Digestive Endoscopy 2015; 27 (Suppl. 1): 45

doi: 10.1111/den.12416

Letters, Techniques and Images Screening colonoscopy: What is the most reliable modality for colorectal lesion’s characterization? New-generation narrow band imaging system for detection of a laterally spreading tumor in the colon Colorectal cancer (CRC) can be prevented by the removal of precancerous lesions. A previous study has suggested that colonoscopic polypectomy is responsible for a 53% reduction in CRC mortality.1 However, a considerable number of adenomatous polyps that may develop into invasive cancer are missed during colonoscopy.2 The use of a narrow band imaging (NBI) system, developed by Olympus Medical Systems (Olympus Co., Tokyo, Japan), has been discussed as a modality that could potentially improve the detection of colorectal adenomas. However, first-generation NBI systems did not increase adenoma or polyp detection rates.3 New-generation NBI systems with a brighter light source were launched in 2012 and were expected to increase the adenoma or polyp detection rates.4 Herein, we report a patient with a laterally spreading tumor (LST) that was visualized using this new-generation NBI system. A 63-year-old woman with a family history of CRC and a prior polypectomy underwent surveillance colonoscopy. Initially, the colonoscope (Olympus PCF-H290I with EVIS LUCERA ELITE system) was advanced up to the cecum without detailed observation. As we withdrew the colonoscope using white light, we detected an irregular fold in the transverse colon (Fig. 1). Upon switching from white light to NBI, we clearly observed an approximately 20-mm brownish area (Fig. 2). Using the electronic magnification function, we observed a regular surface pattern indicative of an adenoma with low-grade dysplasia. En-bloc endoscopic mucosal resection was done and a diagnosis of adenoma with lowgrade dysplasia was confirmed histopathologically. Non-polypoid lesions, including LST, are difficult to detect with white light optical colonoscopy because of their

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Figure 1 An irregular fold was detected in the transverse colon.

Figure 2 We clearly observed an approximately 20-mm brownish area using the new-generation narrow band imaging system.

flat surfaces. However, studies have shown that these types of tumor account for a considerable number of advanced colonic tumors.5 This new-generation NBI system offers promise for the detection of non-polypoid colorectal lesions including LST.

CONFLICT OF INTERESTS

A

UTHORS DECLARE no conflict of interests for this article.

Takuji Kawamura,1 Hiroaki Ikematsu2 and Takahisa Matsuda3 1 Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, 2Department of Gastrointestinal Oncology and Endoscopy, National Cancer Center Hospital East, Kashiwa and 3Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

REFERENCES 1 Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N. Engl. J. Med. 2012; 366: 687–96. 2 van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: A systematic review. Am. J. Gastroenterol. 2006; 101: 343–50. 3 Dinesen L, Chua TJ, Kaffes AJ. Meta-analysis of narrow-band imaging versus conventional colonoscopy for adenoma detection. Gastrointest. Endosc. 2012; 75: 604–11. 4 Leung WK, Lo OS, Liu KS et al. Detection of colorectal adenoma by narrow band imaging (HQ190) vs. high-definition white light colonoscopy: A randomized controlled trial. Am. J. Gastroenterol. 2014; 109: 855–63. 5 Kaku E, Oda Y, Murakami Y et al. Proportion of flat- and depressed-type and laterally spreading tumor among advanced colorectal neoplasia. Clin. Gastroenterol. Hepatol. 2011; 9: 503–8.

© 2014 The Authors Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society

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New-generation narrow band imaging system for detection of a laterally spreading tumor in the colon.

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