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Case 109: Colonoscopic technique

A 61 year old man was having a colonoscopy. This lesion was found.

1. Describe this mucosal appearance?

There is a sessile polyp on the colonic mucosa. The lesion is raised, irregular with a fine crypt pattern which is typical of an adenoma, but it is difficult to see.

2. What techniques are there for visualising this better?

Magnification with a specialised endoscope, also Indigo-carmine dye spray to highlight the mucosal pattern.

3. What has been performed?

Spray with dye, and the lesion is now much more easily identifiable as an adenoma. This lesion could be snared endoscopically, however it may require 'saline lift' (injection of saline under the lesion in the submucosal plane to allow easy excision with a lower incidence of perforation. Mixing in some 'blue dye' into the saline will highlight the submucosal plane.)




PubMed
Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished?