**5. Conclusion**

The combination of AFI and TH results in more accurate detection of colorectal neoplasms. These new modalities lead to high yield colonoscopy, and the increase in detected lesions, resulting in more time, labor and cost being expended on the histopathological diagnosis of small indolent low-grade adenomas. The 'DISCARD-ME' policy using NBI-ME may

Recent Advances in Diagnostic Endoscopy for Colorectal Neoplasm 225

Jemal A., Siegel R., Ward E., Hao Y., Xu J., & Thun M. (2009) Cancer statistics, 2009. *CA: A Cancer Journal for Clinicians,* Vol. 59, No. 4, pp. 22549. ISSN 0007-9235. Kaltenbach T., Saon Y., Friedland S., & Soetikno R. American Gastroenterological

Katagiri A., Fu K., Sano Y., Ikematsu H., Horimatsu T., Kaneko K., Muto M., & Yoshida S.

Kudo S., Hirota S., Nakajima T., Hosobe S., Kusaka H., Kobayashi T., Himori M., & Yagyuu

Leufkens A., DeMarco D., Rastogi A., Akerman P., Azzouzi K., Rothstein R., Vleggaar F.,

Matsuda T., Saito Y., Fu K.I, Uraoka T., Kobayashi N., Nakajima T., Ikehara H., Mashimo Y.,

Matsushita M., Hajiro K., Okazaki K., Takakuwa H., & Tominaga M. (1998) Efficacy of total

Morson B. (1974) President's address: the polyp-cancer sequence in the large bowel.

Rex D., Cutler C., Lemmel G., Eahmani E., Clark D., Helper D., Lehman G., & Mark D..

colonoscopies. *Gastroenterology,* Vol. 112, No. 1, pp. 2428. ISSN 0016-5085. Triadafilopoulos G., Watts H., Higgins J., & Van Dam J. (2007) A novel retrograde-viewing

Uraoka T., Saito Y., Matsuda T., Sano Y, Ikehara H., Mashimo Y., Kikuchi T., Saito D., &

Vucelic B., Rex D., Pulanic R., Pfefer J., Hrstic I., Levin B., Halpern Z., & Arber N. (2006) The

Cap. *Endoscopy,* Vol. 30, No. 5, pp. 444447. ISSN 0013726X.

*Therapeutics,* Vol. 27, No. 12, 12691274. Online ISSN 1365-2036.

No. 1, pp. 327340. ISSN 0016-5085.

10, pp. 880885. ISSN 0021-9746.

480489. ISSN 0016-5107.

pp. 19261932. ISSN 0002-9270.

65, No. 1, pp. 139144. ISSN 0016-5107.

12, pp. 18101815. ISSN 0815-9319.

0016-5085.

Association. (2008) American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. *Gastroenterology,* Vol. 134,

(2008) Narrow band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia. *Alimentary Pharmacology &* 

A. (1994) Colorectal tumors and pit pattern. *Journal of Clinical Pathology,* Vol. 47, No.

Repici A., Rando G., Okolo P., Dewit O., Ignjatovic A., Odstrcil E., East J., Deprez P., Saunders B., Kalloo A., Creel B., Singh V., Lennon A., & Siersema P (The Third Eye Retroscope Randomized Clinical Evaluation [TERRACE] Study Group) (2011) Effect of a retrograde-viewing device on adenoma detection rate during colonoscopy: the TERRACE study. *Gastrointestinal Endoscopy,* Vol. 73, No. 3, pp.

Shimoda T., Murakami Y., Parra-Blanco A., Fujimori T., & Saito D. (2008) Does autofluorescence imaging videoendoscopy system improve the colonoscopic polyp detection rate?--a pilot study. *American Journal of Gastroenterology,* Vol. 103, No. 8,

colonoscopy with a transparent cap in comparison with colonoscopy without the

*Proceedings of the Royal Society of Medicine,* Vol. 67, No. 6, pp. 45157. ISSN 0035-9157.

(1997) Colonoscopic miss rates of adenomas determined by back-to-back

auxiliary imaging device (Third Eye Retroscope) improves the detection of simulated polyps in anatomic models of the colon. *Gastrointestinal Endoscopy,* Vol.

Saito H. (2008) Detectability of colorectal neoplastic lesions using a narrow-band imaging system: a pilot study. *Journal of Gastroenteroogy and Hepatology,* Vol. 21, No.

Aer-O-Scope: Proof of concept of a pneumatic, skill-independent, self-propelling, self-navigating colonoscope. *Gastroenterology,* Vol. 130, No. 3, pp. 672677. ISSN

decrease the time, labor and cost of histopathological diagnosis without running the risk of discarding lesions that require formal histopathological diagnosis for assessment of the possibility of lymph node metastasis. These new diagnostic technologies may contribute to a new 'high yield and discard' era in surveillance colonoscopy.

