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Over the last year, Fujinon, Olympus and Pentax, the three major flexible endoscope manufacturers, have refined their instruments in the quest for the ultimate scope. Here's an update.
Fujinon: lighter-weight controls
Fujinon's next generation of endoscopes, the 2200 series, feature a redesigned control section that is the lightest and easiest to handle of any scope, says the company. The new control section is smaller in circumference and the controls are designed to permit easy fingertip access with less finger travel. "I like how they placed the controls very intuitively to allow me to manipulate the scope with an economy of motion," says Eric King, MD, of Sarasota, Fla. "After multiple cases, there's a noticeable difference in terms of hand fatigue."
The 2200 series also features a new xenon light source, which the company claims delivers 300 percent more light to the operative site. Dr King, however, has not noted a dramatic difference. "The illumination of the site was already quite good," he says.
Olympus: C-arm-free colonoscopy
The Olympus ScopeGuide Endoscopic Imager will be released nationwide later this month. Until now, the only method of visualizing the colonoscope during a procedure was to use a C-arm. The ScopeGuide eliminates the need for fluoroscopy by generating a low-level magnetic field that creates an image that the surgeon can view on a monitor.
Although colonoscopy can be performed without visualization of the scope, this technique has two major benefits in difficult procedures, says Doug Howell, MD, of Portland, Maine, who has been using the system in clinical trials since July 2002. First, visualization helps locate the optimal position for abdominal compression. "This can be tricky with just the scope alone, which is why X-rays were always a helpful guidance to the endoscopist," says Dr. Howell. Visualization also helps solve the problem of looping. "The surgeon may think the scope is advancing normally through the colon, but it is actually forming a loop. Visualizing the scope can help the surgeon get it back on track."
The ScopeGuide generates a magnetic field through 16 electromagnetic pulse units positioned along the inside of the insertion tube. The signals are picked up by a sensor dish, which displays the image of the endoscope on a 10-inch monitor.
According to Olympus product line manager John Power, the ScopeGuide is an improvement over traditional fluoroscopic visualization for the following reasons. First, it provides a three-dimensional image of the entire scope, unlike fluoroscopy, which provides a two-dimensional image of only part of the scope. Also, the system eliminates the need for costly X-ray equipment and the protective equipment associated with it.
Two other notes: As with the other current generation Olympus colonoscopes, the ScopeGuide includes an adjustable stiffness feature (dubbed "Innoflex" by the company). Also, if you want to use a different endoscope with the system, you can purchase a ScopeGuide Probe attachment, which allows a traditional colonoscope to interface with the main unit. The trade-off is reduced suction capability in the scope, because the probe occupies about half of the cross-sectional area of a 3.7 mm instrument channel or two-thirds of 3.2 mm channel.
Dr. Howell believes that in addition to its applications as an adjunct to difficult procedures, visualization technology is an invaluable tool in teaching new physicians to hone their skills in maneuvering the endoscope. "As it becomes increasingly user-friendly for the physician to interface visualization with endoscopy, I think all physicians doing colonoscopy will be encouraged to make wider use of visualized guidance, especially those who were trained knowing all the benefits," he says.
Pentax: upper GI alternative
Pentax's EG-1540 gastroscope is designed to allow transnasal EGD (esophagogastroduodenoscopy) to be performed in the office setting without sedation. The product was developed in conjunction with Reza Shaker, MD, the director of the Digestive Disease Center at the Medical College of Wisconsin. The scope took a mere six months to develop from conception to development of a prototype to clinical usage, says Pentax product manager Nick Tsaclas.
The key to the scope is the ultra-slim diameter (5.1 mm), which allows for transnasal introduction of the scope without anesthesia. "The thinner and smaller the scope, the less discomfort the patient could experience," says Robert Brusco, MD, of Philadelphia, Pa.
"Unsedated T-EGD is often a better way of doing cases," says Dr. Shaker. "More than half of the morbidity and mortality associated with upper GI endoscopy are due to cardiopulmonary complications, mainly from anesthesia."
