Thank you
COLON
Dr. Kang-Moon LEE
Dr. Seong Woo JEON
Dr. Stepan SUCHANEK
Dr. Haitao Shi
Dr. Guowei Liu
CASE 1
CASE 2
CASE 3
Neoplasia Surveillance in Ulcerative Colitis with i-scan
Patient History
A 51-year-old male patient with long-standing ulcerative colitis underwent surveillance colonoscopy for detection of dysplasia.
Endoscopic Findings
With HD-WLE, old cicatricial changes with whitish scars and numerous inflammatory polyps
were observed throughout the entire colon distal to A-colon. There showed no active lesions.
(image 1)
With HD + i-scan, an ovoid flat elevated lesion (6 mm) was detected in mid T-colon. The
lesion showed brown and irregular. Surface. (image 2)
Another ovoid flat lesion (4 mm) was detected in proximal T-colon. (image 3)
i-scan helped to find dysplasia and demarcate the borders of the lesions.
Endoscopic Treatment and Pathology Results
Two lesions were removed by endoscopic mucosal resection.
he final pathology was ¡®tubular adenoma with low grade dysplasia¡¯ in both lesions.
Patient Outcome and Follow-ups
Two colitic neoplasia were detected and removed successfully by surveillance
colonoscopy.
The patient recommended to have regular surveillance colonoscopy.
Image 1
Image 2
Image 3
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
¡° I use PENTAX IMAGINA for colorectal cancer surveillance in patients with long-standing
ulcerative colitis (UC).
Previously, I had performed surveillance using traditional random biopsies or
pan-chromoendoscopy with targeted biopsies,
which required a lot of effort and time. Recently, however, I¡¯m using image-enhanced endoscopy
(virtual chromoendoscopy)
like NBI or i-scan which is more convenient.
Although still controversial, high definition-virtual chromoendoscopy is known to be comparable
to dye-spraying chromoendoscopy in detecting neoplasia in UC.
I assume that combination of high-definition endoscopy with i-scan of PENTAX IMAGINA system can
be useful for colorectal cancer surveillance in UC.¡°
Prophylactic Clip Application for the Prevention of
Postpolypectomy
Bleeding of Large Pedunculated Colonic Polyps
Patient History
A 46-year-old male patient was referred for a large pedunculated colon polyp.
Endoscopic Findings
With HD-WLE, a 15 mm sized pedunculated polyp was noted in the hepatic flexure. The length
and width of stalk was 30 x 8 mm. (image 1)
The surface of the polyp head showed hyperemia and nodularity.
With HD + i-scan, vessels with variable caliber and irregular surface pattern were noted.
(image 2)
i-scan helped to define the microvascular and surface patten of the lesion.
Endoscopic Treatment and Pathology Results
To prevent post-polypectomy bleeding, hemoclip was applied to the base of stalk before
resection.
Then, hot snare polypectomy was performed. (image 3)
The final pathology was early colon cancer.
Adenocarcinoma, moderately differentiated, arising in sessile serrated adenoma with
cytologic dysplasia
a) Size: adenoma 1.5 x 1.5 cm, carcinoma 0.7 x 0.7 cm
b) sm invasion = 300 § (Haggit level 1)
c) Tumor budding: absent
d) Resection margin involvement: absent
Image 1
Image 2
Image 3
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
¡° I use PENTAX IMAGINA in my endoscopic procedures.
When an endoscopist performs a procedure, securing clean vision and smooth operation of
endoscopy are essential factors. In this aspect, clear resolution and good maneuverability of
PENTAX IMAGINA can be of great help to my successful procedure.¡±
Detection of Sessile Serrated Adenoma in the Ascending Colon
Patient History
A 60-year-old female patient underwent colonoscopy for bloating and constipation.
Endoscopic Findings
With HD-WLE, a subtle flat lesion was suspected in the distal A-colon.
After adjusting for air inflation, an ovoid flat elevated lesion was clearly observed.
(image 1)
With HD + i-scan, the surface of lesion showed slightly lighter color than background mucosa
and some dark dots, suggesting a hyperplastic or
sessile serrated polyp. (image 2)
i-scan helped to define the microvascular and surface pattern of the lesion.
