New Devices for Endoscopic Treatments in Gastroenterology: A Narrative Review

: Endoscopy is in a period of continuous innovations in terms of image quality, endoscopes, post-processing software and lastly, application of Artificial Intelligence. Therapeutic boundaries have expanded, widening the grey zone between endoscopy and surgery, and increasing endoscopic approaches in clinical scenarios where, until a few years ago, surgery was the only option. New scopes and accessories have made it easier to access critical areas such as the biliary tree and the small bowel intestine. In the field of hepato-pancreato-biliary endoscopy (HPB), it is now possible to directly access the biliary ducts or cystic lesions though dedicated stents and scopes, rather than having to rely only on fluoroscopy and ultrasound, increasing the diagnostic and therapeutic options by applying a three-dimensional approach. This narrative review will give an overview of some of the most relevant emerging fields in luminal and HPB endoscopy, highlighting advantages and main limitations of the techniques, and providing considerations for future development.

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Shifting perspectives: method, media and the complex image

History and Computing ◽

10.3366/hac.1998.10.1-3.100 ◽

1998 ◽

Vol 10 (1-3) ◽

pp. 100-108 ◽

Cited By ~ 1

Author(s):

Alicia Colson ◽

Ross Parry

Keyword(s):

Image Processing ◽

Three Dimensional ◽

Geographical Location ◽

Spatial Relationship ◽

Two Dimensional ◽

Dimensional Approach ◽

Complex Image ◽

Cultural Resonance

This article argues that the analysis of a threedimensional image demanded a three-dimensional approach. The authors realise that discussions of images and image processing inveterately conceptualise representation as being flat, static, and finite. The authors recognise the need for a fresh acuteness to three-dimensionality as a meaningful – although problematic – element of visual sources. Two dramatically different examples are used to expose the shortcomings of an ingrained two-dimensional approach and to facilitate a demonstration of how modern (digital) techniques could sanction new historical/anthropological perspectives on subjects that have become all too familiar. Each example could not be more different in their temporal and geographical location, their cultural resonance, and their historiography. However, in both these visual spectacles meaning is polysemic. It is dependent upon the viewer's spatial relationship to the artifice as well as the spirito-intellectual viewer within the community. The authors postulate that the multi- faceted and multi-layered arrangement of meaning in a complex image could be assessed by working beyond the limitations of the two-dimensional methodological paradigm and by using methods and media that accommodated this type of interconnectivity and representation.

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Percutaneous transhepatic biliary puncture simulator: a cord network prototype

Advances in Simulation ◽

10.1186/s41077-021-00178-w ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Rubén Lopez Benítez ◽

Tomás Reyes del Castillo ◽

David Benz ◽

Carsten Fechner ◽

Lorant Szabo ◽

...

Keyword(s):

Training Session ◽

Lower Lobe ◽

Biliary Tree ◽

Training Model ◽

Polystyrene Foam ◽

Wooden Frame ◽

Biliary Ducts ◽

Hand Coordination ◽

Radiology Residents ◽

Positive Results

Abstract Background The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. Methods An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. Results After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session. Conclusions This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. Trial registration Retrospectively registered

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