Subscribe to RSS
New techniques in endocytoscopy: submucosal injection heightens the visibility
A 69-year-old patient had an 8-mm 0-IIa lesion located in the transverse colon. We performed colonoscopy using endocytoscopy (CF-H290ECI; Olympus, Tokyo, Japan) without distal attachment ([Video 1]).
Video 1 Endocytoscopy for an 8-mm 0-IIa lesion, located in the transverse colon. Because of the lack of light, we performed submucosal injection. Submucosal injection increased visualization of the lesion at the cellular level. EC, endocytoscopy.
Magnifying narrow-band imaging (NBI) showed Japan NBI Expert Team classification type 2A around the whole surface of the lesion ([Fig. 1 a]) . We then stained the lesion with 0.05 % crystal violet. Magnifying chromoendoscopy revealed type IIIL pit pattern ([Fig. 1 b]) based on Kudo’s classification .
Subsequently, the lesion was stained with 1 % methylene blue ([Fig. 1 c], × 520). Diagnosis was made on the basis of Kudo’s endocytoscopy classification . However, it was difficult to evaluate lumina and nuclei, and we considered the lack of light to be the cause. Therefore, we performed submucosal injection of 0.9 % saline under the lesion. In addition to the light reflected from the scope into the submucosal layer, submucosal injection led to a thickening of the submucosal layer, increasing the amount of light from the surroundings. The increased light intensity provided a clearer contrast to the background stroma and improved the visibility of the lumina and nuclei. The endocytoscopy image showed slit-like smooth lumina, and uniform and roundish nuclei ([Fig. 1 d]). Furthermore, because we did not find irregular and rough lumina and a large number of roundish nuclei, we diagnosed the lesion as EC2. Endoscopic mucosal resection was performed and histopathological findings showed low grade adenoma ([Fig. 1 e]).
Submucosal injection improved cellular visualization because swelling of the submucosal layer with saline strengthened the contrast between stroma, lumina, and nuclei. This method may improve the diagnostic ability of endocytoscopy. Further assessment is necessary to evaluate the effectiveness.
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
23 September 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Inoue H, Kazawa T, Sato Y. et al. In vivo observation of living cancer cells in the esophagus, stomach, and colon using catheter-type contact endoscope, “Endo-Cytoscopy system”. Gastrointest Endosc Clin N Am 2004; 14: 589-594
- 2 Kudo T, Suzuki K, Kudo SE. et al. Endocytoscopy for the differential diagnosis of colorectal low-grade adenoma: a novel possibility for the “resect and discard” strategy. Gastrointest Endosc 2020; 91: 676-683
- 3 Sano Y, Tanaka S, Kudo SE. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28: 526-533
- 4 Kudo SE, Misawa M, Wada Y. et al. Endocytoscopic microvasculature evaluation is a reliable new diagnostic method for colorectal lesions (with video). Gastrointest Endosc 2015; 82: 912-923