Dr. Shaker also points to the current emphasis on cost reduction. With the high prevalence of upper GI complaints, patients may only be referred for EGD on their second or third visit to the physician, rather than upon immediate indication. Alternatively, they may be considered for empiric therapy. "Cumulatively, these issues represent the need for more economic - as well as safer - upper GI diagnostic techniques."
With unsedated T-EGD, there is no waiting and no need to schedule additional appointments. The physician can work alone, which saves on nursing costs, and there is no post-anesthesia recovery time. The patients can leave immediately and return to work the same day.
Dr. Shaker adds that the procedure is insurer-friendly as well. Resource expenditures are minimal, as are professional fees associated with the case. There is no facility fee if the procedure is performed in the office setting. Alternatively, because these cases can be done in a procedure room, costs are minimal in an ASC.
Dr. Shaker cautions that physicians doing ESG cannot expect to switch over immediately to using the EG-1540 scope. There's a learning curve associated with smaller caliber scopes and, more importantly, hurdles in working with unsedated patients.
"Patients expect to go to sleep and awaken without any awareness of their procedure. There is a fear factor to overcome," says Dr. Shaker. "Also, patients undergoing unsedated endoscopy will experience some discomfort as compared to endoscopy with general anesthesia. But what people don't understand is the level of intensity is low, generally about a 3 on a scale of 1 to 10 and the majority of individuals scoped this way report they would consent to an unsedated procedure again." Note that about 5% of patients cannot be scoped in this manner because of their anatomy.
When doing patient education prior to the procedure, Dr. Shaker recommends showing a video that shows actual examinations to alleviate fears and help to answer questions the patient may be afraid to ask.
Should you buy now?
All the surgeons with whom we spoke gave a qualified yes to the question of whether facilities should invest now in the new scopes. It depends, they said, on how long it's been since you last purchased new scopes.
"If you're still using scopes from around 1998 - and we recently replaced two such colonoscopes with the brand new ones - upgrading now should be a priority in the budget because those older scopes are rapidly becoming obsolete," says Martin Risberg, MD, of Minneapolis, Minn. "The technology is moving very fast."
FUJINON 2200 Series (800) 872-0196 Fujinon.com/product/index.htm #medical  |
Fujinon: lighter-weight controls
Fujinon's next generation of endoscopes, the 2200 series, feature a redesigned control section that is the lightest and easiest to handle of any scope, says the company. The new control section is smaller in circumference and the controls are designed to permit easy fingertip access with less finger travel. "I like how they placed the controls very intuitively to allow me to manipulate the scope with an economy of motion," says Eric King, MD, of Sarasota, Fla. "After multiple cases, there's a noticeable difference in terms of hand fatigue."
The 2200 series also features a new xenon light source, which the company claims delivers 300 percent more light to the operative site. Dr King, however, has not noted a dramatic difference. "The illumination of the site was already quite good," he says.
Olympus ScopeGuide System (800) 645-8160 Olympusamerica.com/msg- section/msg-gastro.asp |
Olympus: C-arm-free colonoscopy
The Olympus ScopeGuide Endoscopic Imager will be released nationwide later this month. Until now, the only method of visualizing the colonoscope during a procedure was to use a C-arm. The ScopeGuide eliminates the need for fluoroscopy by generating a low-level magnetic field that creates an image that the surgeon can view on a monitor.
Although colonoscopy can be performed without visualization of the scope, this technique has two major benefits in difficult procedures, says Doug Howell, MD, of Portland, Maine, who has been using the system in clinical trials since July 2002. First, visualization helps locate the optimal position for abdominal compression. "This can be tricky with just the scope alone, which is why X-rays were always a helpful guidance to the endoscopist," says Dr. Howell. Visualization also helps solve the problem of looping. "The surgeon may think the scope is advancing normally through the colon, but it is actually forming a loop. Visualizing the scope can help the surgeon get it back on track."
The ScopeGuide generates a magnetic field through 16 electromagnetic pulse units positioned along the inside of the insertion tube. The signals are picked up by a sensor dish, which displays the image of the endoscope on a 10-inch monitor.
