The Endoscopy Division consists of three fields: gastrointestinal (GI) tract, respiratory system, and head and neck endoscopies. In 2008, a total of 10,686 examinations were performed, of which 9,646 were GI endoscopy, 565 bronchoscopy, and 475 head and neck endoscopy. A digital filing system for endoscopic images has been introduced in the Division since 1997. The digital images have advantages of high quality resolution and the possibility of long-term preservation using the EVIS 260 system. In addition, new high vision endoscopy using a narrow band imaging (NBI) system (high resolution of more than 100 million pixels) based on the LUCERA system (Olympus Optical Co., Ltd., Tokyo, Japan) has been introduced for routine examination since 2003. Furthermore, the Division has performed endoscopic treatments such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), percutaneous endoscopic gastrostomy (PEG), and photodynamic therapy (PDT).
Routine examinations including NBI and endoscopic ultrasound are presently used for the detection of head and neck, esophageal, gastric, and colorectal cancers, and the NBI system has become essential in detecting very early stages of these cancers. With the use of the NBI system, differential diagnosis between neoplasia and non-neoplasia can be performed without the need for a dye solution. In the field of colorectal endoscopy, a magnifying NBI colonoscope is routinely used, and endoscopic day surgery procedures such as polypectomy and EMR are currently performed in one-third of all examinations. Follow-up examinations after endoscopic treatment and chemotherapy in addition to routine examinations are also performed in many cases. Some prospective clinical trials, such as a follow-up study for m1-3 esophageal cancers, a follow-up study for sm esophageal cancers after EMR plus chemoradiotherapy (JCOG0508), an evaluation of NBI observation for minute gastric cancers, an evaluation of NBI back-to-back observation for colorectal neoplastic lesions, and Japan Polyp Study (JPS) of colorectal polyps, are presently on-going.
With the recent progress of instruments and techniques, the number of endoscopic treatment has been increasing. EMR is indicated routinely for early GI tract cancers, and ESD is basically used for gastric cancers. This technique is presently being evaluated in a prospective study (JCOG0607) to achieve en-block resection of larger lesions (> 2 cm in diameter). Recently, ESD is also indicated for other larger GI cancers. On the other hand, EMR and PDT are sometimes indicated as salvage treatments for local residual/recurrent tumors after chemoradiotherapy of esophageal cancer. As for PDT, a phase II clinical trial is performed in patients with local recurrence after chemoradiotherapy. PEG and endoscopic balloon dilatation are valuable supporting techniques during the treatments of patients with head and neck, and esophageal cancers.
| Number of patients examined (2006-2008) | |||
| Section | 2,006 | 2,007 | 2,008 |
| Upper gastrointestinal endoscopy | 6,834 | 5,521 | 5,154 |
| Endoscopic ultrasonography | 231 | 174 | 110 |
| Endoscopic mucosal resection (esophagus) | 161 | 137 | 111 |
| Endoscopic mucosal resection (stomach) | 195 | 217 | 196 |
| Endoscopic balloon dilation | 1,233 | 1,305 | 1,073 |
| Percutaneous endoscopic gastrostomy | 128 | 104 | 146 |
| Photodynamic therapy (esophagus) | 94 | 42 | 36 |
| Colonoscopy | 1,969 | 2,065 | 2,071 |
| Polypectomy/EMR | 533 | 633 | 731 |
| ERCP | 13 | 20 | 18 |
| Bronchoscopy | 560 | 476 | 563 |
| Photodynamic therapy (lung, bronchus) | 2 | 1 | 2 |
| Laryngoscopy | 490 | 498 | 251 |
| Narrow Band Imaging (head and neck) | 284 | 259 | 193 |
| Endoscopic mucosal resection (head and neck) | 33 | 42 | 31 |
| ERCP: Endoscopic retrograde cholangio-pancreatography | |||
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