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Colorectal Case 25

Dr. Shiaw-Hooi Ho

Associate Professor of Medicine at the Department of Medicine,

Universiti Malaya, Malaysia

Disclaimer:

NBI™ and TXI™ technologies are not intended to replace histopathological sampling as a means of diagnosis

The positions and statements made herein by Dr. Ho Shiaw Hooi are based on Dr. Ho Shiaw Hooi’s experiences, thoughts and opinions. As with any product, results may vary, and the techniques, instruments, and settings can vary from facility to facility. The content hereof should not be considered as a substitute for carefully reading all applicable labeling, including the Instructions for Use. Please thoroughly review the relevant user manual(s) for instructions, risks, warnings, and cautions. Techniques, instruments, and setting can vary from facility to facility. It is the clinician’s decision and responsibility in each clinical situation to decide which products, modes, medications, applications, and settings to use.

The EVIS X1™ endoscopy system is not designed for cardiac applications. Other combinations of equipment may cause ventricular fibrillation or seriously affect the cardiac function of the patient. Improper use of endoscopes may result in patient injury, infection, bleeding, and/or perforation. Complete indications, contraindications, warnings, and cautions are available in the Instructions for Use (IFU)

1) Data on file with Olympus (DC00489968)

Procedure Information

Scope: PCF-H190DL

Case Findings: Crohn’s Ileo-colitis

Organ: Terminal ileum & colon

Patient information: 25 years old, Female

Medical history: Chronic diarrhea for about 1 ½ years prior to consultation; no background medical illness in the past

1. WLI Observation

Discontinuous deep longitudinal ulcers were seen throughout the colon under WLI observation

2. WLI Observation

Some of these ulcers were deep and exposed the underlying muscularis propria layer

3. WLI Observation

Similar discontinuous ulcerations were seen in terminal ileum as well

4. TXI™ technology Observation

Under TXI observation, the color and surface texture of the terminal ileal ulcer were enhanced.

5. NBI™ technology Observation

Under NBI™ technology examination, the villi in the terminal ileum were clearly displayed.

6. WLI Observation

In other part of the colon, similar aphthous ulcers arranged in longitudinal fashion with normal intervening mucosa (skip lesions) were seen throughout the colon.

7. TXI™ technology Observation

TXI™ technology observation enhanced the color and texture of these aphthous ulcers

8. NBI™ technology Observation

Under NBI™ technology observation, the surrounding normal mucosa displayed the normal honey-comb mesh capillary pattern

9. NBI™ technology Observation

Under NBI™ technology observation, the surrounding normal mucosa displayed the normal honey-comb mesh capillary pattern

10. WLI Observation

Another deep longitudinal ulcer was seen under WLI

11. TXI™ technology Observation

TXI™ technology observation enhanced the color and texture of the deep ulcer¹. The underlying circular muscle could be clearly seen at the ulcer base.

12. NBI™ technology Observation

NBI™ technology observation revealed the absence of the normal colonic mucosal pattern over the ulcer base.

Case Video

Overall Comment

This young female patient presented with chronic diarrhea for 1 ½ years prior to her consultation in this hospital. The endoscopic findings were classical of typical Crohn’s ileo-colitis: deep longitudinal ulcer with skip lesions and cobblestone appearance. She was started on steroid, azathioprine and was planned for biologic therapy.

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

Case 19: LST-NG-PD (Pseudo-depressed type), pT1a colonic cancer
Dr. Ho Dang Quy Dung

Keyword

EVIS X1

Content Type

Imaging Atlas