2015-06-10 17:40:49 UTC

AGA Panel Explored Promise, Pitfalls of Advanced Endoluminal Imaging

June 10, 2015

Dr. David A. Lieberman and others addressed new advances in treating the colon and neoplasia during Digestive Disease Week® (DDW) 2015.

This post originally appeared in DDW® Daily News

Advanced endoluminal imaging technologies such as high-definition white light and chromoendoscopy allow practitioners to look at a polyp more intelligently to help differentiate between hyperplastic polyps and adenomas.

David A. Lieberman, MD, chief of gastroenterology and hepatology at Oregon Health and Science University, Portland, also said advanced imaging allows for better examination of polyps of 5 millimeters or smaller. He spoke during an AGA symposium on May 19 during Digestive Disease Week® (DDW) 2015 that focused on the promises and challenges ahead related to adopting these new technologies for a variety of GI conditions.

Dr. Lieberman, who addressed new advances in treating the colon and neoplasia, said the key would be getting to the point where highly proficient practitioners can make diagnoses without going through the time and expense of conducting a biopsy.

He said one expert panel recommends that in cases of high-confidence endoluminal imaging, gastroenterologists can resect and discard adenomas of 5 mm or smaller occurring in the rectum or sigmoid colon. In that scenario where the polyp is hyperplastic, the recommendation was to inspect and not resect.

One unresolved issue, he said, is how to train gastroenterologists to meet these proficiency standards and then certify that they have achieved the competency.

Another issue for practices, Dr. Lieberman said, will be getting buy-in from patients after physicians have been preaching to them for years about the dangers of polyps.

“So now you tell a patient, ‘Well, these little polyps, they are not so bad, and we are either going to leave some of them in place, or we are not going to send them to pathology to look at them,’” he said. “That is really a significant change in the approach we have taken with patients.”

Some patients will probably pay extra to have all their polyps biopsied, Dr. Lieberman said.

Prateek Sharma, MD, professor at the University of Kansas Medical Center, Kansas City, KS, said advanced imaging helps in a number of areas concerning Barrett’s esophagus, including characterization and detection of neoplasia prior to endoscopic therapy and detection of residual Barrett’s or dysplasia during or after a procedure.

Dr. Sharma cited one meta-analysis that showed all types of advance imaging yielded a 34-percent improvement in detecting dysplasia or cancer using advanced imaging versus endoscopic therapy. Volumetric laser endomicroscopy looks particularly promising, Dr. Sharma said.

“This is the first technique which allows you to look at the submucosa,” he said. “We are all concerned about buried Barrett’s of the glands after endoscopic therapy, and this allows us to look at those.”

Faten N. Aberra, MD, MSCE, an assistant professor at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, said that chromoendoscopy was a good tool for evaluating and treating IBD, but standard- and high-definition endoscopy still has a role.

The studies demonstrating the benefits of chromoendoscopy have compared it to standard-definition endoscopy. Dr. Aberra argued that more research is needed to test chromoendoscopy versus high-definition endoscopy.

Chromoendoscopy drawbacks include the time — up to an hour — required for a procedure along with questions about reimbursements to cover the time and expense of the procedure. There also can be shortages of the dye.

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