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* = Presenting author

P110 Usefulness of magnifying endoscopy for diagnosis of colitis-associated intraepithelial neoplasia in patients with ulcerative colitis

M. Naganuma*1, Y. Iwao*2, T. Hisamatsu3, H. Ogata1, T. Kanai3

1Keio University, Center for Diagnostic and Therapeutic Endoscopy, Tokyo, Japan, 2Keio University School of Medicine, Center for Preventive Medicine, Tokyo, Japan, 3Keio University, Gastroenterology and Hepatology, Tokyo, Japan

Background

The prognosis of ulcerative colitis-associated cancer (UCAC) is generally poor because early detection of dysplasia/UCAC is difficult. In the present study, we investigated the characteristics of magnifying endoscopic findings for dysplasia or intraepithelial neoplasia to detect the lesions in patients with UC as early as possible.

Methods

Thirty-eight cases of dysplasia/intraepithelial neoplasia from 27 patients were retrospectively reviewed and the clinical and magnifying endoscopic features were analyzed using narrow-band imaging (NBI) and crystal violet staining.

Results

1) Median size of dysplasia/intraepithelial neoplasia was 19mm (range 5-60mm) and these lesions were mainly detected in the rectum or sigmoid colon (31/38). A total of 11 cases (30%) were recognized as flat type (n=9) or depressed type (n=2). Clinical characteristics (age, duration of disease, extent of disease, endoscopic severity at the detection of dysplasia/UCAC) were comparable between dysplasia/intraepithelial neoplasia and invasive neoplasia. 2) Using magnifying endoscopy with crystal violet staining, all lesions were recognized as neoplastic pit patterns including type IV, IIIL, IIIS or V pattern. 74% of flat type lesions were recognized as IIIs pattern whereas all depressed type was found as type V pattern. 3) All dysplasia/intraepithelial neoplasia were distinguished from non-neoplastic lesions on the basis of NBI magnification. Irregularity vascular pattern was observed in 11/12 dysplasia/intraepithelial neoplasia and surface patterns could be recognized in these cases whereas amorphous surface pattern and/or avascular pattern was observed in submucosal or invasive neoplasia.

Conclusion

Dysplasia/intraepithelial neoplasia was recognized as neoplastic pit patterns with irregularity vascular pattern on magnifying endoscopy. Magnifying endoscopy was useful to distinct neoplastic lesions from non- neoplastic lesions.