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Miami Classification for Probe-Based Confocal Laser Endomicroscopy
An essential element for any new advanced imaging technology is standardization of indications, terminology, categorization of images, and research priorities. In this review, we propose a state-of-the-art classification system for normal and pathological states in gastrointestinal disease using probe-based confocal laser endomicroscopy (pCLE). The Miami classification system is based on a consensus of pCLE users reached during a meeting held in Miami, Florida, in February 2009
Difficult Endoscopic Retrieval of a Migrated Stent inside a Pseudocyst
Endoscopic ultrasound (EUS) guided pseudocyst drainage can have complications such as bleeding, perforation, infection, and stent migration. We report a case of iatrogenic migration of stent inside a large dumbbell-shaped pseudocyst managed successfully with a difficult endoscopic retrieval procedure
Computerisation of endoscopy reports using standard reports and text blocks
BACKGROUND: The widespread use of gastrointestinal endoscopy for diagnosis
and treatment requires effective, standardised report systems. This need
is further increased by the limited storage of images, and by the need for
structured databases for surveillance and epidemiology. We therefore aimed
for a report system which would be quick, easy to learn, and suitable for
use in busy daily practice. METHODS: Endobase III is an endoscopy
information system offering three different ways of report writing, i.e.
standard reports, text blocks and Minimal Standard Terminology (MST). A
working group of two university and four general hospitals worked as a
reference group for the development of standard reports and text blocks.
Guidelines from various gastrointestinal endoscopy societies were followed
to compose the reports. RESULTS: Standard reports were based on a list of
distinct diagnoses; text blocks were based on anatomic landmarks and
individual procedures. As such, 316 standard reports were developed for
upper and lower gastrointestinal endoscopy, and endoscopic retrograde
cholangiopancreatography (ERCP). In this way selecting one diagnosis
produces a complete report. A total of 1571 different text blocks were
additionally developed for each part of the gastrointestinal tract and for
procedures during endoscopy. This module allowed generation of a full
report on the combination of text blocks. Reports could be composed and
printed within two minutes for 90% of cases. CONCLUSION: Standard reports
and text blocks are a quick, user-friendly way of report writing accepted
and used by a number of gastroenterologists in the Netherlands
Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions
Background: Endoscopic tri-modal imaging (ETMI) incorporates white light endoscopy (WLE), autofluorescence imaging (AFI) and narrow-band imaging (NBI). Aims: To assess the value of ETMI for the detection and classification of neoplasia in patients with longstanding ulcerative colitis. Design: Randomised comparative trial of tandem colonoscopies. Setting: Academic Medical Centre Amsterdam, Netherlands. Patients and methods: Fifty patients with ulcerative colitis underwent surveillance colonoscopy with ETMI. Each colonic segment was inspected twice, once with AFI and once with WLE, in random order. All detected lesions were inspected by NBI for Kudo pit pattern analysis and additional random biopsies were taken. Main outcome measures: Neoplasia miss-rates of AFI and WLE, and accuracy of the Kudo classification by NBI. Results: Among patients assigned to inspection with AFI first (n = 25), 10 neoplastic lesions were primarily detected. Subsequent WLE detected no additional neoplasia. Among patients examined with WLE first (n = 25), three neoplastic lesions were detected; subsequent inspection with AFI added three neoplastic lesions. Neoplasia miss-rates for AFI and WLE were 0% and 50% (p = 0.036). The Kudo classification by NBI had a sensitivity and specificity of 75% and 81%; however, all neoplasia was coloured purple on AFI (sensitivity 100%). No additional patients with neoplasia were detected by random biopsies. Conclusion: Autofluorescence imaging improves the detection of neoplasia in patients with ulcerative colitis and decreases the yield of random biopsies. Pit pattern analysis by NBI has a moderate accuracy for the prediction of histology, whereas AFI colour appears valuable in excluding the presence of neoplasia. Trial registration number: ISRCTN0527274
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