According to Olympus product line manager John Power, the ScopeGuide is an improvement over traditional fluoroscopic visualization for the following reasons. First, it provides a three-dimensional image of the entire scope, unlike fluoroscopy, which provides a two-dimensional image of only part of the scope. Also, the system eliminates the need for costly X-ray equipment and the protective equipment associated with it.
Two other notes: As with the other current generation Olympus colonoscopes, the ScopeGuide includes an adjustable stiffness feature (dubbed "Innoflex" by the company). Also, if you want to use a different endoscope with the system, you can purchase a ScopeGuide Probe attachment, which allows a traditional colonoscope to interface with the main unit. The trade-off is reduced suction capability in the scope, because the probe occupies about half of the cross-sectional area of a 3.7 mm instrument channel or two-thirds of 3.2 mm channel.
Dr. Howell believes that in addition to its applications as an adjunct to difficult procedures, visualization technology is an invaluable tool in teaching new physicians to hone their skills in maneuvering the endoscope. "As it becomes increasingly user-friendly for the physician to interface visualization with endoscopy, I think all physicians doing colonoscopy will be encouraged to make wider use of visualized guidance, especially those who were trained knowing all the benefits," he says.
Pentax EG-1540 Gastroscope (800) 431-5880 pentaxmedical.com |
Pentax: upper GI alternative
Pentax's EG-1540 gastroscope is designed to allow transnasal EGD (esophagogastroduodenoscopy) to be performed in the office setting without sedation. The product was developed in conjunction with Reza Shaker, MD, the director of the Digestive Disease Center at the Medical College of Wisconsin. The scope took a mere six months to develop from conception to development of a prototype to clinical usage, says Pentax product manager Nick Tsaclas.
The key to the scope is the ultra-slim diameter (5.1 mm), which allows for transnasal introduction of the scope without anesthesia. "The thinner and smaller the scope, the less discomfort the patient could experience," says Robert Brusco, MD, of Philadelphia, Pa.
"Unsedated T-EGD is often a better way of doing cases," says Dr. Shaker. "More than half of the morbidity and mortality associated with upper GI endoscopy are due to cardiopulmonary complications, mainly from anesthesia."
Dr. Shaker also points to the current emphasis on cost reduction. With the high prevalence of upper GI complaints, patients may only be referred for EGD on their second or third visit to the physician, rather than upon immediate indication. Alternatively, they may be considered for empiric therapy. "Cumulatively, these issues represent the need for more economic - as well as safer - upper GI diagnostic techniques."
With unsedated T-EGD, there is no waiting and no need to schedule additional appointments. The physician can work alone, which saves on nursing costs, and there is no post-anesthesia recovery time. The patients can leave immediately and return to work the same day.
Dr. Shaker adds that the procedure is insurer-friendly as well. Resource expenditures are minimal, as are professional fees associated with the case. There is no facility fee if the procedure is performed in the office setting. Alternatively, because these cases can be done in a procedure room, costs are minimal in an ASC.
Dr. Shaker cautions that physicians doing ESG cannot expect to switch over immediately to using the EG-1540 scope. There's a learning curve associated with smaller caliber scopes and, more importantly, hurdles in working with unsedated patients.
"Patients expect to go to sleep and awaken without any awareness of their procedure. There is a fear factor to overcome," says Dr. Shaker. "Also, patients undergoing unsedated endoscopy will experience some discomfort as compared to endoscopy with general anesthesia. But what people don't understand is the level of intensity is low, generally about a 3 on a scale of 1 to 10 and the majority of individuals scoped this way report they would consent to an unsedated procedure again." Note that about 5% of patients cannot be scoped in this manner because of their anatomy.
When doing patient education prior to the procedure, Dr. Shaker recommends showing a video that shows actual examinations to alleviate fears and help to answer questions the patient may be afraid to ask.
Should you buy now?
All the surgeons with whom we spoke gave a qualified yes to the question of whether facilities should invest now in the new scopes. It depends, they said, on how long it's been since you last purchased new scopes.
"If you're still using scopes from around 1998 - and we recently replaced two such colonoscopes with the brand new ones - upgrading now should be a priority in the budget because those older scopes are rapidly becoming obsolete," says Martin Risberg, MD, of Minneapolis, Minn. "The technology is moving very fast."
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