New Challenges in Gastrointestinal Endoscopy

Article Outline

• Copyright

Gastrointestinal endoscopy has evolved remarkably over the past 30 years. Although endoscopy was initially pioneered as a diagnostic examination, the development of endoscopic therapeutics quickly followed. Subsequently, there have been numerous equipment and procedural advancements which can be aggregated into 3 general categories: improvements in imaging (including capsule endoscopy), further development of therapeutics, and the addition of endoscopic ultrasound (EUS). The aim of this 561-page, hard cover book is to review the current “leading edges” of gastrointestinal endoscopy. It is a collection of 56 short chapters organized by organ systems, ending with 7 chapters devoted to EUS. Each chapter begins with a brief summary. There are 5 chapters written by Olympus Medical Corp engineers and 7 chapters written by international authors; the remaining 44 chapters are written by Japanese endoscopists. Indeed, the book reads like a “who's who” in Japanese endoscopy.

The greatest value of this text is the beautiful endoscopic and ultrasound pictures. The numerous, high-quality images are highly effective in illustrating the authors' points. The pictures also make the somewhat stilted and repetitive read much more enjoyable. Another high point is the careful, step-by-step descriptions of some endoscopic techniques, such as how to use acetic acid for image enhancement and how to perform endoscopic submucosal dissection (ESD). We are also given a fascinating view into future technologies, many of which are not yet available in the United States or Europe.

My criticisms of the book include the lack of uniformity between chapters and the frequent “this is my opinion” style of the text, without much background on the topic's literature. Many of the Japanese expert endoscopists simply report their own data and experience; even though it is often pioneering work in an area, more inclusion of the international literature on these topics would have been desirable. In some chapters, the overuse of unfamiliar acronyms makes the reading more difficult. A few examples of this are ISIV (intrastructural irregular vessel), FMS (fine mucosal structure), and RMVP (regular microvascular pattern). Repetition is common in this book and is particularly notable for the technical description of narrow band imaging (NBI) and how it has “dramatically improved” endoscopic imaging. Because so many of the authors extol its value and therefore feel compelled to describe it, a single chapter explaining the technology behind NBI would have been appreciated. Also notable is the failure to mention that NBI as an image enhancement tool, although popular worldwide, has not been shown in controlled trials to be clearly superior to careful inspection using high-definition white light. There are several other examples of poorly supported opinions such as “peri-ampullary diverticula increase the risk of perforation for biliary sphincterotomy” and “covered metal stents are better due to longer patency.” In contrast, some of the chapters are up-to-date reviews of emerging endoscopic techniques with thoughtful and measured conclusions. Examples of this are the chapters on papillary balloon dilation after biliary sphincterotomy for large bile duct stone extraction and ESD/endoscopic submucosal resection (EMR) for esophageal cancer.

As stated in the book's preface, this book was planned by the organizing committee of the EFJ, or Endoscopic Forum Japan, which has met annually since 1999. There is no mention of whether Olympus Medical financially supported the book's publication, although one presumes that to be the case. Indeed, many chapters continually refer to Olympus devices and endoscopes, whereas equipment from other manufacturers is almost completely ignored. This Japanese and Olympus “centricity” of the text detracts somewhat from the book and undermines the fact that Japanese endoscopists and Olympus Medical Corporation frequently have been the physician and industry pioneers in endoscopy. The book would have been more balanced to mention the few situations where they have not dominated the field.

Compared with other books on gastrointestinal endoscopy, this “New Challenges” text reads more like a series of review articles on technical advances as seen in a Gastrointestinal Endoscopy Clinics of North America instead of a thorough endoscopy textbook like Clinical Gastrointestinal Endoscopy (Ginsberg, Kochman, Norton, and Gostout, editors). The focus of the book, as stated in the title, is on the newest advances in enhanced imaging such as endocytoscopy and 3-dimensional ultrasonography, and on endoscopic techniques such as ESD and EMR.

Bottom Line: This beautifully illustrated book is recommended to interventional endoscopists who wish to further their understanding of the latest techniques in endoscopic imaging and therapeutics. Although some of the material is repetitive and is written from a “this is what I do” perspective, it discusses the newest endoscopic methods and technology, many of which originate in Japan.