Written transcript of the video Audio
Acetic acid spray contribution in the endoscopic diagnosis of Serrated Polyposis Syndrome
Pedro Popoutchi, Fernando Lander Mota, Marcelo Averbach, Marcela da Silva Menezes, Renata de Almeida Coudry
Slide 1 to 5: no narration
Slide 6: A 61-year-old female with no personal or family history of colorectal cancer was submitted to screening colonoscopy.
Video Narration: During the inspection of the ascending colon, at least three pale, slightly elevated lesions were visualized and suspected to be neoplastic. The surface was covered by a thin layer of mucus that was washed with water jets.Lesion´s margins are often discrete and difficult to recognize. But here we can observe the erasure of the normal submucosal vessel pattern.Narrow band imaging showed a cloud-like surface with dark spots inside its crypts.2% Acetic acid solution was sprayed over the lesions, revealing a type II-O pit pattern and highlighting its borders.Two other LSTs were diagnosed, at the ascending colon, after the acetic acid solution chromoendoscopy, presenting the same endoscopic characteristics.All LSTs were treated with standard endoscopic mucosal resection.A total of 5 lesions were diagnosed, measuring between 6 and 20 mm.Pathological analysis confirmed sessile serrated adenomatous histology, with no dysplasia, in all specimens.
Slide 7:The world health organization criteria for clinical diagnosis of serrated polyposis syndrome includes: at least 5 sessile serrated adenomas, occurring proximally to the sigmoid colon, with 2 or more lesions larger than 10 mm.
Slide 8: Any number of sessile serrated adenomas occurring proximally to the sigmoid colon in individuals with first degree relatives diagnosed with sessile serrate syndrome
Slide 9:Or patients with more than twenty sessile serrated adenomas throughout the colon.
Slide 10:Acetic acid is widely used for the diagnosis of Barrett´s esophagus and early gastric cancer. The mucolytic effect shown in colonic chromoscopy was described on decade ago but despite the low cost and easy application its use is not as widespread as that of other dyes.
Slide 11:Acetic acid is an accessible and easy-to-use dye that shows significant contribution during endoscopic evaluation of sessile serrated lesions, specially by defining its borders and pit pattern and can aid in endoscopic serrated polyposis diagnosis.