Virtual reality in Gastroentereologia and Hepatology
Written by:It has been commented that endoscopy (fiber optic) and ultrasound (ultrasound) are "the right and left hand of the gastroenterologist", but today we are able to state that just as the biopsy forceps is the third arm of the endoscopist, the Endoscopic ultrasound (endoscopic ultrasonography) that unites both techniques is the third eye of the gastroenterologist. "
Ultrasounds are sound and inaudible vibrations of a frequency higher than 16,000 cycles per second (16 KHz) up to several MHz.
At first, ultrasound was used to perform "liver histograms", transitional elastography, until reaching Fibroscan, which by means of its waves measures the hardness of the liver that correlates with fibrosis and hepatic steatosis.. Non-invasively using a score obtained by sound waves, the hepatic elasticity in Kpa is measured to arrive at a plausible diagnosis of fibrosis or liver cirrhosis.. This is the "virtual liver biopsy". Its only limitations are pregnant or sick patients with implantable medical devices.
Sonoelastography applied to the liver and pancreas, using ultrasound or echoendoscopy, have tried to improve the diagnosis and avoid histological analysis by means of biopsies (Virtual Biopsy versus FNA).. It is also a non-invasive technique that can differentiate between inflammation, fibrosis and cancer, using a scale of different colors (qualitative) or a scale from 1 to 255 (quantitative) that becomes a score (strain ratio).
By means of endoscopy Minisons have been used to improve the diagnosis, but these have nothing to do with the Confoca Minison that is also introduced through the working channel of the endoscope and is connected to a laser-based processor.. The more than 30,000 individual optical fibers give it a resolution 500 to 1000 times greater than the conventional endoscope, in an attempt to analyze the internal microstructure of the tissues of the digestive system (virtual histology). It is indicated in neoplasms of the digestive tract, gastritis, celiac disease, colitis, etc.
You can also introduce this miniprobe by laparoscopy on the surface of the liver, or by endoscopic ultrasound in the pancreas.
Virtual reality is a science based on computers and other devices whose purpose is to produce an appearance of reality. But is it possible to reach the total reality?
The FibroScan, the Sonoelastography, and the Confocal MiniSonde, non-invasive techniques of the digestive system , try to make a histological diagnosis in selected areas of the digestive tract , liver or pancreas, try to perform a virtual biopsy or the differentiation between benignity and malignancy so important in the diagnosis and medical treatment.
Much research is still needed to correlate these techniques with classical biopsies. In some cases, such as fibrosis, inflammation, gastritis, colitis, celiac disease, etc., the approximation to total reality will not be so important; but in cases where it is a question of differentiating between benignity and malignancy, we should be sure that the Virtual Reality correlates exactly with the real Reality.