Endoscopic Treatment and Pathology Results
Endoscopic mucosal resection was done. (image 3)
The final pathology was sessile serrated adenoma.
Sessile serrated adenoma without cytologic dysplasia.
1) size: 0.8x0.8cm
2) resected margin involvement: absent
Patient Outcome and Follow-ups
The procedure performed successfully without any event.
Image 1
Image 2
Image 3
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
¡° I use PETAX IMAGINA for colorectal cancer (CRC) screening. Higher quality colonoscopic
withdrawal techniques, such as
(1)examining the proximal sides of flexures, folds and valves, (2) cleaning and suctioning, (3)
adequacy of distention, and
(4) adequacy of time spent viewing, are associated with lower adenoma missing rate.
I think that clean resolution and good maneuverability of PENTAX IMAGINA may help to improve the
yield of CRC screening.¡±
COLON
Dr. Kang-Moon LEE
Dr. Seong Woo JEON
Dr. Stepan SUCHANEK
Dr. Stepan SUCHANEK
Dr. Stepan SUCHANEK
Endoscopic Differentiation of Colon Polyps
Patient History
The patient is a 61-year-old male who underwent sigmoid colon cancer surgery 2 years
ago.
He is on adjuvant chemotherapy and colonoscopy surveillance was recently performed.
Endoscopic Findings
The colonoscopy revealed 8mm sized sessile polyp at transverse colon.
Endoscopic Treatment and Pathology Results
Endoscopic mucosal resection was done after submucosal injection and snaring.
No bleeding or perforation was noted after procedure. The final pathology was tubular
adenoma, measuring 8mm in size.
Patient Outcome and Follow-ups
The patient will have another surveillance colonoscopy 2 or 3 year later.
Image 1,2 & 3
Video clip available
The i-scan SE shows sessile polyp with whitish surface mimicking sessile serrated polyp.
However, the vascular and surface pattern was regular without white spots on i-scan TE
image.
So, I can expect the pathology as a low-grade dysplasia based on JNET classification.
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
¡°I use PENTAX IMAGINA in daily clinical endoscopy practice. One of our endoscopy purpose is
surveillance after surgery or endoscopic resection of colorectal dysplasia or cancer. I
frequently encounter metachronous polyps during this surveillance and the pathology provide
exact diagnosis after resection of the polyp.
However, it is important to select exact candidates for colonoscopic resection to avoid
unnecessary procedure.
I assume that PENTAX IMAGINA TE mode is useful in this aspect. JNET classification is useful
tool in clinical decision.
Type 1 indicates a hyperplastic polyp or a sessile serrated adenoma/polyp.
Type 2A indicates low-grade dysplasia and includes tubular adenoma and tubulovillous
adenoma.
Type 2B indicates high-grade dysplasia, intramucosal cancer, and superficial submucosal invasive
cancer.
Type 3 indicates deep submucosal invasive cancer.
The PENTAX IMAGINA system have clear resolution and it can let me help to clear diagnosis. ¡°
COLON
Dr. Kang-Moon LEE
Dr. Seong Woo JEON
Dr. Stepan SUCHANEK
Dr. Stepan SUCHANEK
Dr. Stepan SUCHANEK
CASE 1
CASE 2
Endoscopy mucosal resection of traditional serrated
lesion with high-grade
dysplasia in sigmoid colon
Patient History
65 years old men with no CRC family history. Preventive colonoscopy after positive fecal immunochemical test.
Endoscopic Findings
Sessile polyp in aboral sigmoid colon (20 cm from anorectal line), Paris classification
0-Is, size 30 x 20 mm,
macroscopically adenomatous appearance according to the high-definition white light
endoscopy
(HD-WLE, Image 1), i-scan 1 (Image 2), i-scan 2 (Image 3), i-scan 3 (Image 4)
Endoscopic treatment
Polyp was completely removed by endoscopic mucosal resection (EMR), after submucosal
injection of saline solution with diluted Adrenaline.
Immediate bleeding from post-EMR site (Image 5) was stopped with snare tip coagulation,
haemoclips and nylon loop snare replacement(Image 6).
Endoscopic Treatment and Pathology Results
Traditional serrated lesion with high-grade dysplasia, R0 resection.
