Portal Cavernoma Mimicking Pancreatic Malignancy.

Portal cavernoma colangiopathy (PCC) is an uncommon cause of portal hypertension, and it is an important differential diagnosis of pancreatic malignancy given the expanded network of collateral vessels. On imaging studies, portal cavernoma can be seen as a hypoechoic mass, possibly associated with distal common bile duct obstruction. Most cases occur in non-cirrhotic patients. During the symptomatic phase, these patients carry a high-risk of complications related to sustained biliary obstruction. We report a unique patient with obstructive jaundice and a presumed pancreatic mass that proved to be a portal cavernoma complicated by PCC in the setting of nodular regenerative hyperplasia of the liver.

Advances in colonoscopy.

There is intense interest in optimizing currently available colonoscopy techniques and developing new methods to improve early detection and prevention of colorectal cancer. These improvements apply to many aspects of colonoscopy, including screening effectiveness, reduced pain and complications, in vivo lesion classification, and easier insertion methods. Inherent characteristics of colonoscopy such as blind spots, residual stool, colonic contractions, and the subtle nature of some polyps present challenges to colonoscopic effectiveness. With the advent of several promising techniques, these issues are being addressed. Wide-angle colonoscopes, retroflexion, and water immersion technique are methods that have been developed. Concurrently, there is a need to reduce complications and improve patient acceptance and comfort. The education of endoscopists has appropriately focused on awareness of potential complications, with recent advances in the ability to manage complications such as bleeding and perforation. Despite its effectiveness, there are key opportunities to further improve colonoscopy including reducing the cost, improving the quality and tolerance of bowel preparation, and upgrading variance in detection and removal of polyps.

Imaged-enhanced technologies for colorectal polyp detection and classification.

An early diagnosis of colorectal polyp can be achieved through screening and surveillance programs. In the past few years, advances in endoscopic imaging of the colorectal mucosa have been extensively developed, leading to an increased detection of pre-malignant lesions as well as low-grade and nonneoplastic polyps. In order to reduce the overall cost of care with minimal impact on the quality of care in colorectal cancer prevention, the "diagnosis and discard" strategy has been considered. High-definition, narrow band imaging and confocal endomicroscopy are image enhancement technologies that have been widely studied lately. The studies from Pasha et al. and Kuiper et al. demonstrate the limitations of these new advanced imaging technologies and that further studies should continue to be developed.

Confocal endomicroscopy of colorectal polyps.

Confocal laser endomicroscopy (CLE) is one of several novel methods that provide real-time, high-resolution imaging at a micron scale via endoscopes. CLE has the potential to be a disruptive technology in that it can change the current algorithms that depend on biopsy to perform surveillance of high-risk conditions. Furthermore, it allows on-table decision making that has the potential to guide therapy in real time and reduce the need for repeated procedures. CLE and related technologies are often termed "virtual biopsy" as they simulate the images seen in traditional histology. However, the imaging of living tissue allows more than just pragmatic convenience; it also allows imaging of living tissue such as active capillary circulation, cellular death, and vascular and endothelial translocation, thus extending beyond what is capable in traditional biopsy. Immediate potential applications of CLE are to guide biopsy sampling in Barrett's esophagus and inflammatory bowel disease surveillance, evaluation of colorectal polyps, and intraductal imaging of the pancreas and bile duct. Data on these applications is rapidly emerging, and more is needed to clearly demonstrate the optimal applications of CLE. In this paper, we will focus on the role of CLE as applied to colorectal polyps detected during colonoscopy.