Endoscopy Division

Introduction

The Endoscopy Division deals with 3 fields: the gastrointestinal (GI) tract, the respiratory system, and the head and neck region. A total of 14,260 examinations were performed in 2006, including 12,891 GI endoscopies, 562 bronchoscopies, and 807 head and neck endoscopies. Since 1997, a digital filing system has been introduced for filing endoscopic images. Digital images offer the advantages of high quality and resolution and the possibility of long-term preservation using the EVIS 260 system. In addition, new high-resolution (>100 million pixels) endoscopy with narrow band imaging (NBI) using the LUCERA system (Olympus Optical Co. Ltd.) has been included into routine examination since 2003. Recently, there has been a remarkable increase in the number of endoscopic treatments, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), percutaneous endoscopic gastrostomy (PEG), and photodynamic therapy (PDT).

Routine Activities

Routine examinations, including NBI and endoscopic ultrasound (EUS), are presently being used for head and neck, esophageal, gastric, and colorectal cancers, and this system has become essential in detecting very early cancers involving these regions. Using the NBI system, differentiation of diagnosis of neoplastic and non-neoplastic tissue can be performed without using a dye. With regard to colorectal lesions, a magnifying NBI colonoscope is routinely used, and endoscopic day surgery such as polypectomy and EMR are presently performed in approximately one-third of the cases. In addition to routine examinations, follow-up examinations after endoscopic treatment and chemotherapy are also performed in many cases. Some prospective clinical trials, such as a follow-up study for m3 esophageal cancers, a follow-up study for sm esophageal cancers after EMR plus chemoradiotherapy (JCOG0508), and the Japan Polyp Study (JPS) for colorectal polyps, are currently in progress.
With the recent progress in the development of instruments and techniques, the number of endoscopic treatments has been increasing. EMR is indicated routinely for early GI tract cancers, and the ESD technique is primarily used for gastric cancers. A prospective study (JCOG0607) is evaluating the use of this technique to achieve en bloc resection of larger lesions (>2 cm in diameter). Recently, ESD has also been indicated for treating other larger GI cancers. EMR and PDT are sometimes indicated for salvage treatment of local residual/recurrent tumors after chemoradiotherapy for esophageal cancer. With regard to PDT, a phase II clinical trial is being performed in patients with local recurrence after chemoradiotherapy. PEG and endoscopic balloon dilatation are valuable supporting techniques during the treatmen t of patients with cancers of the head and neck and esophageal cancers.

● K. Kaneko, A. Ohtsu ●

Number of Patients Examined during 2005-2007
Section 2005 2006 2007
Upper gastrointestinal endoscopy 6,509 6,834 5,521
Endoscopic ultrasonography 260 231 174
Endoscopic mucosal resection (esophagus) 162 161 137
Endoscopic mucosal resection (stomach) 148 195 217
Endoscopic balloon dilatation 1,009 1,233 1,305
Percutaneous endoscopic gastrostomy 95 128 104
Photodynamic therapy (esophagus) 32 94 42
Colonoscopy 2,222 1,969 2,065
Polypectomy/EMR 824 533 633
ERCP 30 13 20
Bronchoscopy 595 560 476
Photodynamic therapy (lung, bronchus) 6 2 1
Laryngoscopy 427 490 498
Narrow Band Imaging (head and neck) 295 284 259
Endoscopic mucosal resection (head and neck) 12 33 42
ERCP: Endoscopic retrograde cholangio-pancreatography

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