Patient Outcome and Follow-ups
No sign of bleeding recurrence. Surveillance colonoscopy in 1 year negative with intact scar and no metachronous lesions in colorectum.
Image 1
Image 2
Image 3
Image 4
Image 5
Image 6
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
I use the IMAGINA system in every day clinical practice, especially in colorectal cancer
screening program.
The high-quality image has resulted in an increased numbers of polyps detected.
Early rectal cancer treated with endoscopic full thickness resection
Patient History
53 years old men treated for arterial hypertension and dyslipidemia, with no CRC family history. Preventive colonoscopy after positive fecal immunochemical test. (FIT)
Endoscopic Findings
Sessile polyp in oral rectum (12 cm from anorectal line) with central depression, Paris classification 0-Is + 0-IIc, size 25 x 25 mm, macroscopically high suspicion of early cancer, according to HD-WLE (Image 1) and i-scan (Image 2)
Staging
Rectal ultrasound with submucosal infiltration without involvement of muscularis propria, staging T1N0. CT scan negative, MRI staging T2N0.
Endoscopic Treatment
Lesion was completely removed by endoscopic full thickness resection (EFTR) Histopathology results: tubular adenocarcinoma, grade 1-2, pT1, sm3 (1900 um), LVI-, PNI-, R0 resection (2 mm), (Image 3)
Patient Outcome and Follow-ups
Patient denied subsequent surgical therapy. Close follow-up, rectoscopy in 6 months and colonoscopy and CT scan in 1 year. After 1 year all examination negative, scar in rectum intact, no metachronous lesions in colorectum, no metastasis.
Image 1
Image 2
Image 3
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
I use the IMAGINA system in every day clinical practice, especially in colorectal cancer
screening program.
The high-quality image has resulted in an increased numbers of polyps detected.
COLON
Dr. Kang-Moon LEE
Dr. Seong Woo JEON
Dr. Stepan SUCHANEK
Dr. Haitao Shi
Dr. Guowei Liu
Ulcerative Colitis
Patient History
A 37-year-old male patient with intermittent mucopurulent bloody stools for 1 year, aggravated for 2 months, previously diagnosed with ulcerative colitis, treated with 5-ASA with alternating remission-recurrence, and recently with increased frequency of blood in stools, 6-8 times/day.
Endoscopic Findings & Treatment
Colonoscopy showed loss of vascular texture in the mucosa from descending colon to rectum, and congestion and edema, multiple erosions and ulcers were seen, with scattered portions of deeper, rounded ulcers, and the lesions were in a diffuse, contiguous distribution (Figures 1 and 2). Endoscopic diagnosis: Ulcerative colitis (left hemicolon, Mayo endoscopic score 3). Pathology suggested CMV positivity Clinical diagnosis: ulcerative colitis (chronic relapsing type, left half colon, active, severe) combined with CMV infection Treatment: methylprednisolone + ganciclovir antivirus
Patient Outcome and Follow-ups
After 1 week, the frequency of blood in the stool decreased to 2-3 times/day, and the colonoscopy showed that the mucosal erosion and ulceration were better than before (Figure 3), so the patient was treated with vedotinumab, and at the same time, the hormone dosage was gradually reduced to the point of discontinuing, and it was proposed to review the colonoscopy again after 3 months of treatment.
Image 1
Image 3
Image 3
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases
I use PETAX IMAGINA for inflammatory bowel disease screening and diagnosis. The clear resolution of the PENTAX Medical IMAGINA system helps me to more accurately assess the severity of the disease, and more conducive to screening for dysplasia and carcinoma complicating inflammatory bowel disease.
COLON
Dr. Kang-Moon LEE
Dr. Seong Woo JEON
Dr. Stepan SUCHANEK
Dr. Haitao Shi
Dr. Guowei Liu
CASE 1
CASE 2
SSL of Ascending Colon
Patient History
A 30-year-old female patient, previously fit, underwent her first colonoscopy with complaints of intermittent abdominal pain.
