An elusive lesion in the colon

November 05, 2019 By: George Axiaris and Spyros Michopoulos

An elusive lesion in the colon 

How to ensure detection of subtle lesions during screening colonoscopy?

A 55-year-old female patient with no family history of colorectal cancer (CRC) underwent a scheduled screening colonoscopy. The colonoscopy was performed by an experienced endoscopist (adenoma detection rate [ADR] of 54%), using a high-resolution colonoscope with narrow-band imaging (NBI) cabaility. Carbon dioxide was used for bowel insufflation. The patient was sedated with midazolam and propofol, with adequate oxygen supplementation and continuous monitoring of her blood pressure and oxygen saturation. The video shows the colonoscopy and two photos (figure 1) are provided of the ascending colon and of the area near the hepatic flexure during withdrawal of the scope.

 Figure 1 | Images of the ascending colon and of the area near the hepatic flexure during withdrawal of the colonoscope under conventional white-light and narrow-band imaging conditions. 

 

Case Question 1: 

Which of the following statements is correct?

A. There is a serrated lesion without dysplasia

B. There is a serrated lesion with dysplasia

C. There is an adenoma with low-grade dysplasia 

D. There is an adenoma with high-grade dysplasia

 

Case Question 2:

What is the minimum length of time you should spend inspecting the right colon (including the cecum, ascending colon and hepatic flexure)?

A. 3 minutes

B. 4 minutes

C. 5 minutes

D. 6 minutes

 

Case Question 3:

Which of the following is more likely to increase the adenoma detection rate (ADR)?

A. Better training 

B. Chromoendoscopy

C. A mucosal exposure device/cap

D. All of the above 

About the authors

Spyros Michopoulos is Head of the Department of Gastroenterology at ‘Alexandra’ Hospital, Athens, Greece. He trained in medicine and completed his PhD thesis on “Erythromycin on Esophageal Motility” at the Medical School of Athens University. He trained in gastroenterology in Paris, France, where he worked in many university hospitals and undertook his clinical and research fellowship. He is a past President of the Hellenic Society of Gastroenterology (HSG), of the Hellenic Study Group for IBD and the Hellenic Study Group for Helicobacter pylori. He is President of the Educational Committee of HSG and belongs to the executive of the European Section and Board of Gastroenterology and Hepatology (ESBGH) of UEMS. His main research interests include gastrointestinal motility, endoscopy and H. pylori infection. 

 

Georgios Axiaris is a gastroenterology trainee in the Department of Gastroenterology at Alexandra General Hospital, Athens, Greece. He was born in Serres and studied medicine at Aristotle University of Thessaloniki, Greece. His research interests include inflammatory bowel disease and endoscopy.

 

Comments

, November 11, 2019 14:33
A, A, D

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