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
C. A mucosal exposure device/cap
D. All of the above