Endoscopic Findings & Treatments
A type IIa flattened elevated lesion was seen in the ascending colon, about 1 cm in size, with decoloration of the surface, mildly dilated dendritic vessels were seen, the border was clear after staining, punctate mildly dilated type II-O glandular ducts were visible in the openings, and the border was clearer after acetic acid staining, the glandular ducts were swollen into white color, and the time of reddening was a little slower than that of the normal mucosa. whole piece was resected by EMR.
Patient Outcome and Follow-upst
EMR postoperative pathology showing SSL (SSA/P).
Image 1
A type IIa flattened elevated oval lesion of about 1 cm in size was seen in the ascending colon with partially defined borders, basic orthochromatic slightly receding tone on the surface, and mildly dilated dendritic vessels were seen. So, I can expect the pathology as a low-grade dysplasia based on JNET classification.
Image 2
The borders are well defined after indigo carmine staining and punctate mildly dilated type II-O glandular duct openings are visible
Image 3
The borders were more clearly defined after acetic acid staining, and the swollen glandular ducts were observed to be white in I-SCAN mode, with a slightly slower reddening time than in normal mucosa.
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
In upper GI endoscopy, at least 40 images of the whole stomach are first retained using our clinic's own "M" pathway observation method, and different screening strategies are chosen depending on the Helicobacter pylori infection. If HP-positive, look for red depressed IIc or white elevated IIa lesions in atrophic areas, and white receding IIb or IIc morphology in non-atrophic areas. If HP is negative, look for fading IIb or IIc morphology in the sinusoidal junction area, low anisotropy gastric-type tumors in the fundus, and in the gastroesophageal junction, focus on tumors in the cardia region. If there is some doubt about the boundary and nature of the lesion, I-SCAN can be performed for further observation, and if there is still doubt, pigment staining can be performed to enhance the judgment of the boundary and nature of the lesion. In lower GI endoscopy, our clinic recommends wearing an endoscopic cap throughout the procedure, with an average of 3-5 minutes for entry and 8-9 minutes for exit. After the lesion is found, it is firstly flushed to keep the image in the far and middle near view respectively. If the blood vessels and glandular ducts can be well observed under white light and IEE for common adenomas, color staining can be avoided. If the lesion found in the ascending colon is to be diagnosed as SSL, and the lesion found in the left hemicolon is to be diagnosed as susa, TSA, etc., color staining must be performed after rinsing, in order to determine the exact boundaries and nature, and to guide the further precise treatment.
Susa+TSA of Descending Colonn
Patient History
A 68-year-old male patient with a 10-year history of hypertension and fair blood pressure control on long-term oral antihypertensive medication underwent a gastroenteroscopy 10 years ago, which showed no abnormalities.
Endoscopic Findings & Treatment
An Is-type bulging lesion was seen in the descending colon, the lesion was divided into two parts, the cephalic portion was expanded showing lobulation, about 1.2 cm, congested and reddish in color; the tip-neck portion was type IIa flattened, whitish in color, and the borders were well defined on staining; the cephalic portion stained to show the opening of the glandular ducts of IV-H, and the tip-neck portion stained to show the opening of the glandular ducts of type II stellate, and was given a complete resection by EMR.
Patient Outcome and Follow-ups
Rectal ultrasound with submucosal infiltration without involvement of muscularis propria, staging T1N0. CT scan negative, MRI staging T2N0.
Endoscopic Treatment
Lesion was completely removed by endoscopic full thickness resection (EFTR) Histopathology results: tubular adenocarcinoma, grade 1-2, pT1, sm3 (1900 um), LVI-, PNI-, R0 resection (2 mm), (Image 3)
Patient Outcome and Follow-ups
TSA, cephalic component;
Susa, cervical component.
Image 1
The borders were more clearly defined after acetic acid staining, and the swollen glandular ducts were observed to be white in I-SCAN mode, with a slightly slower reddening time than in normal mucosa.
Image 2
An Is-type bulging lesion is seen in the descending colon with well-defined borders, lobulated apically, and reddish in color.
Image 3
On close view, the lesion is seen to be divided into two parts, the cephalic end is expanded and lobulated for about 1.2 cm, congested and reddish in color; the cervical portion of the tip is type IIa flattened, whitish in color, and the blood vessels are not visible.
