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CC BY 4.0 · Endoscopy 2024; 56(S 01): E762-E763
DOI: 10.1055/a-2387-4051
E-Videos

Anal intraepithelial neoplasia screening during colonoscopy: a technical proposal

Authors

  • Willian Ferreira Igi 

    1   Departamento de Gastroenterologia, CAEDRO – Centro Avançado de Endoscopia Digestiva de Rondônia, Porto Velho, Brazil

  • Daiane Marrai Costa Nascimento

    1   Departamento de Gastroenterologia, CAEDRO – Centro Avançado de Endoscopia Digestiva de Rondônia, Porto Velho, Brazil

  • Magda Priscila Cardoso Afonso

    2   Endoscopy Department, Hospital de Amor, Barretos, Brazil (Ringgold ID: RIN67766)

  • Fernando Lander Mota 

    3   Endoscopy Unit, Hospital Sírio-Libanês, São Paulo, Brazil (Ringgold ID: RIN42522)

  • Lucas Santana Nova da Costa

    4   Endoscopy Unit, Hospital Sírio-Libanês, Brasília, Brazil

  • Eloisa Barbosa Brum

    5   Serviço de Coloproctologia, Hospital Barão de Lucena, Recife, Brazil

  • Fernanda Freitas Franca Rocha

    6   Gastroenterology Department, 6. Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil
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Current recommendations for anal cancer screening are limited to high risk populations, utilizing anal cytology, high risk human papillomavirus (HPV) testing, and high-risk HPV-cytology co-testing. Depending on the results, patients are then referred for further evaluation with high-resolution anoscopy (HRA), a resource that is scarce in most locations [1]. This procedure can identify anal intraepithelial neoplasias (AINs), precursor lesions of anal squamous cell carcinoma, allowing for early treatment [2] .

Magnifying or image-enhanced endoscopies provide superior magnification compared to HRA [2], and a classification system for AIN has even been proposed [3]. However, blind anorectal intubation remains a common practice during colonoscopy [4], missing the opportunity to diagnose AIN.

In this video, we demonstrate the inspection of the anal canal using narrow-band imaging (NBI) and near focus with an Evis EXERA III CV-190 processor, Evis EXERA III CLV-190 light source, and CF-HQ-190 colonoscope (Olympus Medical Systems, Tokyo, Japan). The goal is to detect AIN, with a special focus on identifying abnormal intrapapillary capillary loops ([Fig. 1], [Fig. 2]). Given the short length of the anal canal, its inspection can be quickly performed before the colonoscopy ([Video 1]). The proximity of the canal walls makes the use of near focus or magnification highly advantageous, allowing for the detection of lesions that are often underdiagnosed.

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Fig. 1 Low grade dysplastic lesion of the anal canal detected via colonoscopy with narrow-band imaging (NBI) and near focus.
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Fig. 2 High grade dysplastic lesion of the anal canal with dilated, tortuous, and meandering intrapapillary capillary loops assessed using a disposable anoscope and NBI and near focus.
Anal evaluation during colonoscopy with the aim of identifying anal intraepithelial neoplasia.Video 1

Although there are limitations in the evaluation of the anal canal, the squamocolumnar junction can still be reasonably observed through insufflation or retroflexion [2]. After identifying the suspicious lesion, we chose to complement the examination with a disposable anoscope to achieve better visualization and stabilization for performing biopsies.

In this way, we consider that anal canal evaluation should be performed during all colonoscopies using NBI and near focus/magnification, aiming to identify AIN.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

We would like to thank Dr. Andreia Albuquerque from Fernando Pessoa Teaching Hospital, Portugal, for her assistance in improving our management of anal intraepithelial neoplasia cases.


Correspondence

Willian Ferreira Igi, MD
CAEDRO – Centro Avançado de Endoscopia Digestiva de Rondônia
Rua Julio de Castilho, 149, sala 03
Centro, Porto Velho/RO, 76801-078
Brazil   

Publication History

Article published online:
04 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Endoscopy E-Videos – recently publishedEndoscopy 2025; 57(01): 85-85
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Zoom
Fig. 1 Low grade dysplastic lesion of the anal canal detected via colonoscopy with narrow-band imaging (NBI) and near focus.
Zoom
Fig. 2 High grade dysplastic lesion of the anal canal with dilated, tortuous, and meandering intrapapillary capillary loops assessed using a disposable anoscope and NBI and near focus.