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The techniques and clinical opinions presented in this material reflect the personal experience and professional judgment of the healthcare professional and do not necessarily represent the views of Olympus. This material is intended for healthcare professionals only. Users should always refer to the applicable Instructions for Use (IFU) and use Olympus products in accordance with the approved indications and local regulatory requirements. The healthcare professional presenting this material has been engaged by Olympus and compensated at fair market value for their services.

Colorectal Case 23

Prof. Yunho Jung

Department of Internal Medicine, Division of Gastroenterology,

Soonchunhyang University College of Medicine,

Cheonan, Republic of Korea

Procedure information

Scope: CF-EZ1500DI

Case: A 30-mm non-granular laterally spreading tumor (LST-NG-FE) located at the hepatic flexure.

Organ: Colon

Patient Information: M, 80s

Medical History: No significant medical history

1. LST-NG in WLI

A 30-mm non-granular laterally spreading tumor (LST-NG-FE) located at the hepatic flexure is observed as a flat elevated lesion on white light imaging.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

2. LST-NG with TXI (Mode 1)

TXI mode 1 enhances the lesion by combining texture, brightness, and color tone enhancement, improving visualization of surface structure and lesion margins compared with white light imaging.

Enhancement : A8
NBI Mode : NA
TXI Mode : Mode1
RDI Mode : NA
BAI-MAC : On

3. LST-NG with TXI (Mode 2)

TXI mode 2 enhances texture and brightness while preserving natural color tone, allowing clearer delineation of the lesion margin and overall extent.

Enhancement : A8
NBI Mode : NA
TXI Mode : Mode2
RDI Mode : NA
BAI-MAC : On

4. LST-NG in WLI

A 30-mm non-granular laterally spreading tumor (LST-NG-FE) located at the hepatic flexure is observed as a flat elevated lesion on white light imaging.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

5. LST-NG with TXI (Mode 1)

TXI mode 1 enhances the lesion by combining texture, brightness, and color tone enhancement, improving visualization of surface structure and lesion margins compared with white light imaging.

Enhancement : A8
NBI Mode : NA
TXI Mode : Mode1
RDI Mode : NA
BAI-MAC : On

6. LST-NG with TXI (Mode 2)

TXI mode 2 enhances texture and brightness while preserving natural color tone, allowing clearer delineation of the lesion margin and overall extent.

Enhancement : A8
NBI Mode : NA
TXI Mode : Mode2
RDI Mode : NA
BAI-MAC : On

7. LST-NG in NBI

On NBI, the lesion shows suspected focal irregularity of the surface and vascular patterns, suggesting a JNET type IIb pattern.

Enhancement : A8
NBI Mode : On
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

8. NBI with magnification (Near focus)

Magnified NBI with near-focus observation more clearly demonstrates focal irregular surface and vascular patterns, consistent with a JNET type IIb pattern.

Enhancement : A8
NBI Mode : On (Near focus)
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

9. Bleeding in WLI

During ESD, active bleeding is observed on white light imaging.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : Off
BAI-MAC : On

10. Bleeding in RDI Mode 1

After activation of RDI mode 1, the bleeding point is more clearly visualized during ESD, facilitating prompt identification of the bleeding source compared with white light imaging.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : Mode 1
BAI-MAC : On

11. Hemostasis in RDI Mode 1

After activation of RDI mode 1, contact coagulation was performed using a DualKnife J™ tip at the identified bleeding focus.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : Mode 1
BAI-MAC : On

12. Hemostasis confirmed in WLI

White light imaging confirms successful hemostasis. The orange arrow indicates a coagulated clot formed after contact coagulation.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : Off
BAI-MAC : On

13. Submucosal layer visualization with RDI Mode 1

In RDI mode 1, indigo carmine enhances visualization of the submucosal layer during ESD, allowing clearer identification of the cutting line and facilitating controlled dissection.

Enhancement : A8
NBI Mode : NA
TXI Mode : NA
RDI Mode : Mode 1
BAI-MAC : On

Case Video

This video demonstrates stepwise lesion evaluation using EVIS X1 imaging modalities. TXI is used to improve visualization of lesion margins and overall extent, followed by NBI and magnified NBI with near-focus observation to assess surface and vascular patterns.

This video shows the use of RDI mode 1 during ESD. After activation of RDI mode 1, the bleeding focus is clearly visualized, allowing contact coagulation using a DualKnife J™. In addition, RDI mode 1 combined with indigo carmine enhances visualization of the submucosal layer, facilitating identification of the cutting line during dissection.

Overall Comment

This case demonstrates the clinical utility of the EVIS X1 system using a CF-EZ1500DI colonoscope for the evaluation and treatment of a large laterally spreading tumor.
TXI improved delineation of the lesion margins and overall extent, while magnified NBI enabled detailed assessment of surface and vascular patterns, suggesting a JNET type IIb pattern.
During ESD, RDI mode 1 enhanced visualization of bleeding points and supported appropriate hemostatic management.
In addition, RDI mode 1 combined with indigo carmine improved visualization of the submucosal layer, allowing clearer identification of the cutting line and more controlled dissection.

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

Case 22: Multiple lesions in ascending colon
Prof. Dr. Hu Xiao

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