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases :
The borders are well defined after indigo carmine staining, and the cephalic portion stains to show the ductal openings of IV-H, and the cervical portion of the tip stains to show the type II stellate ductal openings.
COLON
>
CASE 1
CASE 2
CASE 3
Cascade Stomach
Patient History
A 51-year-old male patient with long-standing ulcerative colitis underwent surveillance colonoscopy for detection of dysplasia.
Endoscopic Findings
With HD-WLE, old cicatricial changes with whitish scars and numerous inflammatory
polyps were observed throughout the entire colon distal to A-colon. There showed no
active lesions. (image 1)
With HD + i-scan, an ovoid flat elevated lesion (6 mm) was detected in mid T-colon.
The lesion showed brown and irregular. Surface. (image 2)
Another ovoid flat lesion (4 mm) was detected in proximal T-colon. (image 3)
i-scan helped to find dysplasia and demarcate the borders of the lesions.
Endoscopic Treatment
and Pathology Results
Two lesions were removed by endoscopic mucosal resection.
he final pathology was ¡®tubular adenoma with low grade dysplasia¡¯ in both lesions.
Patient Outcome and
Follow-ups
Two colitic neoplasia were detected and removed successfully by surveillance
colonoscopy.
The patient recommended to have regular surveillance colonoscopy.
Image 1
Image 2
Image 3
Summary
How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :
¡° I use PENTAX IMAGINA for colorectal cancer surveillance in patients with long-standing
ulcerative colitis (UC).
Previously, I had performed surveillance using traditional random biopsies or
pan-chromoendoscopy with targeted biopsies,
which required a lot of effort and time. Recently, however, I¡¯m using image-enhanced
endoscopy (virtual chromoendoscopy)
like NBI or i-scan which is more convenient.
Although still controversial, high definition-virtual chromoendoscopy is known to be
comparable to dye-spraying chromoendoscopy in detecting neoplasia in UC.
I assume that combination of high-definition endoscopy with i-scan of PENTAX IMAGINA
system can be useful for colorectal cancer surveillance in UC.¡°
Prophylactic Clip
Application for the
Prevention of
Postpolypectomy
Bleeding of Large
Pedunculated
Colonic Polyps
Patient History
A 46-year-old male patient was referred for a large pedunculated colon polyp.
Endoscopic Findings
With HD-WLE, a 15 mm sized pedunculated polyp was noted in the hepatic flexure. The
length and width of stalk was 30 x 8 mm. (image 1)
The surface of the polyp head showed hyperemia and nodularity.
With HD + i-scan, vessels with variable caliber and irregular surface pattern were
noted. (image 2)
i-scan helped to define the microvascular and surface patten of the lesion.
Endoscopic Treatment and Pathology Results
To prevent post-polypectomy bleeding, hemoclip was applied to the base of stalk
before resection.
Then, hot snare polypectomy was performed. (image 3)
The final pathology was early colon cancer.
Adenocarcinoma, moderately differentiated, arising in sessile serrated adenoma with
cytologic dysplasia
a) Size: adenoma 1.5 x 1.5 cm, carcinoma 0.7 x 0.7 cm
b) sm invasion = 300 § (Haggit level 1)
c) Tumor budding: absent
d) Resection margin involvement: absent
Image 1
Image 2
Image 3
Summary
How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :
¡° I use PENTAX IMAGINA in my endoscopic procedures.
When an endoscopist performs a procedure, securing clean vision and smooth operation of
endoscopy are essential factors. In this aspect, clear resolution and good
maneuverability of PENTAX IMAGINA can be of great help to my successful procedure.¡±
Prophylactic Clip
Application for the
Prevention of
Postpolypectomy
Bleeding of Large
Pedunculated
Colonic Polyps
Detection of Sessile
Serrated Adenoma
in the Ascending
Colon
Patient History
A 60-year-old female patient underwent colonoscopy for bloating and constipation.
Endoscopic Findings
With HD-WLE, a subtle flat lesion was suspected in the distal A-colon.
After adjusting for air inflation, an ovoid flat elevated lesion was clearly
observed. (image 1)
With HD + i-scan, the surface of lesion showed slightly lighter color than
background mucosa and some dark dots, suggesting a hyperplastic or
sessile serrated polyp. (image 2)
i-scan helped to define the microvascular and surface pattern of the lesion.
