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Colorectal Case 26

Dr. Shiaw-Hooi Ho

Associate Professor of Medicine at the Department of Medicine, 

Universiti Malaya, Malaysia

 

Procedure Information

Scope: PCF-H190DL

Case Findings: Large 40mm splenic flexure NG-LST (histology: tubular adenoma with high grade dysplasia)

Organ: colon

Patient information: 86 years old, Male

Medical history: Known dyslipidemia; complained of dyspepsia but was found to have positive fecal occult blood test

1. WLI Observation
This large 40mm NG-LST (flat elevated type) was noted at splenic flexure. Part of the border of the lesion that was closer to the fold appeared inconspicuous under WLI.

2. TXI Observation
TXI mode enhanced the surface and color of the lesion and helped in delineating the border.

3. NBI Observation
Observation under standard NBI mode also provided further aid in border delineation.

4. NBI Observation
Observed under closed-up NBI mode revealed JNET Type 2A vessel on the upper part of the lesion

5. NBI Observation
NBI mode with closed-up view was able to enhance the visualization of the lower border of the lesion and at the same time reveal the underlying JNET Type 2B vessel.

6. NBI Observation
Same as picture 5

7. NBI Observation
Same as picture 5

8. NBI Observation
Same as picture 5

9. Indigocarmine Chromoendoscopy

Conventional chromoendoscopy (dye-based image enhanced endoscopy) using 0.4% undiluted indigocarmine further aided in the border delineation of this lesion especially the inconspicuous lower border

Case Video

Overall Comment

The lesion was a flat elevated non-granular lateral spreading tumor measuring about 40mm at around the splenic flexure. Part of the lesion had indistinct border. Despite the inability to perform near focus examination due to the use of pediatric colonoscope, closed-up view under NBI was able to provide certain magnification of this lesion and it helped in border delineation and recognition of the superficial vessel type under JNET classification. Conventional chromoendoscopy using indigocarmine dye further aided the border delineation. This lesion will be subjected for endoscopic submucosal dissection.

* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer

Case 25: Crohn’s Ileo-colitis
Dr. Shiaw-Hooi Ho Case 27: Intramucosal Carcinoma (High-grade Dysplasia)
Prof. Yoji Takeuchi
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