GI Endoscopy · 2 min read
Train Your Eyes to Detect and Characterize Colon Polyps - LST
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When evaluating LST the inspection must be dynamic and visually-enhanced. Dynamic inspection means: a) looking at the location of the lesion and its response to colon motility, insufflation and application of water....
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When evaluating LST the inspection must be dynamic and visually-enhanced. Dynamic inspection means: a) looking at the location of the lesion and its response to colon motility, insufflation and application of water. Often, a an LST sitting on a fold will appear as sessile appearing lesion, but it only becomes clear that it is an LST after proper insufflation of the lumen. This LST is flat-elevated (IIa) and granular (G) and homogeneous (H). At one point it appeared to have some "bumps" or sessile (0-Is) characteristics, but when applying enough insufflation the flatness of the LST became evident. Photos: Yutaka Saito , National Cancer Center, Tokyo, Japan. Presentation and Text: Klaus Mönkemüller
"Visual-enhanced" means using additional color (chromoscopic) tools to better evaluate the surface and sub-surface of the colon polypoid lesion. In order to better evaluate the pit pattern chromoendoscopy (virtual and classic) are useful.
In 2014 we also proposed the technique "interventional chromoendoscopy" as means to better characterize colon polyps and polypoid lesions.
The Sano vascular classification allows for predicting degree of neoplasia. Neovascularization due to angioneogenesis is a hallmark of neoplastic progression. Too many distorted vessels portend more invasive malignant status.
The narrow-band imaging (NBI) International Colorectal Endoscopic (NICE) classification is widely used around the world as a universal NBI endoscopic classification. However, NICE classification does not use magnification endoscopy.
The JNET classification is focuses on surface and vessel classification. In addition to NBI it uses magnification endoscopy. The Japan NBI Expert Team (JNET) proposed the JNET classification as a universal NBI magnifying endoscopic classification in 2014. The attached article is contains a link to a video produced by the Yutaka Saito Group.
Reference and source of last photo: Sano, Hirata and Saito. Digestive Endoscopy 2018
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