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Colorectal Case 22

Prof. Yasushi Sano

Kansai Medical University, Osaka, Japan

Sano Hospital, Kobe, Japan

Disclaimer:

NBI™ technology is not intended to replace histopathological sampling as a means of diagnosis

The positions and statements made herein by Prof. Sano are based on Prof. 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).

Procedure Information

Scope: CF-EZ1500 DI

Case Findings: 0-Is (submucosal invasive carcinoma), 11mm, JNET 2B

Histology: Well to moderately differentiated tubular adenocarcinoma, pT1b (SM2, 3600 µm invasion), ly0, v0, pHM0, pVM0. After ESD, no recurrence was found at 3-year follow-up.

Organ: Rectum

Patient information: Female, 81 y.o.

Medical history: Melena

1. WL

WL observation shows a protruding, reddened lesion. At first glance, the surface appears smooth. Chicken skin spots are seen around the lesion.

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

2. WL

Red dilated blood vessels are observed on the surface.

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

3. NBI™ technology

On NBI™ technology observation, the tumor is recognized as a tumor presenting an irregular surface.

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

4. NBI™ technology in near mode

NBI™ technology close observation revealed irregular surface structures and irregular vascular patterns.

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

5. NBI™ technology with near mode and electronic zoom

Irregular vessels of uneven caliber and irregular surface structures are seen (JNET 2B).

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

6. Chromoendoscopy

The surface shows irregular pit patten (Kudo‘s Vi pit).

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

7. ESD procedure

The patient preferred endoscopic treatment as she was elderly (81 years) and the lesion was located in the rectum. Therefore, ESD was performed.

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

8. En bloc resection

En bloc resection was completed.

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

9. Histology (low power)

Histopathology was negative for margins, and a diagnosis of complete local resection was made.

10. Histology (high power)

The pathological diagnosis was well to moderately differentiated tubular adenocarcinoma, pT1b (SM2, 3600 µm invasion), ly0, v0, pHM0, pVM0.

Case Video

Video 1: Observation by WL, NBI™ technology

Video 2: Observation by chromoendoscopy with Indigo carmine

Overall Comment

This case was an early-stage cancer (SM cancer) of type 0-Is. At first glance, it appeared to be an intramucosal carcinoma on WL, but it presented JNET 2B on NBI™ technology. In Japan, dye endoscopic observation is recommended for JNET 2B lesions^a. ESD was performed at the patient’s desire and three years have passed without evidence of recurrence.

a. Iwatate M, Sano Y, et al. Validation study for development of the Japan NBI Expert Team classification of colorectal lesions. Dig Endosc. 2018 Sep;30(5):642-651.

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

Case 21: 0-IIa (LST-non-granular type), 25mm, JNET 2A+2B
Prof. Yasushi Sano Case 23: Large non-polypoid rectal tumor
Prof. Han-Mo Chiu

Keyword

EVIS X1

Content Type

Imaging Atlas