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Colorectal Case 33

Prof. Dr. Fatih Aslan

Koc University Hospital

Istanbul, Turkey

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-magnification

Magnified view of the lesion in WLI mode, revealing an irregular vascular pattern in this area.

#WLI #A8 structure enhancement #optic magnification

3. NBI-magnification

Magnified view of the lesion in NBI mode, showing a clearly defined and detailed irregular surface pattern in the malignant area.

#NBI #A8 structure enhancement #optic magnification

4. NBI-optic magnification

NBI view of the lesion under optical magnification, 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

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

#TXI #A8 structure enhancement #Auto Iris

7. NBI

In NBI 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

In TXI 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

#NBI #A8 structure enhancement #optic magnification

10. TXI

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

#TXI #A8 structure enhancement #optic magnification

11. NBI

Evaluation of the lesion in NBI 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 magnification.

#WLI #A8 structure enhancement #optic magnification

13. TXI-magnification

In TXI mode 1 with water immersion and optical magnification, irregularities in the surface and vascular patterns are clearly visualized.

#TXI #A8 structure enhancement #optic magnification

14. NBI-magnification

Evaluation of the lesion in NBI mode under water immersion and optical magnification allows clear visualization of the irregular surface and vascular patterns.

#NBI #A8 structure enhancement #optic magnification

15. NBI

In NBI 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 magnification feature allowed for meticulous inspection of the lesion. The integration of TXI and NBI 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 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 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, significantly enhance the ability to perform targeted biopsies and improve diagnostic accuracy. Moreover, accurate diagnosis and staging through these modalities facilitate the selection of the most appropriate therapeutic approach.