INFLAMMATORY BOWEL DISEASE

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

J E East¹, N Suzuki¹, A von Herbay², B P Saunders¹

¹ Wolfson Unit for Endoscopy, St Mark’s Hospital, Middlesex, UK
² Academic Department of Pathology, St Mark’s Hospital, Middlesex, UK

Correspondence to:
Correspondence to:
Dr B P Saunders
Wolfson Unit for Endoscopy, St Mark’s Hospital, Watford Rd, Harrow, Middlesex HA1 3UJ, UK; b.saunders{at}imperial.ac.uk

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.

Abbreviations: DALM, dysplasia associated lesion or mass; NBI, narrow band imaging

Keywords: ulcerative colitis; surveillance; dysplasia; narrow band imaging; magnification

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller
Gut 2006 55: 1373. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• van den Broek, F J C, Fockens, P, van Eeden, S, Reitsma, J B, Hardwick, J C H, Stokkers, P C F, Dekker, E (2008). Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions. Gut 57: 1083-1089 [Abstract] [Full Text]  
• East, J. E, Guenther, T., Kennedy, R. H, Saunders, B. P (2007). Narrow band imaging avoids potential chromoendoscopy risks. Gut 56: 1168-1169 [Full Text]