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Colorectal Case 20

Prof. Yasushi Sano

Kansai Medical University, Osaka, Japan

Sano Hospital, Kobe, Japan

Disclaimer:

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

The positions and statements made herein by Prof. Yasushi Sano are based on Prof. Yasushi Sano’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)
2. Data on file with Olympus as of 07/17/2020
3. Young E, Rajagopalan A, Tee D, et al. Texture and color enhancement imaging improves colonic adenoma detection: A multicenter randomized controlled trial. Gastroenterology. 2024;166(2):338-340.e3.
4. Sano Y, Saito Y, et al. Efficacy of magnifying chromoendoscopy for the differential diagnosis of colorectal lesions. Digestive Endoscopy. April 2005 Pages 105-116.

Procedure Information

Scope: CF-EZ1500 DI

Case Findings: 0-Is (LST-mixed type), 22mm, JNET 2A with fern-like pits

Histology: Tubulovillous adenoma, low-grade dysplasia, including small foci of high-grade dysplasia with traditional serrated adenoma-like appearance.

Organ: Rectum

Patient information: Male, 73 y.o.

Medical history: FIT positive

1. WL

White light observation reveals an area of indistinct vascular penetration with an elevation in the center of the image

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

2. WL close view

The close-up image shows disappearance of vascular transillumination and areas of small nodules.

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

3. TXI™ technology close view

The TXI™ technology mode 2 provides enhanced contrast and clearly highlights the extent of the lesion.¹

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

4. NBI™ technology close view

EDOF colonoscope may help endoscopists to obtain details of the whole lesion quickly. The NBI™ technology function delineates the extent of the lesion in brown.²

Enhancement : A8
NBI Mode : On (mode 3)
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

5. NBI™ technology with electronic zoom

Tubular or branchial structures and regular brown blood vessels are observed (JNET 2A).

Enhancement : A8
NBI Mode : On (mode 3)
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

6. NBI™ technology with electronic zoom

In the elevated portion of the lesion, vessels with corkscrew-like changes are observed around slightly thicker vessels (cicada wing-like findings). In addition, the structure is indistinct, and the surface is smooth. These are the endoscopic findings of traditional serrated adenoma.

Enhancement : A8
NBI Mode : On (mode 3)
TXI Mode : NA
RDI Mode : NA
BAI-MAC : On

7. Chromoendoscopy

Chromoendoscopy can support Paris classification of 0-Is (LST-mixed type), 20 mm in size.

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

8. Chromoendoscopy with electronic zoom

This area shows a type IV finding of the Kudo’s pit pattern.

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

9. Chromoendoscopy with electronic zoom

This is a type IV villous finding of the Kudo’s pit pattern. This is a type 4 villous finding of the Kudo pit pattern. The surface is smooth and the glandular pit morphology is indistinct.

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

10.Chromoendoscopy with electronic zoom

High magnification observation using the digital zoom function (x1.4) reveals numerous small pit openings on the surface.

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

11. Cutting line for histology

ESD was performed in this case. Sections were made on lines A and B.

12. Histology (low power)

The pathological diagnosis was tubulovillous adenoma, low-grade dysplasia, including small foci of high-grade dysplasia.

13. Histology (high power)

The pathological diagnosis of the area of cicada wing-like findings in the elevated area showed traditional serrated adenoma-like appearance.

Case Videos

Video 1: Observation by WL, TXI™, NBI™ technologies

Video 2: Observation by chromoendoscopy with Indigo carmine

Overall Comment

EVIS X1™ technology with CF-EZ1500 DI colonoscope provides a high-quality image. TXI™ technology will enhance the identification of lesions during examination.³ Once a lesion has been identified, the clear focused image contributes a detailed examination of morphology of the lesion. The excellent image quality extends to NBI™ technology mode, and together with electronic zoom function, accurate characterization of the lesion can be made.²

In this case, the parts of tubulovillous adenoma and traditional serrated adenoma (cicada wing-like findings) are mixed, and the differences in endoscopic findings can be well educated ^4.

* 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 Case 21: 0-IIa (LST-non-granular type), 25mm, JNET 2A+2B
Prof. Yasushi Sano

Keyword

EVIS X1

Content Type

Imaging Atlas