Here are a few of the latest advances in flexible endoscopes I saw at the national conference of the Society of Gastroenterology Nurses and Associates (SGNA) in Baltimore last May.

Semi-disposable colonoscopes. Every GI nurse's primary concern is preventing cross contamination. We wear personal protective equipment and reprocess scopes thoroughly, but even under the best circumstances there's always a small chance something could carry over from one patient to another. The Sightline CS semi-disposable colonoscope by Stryker GI is designed so that the patient's contaminates bypass the main body of the scope, which means it's reusable without reprocessing. All the staff has to do is remove the contaminated exterior sheath and internal channels.

You may remember when this concept was introduced in the 1980s, and you probably also remember how those early models were cumbersome to use, expensive compared to their conventional counterparts and still required some reprocessing for the non-disposable components. But this new generation has resolved those issues with a scope that has state-of-the-art diagnostic and therapeutic technology, is user-friendly and completely eliminates any risk of patient cross contamination.

Deciphering our high-tech imaging options. What do narrow-band imaging, real-time image mapping software and spectral estimation technology have to do with getting and recording clearer endoscopic images? Plenty, if only we knew what these terms meant.

Narrow-band imaging enhances the visibility of capillaries, veins and other subtle tissues by using two slim beams of light. Olympus uses this technology in its Exera II line of endoscopes.

Real-time image mapping software, when combined with a fast processor, can give you instant and highly detailed images of the patient's tissue. Pentax offers this as part of its endoscope system.

Spectral estimation technology uses variants of the traditional white light spectrum to provide images of target areas so clear they may eliminate the need for a biopsy. Fujinon uses this in its EPX-4400 system.

Smart scopes. In addition to the cameras, manufacturers have also improved endoscopes' data management capabilities to make documentation, storage and retrieval of patient information more efficient. Some of these new features are aimed at collecting the information we need before each procedure and storing it in the OR. These include:

• patient information, such as scheduling, procedures, reports, videos, photos and radiologic images;
• personalized profiles that recognize each physician's preferences;
• nurses' notes from any phase of the patient's visit;
• the facility's inventory of scopes along with each one's repair history; and
• benchmarking services that automatically timestamp all procedure details, such as how long it took and the settings used.
• The skinny on the smallest scopes. In addition to becoming easier to handle and taking better images, endoscopes continue to get thinner. For example, the GIF-N180 gastroscope from Olympus is just over 4.9mm in diameter. It's so narrow it can be used for unsedated upper endoscopy procedures in a physician's office.

We may soon see smaller scopes play a larger role in endoscopy. The technology behind mother-baby scopes, where a smaller scope is passed through the operating channel of a larger scope to extend the area of visibility, has been around for two decades. However, endoscopy centers have been slow to adopt these because they needed two scope systems to be effective, and that was simply out of most budgets.

Some new "baby" scopes are currently under development that may improve the diagnostic value of your procedures. One of these, the SpyGlass System for endoscopic retrograde cholangiopancreatography from Boston Scientific, can be passed through a standard duodenoscope to provide direct visualization of the biliary tree, lithotripsy and visually guided biopsies. Another is the Third Eye Retroscope by Avantis Medical Systems, which is designed to pass through a standard colonoscope and can automatically turn 180 degrees to provide a "backward" or retrograde view behind folds in the colon when it emerges.

NeoGuide Systems
NeoGuide Colonscope
(408) 399-9999
www.neoguidesystems.com
Price: Not yet on the market
FYI: The NeoGuide features a sensor at the tip of the scope that measures the depth of insertion and records the angle of the tip so the following segmented scope follows in the same pattern, which means it effectively remembers the shape of the patient's colon. This eliminates the possibility of "looping" by not stretching the colon wall in the way conventional scopes often do when they advance. Physicians can control this device through a single button and monitor the tip's position through a graphic interface. The manufacturer says it plans to have this system available for facilities in early 2008.

Pentax Medical
90 i-Flex Series Scopes
(800) 431-5880
www.pentaxmedical.com
Price: $31,500 for the EG-2990i and $27,500 for the EG-2990k'gastroscopes, $36,950 for the EC-3890Li and $42,250 for the EC-3890Lk colonoscopes.
FYI: This new line of scopes incorporate high-definition imaging technology with physician-focused ergonomic design. To maneuver during the procedure, these scopes use a multi-stage stiffness insertion tube that moves without increasing size. The manufacturer says that, according to its research, these scopes can reduce the time a physician needs to examine a cecum by up to 25 percent.

Stryker GI
Sightline CS With SafetySleeve
(877) SYK-FLEX
www.stryker.com
Price: Not yet determined
FYI: Reprocessing endoscopes is many staffers' least favorite task, but the Sightline CS colonscope offers a simple solution. This device can be covered with a disposable SafetySleeve that protects the instrument during the procedure and also features disposable channels to prevent contamination. Instead of reprocessing it after each procedure, simply throw out the sleeve and disposable parts. An LED light at the tip eliminates the need for a separate light source, delivers high-resolution images and has all the functions common to flexible endoscopy equipment.

Medtronic ENT
Endosheath SlideOn System
(800) 874-5797
www.medtronicENT.com
Price: $12 to $16 for basic sheaths; $20 to $40 for specialty sheaths
FYI: The EndoSheath SlideOn system covers the endoscope with a sterile latex-free microbial barrier, which could lead to a quicker alternative to traditional processing after ENT procedures if used properly. A study provided by the manufacturer reported no signs of bacterial contamination on their brand of flexible endoscopes when they were used with this device and a thorough post-use enzymatic detergent cleaning, followed by a wipe down with 70 percent ethanol.

Fujinon
EPX-4400
(800) 490-0661
www.fujinonendoscopy.com
Price: Not disclosed
FYI: Fujinon's endoscope system combines a digital scope with digital processing and high-definition output, according to the manufacturer. It uses spectral estimation technology to show exceptionally detailed pictures of tissue. This application is software-based, so the physician can customize the exact combination of variants of white light for the anatomical locations he most often examines.

Karl Storz
Endoscopy-America
Flexible Video Cystoscope
www.ksea.com
(800) 421-0837
Price: Not disclosed
FYI: The Flexible Video Cystoscope combines the versatility of a flexible endoscope with the advantages of advanced distal chip technology, says the manufacturer. Its features include three programmable buttons to give the surgeon simple fingertip control of all functions, a single-lever deflection to provide distal tip control and continuous controlled dual deflection to make it easier to reach difficult spots. With its metal handle and mechanical design, the manufacturer says this scope will have a long, functional life.

Olympus
Evis Exera II 180 Scopes
(800) 848-9024
www.olympusamerica.com
Price: Not provided
FYI: Olympus's new line of ultra-slim flexible endoscopes includes the GIF-H180 gastroscope, which is 4.9mm wide, and the CF-H180A/L colonoscope, which offers a 170-degree field of view. Olympus says these scopes are ergonomically designed to make them easy to handle. Each has a camera that is equipped with both high-definition and narrow-band imaging to capture lifelike images when used with a compatible platform.