Narrow band imaging with magnification for dysplasia detection and pit pattern assessment in ulcerative colitis surveillance: a case with multiple dysplasia associated lesions or masses

A 62 year old man with longstanding ulcerative colitis and previous endoscopic excision of two dysplasia associated lesions or masses (DALMs) was admitted to our endoscopy unit for evaluation and resection of other possible DALMs. He had previously been offered and refused colectomy because of comor...

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Bibliographic Details
Published in:Gut 2006-10, Vol.55 (10), p.1432-1435
Main Authors: East, J E, Suzuki, N, von Herbay, A, Saunders, B P
Format: Article
Language:English
Subjects:
Biological and medical sciences
Biopsy
Colitis, Ulcerative - pathology
Colon
Colon, Sigmoid - pathology
Colonic Neoplasms - pathology
Colonic Polyps - pathology
Colonoscopy - methods
DALM
dysplasia
dysplasia associated lesion or mass
Endoscopy
Gastroenterology. Liver. Pancreas. Abdomen
Histology
Humans
Inflammation
Inflammatory Bowel Disease
magnification
Male
Medical sciences
Middle Aged
narrow band imaging
NBI
Other diseases. Semiology
Precancerous Conditions - pathology
Radiographic Magnification
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Surveillance
ulcerative colitis
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Summary:A 62 year old man with longstanding ulcerative colitis and previous endoscopic excision of two dysplasia associated lesions or masses (DALMs) was admitted to our endoscopy unit for evaluation and resection of other possible DALMs. He had previously been offered and refused colectomy because of comorbidity from Parkinson’s disease. He had multiple polypoid and sessile lesions which were assessed using a third generation prototype narrow band imaging (NBI) colonoscope with magnification. Selected lesions were either biopsied or resected with a combination of endoscopic submucosal dissection and endoscopic mucosal resection techniques. We correlated the pit pattern and vascular pattern intensity seen with magnification NBI with histology of both inflammatory and dysplastic lesions. Dysplastic areas showed Kudo pit patterns II, IIIL, and IV and high vascular pattern intensity. Non-dysplastic and dysplastic areas of recurrence immediately adjacent to the scar from a previous endoscopic mucosal resection site were also assessed. This is the first case report where NBI has been shown to help in DALM detection and to distinguish dysplastic from non-dysplastic mucosa in ulcerative colitis.
ISSN:0017-5749
1468-3288
DOI:10.1136/gut.2005.087171