Endoscopic Treatment and Pathology Results
Endoscopic mucosal resection was done. (image 3)
The final pathology was sessile serrated adenoma.
Sessile serrated adenoma without cytologic dysplasia.
1) size: 0.8x0.8cm
2) resected margin involvement: absent
Patient Outcome and Follow-ups
The procedure performed successfully without any event.
Image 1
Image 2
Image 3
Summary
How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :
¡° I use PETAX IMAGINA for colorectal cancer (CRC) screening. Higher quality colonoscopic
withdrawal techniques, such as
(1)examining the proximal sides of flexures, folds and valves, (2) cleaning and
suctioning, (3) adequacy of distention, and
(4) adequacy of time spent viewing, are associated with lower adenoma missing rate.
I think that clean resolution and good maneuverability of PENTAX IMAGINA may help to
improve the yield of CRC screening.¡±
COLON
>
Endoscopic
Differentiation of
Colon Polyps
Patient History
The patient is a 61-year-old male who underwent sigmoid colon cancer surgery 2 years
ago.
He is on adjuvant chemotherapy and colonoscopy surveillance was recently performed.
Endoscopic Findings
The colonoscopy revealed 8mm sized sessile polyp at transverse colon.
Endoscopic Treatment and Pathology Results
Endoscopic mucosal resection was done after submucosal injection and snaring.
No bleeding or perforation was noted after procedure. The final pathology was
tubular adenoma, measuring 8mm in size.
Patient Outcome and Follow-ups
The patient will have another surveillance colonoscopy 2 or 3 year later.
Image 1,2 & 3
The i-scan SE shows sessile polyp with whitish surface mimicking sessile
serrated polyp. However, the vascular and surface pattern was regular without
white spots on i-scan TE image.
So, I can expect the pathology as a low-grade dysplasia based on JNET
classification.
Summary
How do I use
PENTAX IMAGINA
in my clinical endoscopy
cases :
¡°I use PENTAX IMAGINA in daily clinical endoscopy practice. One of our endoscopy purpose
is surveillance after surgery or endoscopic resection of colorectal dysplasia or cancer.
I frequently encounter metachronous polyps during this surveillance and the pathology
provide exact diagnosis after resection of the polyp.
However, it is important to select exact candidates for colonoscopic resection to avoid
unnecessary procedure.
I assume that PENTAX IMAGINA TE mode is useful in this aspect. JNET classification is
useful tool in clinical decision.
Type 1 indicates a hyperplastic polyp or a sessile serrated adenoma/polyp.
Type 2A indicates low-grade dysplasia and includes tubular adenoma and tubulovillous
adenoma.
Type 2B indicates high-grade dysplasia, intramucosal cancer, and superficial submucosal
invasive cancer.
Type 3 indicates deep submucosal invasive cancer.
The PENTAX IMAGINA system have clear resolution and it can let me help to clear
diagnosis. ¡°
COLON
>
CASE 1
CASE 2
Endoscopy mucosal resection of
traditional serrated lesion with
high-grade dysplasia in sigmoid colon
Patient History
65 years old men with no CRC family history.
Preventive colonoscopy after
positive fecal immunochemical test.
Endoscopic Findings
Sessile polyp in aboral sigmoid colon
(20 cm from anorectal line), Paris
classification 0-Is, size 30 x 20 mm,
macroscopically adenomatous appearance according to the high-definition white light
endoscopy
(HD-WLE, Image 1),
i-scan 1 (Image 2), i-scan 2 (Image 3),
i-scan 3 (Image 4)
Endoscopic treatment
Polyp was completely removed by endoscopic mucosal resection (EMR), after submucosal
injection of saline solution with diluted Adrenaline.
Immediate bleeding from post-EMR site (Image 5) was stopped with snare tip
coagulation,
haemoclips and nylon loop snare replacement(Image 6).
Endoscopic Treatment and Pathology Results
Traditional serrated lesion with high-grade
dysplasia, R0 resection.
Patient Outcome and Follow-ups
No sign of bleeding recurrence. Surveillance colonoscopy in 1 year negative with intact scar and no metachronous lesions in colorectum.
