
Colonic Polyps
Detection of Sessile
Serrated Adenoma
in the Ascending
Colon

Patient History

A 60-year-old female patient underwent colonoscopy for bloating and constipation.

Endoscopic Findings

With HD-WLE, a subtle flat lesion was suspected in the distal A-colon.

After adjusting for air inflation, an ovoid flat elevated lesion was clearly observed. (image 1)
With HD + i-scan, the surface of lesion showed slightly lighter color than background mucosa and some dark dots, suggesting a hyperplastic or
sessile serrated polyp. (image 2)

i-scan helped to define the microvascular and surface pattern of the lesion.

Endoscopic Treatment and Pathology Results

Endoscopic mucosal resection was done. (image 3)

The final pathology was sessile serrated adenoma.

Sessile serrated adenoma without cytologic dysplasia.

1) size: 0.8x0.8cm
2) resected margin involvement: absent

Patient Outcome and Follow-ups

The procedure performed successfully without any event.

Image 1

Image 2

image
image

Image 3

image image

Summary

  • Colonoscopic removal of adenomatous polyps can prevent colorectal cancer (CRC) and death from CRC. However, colonoscopy is known to be less
  • effective in preventing death from right-sided CRC. One of the possible explanation is that right-sided colonic adenomas are more often flat, which makes them harder to identify and remove.
  • Therefore, endoscopists should make the best efforts to detect adenoma of the right colon, and in particular, be familiar with the endoscopic features of sessile serrated adenoma/polyp (SSA/P), which are common in the right colon.
  • In this case, a flat lesion in the distal A-colon showed JNET type 1 findings (invisible vessel pattern, regular dark spots on the surface, and similar to surrounding normal mucosa), suggesting hyperplastic or SSA/P and histologically confirmed as SSA after resection.
qrcode
COLON Prof. Seong Woo JEON

COLON

< image >
  • Prof. Seong Woo JEON
  • Division of Gastroenterology & Hepatology
  • Department of Medicine
  • Kyungpook National University Hospital
  • Area of Interest
  • Therapeutic endoscopy in esophageal, gastric and colon cancer
  • Prevention and screening of early gastric cancer
  • Development of novel endoscopic devices
  • Helicobacter pylori diagnosis and treatment

How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :

“I use PENTAX IMAGINA in daily clinical endoscopy practice. One of our endoscopy purpose is surveillance after surgery or endoscopic resection of colorectal dysplasia or cancer. I frequently encounter metachronous polyps during this surveillance and the pathology provide exact diagnosis after resection of the polyp.
However, it is important to select exact candidates for colonoscopic resection to avoid unnecessary procedure.
I assume that PENTAX IMAGINA TE mode is useful in this aspect. JNET classification is useful tool in clinical decision.
Type 1 indicates a hyperplastic polyp or a sessile serrated adenoma/polyp.
Type 2A indicates low-grade dysplasia and includes tubular adenoma and tubulovillous adenoma.
Type 2B indicates high-grade dysplasia, intramucosal cancer, and superficial submucosal invasive cancer.
Type 3 indicates deep submucosal invasive cancer.
The PENTAX IMAGINA system have clear resolution and it can let me help to clear diagnosis. “

Endoscopic
Differentiation of
Colon Polyps

Patient History

The patient is a 61-year-old male who underwent sigmoid colon cancer surgery 2 years ago.
He is on adjuvant chemotherapy and colonoscopy surveillance was recently performed.

Endoscopic Findings

The colonoscopy revealed 8mm sized sessile polyp at transverse colon.

Endoscopic Treatment and Pathology Results

Endoscopic mucosal resection was done after submucosal injection and snaring.
No bleeding or perforation was noted after procedure. The final pathology was tubular adenoma, measuring 8mm in size.

Patient Outcome and Follow-ups

The patient will have another surveillance colonoscopy 2 or 3 year later.

Image 1,2 & 3

image image

The i-scan SE shows sessile polyp with whitish surface mimicking sessile serrated polyp. However, the vascular and surface pattern was regular without white spots on i-scan TE image.
So, I can expect the pathology as a low-grade dysplasia based on JNET classification.

Summary

  • The i-scan has comparable diagnostic accuracies for the histologic prediction of intermediate-to-large colorectal polyps.
  • Furthermore, the inter-observer agreement and intra-observer agreement were acceptable for i-scan when the JNET classification was applied.
  • JNET type 1 is characterized by changes in normal vessels and mucosal patterns, as well as the presence of dark and white spots.
  • Type 2A is characterized by vessels of a regular caliber and a normal distribution pattern.
  • Type 2B is characterized by vessels of a variable caliber with an irregular distribution pattern and an obscure mucosal pattern.
  • Type 3 is defined as a vessel pattern that is typified by areas of interrupted thick vessels and a mucosal pattern involving amorphous areas.
qrcode

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