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Colorectal Case 28

Mr. Peter Borch-Johnsen

RN, M.Sci, PhD- Student

Department of Medicine

Ersta Hospital

Department of Medical Sciences

Uppsala University

 

Procedure Information

Scope: CF-XZ1200

Case Findings: Multifocal Anal Squamous Intraepithelial Lesions (ASIL) with low and high-grade dysplasia

Organ: Anal canal

Patient information: Male, MSM+HIV

Medical history: Good CD4 count

1a. ASIL WLI
ASIL ( Anal Squamous Intraepithelial Lesion) seen with WLI. ​

1b. ASIL TXI mode 1
Villous ASIL with slightly irregular, dilated and elongated microvessels (so called IPCL). The vascular structure is enhanced in TXI mode 1.

1c. ASIL TXI mode 2
TXI mode 2 also enhances the vascular network but less than TXI mode 1.​

1d. ASIL NBI
With NBI, the vascular structure is seen more clearly. The slightly irregular, dilated and elongated microvessels can now be carefully observed and assessed.

1e. ASIL RDI mode 3
With RDI mode 3 displace the vascular network clearly. Even the small deeper vessels appeared to be clearer, probably due an increased depth of field.​

2a. TXI mode 1 ASIL

An ASIL with a prickly appearance with irregular and dilated IPCL as seen with TXI mode 1​.

2b. NBI ASIL

With NBI the irregular, dilated and microvessels can now be carefully observed and assessed.

2c. RDI mode 3 ASIL

With RDI mode 3 we can see the vascular structure clearly and also the small deeper vessels seems bit clearer.

Case Video

This is a case with multi-focal anal squamous intraepithelial lesion (ASIL) in a high-risk patient for anal cancer (MSM (Men who have sex with men) and HIV+). Referral for colonoscopy due to irregular stools and blood per rectum. Colonoscopy and endoscopic high resolution anoscopy were performed with a zoom colonoscope - CF-XZ1200. A distal attachment was secured leaving approximately 2 mm of free cap at the tip to maintain a suitable distance between the instrument and the mucosa. Co2 is turned off and the anal canal filled with water. TXI mode 1 increases the vascular structure compared with WLI. We usually initiate the examination with TXI mode 1 because it highlights the morphology, vascular structure and colour of the mucosa. NBI and RDI mode 3 are intermittent used and seem to further increase the contrast and resolution making the vessel network even more conspicuous.​

Overall Comment

Several studies are ongoing regarding endoscopic detection (optical diagnosis), resection and screening for ASIL in high-risk individuals. The endoscopic method description for detection and resection has previously published.​

* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer
* The product used in this case is sold for limited area. This page is provided as information.

Case 27: Multifocal Anal Squamous Intraepithelial Lesions (ASIL) with low and high-grade dysplasia
Mr. Peter Borch-Johnsen Cases 32: High quality and high magnification imaging provided by the CF-XZ1200 will advance quality of colonoscopic diagnosis during both screening and detailed examination
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