Evis exera 2

Fluoroscopy was available for all procedures. FB was performed by four trained pulmonary physicians who were blinded to the echocardiographic findings. Oxygen was administered to all the patients to ensure peripheral capillary oxygen saturation (SpO₂) >90% prior to introduction of the bronchoscope. Continuous pulse oximetry, electrocardiogram, and noninvasive blood pressure monitoring were obtained throughout the procedure. Sedation was achieved using midazolam and analgesic treatment included alfentanil 50–100 μg. Topical anesthesia was obtained using 2% lidocaine. All hemodynamic parameters including blood pressure, heart rate, and O₂ saturation were monitored during and after the procedure, until the patient awoke and stabilized.
Bronchoscopy was performed with white light illumination in all patients and narrow band imaging in 47 patients (Olympus EVIS EXERA II, Olympus, Hamburg Germany). Interventions conducted during FB included bronchoalveolar lavage (BAL) for cytology and cultures in all cases, as well as endobronchial brushings, TBB, endobronchial biopsies, and transbronchial needle aspiration, as indicated.

Endoscopy was performed after standard bowel preparation, optionally under conscious sedation with midazolam and fentanyl. All procedures were performed with a routine clinical HD video endoscope, which is standard of care during surveillance endoscopies (CF-H180AL/I or GIF-H180J; EVIS EXERA II; Olympus Corporation, Tokyo, Japan). White light was provided by a standard xenon light source (CLV-180 EVIS EXERA II; Olympus Corporation), in which a short pass filter was installed (<750 nm, E700SP-2P; Chroma, Bellows Falls, VT, USA). When the caecum or ileorectal anastomosis was reached, the NIR-FME probe was introduced in the working channel of the video endoscope (online Figure S1A) 13 (link). During withdrawal, adenomas were concurrently visualized with both the video endoscope and the NIR-FME probe. The NIR-FME images (color, fluorescence and overlay) were displayed on a separate monitor (Figure 2). Subsequently, all large adenomas (≥5 mm; standard clinical care) and a maximum of six small adenomas (<3 mm) were excised. Additionally, four biopsies of normal appearing colorectal mucosa were taken for research purposes only. See supplementary materials for detailed information on tracer production and the technical background of the NIR-FME system.

The simulated set-up included an endoscopy tower with a flexible bronchoscope (EVIS Exera II and Q180 flexible bronchoscope, Olympus, Japan). The phantom was a bronchoscopy model equipped with a three-dimensional bronchial tree (CLA Broncho Boy, CLA, Coburg, Germany). The right lung has ten segments (segments #1–#3 in the upper lobe; #4 and #5 in the middle lobe; #6–#10 in the lower lobe), while the left lung has eight segments (#1–#3 in the upper lobe with #1–#2 fused together to form one segment; #4–#5 in lingula; #6–#10 in the lower lobe without a segment #7).

Bowel preparation was done using a polyethylene glycol-based electrolyte solution (Peglec-Powder, Tablets India Limited). Full colonoscopy was performed using a video colonoscope (Q180AL, 2008483, and OLYMPUS EVIS EXERA II). All colonoscopies were performed by the same endoscopist. Tumor sites were classified as the right colon (cecum, ascending, and transverse colon), left colon (descending and sigmoid colon), and rectum (distal 18 cm). Location and size of polyps were noted before removal [Figure 1]. All lesions were removed and/or biopsied. Histopathological examination was performed by independent pathologists blinded to clinical findings. Polyps were classified as neoplastic (adenomas and adenocarcinomas) or nonneoplastic (i.e., hyperplastic polyps).[23 ] No complications occurred during colonoscopy.

A human-based colon phantom (Kyoto Kaguku, Kyoto, Japan) was placed in standard configuration in a non-magnetic frame in the supine position (
Fig. 2). The phantom was covered with an opaque sheet to prevent participants from visualizing the location of the endoscope within the phantom. A pediatric colonoscope (Olympus PCF-H180AL, Tokyo, Japan) with an Olympus Evis Exera II light source (CLV-180) and video processor (CV-180) (Tokyo, Japan) was used as the conventional colonoscope. The video feed from the MFE and pediatric colonoscope (PCF) were connected to the same external monitor located above the phantom to display the appropriate single feed when in use (
Fig. 3).