Image 1
Image 2
Image 3
Image 4
Image 5
Image 6
How do I use
PENTAX IMAGINA
in my clinical
endoscopy
cases :
I use the IMAGINA system in every day clinical practice, especially in colorectal cancer
screening program.
The high-quality image has resulted in an increased numbers of polyps detected.
Early rectal cancer treated with endoscopic full thickness resection
Patient History
53 years old men treated for arterial hypertension and dyslipidemia, with no CRC family history. Preventive colonoscopy after positive fecal immunochemical test. (FIT)
Endoscopic Findings
Sessile polyp in oral rectum (12 cm from anorectal line) with central depression, Paris classification 0-Is + 0-IIc, size 25 x 25 mm, macroscopically high suspicion of early cancer, according to HD-WLE (Image 1) and i-scan (Image 2)
Staging
Rectal ultrasound with submucosal infiltration without involvement of muscularis propria, staging T1N0. CT scan negative, MRI staging T2N0.
Endoscopic Treatment
Lesion was completely removed by endoscopic full thickness resection
(EFTR)
Histopathology results: tubular adenocarcinoma, grade 1-2, pT1, sm3 (1900
um), LVI-, PNI-, R0 resection (2 mm), (Image 3)
Patient Outcome and Follow-ups
Patient denied subsequent surgical therapy. Close follow-up, rectoscopy in 6 months
and colonoscopy and CT scan in 1 year.
After 1 year all examination negative,
scar in rectum intact, no metachronous lesions in colorectum, no metastasis.
Image 1
Image 2
Image 3
How do I use PENTAX
IMAGINA in my clinical
endoscopy cases
:
I use the IMAGINA system in every day clinical practice, especially in colorectal cancer screening program. The high-quality image has resulted in an increased numbers of polyps detected.
COLON
>
Ulcerative Colitis
Patient History
A 37-year-old male patient with intermittent mucopurulent bloody stools for 1 year, aggravated for 2 months, previously diagnosed with ulcerative colitis, treated with 5-ASA with alternating remission-recurrence, and recently with increased frequency of blood in stools, 6-8 times/day.
Endoscopic Findings & Treatment
Colonoscopy showed loss of vascular texture in the mucosa from descending colon to rectum, and congestion and edema, multiple erosions and ulcers were seen, with scattered portions of deeper, rounded ulcers, and the lesions were in a diffuse, contiguous distribution (Figures 1 and 2). Endoscopic diagnosis: Ulcerative colitis (left hemicolon, Mayo endoscopic score 3). Pathology suggested CMV positivity Clinical diagnosis: ulcerative colitis (chronic relapsing type, left half colon, active, severe) combined with CMV infection Treatment: methylprednisolone + ganciclovir antivirus
Patient Outcome and Follow-ups
After 1 week, the frequency of blood in the stool decreased to 2-3 times/day, and the colonoscopy showed that the mucosal erosion and ulceration were better than before (Figure 3), so the patient was treated with vedotinumab, and at the same time, the hormone dosage was gradually reduced to the point of discontinuing, and it was proposed to review the colonoscopy again after 3 months of treatment.
Image 1
Image 3
Image 5
Summary
How do I use PENTAX IMAGINA in my clinical endoscopy cases
I use PETAX IMAGINA for inflammatory bowel disease screening and diagnosis. The clear resolution of the PENTAX Medical IMAGINA system helps me to more accurately assess the severity of the disease, and more conducive to screening for dysplasia and carcinoma complicating inflammatory bowel disease.
COLON
>
CASE 1
CASE 2
SSL of Ascending Colon
Patient History
A 30-year-old female patient, previously fit, underwent her first colonoscopy with complaints of intermittent abdominal pain.
Endoscopic Findings & Treatments
A type IIa flattened elevated lesion was seen in the ascending colon, about 1 cm in size, with decoloration of the surface, mildly dilated dendritic vessels were seen, the border was clear after staining, punctate mildly dilated type II-O glandular ducts were visible in the openings, and the border was clearer after acetic acid staining, the glandular ducts were swollen into white color, and the time of reddening was a little slower than that of the normal mucosa. whole piece was resected by EMR.
