TOOLS OF THE TRADE Colon cancer detection demands colonoscopes that provide excellent visualization and easy maneuverability.

Can some of the latest innovations on the market today improve colonoscopy screenings? We talked with some physician-users to find out.

EndoChoice
Full Spectrum Endoscopy (FUSE)
Three imaging chips on the tip of a proprietary scope offer a 330° field of view that has revolutionized the way physicians perform colonoscopy. During extubation, physicians focus on the center screen for traditional forward views of the colon wall and refer to 2 secondary screens for rear-view-mirror-like views behind folds in the colon.

Blair S. Lewis, MD, PC, of Carnegie Hill Endoscopy in New York City, says the 3-screen setup isn’t necessarily intuitive. The self-described “slow learner” says it took him about 60 cases to retrain his movements. He says the system differentiates his Manhattan practice from the competition and, more importantly, lets him detect polyps he would have otherwise missed with conventional forward-viewing technology. Working with the FUSE demands investing in an entire new platform, but Dr. Lewis says the added cost is negligible when considered in the context of performing quality colonoscopy.

Medivators
Endocuff
This device fits over the tip of most endoscopes to hold colon folds open during extubation, which lets physicians see more mucosa for easier polyp identification. It can also anchor the scope against the colon wall, creating more stability and improved control during procedures.

Jeremy D. Barber, DO, of Mercy Internal Medicine in Muskegon, Mich., says the cuff improves visualization in patients with poor preps. “Pulling back the folds lets me access and suction pools of liquid,” he explains. “It flattens out the areas so I can visualize what’s there, which provides more reassurance that I’m not missing a flat polyp.”

Dr. Barber uses the cuff during screenings of patients at high risk for colon cancer and to stabilize the scope during endoscopic mucosal resection. He says it’s more difficult, but not impossible, to intubate the terminal ileum with the cuff on. He also believes the device helps him maneuver through difficult colons. Cost is the only factor that prevents Dr. Barber from using the cuff during every case. “The device is outstanding, but I have to be reasonable about adding about $20 to a case,” he says.

Pentax Medical
RetroView Colonoscope
This scope differentiates itself from others on the market with its 210° angulation in the up position, shortened bending section and slimmer diameter in the retroflex position, which provides better views of polyps behind folds in the colon.

Subas Banerjee, MD, associate professor of medicine at the Stanford University Medical Center in Palo Alto, Calif., says the very short turning radius makes it easier to retroflex. He says the scope successfully negotiates difficult colons ravaged by scar tissue, attacks of inflammation or previous surgeries. “The scope can bend on a dime to snake its way through where standard slim scopes or pediatric scopes couldn’t,” says Dr. Banerjee. i-SCAN imaging technology enhances the surface architecture of polyps, which Dr. Banerjee says lets him differentiate between cancerous and benign growths. “You can leave behind clearly benign growths and remove clearly cancerous polyps,” he says.

Fujifilm
600 Series Colonoscope
This new scope’s megapixel CMOS imaging technology provides high-definition images as close as 2 mm for enhanced views of mucosal surfaces and microvascular patterns with less distortion. The scope has a modified insertion tube and a slimmer 12-mm diameter to accommodate various physician techniques. The results: shadow-free, sharper images that provide clearer views of flat polyps and their margins, says Jose Lantin, PC, a gastroenterologist in Yonkers, N.Y.

The tip of the scope is more flexible, leading to faster and easier navigation. “My intubation time to the cecum takes only 3 to 4 minutes,” says Dr. Lantin. He also says the scope is considerably lighter than previous generations and its control heads are soft and easy to manipulate, important ergonomic factors for physicians who complain of aching hands at the end of a busy day in the procedure room.

Avantis Medical
Third Eye Panoramic Clip-On
The company that pioneered technology designed to look behind folds in the colon is back with a neat new device that attaches snugly to the tips of standard colonoscopes to provide panoramic views during screenings. Lenses on the right and left sides of the device combine with the colonoscope’s forward-viewing lens to send 3 images to a single screen.

“The side images are slightly smaller and less intrusive, so the physician’s focus remains on the dominant center view,” says Moshe Rubin, MD, director of gastroenterology at New York Hospital Queens. “The ability to see the mucosa close up is excellent. It provides views that enhance the ability to see behind folds and flexures.”

The device transmits images through a wire that rides parallel with the scope, which Dr. Rubin says adds minimally perceptible resistance to the scope’s movement — not enough to interfere with the endoscopist’s ability to reach the cecum. “That friction will become less of an issue as the company continues to improve the cap tip to make it smoother, rounder and thinner,” he says.

“The advantage of this device, unlike competing technology, is that you don’t have to invest in new equipment,” he adds, noting that endoscopists are partial to the brand of scopes they use.

Olympus
EVIS EXERA III & 190 series colonoscope
Olympus’s latest endoscopy imaging processing platform combines with the company’s 190 series colonoscopes to provide enhanced views of easy-to-miss polyps. The complete system features narrow-band imaging (NBI) technology, improved image capture capabilities, passive bending behind the scope’s active bending section and a built-in scope-tracking device.

“The scope’s tip bends a little easier, so you have an easier time getting through turns and performing retroflexion in the right colon to see behind the folds,” says Michael D. Brown, MD, MACM, FACP, FACG, AGAF, professor of medicine and gastroenterology fellowship program director at Rush University Medical Center in Chicago, Ill. “It provides the advantage of the increased flexibility afforded by a pediatric scope without the disadvantage of working with a flexible instrument that tends to loop more severely,” he says.

The NBI technology captures clearer pictures of growths and lets physicians notice nuances in the pitting of lesions, a macropathology that coincides with the movement to classify growths during screenings. Although the scope-tracking technology is marketed as a teaching tool, Dr. Brown finds it useful during difficult exams. “It makes me try something different to reduce looping, instead of repeating the technique that’s not working,” he explains. “This instrument helps you become a better endoscopist.”

Invendo Medical
invendoscopy

This single-use colonoscopy system is a complete departure from conventional screening instrumentation. Endoscopists use a handheld device to drive the device in and out of the colon, which limits pressure on the colonic wall and lets most patients undergo the procedure without sedation.

“You must retrain yourself to perform this type of exam using the remote control,” says Adam J. Goodman, MD, director of endoscopy at Bellevue Hospital Center in New York, N.Y. “But once you learn how to do that, it makes the procedure much easier.”

The exams last longer because the device works at a single speed, for patient safety; Dr. Goodman says he can typically reach the cecum in 15 to 20 minutes, and it takes him about the same amount of time to pull out.

It’s a very comfortable procedure, so its biggest potential is for use in patients who are afraid of being sedated or who don’t have a friend or family member to escort them to and from endoscopy centers, says Dr. Goodman, adding that “it could bring perforation rates down close to zero.”