Endoscopic diagnosis of colon polyps using the NICE classification: initial experience with BLI and LCI

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Alexander Meining, Ulm


Sequence 1

The new generation of the Fujifilm electronic endoscopy system allows virtual chromoendoscopy alongside zoom endoscopy.
Blue laser imaging (BLI), like narrow-band imaging (NBI), allows further classification of polyps on the basis of the NICE classification. The polyp identified here shows characteristics of a NICE type II polyp. These characteristics can be well demonstrated with BLI and also with the linked color imaging (LCI) mode. Histological analysis showed that the polyp was a tubulovillous adenoma with low-grade neoplasia.

Sequence 2

In the same patient, another polyp was also found in the ascending colon. The polyp’s irregular, polypoid surface and mucus covering is already noticeable in the overview. In BLI mode, and also later in LCI mode, hypervascularization of the mucosa and a gyrate surface can be seen in the polyp’s polypoid marginal areas.

Sequence 3

In zoom mode, it then becomes clear that the central, partly subsided part of the polyp has all the characteristics of a NICE type III lesion, so that there is already a suspicion of incipient submucosal invasion. In accordance with the endoscopic classification, a full-thickness wall resection was therefore carried out instead of snare polypectomy. Histologically, the lesion was a T1 carcinoma with low-risk criteria, so that subsequent surgical oncological resection did not appear necessary.

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