Patient Outcome and Follow-upst
EMR postoperative pathology showing SSL (SSA/P).
Image 1
A type IIa flattened elevated oval lesion of about 1 cm in size was seen in the ascending colon with partially defined borders, basic orthochromatic slightly receding tone on the surface, and mildly dilated dendritic vessels were seen. So, I can expect the pathology as a low-grade dysplasia based on JNET classification.
Image 3
vThe borders are well defined after indigo carmine staining and punctate mildly dilated type II-O glandular duct openings are visible
Image 5
The borders were more clearly defined after acetic acid staining, and the swollen glandular ducts were observed to be white in I-SCAN mode, with a slightly slower reddening time than in normal mucosa.
How do I use
PENTAX IMAGINA
in my clinical
endoscopy
cases :
In upper GI endoscopy, at least 40 images of the whole stomach are first retained using our clinic's own "M" pathway observation method, and different screening strategies are chosen depending on the Helicobacter pylori infection. If HP-positive, look for red depressed IIc or white elevated IIa lesions in atrophic areas, and white receding IIb or IIc morphology in non-atrophic areas. If HP is negative, look for fading IIb or IIc morphology in the sinusoidal junction area, low anisotropy gastric-type tumors in the fundus, and in the gastroesophageal junction, focus on tumors in the cardia region. If there is some doubt about the boundary and nature of the lesion, I-SCAN can be performed for further observation, and if there is still doubt, pigment staining can be performed to enhance the judgment of the boundary and nature of the lesion. In lower GI endoscopy, our clinic recommends wearing an endoscopic cap throughout the procedure, with an average of 3-5 minutes for entry and 8-9 minutes for exit. After the lesion is found, it is firstly flushed to keep the image in the far and middle near view respectively. If the blood vessels and glandular ducts can be well observed under white light and IEE for common adenomas, color staining can be avoided. If the lesion found in the ascending colon is to be diagnosed as SSL, and the lesion found in the left hemicolon is to be diagnosed as susa, TSA, etc., color staining must be performed after rinsing, in order to determine the exact boundaries and nature, and to guide the further precise treatment.
Susa+TSA of Descending Colonn
Patient History
A 68-year-old male patient with a 10-year history of hypertension and fair blood pressure control on long-term oral antihypertensive medication underwent a gastroenteroscopy 10 years ago, which showed no abnormalities.
Endoscopic Findings & Treatment
An Is-type bulging lesion was seen in the descending colon, the lesion was divided into two parts, the cephalic portion was expanded showing lobulation, about 1.2 cm, congested and reddish in color; the tip-neck portion was type IIa flattened, whitish in color, and the borders were well defined on staining; the cephalic portion stained to show the opening of the glandular ducts of IV-H, and the tip-neck portion stained to show the opening of the glandular ducts of type II stellate, and was given a complete resection by EMR.
Patient Outcome and Follow-ups
TSA, cephalic component;
Susa, cervical component.
Image 1
The borders were more clearly defined after acetic acid staining, and the swollen glandular ducts were observed to be white in I-SCAN mode, with a slightly slower reddening time than in normal mucosa.
Image 2
An Is-type bulging lesion is seen in the descending colon with well-defined borders, lobulated apically, and reddish in color.
Image 3
On close view, the lesion is seen to be divided into two parts, the cephalic end is expanded and lobulated for about 1.2 cm, congested and reddish in color; the cervical portion of the tip is type IIa flattened, whitish in color, and the blood vessels are not visible.
How do I use PENTAX
IMAGINA in my clinical
endoscopy cases
:
I use the IMAGINA system in every day clinical practice, especially in colorectal cancer screening program. The high-quality image has resulted in an increased numbers of polyps detected.
PENTAX Medical Singapore Pte. Ltd. Asia Pacific Headquarters
438A Alexandra Road #08-06, Alexandra Technopark, 119967 Singapore
Tel. +65-6507-9266Email. inquiryAPAC@pentaxmedical.com
PENTAX Medical Singapore Pte. Ltd. Asia Pacific Headquarters 438A Alexandra Road #08-06, Alexandra Technopark, 119967 Singapore Tel. +65-6507-9266 Email. inquiryAPAC@pentaxmedical.com
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