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Colorectal Case 33

Prof. Dr. Fatih Aslan

Koc University Hospital

Istanbul, Turkey

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. Dr. Fatih Aslan are based on Prof. Dr. Fatih Aslan’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)​.

 

NBI™ and TXI™ technologies are 510(k) cleared in the United States. This case study is being furnished to provide examples of NBI™ and TXI™ technology use. The CF-XZ1200 used in this case is not available in the US market at this time, nor is there an established time for its release. The safety and effectiveness of this product and/or the use of these products has not yet been established in the United States market

Procedure information

Scope: CF-XZ1200​​

Case: LST-GM, invasive cancer​​

Organ: Rectum​

1. WLI​
Endoscopic view of the lesion in WLI mode​.

#WLI #A8 structure enhancement #Auto Iris​

2. WLI + close view
Close view of the lesion in WLI mode, revealing an irregular vascular pattern in this area​.

#WLI #A8 structure enhancement #optic magnification​

3. NBI™ Technology + close view
Closer view of the lesion in NBI™ technology mode, showing a clearly defined and detailed irregular surface pattern in the malignant area.

#NBI #A8 structure enhancement #optic magnification​

4. NBI™ Technology + optic zoom
NBI™ technology view of the lesion under optical zoom, demonstrating the surface and vascular patterns in the premalignant area.​

#NBI #A8 structure enhancement #optic magnification​

5. WLI​
In WLI mode under water immersion, irregular reddish areas of the lesion are clearly visualized.​

#WLI #A8 structure enhancement #Auto Iris​

6. TXI​™ Technology
Under water immersion in TXI™ technology mode 1, the irregular reddish areas of the lesion are visualized with greater clarity and detail.

#TXI #A8 structure enhancement #Auto Iris​

7. NBI​™ Technology
In NBI™ technology mode with water immersion and optical magnification, irregular vascular and surface patterns are clearly visualized. Premalignant regions appear on the left, whereas malignant regions are identifiable on the right side of the image​.

#NBI #A8 structure enhancement #optic magnification​

8. TXI​™ Technology
In TXI™ technology mode 1 with water immersion and optical magnification, irregular vascular and surface patterns are clearly visualized. Premalignant regions appear on the left, whereas malignant regions are identifiable on the right side of the image.

#TXI #A8 structure enhancement #optic magnification​

9. NBI™ Technology
In NBI™ technology mode with water immersion and optical magnification, irregular vascular and surface patterns are clearly visualized. Premalignant regions appear on the left, whereas malignant regions are identifiable on the right side of the image​.

#NBI #A8 structure enhancement #optic magnification​

10. TXI™ Technology
Irregular areas of the lesion can be assessed more clearly using TXI™ technology mode 1 with water immersion and optical magnification.

#TXI #A8 structure enhancement #optic magnification

11. NBI™ Technology
Evaluation of the lesion in NBI™ technology mode under water immersion and optical magnification allows clearer and more detailed assessment of irregular vascular areas.

#NBI #A8 structure enhancement #optic magnification

12. WLI + magnification​
Evaluation of the lesion in WLI mode under water immersion and optical zoom​.

#WLI #A8 structure enhancement #optic magnification

13. TXI™ Technology + zoom
In TXI™ technology mode 1 with water immersion and optical zoom, irregularities in the surface and vascular patterns are clearly visualized.

#TXI #A8 structure enhancement #optic magnification

14. NBI™ Technology + zoom
Evaluation of the lesion in NBI™ technology mode under water immersion and optical zoom allows clear visualization of the irregular surface and vascular patterns.

#NBI #A8 structure enhancement #optic magnification

15. NBI​™ Technology
In NBI™ technology mode, an irregular depressed area consistent with malignancy is observed in the center of the image, while premalignant regions are seen on both lateral sides.

#NBI #A8 structure enhancement ​

Case Video

High-definition imaging with the Olympus CF-XZ1200 endoscope and its optical zoom feature allowed for meticulous inspection of the lesion. The integration of TXI™ and NBI™ technology modes, in conjunction with underwater magnified observation, proved particularly valuable in delineating suspicious zones and assessing potential submucosal invasion, as clearly seen in the video documentation.

Overall Comment

A 66-year-old female patient presented with rectal bleeding. Colonoscopic examination revealed a granular mixed-type laterally spreading tumor-mixed type measuring approximately 8 cm in diameter. Random biopsies were reported as tubular adenoma with low-grade dysplasia. The patient was referred to our center for endoscopic resection.​

The lesion was evaluated using an Olympus CF-XZ1200 endoscope equipped with optical magnification. With the use of TXI™ and NBI™ technology modes, the entire lesion surface was examined in detail. As demonstrated in the accompanying images and video, these imaging modes—combined with underwater observation and optical magnification—enabled me to complete a thorough assessment of suspicious areas, particularly with respect to potential submucosal invasion.​

In this case, targeted biopsies taken from areas suspicious for malignancy were reported as invasive carcinoma. Radiological evaluation revealed malignant lymph nodes in the mesorectum, and the lesion was observed to have invaded the muscularis propria in certain regions.​

Next-generation magnifying endoscopes, together with advanced imaging technologies such as TXI™ and NBI™ technology, enhance my ability to perform targeted biopsies and improve diagnostic accuracy. Moreover, accurate diagnosis and staging through these modalities facilitated my selection of the most appropriate therapeutic approach.

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

Case 31: Multiple lesions in ascending colon
Prof. Dr. Hu Xiao
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