### **6. References**


decrease the time, labor and cost of histopathological diagnosis without running the risk of discarding lesions that require formal histopathological diagnosis for assessment of the possibility of lymph node metastasis. These new diagnostic technologies may contribute to a

Adler A., Pohl H., Papanikolaou I., Abou-Rebyeh H., Schachschal G., Veltzke-Schlieker W.,

Adler A., Aschenbeck J., Yenerim T., Mayr M., Aminalai A., Drossel R., Schröder A.,

Aminalai A., Rösch T., Aschenbeck J., Mayr M., Drossel R., Schröder A., Scheel M., Treytnar

Brooker J., Saunders B., Shah S., Thapar C., Thomas H., Atkin W., Cardwell C., & Williams

Chung S., Kim D., Song J., Park M., Kim YS, Kim J., Jung H., & Song I. (2010) Efficacy of

Hewett D. & Rex D. (2010) Cap-fitted colonoscopy: a randomized, tandem colonoscopy

Hirata M., Tanaka S., Oka S., Kaneko I., Yoshida S., Yoshihara M., & Chayama K. (2007)

Inoue T., Murano M., Murano N., Kuramoto T., Kawakami K., Abe Y., Morita E., Toshina K.,

*Lancet Oncology,* Vol. 10, No. 12, pp. 11711178. ISSN 1470-2045.

Vol. 43, No. 1. pp. 4550. ISSN 0944-1174.

*Endoscopy,* Vol.56, No.3, pp. 333338. ISSN 0016-5107.

*Endoscopy,* Vol.72, No.1, pp. 136142. ISSN 0016-5107.

Khalifa A., Setka E., Koch M., Wiedenmann B., & Rösch T. (2008) A prospective randomized study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a leaning effect? *Gut,* Vol.

Scheel M., Wiedenmann B., & Rösch T. (2009) Narrow-band versus whitelight high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial. *Gastroenterology,* Vol. 136, No. 2, pp. 410416. ISSN

D., Gauger U., Stange G., Simon F., & Adler A. (2010) Live image processing does not increase adenoma detection rate during colonoscopy: a randomized comparison between FICE and conventional imaging (Berlin Colonoscopy Project 5, BECOP-5) *American Journal of Gastroenterology,* Vol. 105, No. 11, pp. 23832388. ISSN

C. (2002) Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. *Gastrointestinal* 

computed virtual chromoendoscopy on colorectal cancer screening: a prospective, randomized, back-to-back trial of Fuji Intelligent Color Enhancement versus conventional colonoscopy to compare adenoma miss rates. *Gastrointestinal* 

study of adenoma miss rates. *Gastrointestinal Endoscopy,* Vol.72, No.4, pp. 775781.

Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. *Gastrointestinal Endoscopy,* Vol.65, No. 7, pp. 988995. ISSN 0016-5107. Ignjatovic A., East J., Suzuki N., Vance M., Guenther T., & Saunders B.. (2009) Optical

diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study.

Hoshiro H., Egashira Y., Umegaki E, & Higuchi K. (2008) *Journal of Gastroenterology,*

new 'high yield and discard' era in surveillance colonoscopy.

57, No. 1, pp. 5964. ISSN 0017-5749

**6. References** 

0002-9270.

0002-9270.

ISSN 0016-5107.


**16** 

*Spain* 

**Efficacy of the Pediatric** 

Francisco Pérez-Roldán,

**Colonoscope Used as a Push Enteroscope** 

Pedro González-Carro and María Concepción Villafáñez-García

Numerous advances have recently been made in endoscopy for both diagnosis and treatment of gastrointestinal diseases. However, these advances have taken little account of the small bowel, as access by endoscopy is often difficult. With the advent of push endoscopy in 1971, the proximal jejunum could be examined to about 50 cm from the ligament of Treitz. The subsequent introduction of videoendoscopy combined with an overtube enabled us to examine the whole jejunum. The most recent discoveries—capsule endoscopy and double-balloon enteroscopy—have improved our ability to examine the small intestine. Capsule endoscopy has provided us with a new challenge, namely, how to diagnose and treat the lesions found. Hospitals with a small bowel unit in which doubleballoon enteroscopy and push endoscopy are available can provide an effective solution in a large percentage of cases. In hospitals where these techniques are not available, lesions identified in the jejunum must be resolved using non-balloon enteroscopy. Colonoscopy is a well-known alternative, although its rigidity and caliber prevent it from advancing smoothly through the jejunum. An intermediate solution could be found in the pediatric colonoscope, which is smaller in cross-section and more flexible and has a working channel

In this chapter, we describe the different diagnostic therapeutic approaches to lesions of the small bowel. We also examine the application of endoscopy, including the possibilities offered by the pediatric colonoscope in the diagnosis and treatment of lesions found using

The small bowel is the longest part of the digestive tract; however, it is the least examined using radiological techniques. Although simple in structure—it is a tube of regular caliber with fairly constant folds—examination is problematic due to its length and motility, the lower incidence of small bowel disease, frequent overlapping between loops, and the

Originally, the small bowel could only be examined using radiological techniques, some of which were barium-based. These techniques have improved over the years. Below we

**1. Introduction** 

that enables therapy to be administered.

describe the methods used to date.

**2. Radiological examination of the small bowel** 

difficulty in differentiating between a healthy bowel and a diseased one.

capsule endoscopy.

*Hospital General La Mancha-Centro; Alcázar de San Juan* 

Winawer S., Zauber A., Ho M., O'Brien M., Gottlieb L., Sternberg S., Waye J., Schapiro M., Bond J., Panish J., Ackroyd F., Shike M., Kurtz R., Lewis L., Gerdes H., Stewart E., & the National Polyp Study Workgroup. (1993) Prevention of colorectal cancer by colonoscopic polypectomy. *New England Journal of Medicine,* Vol. 329, No. 27, pp. 19771981. ISSN 0028-4793.
